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J Kim, E Shahar,
RV Luepker, D Jacobs, S Duval, C Barber, and K Margolis.
University of Minnesota
Prognostic factors for mortality in patients with diastolic dysfunction
(DD) are ill defined and may differ from those with systolic dysfunction
(SD). We studied a 50% random sample of 35-84 year old patients
with an ICD9 428 discharge code from a Twin Cities area hospital
in 1995 (N=4,593). Validated cases had both a physician diagnosis
of HF and symptoms of HF on admission or during hospitalization
(n=3,273). DD and SD were defined as clinical HF with normal (>40%)
or reduced ( <40%) left ventricular ejection fraction (LVEF),
respectively. Follow-up for mortality (n=1,681) through 1998 used
a statewide death certificate registry. Adjusted hazard ratios (RR)
were derived using Cox regression. There were 636, 248, and 797
deaths in the SD, DD, and missing LVEF groups, respectively. Significant
predictors of mortality were duration of HF, gender, age, Charlson
Comorbidity Index, BSA, SBP, heart rate, pulmonary congestion, peripheral
edema, serum sodium or potassium, and ACE inhibitor, beta-blocker
or intravenous inotropic therapy. Prognostic factors that differed
between SD and DD are listed below (TABLE). We conclude that there
are both overlapping and unique prognostic factors for long-term
mortality between DD and SD patients.
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