Outcome

Cardiac failure has a very poor long term outcome and the prognosis can be worse than that of many cancers.

The ESC 2016 Guidelines report that acute heart failure associated with cardiogenic shock has a poor prognosis. However, in those that present with hypertensive acute heart failure, the in-hospital mortality is low [1].

In the 3CPO trial, the 7-day mortality was 9.5% for the NIV arms, 9.8% for the standard therapy arm and 9.9% for non-recruited patients.  The 30-day mortality was 15.2% in the combined NIV arms and 16.2% in the standard therapy arm [4].

A worse outcome is associated with [1]:

• Advanced Age
• Wide QRS
• Hyponatraemia
• Low Left Ventricular Ejection Fraction
• Hypotension
• Precipitated by ischaemia
• Previous hospitalisation for heart failure
• Marked BNP elevation
• Elevated troponin