Results of Five-Year Outpatient Follow-Up of Patients With Heart Failure in a Specialized Center

Aim    To evaluate the risks of all-cause death (ACD), cardiovascular death (CVD), death from recurrent acute decompensated heart failure (ADHF), and a composite index of CVD and death from recurrent ADHF in patients with chronic heart failure (CHF) after the first hospitalization for ADHF during a long-term, five-year follow-up in the conditions of specialized medical care and in real clinical practice.
Material and methods    This prospective cohort observational study included 942 patients after ADHF. Group 1 consisted of 510 patients who continued the outpatient follow-up at a specialized center for the treatment of CHF (cCHF); group 2 consisted of 432 patients followed up at outpatient and polyclinic institutions (OPI) at the place of residence. During the five-year follow-up, the causes of death were determined based on the medical records of inpatients, postmortem examinations, or the conclusion in the medical records of outpatients. Rates of ACD, CVD, death from recurrent ADHF, and the composite index (CVD and death from ADHF) were analyzed. Statistical analysis was performed with a R statistical package.
Results    ACD was 32.3% and 53.5% in groups 1 and 2, respectively (p<0.001). Based on the results of Cox proportional hazards models, it was shown that the follow-up in group 1, regardless of other factors, was associated with a decrease in the ACD risk (HR 2.07; 95% CI 1.68-2.54; p<0.001), CVD (HR 1.94; 95% CI 1.26-2.97; p=0.002), death from recurrent ADHF (HR 2.4; 95% CI 1.66–3.42; p<0.001) and the composite mortality index (HR 2.2; 95% CI 1.65-2.85; p<0.001) compared to group 2. The risks of death in CHF patients with moderately reduced left ventricular ejection fraction (LVEF) (HFmrEF) were consistent with the death rates in CHF patients with low LVEF (HFrEF) and were significantly higher than in CHF patients with preserved LVEF (HFpEF). The prognosis of life worsened with an increase in the Clinical Condition Assessment Scale score and age. The prognosis of life was better in women, as well as with higher values of systolic blood pressure (BP) and 6-minute walk test. In the structure of death in both groups, death from ADHF and sudden cardiac death (SCD) prevailed.
Conclusion    The absence of specialized follow-up at an outpatient CHF center increases the risks of ACD, CVD, death from recurrent ADHF, and the composite endpoint at a depth of five-year observation. The leading causes of death were recurrent ADHF and SCD.

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