Even "Stable" Patients Are at Risk of Heart Failure Death

Heart failure is a clinical syndrome associated with abnormality of cardiac structure and function, leading to progressive symptoms such as dyspnea and fatigue, but even stable patients with mild symptoms may have relatively high risk of hospitalization and death.1,2

Heart failure is deadlier than many cancers

Heart failure patients continue to face a poor prognosis

Many heart failure patients continue to face a poor prognosis

* EMPHASIS was a randomized, double-blind, placebo-controlled trial of 2737 patients at least 55 years of age. Patients received eplerenone (up to 50 mg daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure.6

† The CHARM Low–Left Ventricular Ejection Fraction (LVEF) trials were two randomized, parallel, placebo-controlled trials (CHARM-Alternative, for patients who cannot tolerate ACE inhibitors, and CHARM-Added, for patients who were receiving ACE inhibitors). Mortality and morbidity were determined in 4576 low (≤40%) LVEF patients (2289 candesartan and 2287 placebo), titrated as tolerated to a target dose of 32 mg once daily, and observed for 2 to 4 years (median, 40 months). The primary outcome (time to first event by intention to treat) was cardiovascular death or heart failure hospitalization for each trial, in the pooled analysis of the low LVEF trials.7

‡ An analysis of 6 trials/registries comprising over 10,000 heart failure patients followed for a mean of 1.6 years evaluated the Seattle Heart Failure model and its relationship to NYHA class for predicting mode of death. A key finding was that sudden death accounted for 65% of all deaths in NYHA class II patients. In a posthoc analysis of data from a randomized trial of nearly 4000 heart failure patients, the proportion of patients who died from worsening heart failure increased with NYHA class.8


  1. McMurray JJV, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787-1847.
  2. Fauci AS, Braunwald E, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008.
  3. Levy D, Kenchaiah S, Larson MG, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002;347(18):1397-1402.
  4. Roger VL, Weston SA, Redfield MM, et al. Trends in heart failure incidence and survival in a community-based population. JAMA. 2004;292(3):344-350.
  5. National Cancer Institute. Surveillance, epidemiology, and end results program. Cancer stat fact sheets. http://seer.cancer.gov/statfacts. Accessed July 30, 2014.
  6. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 2011;364:11-21.
  7. Young JB, Dunlap ME, Pfeffer MA, et al. Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) Investigators and Committees. Mortality and morbidity reduction with candesartan in patients with chronic heart failure and left ventricular systolic dysfunction: results of the CHARM low-left ventricular ejection fraction trials. Circulation. 2004;110(17):2618-2626.
  8. Mozaffarian D, Anker SD, Anand I, et al. Prediction of mode of death in heart failure: the Seattle Heart Failure Model. Circulation. 2007;116(4):392-398.