SPC365

Reevaluating Prognostic Factors in Advanced Heart Failure: Insights from a Multivariate Analysis

Session: Sessão de Comunicações Orais 04 – A bomba em falência: fronteiras hemodinâmicas e metabólicas na doença cardíaca crítica
Speaker: Ana Rita Andrade

Congress: CPC 2026
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Rita Andrade; João Cravo; Ana Francês; Fátima Salazar; Nuno Lousada; Joana Rigueira; Rafael Santos; Doroteia Silva; Fausto Pinto; Dulce Brito; João Agostinho

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">: Advanced heart failure (HF) is associated with high mortality, and various clinical factors have been proposed as prognostic indicators. Conventional risk factors, such as left ventricle ejection fraction (LVEF), NYHA class, NT-proBNP or diuretic dose are commonly used to predict mortality risk. Many previous publications consider recurrent hospitalizations as the main risk factor for death in these patients, however ventricular arrhythmias also seem to be gaining increasing attention as they are becoming more frequent as survival is improving with new therapies.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">: To evaluate the relative impact of recurrent hospitalizations and ventricular arrhythmias in the mortality risk of patients with advanced heart failure.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">: Analysis of a single-centre, retrospective cohort of patients with advanced HF (either candidates for heart transplant or left ventricle assist device implant or dependent of intermittent inotropic therapy) was performed by using multivariate Cox regression to identify independent predictors of mortality. The variables used in the multivariate analysis were LVEF, age, HF etiology, frequency of hospitalizations, diuretic dose, NT-proBNP levels and the occurrence of ventricular arrhythmias.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">:&nbsp; A total of 34 patients were included in the study, with a median age of 68 years (IQR: 63&ndash;73). Of these, 47.1% had an ischemic etiology. The median LVEF was 24% (IQR: 16&ndash;27%) and most patients were classified as NYHA Class III (82.4%). All patients had either an ICD or CRT-D. During a follow-up of 1,3 years (IQR 0,7-2,7 years), 50% of the patients died, 31 were admitted due to HF worsening and 15 had either an appropriate ICD shock, appropriate and effective anti-tachycardia pacing or slow ventricular tachycardia.&nbsp;&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">The multivariate analysis identified ventricular arrhythmias as the most significant independent predictor of mortality (HR: 10.253; 95% CI 2.454-42,850; p=0.001) &ndash; Figure 1. In fact, none of the other variables included for analysis showed a significant association with mortality: LVEF (p=0.77), age (p=0.308), ischemic etiology (p=0.897), recurrent hospitalizations (p=0.07), diuretic dose (p=0.926) and NT-proBNP (p=0.815). Interestingly, having a ventricular arrythmia was more impactful than having an HF related admission &ndash; Figure 2.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusions</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">: The occurrence of ventricular arrhythmias seems to be one of the strongest predictors of higher mortality risk in advanced heart failure, so its role as a criterion to seek for advanced heart failure therapies should be empathized.</span></span></span></p>