Objectives: The waiting time for heart transplantation (HTx) has steadily increased in Spain. This increases the risk for worsening heart failure (HF) and death in patients with advanced HF. Our aims were to assess characteristics of patients referred for evaluation to a HTx unit and identify predictors of mortality or hospitalization for HF.
Methods: Retrospective analysis of consecutive patients referred for evaluation to an outpatient clinic between 2011 and 2014. Endpoints evaluated were a) A combined end point of all cause mortality or hospitalization for HF and b) All cause mortality free of urgent HTx. Cox regression analysis and survival Kaplan-Meier curves were performed to identify predictors of risk.
Results: 125 patients were included, age 56.4 ± 9.8 y, 78% males, 41% ischemic CMP. Mean LVEF was 23.8 ± 6%, 56 (45%) had pulmonary hypertension (PH) and 63 (50%) reduced right ventricular (RV) function. After a median follow-up of 14 ± 10 m, 26 pats underwent HTx and 34 died or had hospitalization for HF. Total survival free of hospitalization or HTx was 72.8%. Cox regression analysis identified the presence of hospitalizations for HF in the previous 12 months (HR 1.8; 95% IC: 1.3-2.5; p < 0.001) and PH with and without RV dysfunction (HR 6.6, 95% IC: 1.2-37.5; p = 0.032 and HR 4.1, 95% IC: 1.4-12.5; p = 0.01) as independent predictors for death or rehospitalisation and the presence of hospitalization for HF as the only predictor for all cause mortality free of urgent HTx (HR 7.7, 95% IC:1.7-35.2;p = 0.008).
Conclusions: In patients with advanced HF, the presence of PH determined by echocardiography with or without RV dysfunction is predictor of death or rehospitalisation. Hospitalization for HF in the previous 12 months was an independent predictor of all cause mortality and HF.