Multidiscip Cardio Annal. 2020 January; 11(1):e98039. Published online 2020 January 19. doi: 10.5812/mca.98039. Research Article Clinical and Laboratory Predictors of Mortality in Patients with Advanced Heart Failure (Stage D), Data Derived from Rajaie Acute Systolic Heart Failure (RASHF) Data Registry Rabeah Zamani 1 , Maryam Chenaghlou 1, * , Zeinab Norouzi 1 , Mohammad Mostafa Ansari Ramandi 2 , Sepideh Taghavi 1 , Ahmad Amin 1 and Nasim Naderi 1 1 Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran 2 Seyed Mostafa Khomeini Hospital, Birjand University of Medical Sciences, Birjand, Iran * Corresponding author: Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Valiasr Ave, Hashemi Rafsanjani Blvd, Tehran, Iran. Tel: +98-9144012182. Email: mchenaghlou@yahoo.com Received 2019 September 12; Revised 2019 October 28; Accepted 2019 December 12. Abstract Background: Mortality, morbidity and the burden of the advanced heart failure and also the cost of frequent admissions is high. Several registries were done all over the world to manage the patients with heart failure; however studies about the advanced stage are limited. Objectives: The present study aimed to determine the prognostic predictors of patients with advanced heart failure. Methods: In this study 178 (74.2% male) patients with advanced heart failure (stage D) from 2011 to 2016 were selected according to the following inclusion criteria; highly symptomatic heart failure patients with severe left ventricular (LV) systolic dysfunction (LV ejection fraction less than 30%) who have been admitted for at least two times in the recent year because of decompensation. The data regarding the clinical findings, readmissions, mortality, laboratory tests, electrocardiography, echocardiography, etc. of patients were all derived from Rajaie Acute Systolic Heart Failure (RASHF) data registry. Results: In a 5-year follow-up, we realized that more than 70% of the patients died. The rate of mortality were significantly higher in females (P value = 0.006) and there was a significant correlation between anemia and the mortality (P value = 0.002). There was no remarkable association between the serum creatinine, sodium and uric acid levels with the mortality of the patients. Conclusions: Data about stage D of heart failure are limited. The mortality rate for such patients is relatively high and there’s no clear best treatment approach. Large registries and data acquisition of these patients could be helpful for better management approaches. Keywords: Advanced Heart Failure, Registry, Mortality, Clinical Outcome 1. Background The prevalence of heart failure is increasing and the rate of admission due to decompensated heart failure (DHF) is high. Many studies were done to evaluate the rea- sons of frequent admissions in these patients. Inappro- priate treatment, limited capacity of hospitals for patients to be admitted, and worsening of the patients’ condition were some of the reasons for readmissions due to DHF mor- bidity of the patients. In addition the cost of treatment is high. Many guidelines have been written for diagnosis and management of patients with DHF. Registry studies are valuable tools to guide diagnosis and management of heart failure (1). Stage D or advanced heart failure is the end stage of the disease. According to the American Heart Failure soci- ety, advanced or stage D heart failure was defined as per- sistent and/or progressive severe heart failure signs and symptoms despite optimal medical, surgical, and device therapy. Patients in this phase are symptomatic most of the time (NYHA function class IV) and many of them are resistant to the treatments. Fluid retention, arrhythmias, and heart failure complications including renal failure, electrolyte abnormalities, side effects of the drugs and pul- monary thromboembolism are some of the reasons for readmission (2-4). The estimated proportion of patients with stage D heart failure is about 5 - 10% of all heart failure population (5) and the studies regarding these patients, their clini- cal characteristics, prognosis and para-clinical evaluations Copyright © 2020, Multidisciplinary Cardiovascular Annals. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.