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

Czech version

Authors: E. Goncalvesová ¹; I. Varga ¹; P. Lesný ¹; B. Líška ²; M. Luknár ¹; P. Solík Za Slovasez Investigátorov ¹
Authors‘ workplace: 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: Vnitř Lék 2010; 56(8): 845-853
Category: 50th Birthday - Jindřich Špinar, MD, CSc., FESC

Overview

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

Sources

1. Dickstein K, Cohen‑Solal A, Filippatos G et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29: 2388–2442.

2. Krum H, Abraham WT. Heart failure. Lancet 2009; 373: 941–955.

3. Spinar J, Spinarova L. Gender differences in acute heart failure. Future Cardiol 2009; 5: 109–111.

4. Hobbs FD. Clinical burden and health service challenges of chronic heart failure. Eur J Heart Fail 2009; 8 (Suppl 1): i1–i4.

5. Alla F, Zannad F, Filippatos G. Epidemiology of acute heart failure syndromes. Heart Fail Rev 2007; 12: 91–95.

6. Miller LW. Heart failure: who we treat versus who we study. Cardiol Clin 2008; 26: 113–125.

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

8. Zannad F, Mebazaa A, Juillière Y et al. 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.

9. Tavazzi L, Maggioni AP, Lucci D et al. Nationwide survey on acute heart failure in cardiology ward services in Italy. Eur Heart J 2006; 27: 1207–1215.

10. Siirilä‑Waris K, Lassus 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.

11. Adams KF Jr, Fonarow GC, Emerman CL et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 2005; 149: 209–216.

12. Granger CB, Gersh BJ. Clinical trials and registries in cardiovascular disease: competitive or complementary? Eur Heart J 2010; 31: 520–521.

13. Gitt AK, Bueno H, Danchin N et al. The role of cardiac registries in evidence‑based medicine. Eur Heart J 2010; 31: 525–529.

14. Komajda M. How well are we implementing evidence‑based care? Eur J Heart Fail 2009; 8 (Suppl 1): i39–i44.

15. MacDonald MR, Petrie MC, Hawkins NM et al. Diabetes, left ventricular systolic dysfunction, and chronic heart failure. Eur Heart J 2008; 29: 1224–1240.

16. De Luca L, Fonarow GC, Adams KF Jr et al. Acute heart failure syndromes: clinical scenarios and pathophysiologic targets for therapy. Heart Fail Rev 2007; 12: 97–104.

17. Hamaguchi S, Tsuchihashi‑Makaya M, Kinugawa S et al. Anemia is an independent predictor of long‑term adverse outcomes in patients hospitalized with heart failure in Japan. Circ J 2009; 73: 1901–1908.

18. Sánchez‑Torrijos J, Gudín‑Uriel M, Nadal‑Barangé M et al. Prognostic value of discharge hemoglobin level in patients hospitalized for acute heart failure. Rev Esp Cardiol 2006; 59: 1276–1282.

19. Solík P, Murín J. Anémia a chronické srdcové zlyhávanie. Interná Med 2007; 7: 309–315.

20. Hamaguchi S, Yokoshiki H, Kinugawa S et al. Effects of atrial fibrillation on long‑term outcomes in patients hospitalized for heart failure in Japan. Circ J 2009; 73: 2084–2090.

21. Lukl J. Jak zlepšit odpověď na srdeční resynchronizační léčbu? Vnitř Lék 2009; 55: 808–811.

22. Gheorghiade M, Abraham WT, Albert NM et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA 2006; 296: 2217–2226.

23. Parenica J, Miklik R, Belohlavek J et al. AHEAD MAIN – Multicenter Acute Heart Failuer Registry – baseline characteristics and in‑hospital mortality. Eur J Heart Fail Suppl 2009; 8. Abstract 735.

24. Varga I. Charakteristiky pacientov s akútnym srdcovým zlyhávaním na Slovensku. Dizertačná práca. Bratislava: Lekárska fakulta Univerzity Komenského 2010.

25. Tsuchihashi‑Makaya M, Hamaguchi S, Kinugawa S et al. Characteristic and outcomes of hospitalized patients with heart failure and reduced vs. preserved ejection fraction. Circ J 2009; 73: 1893–1900.

26. Yancy CW, Lopatin M, Stevenson LW et al. Clinical presentation, management, and in‑hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function. J Am Coll Cardiol 2006; 47: 76–84.

27. Bhatia RS, Tu JV, Lee DS et al. Outcome of heart failure with preserved ejection fraction in a population‑based study. N Engl J Med 2006; 355: 260–269.

28. Flaherty JD, Rossi JS, Fonarow GC et al. Influence of coronary angiography on the utilization of therapies in patients with acute heart failure syndromes: Findings from OPTIMIZE‑HF. Am Heart J 2009; 157: 1018–1025.

29. Rossi JS, Flaherty JD, Fonarow GC et al. Influence of coronary artery disease and coronary revascularization status on outcomes in patients with acute heart failure syndromes: A report from OPTIMIZE‑HF. Eur J Heart Fail 2008; 10: 1215–1223.

30. Szadkowska I, Pawlicki L, Kowalski J et al. Left ventricular dysfunction and NT‑proBNP levels in patients with one‑vessel disease after first ST‑elevation myocardial infarction treated with primary coronary angioplasty. Kardiol Pol 2009; 67: 1201–1206.

31. Dickstein K. Diagnosing acute heart failure: the mathematician and the clinician. J Am Coll Cardiol 2009; 54: 1522–1523.

32. Steinhart B, Thorpe KE, Bayoumi AM et al. Improving the diagnosis of acute heart failure using a validated prediction model. J Am Coll Cardiol 2009; 54: 1515–1521.

33. Moe GW, Howlett J, Januzzi JL et al. N‑terminal pro‑B‑type natriuretic peptide testing improves the management of patients with suspected acute heart failure. Circulation 2007; 115: 3103–3110.

34. Maisel AS, Peacock WF, McMullin N et al. Timing of immunoreactive B‑type natriuretic peptide levels and treatment delay in acute decompensated heart failure: an ADHERE analysis. J Am Coll Cardiol 2008; 52: 534–540.

35. Shinagawa H, Inomata T, Koitabashi T et al. Prognostic significance of increased serum bilirubin levels coincident with cardiac decompensation in chronic heart failure. Circ J 2008; 72: 364–369.

36. Gheorghiade M, Abraham WT, Albert NM et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE‑HF registry. Eur Heart J 2007; 28: 980–988.

37. Rusinaru D, Buiciuc O, Leborgne L et al. Relation of serum sodium level to long‑term outcome after a first hospitalization for heart failure with preserved ejection fraction. Am J Cardiol 2009; 103: 405–410.

38. Pang PS, Komajda M, Gheorghiade M. The current and future management of acute heart failure syndromes. Eur Heart J 2010; 31: 784–793.

39. Costanzo MR, Johannes RS, Pine M et al. The safety of intravenous diuretics alone versus diuretics plus parenteral vasoactive therapies in hospitalized patients with acutely decompensated heart failure: A propensity score and instrumental variable analysis using ADHERE database. Am Heart J 2007; 154: 267–277.

40. Mebazaa A, Nieminen MS, Filippatos GS et al. Levosimendan vs. dobutamine: outcomes for acute heart failure patients on ‑blockers in survive. Eur J Heart Fail 2009; 11: 304–311.

41. Zannad F, Huvelle E, Dickstein K et al. Left bundle branch block as a risk factor for progression to heart failure. Eur J Heart Fail 2007; 9: 7–14.

42. Huvelle E, Fay R, Alla F et al. Left bundle branch block and mortality in patients with acute heart failure syndrome: a substudy of the EFICA cohort. Eur J Heart Fail 2010; 12: 156–163.

43. Studenčan M, Baráková A, Hlava P et al. SLOVenský register Akútnych Koronárnych Syndrómov (SLOVAKS) – analýza údajov z roku 2007. Cardiol 2008; 17: 179–190.

44. Gheorghiade M, Zannad F, Sopko G el al. Acute heart failure syndromes: current state and framework for future research. Circulation 2005; 112: 3958–3968.

45. 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.