Short-term prognosis and treatment of patients hospitalized for acute heart failure in a regional hospital without a cardiocentre

Česká verzia

Authors: K. Zeman ¹; L. Pohludková ¹; J. Špinar ²; J. Jarkovský ³ ; S. Littnerová ³; L. Dušek ³; R. Miklík ²; M. Felšöci ²; J. Pařenica ²
Authors place of work: Interní oddělení Nemocnice ve Frýdku-Místku, p. o., Frýdek-Místek, prim. MUDr. Petr Vítek ¹; Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC ²; Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty MU Brno, ředitel doc. RNDr. Ladislav Dušek, Ph. D. ³
Published in the journal: Vnitř Lék 2012; 58(4): 273-279
Category: Original Contributions

Summary

Background:
Heart failure is a syndrome with increasing prevalence and poor prognosis. The aim of the article is to describe the characteristics, etiology, treatment and short-term prognosis of consecutive patients hospitalized for acute heart failure (AHF) in a regional hospital without Cardiocentre.

Patients and methods:
From 1/2007 to 5/2009 in total 752 patients were hospitalized in Hospital in Frýdek-Místek with diagnosis of AHF, 18% of them were in that period re-hospitalized. Data collection was performed by doctors using the National registry of acute heart failure AHEAD. Systematic sorting of patients with heart failure was made on the basis of guidelines for the diagnosis and treatment of acute heart failure (2005). Statistical analysis was performed at the Institute of Biostatistics and Analyses Masaryk University in Brno.

Results:
AHF was a reason of 9% of all hospital admissions. This represents approximately 250 hospitalizations due to AHF per 100 000 inhabitants/year. A median of hospital stay was 6.5 days. Patients with de-novo AHF formed 40.8% of all hospitalizations. The most common syndromes of AHF were acute decompensated heart failure (57.7%) and pulmonary oedema (19.8%). According to laboratory tests the incidence of renal insufficiency was in 35.6% of patients, anemia in 39.9%, blood glucose on admission above 10 mmol/l in 29.5% and hyponatremia < 135 mmol/l in 19.1%. During hospitalization, there was a significant increase in the treatment of heart failure. Diuretics were receiving 91% of discharged patients, ACE inhibitors and/or AT₂ blockers 85.7% and beta-blockers 69.6% of patients. A total of 30% of discharged patients were not self-sufficient. The total 30-day mortality was 16.8%. Using univariante logistic regression factors most affecting the 30-day mortality were identified: cardiogenic shock, female gender, age over 70 years, acute coronary syndrome, hypotension on admission, atrial fibrillation, renal insufficiency, chronic obstructive pulmonary disease, anemia, hyperglycemia, hyperkalemia, and hyponatremia.

Conclusion:
The paper provides an overview and characteristics of consecutive patients hospitalized in the regional hospital. We identified factors pointing to the adverse short-term prognosis. The work draws attention to social problems, up to 30% of patients hospitalized for acute heart failure were not self-sufficient at discharged.

Key words:
acute heart failure – epidemiology – prognosis – AHEAD

Zdroje

1. Nieminen MS, Böhm M, Cowie MR et al. ESC Committe for Practice Guideline (CPG). Executive summary of the guidelines on the diagnosis and treatment of acute heart failure. Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 2005; 26: 384–416.

2. Ondrackova B, Miklik R, Parenica J et al. In hospital costs of acute heart failure patients in the Czech Republic. Cent Eur J Med 2009; 4: 483–489.

3. Bueno H, Ross JS, Wang Y et al. Trends in Length of Stay and Short-term Outcomes Among Medicare Patients Hospitalized for Heart Failure, 1993–2006. JAMA 2010; 303: 2141–2147.

4. Abraham WT, Adams KF, Fonarow GC et al. ADHERE Scientific Advisory Committee and Investigators; ADHERE Study Group. In-Hospital Mortality in Patients With Acute Decompensated Heart Failure Requiring Intravenous Vasoactive Medications: An Analysis From the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol 2005; 46: 57–64.

5. Abraham WT, Fonarow GC, Albert NM et al. OPTIMIZE-HF Investigators and Coordinators. Predictors of In-Hospital Mortality in Patients Hospitalized for Heart Failure: Insights From the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol 2008; 52: 347–356.

6. Cleland JG, Swedberg K, Cohen-Solal A et al. The Euro Heart Failure Survey of The EUROHEART Survey Programme: A survey on the quality of care among patients with heart failure in Europe. The Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology. The Medicines Evaluation Group Centre for Health Economics University of York. Eur J Heart Fail 2000; 2: 123–132.

7. Follath F, Delgado JF, Mebazaa A et al. Classifying patients with acute heart failure presentation, treatment and outcome. A nine country survey of acute heart failure management (ALARM--HF). Eur J Heart Fail 2008; 7 (Suppl): 64.

8. Nieminen MS, Brutsaert D, Dickstein K et al. EuroHeart Survey Investigators; Heart Failure Association, European Society of Cardiology. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J 2006; 27: 2725–2736.

9. Siirilä-Waris K, Assus J, Melin J et al. Characteristics, outcomes, and predictors of 1-year mortality in patients hospitalized for acute heart failure. Eur Heart J 2006; 27: 3011–3017.

10. 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.

11. Spinar J, Ascherman M, Al Hiti L et al. Databáze akutního srdečního selhání na specializovaných kardiologických klinikách. Cor Vasa 2008; 50: 12–21.

12. Spinar J, Spinarova L. Gender differences in the Acute Heart Failure Database Registry. US Cardiology 2009; 6: 64–66.

13. Špinar J, Janský P, Kettner J et al. Doporučení pro diagnostiku a léčbu akutního srdečního selhání. Cor Vasa 2006; 48: K3–K 31.

14. Jhund PS, MacIntyre K, Simpson CR et al. Long-Term Trends in First Hospitalization for Heart Failure and Subsequent Survival Between 1986 and 2003: a population study of 5.1 million people. Circulation 2009; 119: 515–523.

15. Solomon SD, Dobson J, Pocock S et al. Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) Investigators. Influence of Nonfatal Hospitalization for Heart Failure on Subsequent Mortality in Patients With Chronic Heart Failure. Circulation 2007; 116: 1482–1487.

16. Curtis LH, Greiner MA, Hammill BG et al. Early and Long-term Outcomes of Heart Failure in Elderly Persons, 2001–2005. Arch Intern Med 2008; 168: 2481–2488.

17. Harjola VP, Follath F, Nieminen MS et al. Characteristics, outcomes, and predictors of mortality at 3 months and 1 year in patients hospitalized for acute heart failure. Eur J Heart Fail 2010; 12: 239–248.

18. Rosolova H, Cech J, Simon J et al. Short to long term mortality of patients hospitalised with heart failure in the Czech Republic. Report from the EuroHeart Failure Survey. Eur J Heart Fail 2005; 7: 780–783.

19. Felšöci M, Pařenica J, Špinar J et al. Does previous hypertension affect outcome in acute heart failure? Eur J Intern Med 2011; 22: 591–596.