Cause-specific noncardiac mortality in patients with congestive heart failure--a contemporary Canadian audit. Clinical Quality Improvement Network (CQIN) Investigators.
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BACKGROUND: Noncardiac mortality in congestive heart failure (CHF) is substantial. OBJECTIVE: To define the specific causes of noncardiac mortality among hospitalized CHF patients. DESIGN: Retrospective medical record audit. SETTING: Three hospitals in British Columbia and Alberta, 1992-93. PATIENTS: A total of 2216 consecutive patients admitted with CHF. MAIN RESULTS: The overall mortality rate was 404 of 2216 (18%). Cause of death was cardiac in 290 of 404 (72%) patients, with an average age of 76 years. However, 114 of 404 (28%) deaths, in patients with an average age of 69 years, had noncardiac causes. Four causes accounted for almost 70%, of the noncardiac deaths: cancer (24%); pneumonia (16%); other pulmonary diseases, including embolism (15%); and cerebrovascular disease (11%). Renal disease (9%), gastrointestinal disorders (9%), non-pulmonic sepsis (7%), multiple system failure (5%) and trauma or surgical complications (4%) accounted for most of the remaining noncardiac deaths. CONCLUSIONS: Noncardiac causes produce a substantial proportion of deaths among elderly and sick CHF patients. As the survival of patients with CHF improves, the relative risk of noncardiac mortality in this population will likely increase. However, since hospitalized CHF patients so closely reflect their general population counterparts in terms of cause-specific mortality risk, the search for an ideal therapy might be viewed as a quixotic search for the cure of death.
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