Is the prognosis of congestive heart failure patients still so bad?

Česká verzia

Authors: O. Ludka; L. Galková; M. Šablaturová; J. Jarkovský ; L. Dušek; J. Špinar
Published in the journal: Kardiol Rev Int Med 2011, 13(1): 30-36
Category: From Hypertension to Heart Failure

Summary

Background:
According to a Framingham study, more than half of patients with congestive heart failure die within five years of the occurrence of clinical symptoms, and about 17% of patients within a year of clinical manifestation of the disease.

Aim:
To determine the mortality rate of patients with CHF monitored in the outpatient heart failure clinic of University Hospital Brno.

Methods:
Retrospective analysis of data obtained from outpatient records of consecutive patients with CHF.

Patients:
159 patients, 70.4% men, 29.6% women, age 66 (40–84) years, follow up period 32.5 (11.1–61.9) months (8 to 66 months), NYHA class I–II/II/III 26.4/61.6/12%, LV EF 30 (15–45) %, diastolic dysfunction 94.3%, aetiology of CHF – 68.6% ischaemic heart disease, 22.6% dilatative cardiomyopathy, other 8.8%, comorbidities – hypertension 67.9%, myocardial infarction 49.1%, dyslipoproteinaemia 56.6%, diabetes mellitus 34%, stroke + TIA 11.3%, COPD 8.8%, anemia 16.4%, atrial fibrilation 15.1%, GF according to Cockroft formula 66.8 (27.2–125.2) ml/s, GF < 60 ml/s 44.7%, pharmacological treatment: ACE-I 84.3%, ARB 13.2%, BB 95.6%, loop diuretics 60.4%, hydrochlorothiazid 21.7%, spironolacton 52.8%, digitalis 22.6%, statins 61.6%, non-pharmacological treatment: pacemaker 18.9%, CRT-D 5%, CRT-P 7.5%, PCI 30.2%, CABG 10.1%.

Results:
24 patients (15.1%) died during the monitoring period, 18 (11.3%) of them from non-cardiovascular complications. The cumulative survival rate was 96.2% after first year, 90.8% after the second year, 87.6% after the third year and 82.7% after the fourth year of monitoring.

Conclusion:
Mortality in the Framingham study highly exceeds mortality in our sample, which may be explained not only by improvements in both pharmacological and non-pharmacological treatment strategies, but also by slightly different spectra of patients.

Keywords:
chronic heart failure – prognosis – pharmacological treatment – non-pharmacological treatment

Zdroje

1. McCullough PA, Philbin EF, Spertus JA et al. Resource Utilization Among Congestive Heart Failure (REACH) Study. Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study. J Am Coll Cardiol 2002; 39: 60–69.

2. Remme WJ, Swedberg K. The task force for the diagnosis and treatment of chronic heart failure. European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 2001; 22: 1527–1560.

3. Rich MW. Epidemiology, pathophysiology, and etiology of congestive heart failure in older adults. J Am Geriatr Soc 1997; 45: 968–974.

4. McMurray J, McDonagh T, Morrison CE et al. Trends in hospitalization for heart failure in Scotland 1980–1990. Eur Heart J 1993; 14: 1158–1162.

5. Cowie MR, Mosterd A, Wood DA et al. The epidemiology of heart failure. Eur Heart J 1997; 18: 208–225.

6. Fonarow GC, Adams KF Jr, Abraham WT et al. ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA 2005; 293: 572–580.

7. Zannad F, Mebazaa A, Juillière Y et al. EFICA Investigators. Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study. Eur J Heart Fail 2006; 8: 697–705.

8. Ho KK, Pinsky JL, Kannel WB et al. The epidemiology of heart failure: the Framingham study. J Am Coll Cardiol 1993; 22A: 6A–13A.

9. Berry C, Murdoch DR, McMurray JJ. Economics of chronic heart failure. Eur J Heart Fail 2001; 3: 283–291.

10. MacIntyre K, Capewell S, Stewart S et al. Evidence of improving prognosis in heart failure: trends in case fatality in 66,547 patients hospitalized between 1986 and 1995. Circulation 2000; 102: 1126–1131.

11. Murdoch DR, Love MP, Robb SD et al. Importance of heart failure as a cause of death. Changing contribution to overall mortality and coronary heart disease mortality in Scotland 1979–1992. Eur Heart J 1998; 19: 1829–1835.

12. Levy D, Kenchaiah S, Larson MG et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med 2002; 347: 1397–1402.

13. Ho KK, Pinsky JL, Kannel WB et al. The epidemiology of heart failure: the Framingham study. J Am Coll Cardiol 1993; 22A: 6A–13A.

14. Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. JAMA 1995; 273: 1450–1456.

15. McMurray JJ. Major beta blocker mortality trials in chronic heart failure: a critical review. Heart 1999; 82: IV14–IV22.

16. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987; 316: 1429–1435.

17. The SOLVD Investigators. Effects of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325: 293–302.

18. Yusuf S, Pitt B. A lifetime of prevention: the case of heart failure. Circulation 2002; 106: 2997–2998.

19. Cleland JG, Cohen-Solal A, Aguilar JC et al. IMPROVEMENT of Heart Failure Programme Committees and Investigators. Improvement programme in evaluation and management; Study Group on Diagnosis of the Working Group on Heart Failure of The European Society of Cardiology. Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet 2002; 360: 1631–1639.

20. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhytmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Invesigators. N Engl J Med 1997; 337: 1576–1583.

21. CASH Investigators. Siebels J, Cappato R, Rüppel R et al. Preliminary results of the Cardiac Arrest Study Hamburg (CASH). Am J Cardiol 1993; 72: 109F–113F.

22. Buxton AE, Lee KL, Fisher JD et al. A randomized study of prevention of sudden death in patients with coronary artery disease: Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med 1999; 341: 1882–1890.

23. Connolly SJ, Gent M, Roberts RS et al. Canadian implantable defibrillator study (CIDS): a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation 2000; 101: 1297–1302.

24. Moss AJ, Hall WJ, Cannom DS et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhytmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996; 335: 1933–1940.

25. Moss AJ, Zareba W, Hall WJ et al. Multicenter Automatic Defibrillator Implantation Trial II. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002; 346: 877–883.

26. Bardy GH, Lee KL, Mark DB et al. Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrilator for congestive heart failure. N Engl J Med 2005; 352: 225–237.

27. Cazeau S, Ritter P, Bakdach S. Four chamber pacing in dilated cardiomyopathy. Pacing Clin Electrophysiol 1994; 17: 1974–1979.

28. Bristow MR, Saxon LA, Boehmer J et al. Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac--resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140–2150.

29. Cleland JGF, Daubert JC, Erdmann E et al. Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352: 1539–1549.

30. Moss AJ, Hall WJ, Cannom DS et al. MADIT-CRT Trial Investigators. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009; 361: 1329–1338.