Risk stratification in chronic heart failure

Despite advances in medical and surgical management, the prognosis of chronic heart failure remains poor. Few patients with chronic heart failure can be considered to have a good prognosis, but different trials have indicated a 6 month mortality between 5% and 60% depending on the severity of heart failure; identifying patients at truly low risk is difficult. A host of factors have been identified that predict outcome, at least in univariate analyses. Cohn wrote an article entitled ‘Poverty Amidst a Wealth of Variables’ some years ago, describing the difficulties in choosing which prognostic variables to use for clinical purposes in heart failure. This article reviews in a systematic fashion those peer-reviewed papers that have assessed the utility of prognostic variables in heart failure. This summary of existing knowledge should determine those prognostic factors that have proved most reliable so far, indicate which of the many new potential factors are most promising for further research and suggests ways in which the interpretation and reporting of such information might be improved.