Risk-Stratification in Heart Failure Patients with Varying Disease Severity

Abstract

Heart failure (HF) is one of the major cardiovascular problems, affecting 15 million people worldwide [1,2]. Despite declining mortality from heart disease, the number of patients affected by HF is still increasing [3]. There is an overall 5-year mortality of 50%, and in severe cases this percentage reaches 35%-40% in 1 year [4]. The rates for total mortality and sudden death vary by functional class. In mild HF [New York Heart Association (NYHA) functional class II], the overall annual mortality is 5%-15%, with approximately one-half to two-thirds being classified as sudden. In NYHA class III, the annual mortality increases to 20%-50% and in class IV it often exceeds 50% [5]. Considering the wide spectrum of disease severity in patients with HF, a risk stratification strategy is reasonable to identify those at high risk of cardiac events, in whom more aggressive management may be beneficial. This is especially important for ambulatory patients with moderate-to-severe congestive heart failure (CHF). In this respect, a number of variables have been thorougly investigated. A review of the most commonly used ones will be discussed in this chapter.