Research Article: Survival analysis of heart failure patients: A case study

Date Published: July 20, 2017

Publisher: Public Library of Science

Author(s): Tanvir Ahmad, Assia Munir, Sajjad Haider Bhatti, Muhammad Aftab, Muhammad Ali Raza, Chiara Lazzeri.


This study was focused on survival analysis of heart failure patients who were admitted to Institute of Cardiology and Allied hospital Faisalabad-Pakistan during April-December (2015). All the patients were aged 40 years or above, having left ventricular systolic dysfunction, belonging to NYHA class III and IV. Cox regression was used to model mortality considering age, ejection fraction, serum creatinine, serum sodium, anemia, platelets, creatinine phosphokinase, blood pressure, gender, diabetes and smoking status as potentially contributing for mortality. Kaplan Meier plot was used to study the general pattern of survival which showed high intensity of mortality in the initial days and then a gradual increase up to the end of study. Martingale residuals were used to assess functional form of variables. Results were validated computing calibration slope and discrimination ability of model via bootstrapping. For graphical prediction of survival probability, a nomogram was constructed. Age, renal dysfunction, blood pressure, ejection fraction and anemia were found as significant risk factors for mortality among heart failure patients.

Partial Text

Heart failure is the state in which muscles in the heart wall get fade and enlarge, limiting heart pumping of blood. The ventricles of heart can get inflexible and do not fill properly between beats. With the passage of time heart fails in fulfilling the proper demand of blood in body and as a consequence person starts feeling difficulty in breathing.

Up to end of follow-up period, 96 (32%) patients died due to CHD. Table 1, presents different baseline characteristics of dead and censored patients at the end of follow up period.

The statistical analysis identified age, EF, creatinine, sodium, anemia and BP as the significant variables affecting the likelihood of mortality among heart failure patients. Most of studies [16–17] supported the male gender as predictor of mortality among heart failure patients. However, like Román et al. [18] in this study odd ratio of men/women is not significant. With respect to significance and importance of variables the findings of the present study are more in lines with Rahimi et al. [19]. The results are found to be similar with other international studies like [20–23].

It can be concluded that growing age, renal dysfunction (having serum creatinine greater than its normal level 1.5), high BP (higher than normal range), higher level of anaemia and lower values of ejection fraction (EF) are the key factors contributing towards increased risk of mortality among heart failure patients. Increased level of serum sodium can reduce the odds of death. No significant differences were found due to smoking status, diabetes and gender of patients.




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