Study Cohort

Patients age 40 years or older who were hospitalized between January 1, 1994 and July 14, 1999 at Barnes-Jewish Hospital at Washington University Medical Center in St. Louis with an admitting diagnosis of HF, dyspnea, or acute myocardial infarction (MI) were screened for eligibility. Patients younger than 40 were excluded both because prevalence of HF is very low among individuals younger than 40 years old and because major adverse cardiac events are less common among younger than middle-aged and elderly HF patients (19).

Inclusion required the permission of the attending physician, evidence of HF on chest x-ray, and documentation of at least two of the following to fulfill a clinical diagnosis of HF: 1) dyspnea, 2) third heart sound, 3) jugular venous distention, 4) hepatojugular reflux, 5) pulmonary rales, 6) peripheral edema, or 7) symptomatic or clinical improvement in response to diuretics. Patients were excluded if they 1) were too medically unstable to participate (in the judgment of their attending physician); 2) had isolated right-sided HF; 3) had HF associated with valve disease for which surgical correction was pending; 4) had a terminal illness other than HF; or 5) had a neuropsychiatric condition or language barrier that would preclude informed consent or valid assessments. Participants signed an informed consent form approved by the institutional review board at Washington University School of Medicine. Participants (n=20; 2.9% of 682 enrolled patients) who died during the index hospitalization were excluded from this analysis.