Characteristics and the prognosis of patients with acute heart failure in current clinical practice

Česká verzia

Authors: E. Goncalvesová ¹; I. Varga ¹ ; P. Lesný ¹; B. Líška ²; M. Luknár ¹; P. Solík Za Slovasez Investigátorov ¹
Authors place of work: Oddelenie zlyhávania a transplantácie srdca Národného ústavu srdcových a cievnych chorôb, a. s., Bratislava, prednostka doc. MUDr. Eva Gonçalvesová, CSc., FESC ¹; Oddelenie invazívnej kardiológie Národného ústavu srdcových a cievnych chorôb, a. s., Bratislava, prednosta MUDr. Viliam Fridrich, PhD ²
Published in the journal: Vnitř Lék 2010; 56(8): 845-853
Category: 50th Birthday - Jindřich Špinar, MD, CSc., FESC

Summary

Purpose:
Analysis of predefined characteristics and outcomes in a non‑selected population of patients hospitalized for acute heart failure (AHF) in Slovakia.

Methods:
We conducted a nationwide prospective multicenter survey with 860 consecutive patients enrolled in 11 hospitals throughout Slovakia – two centres with a non‑stop catheterization service, two central and 7 regional hospitals. Relevant data of 78 characteristics in 9 categories were collected during 3 months (between 1 May 2009 and 31 July 2009). There was a specific form designed for this survey. Collected data were then transferred into the electronic database and statistically analysed.

Results:
Mean age was 72 years, 81% of patients were in NYHA class III/IV (52% male). The majority of patients were admitted with decompensated heart failure (68.4%), frequency of cardiogenic shock was 0.3%. New‑onset AHF (AHF de novo) was diagnosed in 31.1%, of which 20.8% was due to acute coronary syndromes. Coronary heart disease was the predominant primary aetiology of AHF (67%), followed by almost equally represented hypertension (10.5%), valvular disease (10%) and dilated cardiomyopathy (9%). Hypertension was referred as the most frequent comorbidity (82%), followed by atrial fibrillation (48%), diabetes mellitus (42%), history of renal failure (31%) and with anaemia at admission (38%). Rales were the dominant physical sign (69.9%). Systolic blood pressure greater than 140 mm Hg was present in 37.8% and QRS length > 120 ms in 21.4% of patients. Preserved left ventricular ejection fraction (≥ 40%) was observed in 57% out of 70% documented cases in the whole survey. 23.3% of patients had a history of coronary angiography. 84.3% of patients received intravenous treatment, diuretics, nitrates and inotropes were given to 82.2%, 18% and 6%, respectively. The number of patients with cardiac resynchronization therapy (CRT), with or without defibrillator function, was 0.9%. Mean length of stay was 9.2 days and in‑hospital mortality was 9.1%. At discharge, 76% of patients were on angiotensin‑converting enzyme inhibitors (ACE‑I) or angiotensin receptor blockers (ARB), 62% were using beta‑blockers (BB), however the doses of drugs were lower then recommended values.

Conclusions:
Results of the survey are comparable with other observational studies, surveys and large registries. Although the percentage of patients with ACE‑I/ARB and BB at discharge seems promising, there is still area for improvement in AHF patients health care.

Key words:
acute heart failure – diagnostics – therapy – outcome – registry

Zdroje

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