Invasive investigation

This chapter describes the prognostication of heart failure. Heart failure is a frequently progressive condition, although after commencing treatment patients usually reach a period of clinical ‘stability’, the duration of which varies between individuals. Most patients, if they do not suffer from sudden death, will ultimately deteriorate with refractory heart failure symptoms leading up to their death. Identifying such patients is one of the great challenges of heart failure management. Decisions regarding appropriateness and timing of scarce treatments—such as cardiac transplantation or mechanical circulatory support—or the need for end-of-life care can be aided by repeated prognostic assessment. As the one-year mortality following cardiac transplantation is approximately 15.5%, the selection of candidates for cardiac transplantation is therefore determined by identifying those patients whose annual mortality from heart failure exceeds this rate and who might therefore benefit prognostically from advanced therapy. Prognostic assessment of chronic heart failure can be made by a number of methods, including evaluation of univariable predictors, as well as multivariable clinical models.