Heart failure hospitalizations with preserved or reduced ejection fraction

Transcription

1 Clinical profile and in-hospital outcomes in patients admitted for heart failure with preserved or reduced ejection fraction. EPI-CARDIO prospective registry Tajer, C; Mariani, J; de Abreu, M; Charask, A; Gonzalez, M; Gagliardi, J; Doval, H. GEDIC-GESICA, Argentina

2 BACKGROUND Heart failure is a growing cause of hospitalizations around the world, and it has been shown that a relevant proportion is not related to left ventricular systolic disfunction. Evolution and treatment strategies of HF without LVSD is heterogeneous. We have no extensive data about this particular presentation of acute heart failure in Latin-America.

3 Objectives: To assess clinical profile and inhospital evolution in patients admitted for heart failure (HF) with preserved or reduced ejection fraction in a wide network (37 CCU). To evaluate strategies of treatment applied.

4 Electronic discharge record form (Epicrisis) Included as discharge report of the clinical record form of each institution.

5 Network operation Coordinating center Processing Scientific Committee Send Individual and global reports EPICARDIO Centers DATA BASE Backup Attending Physician Clinical record Patient

6 Distribution of EPI-CARDIO 37 (42) Centers in Argentina Oct Dec hospitalizations Monthly > 1.000

7 Causes of admission to CCU oct-06 /may-08 Other 21% Angina 15% Non C Diag 4% PM. ICD 4% Syncope 3% CVSurg 6% Arrhythmias 14% Heart Failure 7% M. Infarction 9% NC CH.Pain 6% Hem Lab Proc. 11% n: 19190

8 Heart failure with or without LVSD Heart Failure: 1263p 1160p with complete data (HF form) LVSD non LVSD Definitions Group A: depressed LVEF: 788 (67.9%) LVEF 40% Moderate or severe depression of LVEF (angiography qualitative estimation) Group B: preserved LVEF: 372 p (32.1%) n:; 372; 32% n:; 788; 68% n: 1160p

9 Heart failure with or without LVSD N:19190 Heart Failure: 1160p with complete data (HF form) N: Update p with complete data (HF form) LVSD non LVSD LVSD non LVSD n:; 372; 32% n:; 979; 42% n:; 1370; 58% n:; 788; 68% n: 1160p n: 2349p

10 Triggers of HF 100% + Infection 75% + + Arrhythmia Progression Salt excess 50% + Discontinuation of treatment Medication change 25% Others Without data 0% DHF SHF p < 0.001

11 Clinical presentation 100% p < 0.01 Shock HT acute pulmonary edema Progression HF Others % 0% Shock HT acute pulmonary edema DHF SHF Progression HF Others 3 3.3

12 Heart failure: congestion and/or hypoperfusion DHF SHF 100% 75% 50% 25% LV + RV PC + LCO Low Cardiac output RV failure Pulmonary congestion Without data % % % DHF SHF p < 0.001

13 Clinical characteristics and history Reduced ejection fraction n: 788p Preserved ejection fraction n: 372p p value Age 69.6 ± ± Systolic BP 129 ± ± % % Female Hypertension Atrial fibrillation Previous MI , Previous CABG Chronic HF

14 Inhospital treatment Reduced LVEF n: 788p % Preserved LVEF n: 372p % p value Diuretics infusion NS Ultrafiltration NS Swan Ganz Catheter Non invasive ventilation Mechanical ventilation NS Inotropics Inhospital Stay 3.5( ) 3.5 ( ) NS

15 HF treatment at discharge Reduced LVEF n: 788p % Preserved LVEF n: 372p % p value Calcium Blockers Spironolactone ACE inhibitors NS ACE inh or ARB NS Digoxin NS Beta Blockers NS Fursemide NS

16 Antithrombotic and digoxin treatment at discharge Interaction with Atrial Fibrillation Reduced LVEF Preserved LVEF p value n: 788p % n: 372p % Aspirin Clopidogrel NS Oral Anticoagulation NS Atrial Fibrillation Oral Anticoagulation NS Digoxin NS Sinus Rhythm Oral Anticoagulation Digoxin

17 Inhospital mortality % DHF SHF Global Unadjusted Adjusted DHF/SHF OR 0.4 ( )

18 1160p /19190p Inhospital mortality Update 2349p /38680p % *** Unadjusted 5.5 DHF SHF Global % *** Unadjusted 6.3 DHF SHF Global Unadjusted OR 0.43 ( ) Unadjusted OR 0.48 ( ) Adjusted DHF/SHF OR 0.4 ( ) *** p < 0,001

19 Conclusions Heart failure without reduced ejection fraction, commonly considered as diastolic heart failure, accounts for almost one third to 40% of HF admissions in a network of CCU in Argentina. Patients with DHF are older, more often females, with more history of hypertension, atrial fibrillation and less history of coronary heart disease. Shock and global heart failure were more common in SHF p and isolated pulmonary congestion, particularly acute pulmonary edema was more common in DHF.

20 Conclusions Critical care stay length was similar in both groups, as was clinical treatment at discharge. Hospital mortality in the univariate and multivariate analysis was lower in DHF patients. Heart failure without reduced ejection fraction is a significant part of the burden of hospitalizations for HF in Argentina. Epi/Cardio Registry is a valuable tool to explore the trend in hospitalizations and clinical evolution in a network of CCU.

21 Use of inotropics IV inotropics 21,6% Other comb 12% Dopamine- Dobutamine 27% Dopamine 24% Milrinone 0% Levosimendan 2% Dobutamine 35%