Vascular disease as a predictor of long-term mortality in patients hospitalized for new-onset heart failure

Background. - Comorbidities have an adverse influence on the outcome of patients with heart failure (HF). Aim. - We investigated the impact of peripheral vascular disease (PVD) on long-term mortality in hospitalized patients with HF. Methods. - We included prospectively consecutive patients (N = 799) hospitalized for a first episode of HF in all healthcare establishments within a single French department during 2000. Patients with peripheral arterial disease and/or history of stroke were considered to have PVD. Baseline characteristics and 5-year mortality were compared according to PVD status. Results. - PVD was diagnosed in 172 patients (22%) and clinical coronary artery disease in 302 patients (38%). Patients with PVD were older, predominantly men, smokers, and more often had diabetes and coronary artery disease. PVD was associated with an increased risk of crude 5-year overall mortality (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.35-2.03; P<0.001). After adjustment for covariates, the relationship remained significant (HR 1.33, 95% CI 1.08-1.65; P = 0.008). Compared with the expected survival, the 5-year survival of the PVD group was dramatically lower (24% versus 67%). The risk of cardiovascular death was higher for PVD patients (HR 1.39, 95% CI 1.07-1.80; P = 0.014). PVD probably modulates the impact of other covariates on outcome. Conclusion. - PVD is a potent predictor of adverse outcome in patients with new-onset HE (C) 2008 Elsevier Masson SAS. All rights reserved.