CLINICAL PREDICTORS OF LONG-TERM SURVIVAL IN CHRONIC HEART FAILURE: RESULTS FROM A 5-YEAR PROSPECTIVE COHORT STUDY
Nana V. Pogosova,
Tatevik A. Terteryan,
Ashot A. Avagimyan,
Arthur A. Arutyunov,
Anna B. Popova,
Natalya M. Vorobyeva,
Irina V. Osipova,
Radima A. Zhetisheva,
Aza K. Ausheva Abstract
Highlights
- Chronic heart failure (CHF) is associated with high mortality rates, which exceed those associated with cancer. Traditional methods for assessing the prognosis (based on the etiology of CHF and the condition of the left ventricle) are not accurate enough, so new predictors of an unfavorable outcome are needed.
- The severity of clinical manifestations and concomitant diseases has a stronger effect on the prognosis than the initial etiology of CHF.
- The study justifies the transition from static diagnosis to dynamic assessment of the symptomatic status of patients. The emphasis on the correction of concomitant diseases can improve the results of CHF treatment in real clinical practice.
Background. Chronic heart failure (HF) remains a condition associated with high mortality rates, exceeding those of oncological diseases. Traditional risk stratification approaches, based on the HF etiology and left ventricular function parameters, do not fully capture individual prognosis, necessitating the identification of new clinically significant predictors.
Aim. To conduct a comprehensive assessment of clinical symptoms, functional class (FC) of HF, and comorbid conditions in relation to 5-years mortality and survival in HF patients in real-world clinical practice settings.
Methods. In this prospective cohort study 150 consecutive patients with HF were enrolled in two outpatient clinics and two hospitals located in Moscow and Barnaul in February-May 2018. Vital status during 5-years of follow-up (median 3.29 years) was obtained in 147 (98%) patients. Survival analysis was performed using the Kaplan-Meier method. For assessment of predictors’ univariate Cox regression was used to calculate hazard ratios (HR) and 95% coincidence intervals (CI).
Results. The 5-years overall survival rate was 59.9% (88/147). HF etiology showed no statistically significant association with outcomes. Hepatojugular reflux (p = 0.001) and weight loss > 4.5 kg in response to 5 days therapy (p < 0.001) were associated with the highest mortality rates. HF NYHA FC demonstrated strong prognostic significance: compared to FC I, the risk of death was 7.7 times higher for patients with FC III (95% CI 3.03–19.76) and 19 times higher for those with FC IV (95% CI 4.50–80.29). The presence of comorbidities, including anemia (HR = 3.51; 95% CI 2.08–5.90), atrial fibrillation (HR = 2.12; 95% CI 1.25–3.61), chronic obstructive pulmonary disease (HR = 2.55; 95% CI 1.48–4.37), and obstructive sleep apnea (HR = 2.73; 95% CI 1.32–5.62), were associated with higher 5-years mortality. A history of endovascular interventions acted as a protective factor (HR = 0.44; 95% CI 0.24–0.81; p = 0.008).
Conclusion. The severity of current clinical manifestations of HF and the cumulative burden of comorbid conditions has a greater impact on long-term prognosis than the initial etiology. These findings underscore the need to shift the focus from a static diagnosis towards dynamic assessment of symptomatic status and active targeting of key comorbidities to improve outcomes in patients with HF in clinical practice.
Supporting agencies: Authors declare no funding for the study.
About the Authors
Nana V. Pogosova
Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation;
Peoples' Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
MD, PhD, Professor, Corresponding member of Russian Academy of Sciences, Deputy General Director for Scientific and Analytical Work and Preventive Cardiology, Head of the Laboratory of Preventive Cardiology, Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation, Moscow, Russian Federation; Head of the Department of Evidence-Based Medicine, Institute of Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba, Moscow, Russian Federation
Tatevik A. Terteryan
Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation;
Peoples' Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
Cardiologist, Department of Cardiac Rehabilitation, Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation, Moscow, Russian Federation; Assistant, Department of Evidence Based Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba, Moscow, Russian Federation
Ashot A. Avagimyan
Yerevan State Medical University after Mkhitar Heratsi
Russian Federation
Russian Federation
PhD, Assistant Professor, Department of Internal Diseases Propaedeutics, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Republic of Armenia
Arthur A. Arutyunov
Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Junior Research Fellow, Laboratory of Preventive Cardiology, Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation, Moscow, Russian Federation
Anna B. Popova
Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation;
Peoples' Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
PhD, Senior Research Fellow, Laboratory of Preventive Cardiology, Cardiologist, Department of Cardiac Rehabilitation, Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation, Moscow, Russian Federation; Senior Lecturer, Department of Evidence Based Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba, Moscow, Russian Federation
Natalya M. Vorobyeva
Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
PhD, MD, Senior Research Fellow, Laboratory for Study of Geroprotectors and Clinical Trials, Russian Gerontology Clinical and Research Center, Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
Irina V. Osipova
Altay State Medical University
Russian Federation
Russian Federation
PhD, MD, Professor, Head of the Department of Faculty Therapy and Geriatrics, Department of Facultative Therapy and Occupational Diseases, Altay State Medical University, Barnaul, Russian Federation
Radima A. Zhetisheva
Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation;
Peoples' Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
PhD, Research Fellow, Laboratory of Preventive Cardiology, Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation, Moscow, Russian Federation; Assistant, Department of Evidence Based Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba, Moscow, Russian Federation
Aza K. Ausheva
Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation;
Peoples' Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
PhD, Leading Research Fellow, Laboratory of Preventive Cardiology; Head of the Cardiac Rehabilitation Department, Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” Ministry of Health of the Russian Federation, Moscow, Russian Federation; Associate Professor, Department of Evidence Based Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba, Moscow, Russian Federation
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For citations:
Pogosova N.V., Terteryan T.A., Avagimyan A.A., Arutyunov A.A., Popova A.B., Vorobyeva N.M., Osipova I.V., Zhetisheva R.A., Ausheva A.K. CLINICAL PREDICTORS OF LONG-TERM SURVIVAL IN CHRONIC HEART FAILURE: RESULTS FROM A 5-YEAR PROSPECTIVE COHORT STUDY. Complex Issues of Cardiovascular Diseases. 2026;15(3):170-180.
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