Prognosis of cardiac disease in the ambulant patient.

Much investigation and treatment in cardiac practice is based on the assumption that unexpected death is common in cardiac patients. The validity of this assumption was examined in 636 of 669 (95.1%) consecutive ambulant patients. During the period from 1978 to 1981, inclusive, 16 (3.9%) of the 407 men (median age, 52 years) and six (2.6%) of the 229 women (median age, 54 years) died. Nineteen of these 22 patients died of cardiac causes; most of these were elderly (average age, 68.5 years), had advanced cardiac disease for many years before their death, and complained of breathlessness at the initial interview. None of these deaths was unexpected. It is concluded that unexpected death is relatively uncommon, even in cardiology practice. The intensive diagnostic and therapeutic regimens directed at younger patients with cardiomyopathy and coronary disease who do not complain of breathlessness are unlikely to have an appreciable impact on mortality.