IN-HF on line: patient settings (Enrollement period= )

Transcription

1 IN-HF on line: atient settings (Enrollement eriod= ) N of centers (total) 187 N of centers (ts. AHF only) 13 N of centers (ts. CHF only) 71 N of centers (both ts. AHF and CHF) 103 N of atients (total) N of atients (AHF) 3308 (/32599, 10.2%) N of atients (AHF worsening) 1708 (/3308, 51.6%) N of atients (AHF De-novo) 1600 (/3308, 48.4%) N of atients (CHF) (/32599, 89.8%) N of atients (CHF NYHA I class) 4953 (/29291, 16.9%) N of atients (CHF NYHA II class) (/29291, 60.4%) N of atients (CHF NYHA III class) 6279 (/29291, 21.4%) N of atients (CHF NYHA IV class) 363 (/29291, 1.3%) N

2 IN-HF on line: atient settings (Enrollement eriod= ) CHF N (89.8%) AHF N 3308 (10.2%) N of atients enrolled in N of atients enrolled in (18.9%) 7677 (26.2%) // 5541 // 7677 N of atients enrolled in (25.4%) 1923 (58.1%) 9363 N of atients enrolled in (11.0%) 157 (4.8%) 3376 N of atients enrolled in (18.5%) 1228 (37.1%) 6642

3 AHF and CHF: descrition of the baseline characteristics CHF ts (n ) AHF ts (n. 3308) Age (years), mean±sd 67±13 72±12 Females, % SBP (mmhg), mean±sd 128±21 133±31 HR (bm), mean±sd 74±15 92±26 Hyertension, % Diabetes mellitus, % History of Atrial Fibrillation, % Renal dysfunction, % 29.7 (on ts) 35.1 ICD, % CRT, % CRT-D, %

4 Acute HF: baseline characteristics (1) (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) Age 70 years, % Age (years), mean±sd 72±12 73±11 72± Females, % Ischemic etiology, % available for 3269 ts BMI 30 (kg/m 2 ), % available for 2330 ts BMI (kg/m 2 ), mean±sd available for 2330 ts 28±5 27±5 28±5 0.04

5 Acute HF: baseline characteristics (2) (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) SBP <110 mmhg, % available for 3288 ts <.0001 SBP (mmhg), mean±sd available for 3288 ts 133±31 129±30 139±31 <.0001 HR (bm), mean±sd available for 3263 ts 92±26 88±24 97±27 <.0001 EF (%) in the revious 6 months, available for 1164 ts <.0001 EF (%) in the revious 6 months, mean±sd available for 1164 ts 38±13 36±13 44±12 <.0001

6 Acute HF: clinical history (n. 3308) Worsening HF (n. 1708) HF diagnosis > 48 months% available for 1697 ts 49.7 Hositalization for HF last year% 43.7 De Novo (n. 1600) Hyertension, % Diabetes, % History of Atrial Fibrillation, % <.0001 Previous stroke, % PAD, % <.0001 Renal dysfunction, % <.0001 COPD, % <.0001 ICD, % <.0001 CRT, % CRT-D, % <.0001

7 Acute HF: clinical signs at entry (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) Pulmonary congestion, % Periheral congestion, % <.0001 Pulmonary or eriheral congestion, % Periheral hyoerfusion, % Cold, % Somnolent, confused, sedated, %

8 Acute HF: IV treatment during hositalization (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) Furosemide (IV or oral), % IV Furosemide, % IV Furosemide, median [IQR] daily max dosage available for 3075 ts 80 [40-240] 100 [50-250] 80 [40-125] <.0001 Oral Furosemide, % Oral Furosemide, median [IQR] daily max dosage available for 2505 ts 75 [50-125] 100 [50-125] 50 [50-100] <.0001 IV diuretics, % Other IV diuretics, % IV nitrates, % Inotroes, % Doamine, % Dobutamine, % Levosimendan, % <.0001 <.0001 <

9 Acute HF: laboratory examinations at entry (1) Hemoglobin <12g/dL, % available for 3198 ts Creatinine >1.5mg/dL, % available for 3159 ts egfr <60 ml/min/1.73m 2, % available for 3092 ts egfr <30 ml/min/1.73m 2, % available for 3092 ts Glycemia >126mg/dL, % available for 2752 ts (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) < < < <

10 Acute HF: laboratory examinations at entry (2) Sodium <136mEq/L, % available for 2968 ts (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) <.0001 BUN>50mg/dL,% available for 2100 ts <.0001 NT-ro BNP, g/ml, median [IQR] (available for 779 ts) BNP, g/ml, median [IQR] (available for 546 ts) hs-crp, mg/l, median [IQR] (available for 589 ts) 5176 [ ] 1021 [ ] 5.7 [ ] 5809 [ ] 1092 [ ] 5.6 [ ] 4548 [ ] 912 [ ] 5.9 [ ]

11 Acute HF: drug treatment rior hositalization (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) ACE-i/ARBs, % <.0001 Betablockers, % <.0001 Digitalis, % <.0001 Diuretics, % <.0001 Aldosterone blockers, % <.0001 Ivabradine*, % * 1225 ts enrolled from march 1st, 2017 (worsening HF: 542; de novo HF: 683)

12 Acute HF: drug treatment (os) during hositalization (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) ACE-i/ARBs, % Betablockers, % Digitalis, % <.0001 Diuretics, % Aldosterone blockers, % Ivabradine*, % * 1225 ts enrolled from march 1st, 2017 (worsening HF: 542; de novo HF: 683)

13 Acute HF: drug treatment at discharge (only survivors) (n. 3138) Worsening HF (n. 1613) De Novo (n. 1525) ACE-i/ARBs, % <.0001 Betablockers, % Digitalis, % <.0001 Diuretics, % Aldosterone blockers, % Ivabradine*, % * 1185 ts enrolled from march 1st, 2017 (worsening HF: 518; de novo HF: 667)

14 Acute HF: discharge status Death % Alive % Lenght of Stay (days) Median [IQR] (n. 3308) [7-15] Worsening HF (n. 1708) [7-16] De Novo (n. 1600) [7-14] ICU admission, % <.0001 ICU Lenght of Stay (days) Median [IQR] available for 1631 ts 4 [2-6] 4 [2-7] 4 [2-6] 0.15

15 Chronic HF: baseline characteristic (1) (n ) NYHA I-II (n , 77.3%) NYHA III-IV (n. 6642, 22.7%) Age 70 years, % available for ts <.0001 Age (years), mean±sd available for ts 67±13 67±13 70±12 <.0001 Females, % <.0001 Ischemic etiology, % available for ts <.0001 BMI 30 (kg/m 2 ), % available for ts BMI (kg/m 2 ), mean±sd available for ts 27±5 27±5 27±

16 Chronic HF: baseline characteristic (2) (n ) NYHA I-II (n , 77.3%) NYHA III-IV (n. 6642, 22.7%) SBP >140 mmhg, % available for ts <.0001 SBP (mmhg), mean±sd available for ts 128±21 129±20 124±22 <.0001 HR (bm), mean±sd available for ts 74±15 72±14 78±16 <.0001 Third heart sound, % <.0001 Periheral congestion, % <.0001 Rales, % <.0001

17 Chronic HF: clinical history (n ) NYHA I-II (n ) NYHA III-IV (n. 6642) HF duration >48 months, % available for ts <.0001 Hosital admission for HF in revious year, % <.0001 Hyertension, % <.0001 Diabetes mellitus, % <.0001 History of Atrial Fibrillation, % <.0001 Previous stroke, % <.0001 PAD, % available for ts <.0001 Renal dysfunction, % available for ts <.0001 COPD, % available for ts <.0001 ICD, % <.0001 CRT, % CRT-D, %

18 Chronic HF: harmacological treatment (n ) NYHA I-II (n ) NYHA III-IV (n. 6642) ACE-i, % <.0001 ARBs, % ACE-i/ARBs, % <.0001 Betablockers, % <.0001 Digitalis, % <.0001 Diuretics, % <.0001 Aldosterone blockers, % <.0001 Nitrates, % <.0001 Asirin, % <.0001 Oral anticoagulants, % <.0001 Statins, % <.0001

19 Chronic HF: harmacological treatment Ivabradine Patients enrolled from 01January 2011 (n. 8633) NYHA I-II (n. 6903) NYHA III-IV (n. 1730) Ivabradine

20 Chronic HF: Combinations of recommended treatments Betablockers + ACE-i/ARBs + Aldosterone blockers, % Betablockers + ACE-i + ARBs, % At least 2 neurohormonal blockers, % (n ) NYHA I-II (n ) NYHA III-IV (n. 6642) <.0001

21 Chronic HF: ECG (*) Findings (available for ts, 96.0%) (n ) NYHA I-II (n ) NYHA III-IV (n. 6332) Atrial Fibrillation/Flutter, % available for ts <.0001 LBBB, % QRS 120 msec, % available for ts <.0001 QRS duration, median [IQR] available for ts 110 [90-130] (*) within 60 days from enrollement visit 107 [90-130] 118 [90-140] <.0001

22 Chronic HF: ECHO (*) Findings (available for ts, 70.0%) (n ) NYHA I-II (n ) NYHA III-IV (n. 4855) EF (%) <30, % 30-40, % >40, % available for ts EF (%), median [IQR] available for ts [29-45] [30-45] [25-41] <.0001 <.0001 Severe mitral regurgitation, % available for ts <.0001 (*) within 60 days from enrollement visit

23 Chronic HF: Chest X-ray (*) Findings (available for 2319 ts, 7.9%) (n. 2319) NYHA I-II (n. 1506) NYHA III-IV (n. 813) Cardiomegaly, % available for 598 ts <.0001 Pulmonary venous congestion, % <.0001 Interstitial edema, % <.0001 Alveolar edema, % Pleural effusion, % <.0001 (*) within 60 days from enrollement visit

24 Chronic HF: laboratory examinations (*) (n ) NYHA I-II (n ) NYHA III-IV (n. 6642) Hemoglobin <12g/dL, % available for ts <.0001 Creatinine >1.5mg/dL, % available for ts egfr <60 ml/min/1.73m 2, % available for ts egfr <30 ml/min/1.73m 2, % available for ts < < <.0001 Glycemia >126mg/dL, % available for 7650 ts Sodium <136mEq/L, % available for ts <.0001 BUN >50mg/dL, % available for 8649 ts <.0001 Uricemia >6.9 mg/dl, % available for 5336 ts <.0001 (*) within 60 days from enrollement visit