Université d'Auvergne Clermont1 | CNRS

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Impact of clinical characteristics and management on the prognosis of unselected heart failure patients.

TitleImpact of clinical characteristics and management on the prognosis of unselected heart failure patients.
Publication TypeJournal Article
Year of Publication2015
AuthorsEschalier, R., C. Chenaf, A. Mulliez, A. Yalioua, G. Clerfond, N. Authier, C. Vorilhon, B. Citron, B. Pereira, F. Jean, G. Souteyrand, P. Motreff, A. Eschalier, and J. - R. Lusson
JournalCardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy
Volume29
Issue1
Pagination89-98
Date Published2015 Feb
ISSN1573-7241
Abstract

PURPOSE: Heart failure (HF) is a major public health issue. This study conducted a real-life analysis of the impact of clinical characteristics and medical management of HF on its prognosis.

METHODS: Analysis was based on the EGB ("Echantillon Généraliste des Bénéficiaires") database. A cohort comprising 1825 adult patients with a first admission for HF between 2009 and 2011 was created and followed until June 2013 (median 22.3 [7.7-34.5] months) for survival analysis.

RESULTS: Mean age was 77.3 ± 13.2 years (53 % ≥80 years). The overall incidence of HF admission was 117 [112-122] per 100,000 population with a marked increase in patients >80 years (1297 [1217-1348]). At discharge, only 8 % of patients received recommended combination of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), beta-blockers (BB) and mineralocorticoid receptor antagonists (MRA). Only prescription levels of BB and vitamin K antagonists, at discharge, increased during the study period. In-hospital mortality was 9 % and survival was 71.6 %[69.5-73.6] and 52.0 %[49.4-54.6] at 12 and 36 months, respectively. In multivariate analysis, female gender [HR:0.78 (0.67-0.91), p = 0.001], ACEi/ARB + BB + MRA [0.41 (0.28-0.60), p < 0.001] and ACEi/ARB + BB [0.47 (0.39-0.57) p < 0.001] treatments were associated with improved survival, conversely to age 70-79 [1.90 (1.20-3.00), p = 0.003] and ≥80 [3.50 (2.30-5.40), p < 0.001], cardiogenic shock [3.00 (2.10-4.40), p < 0.001], acute pulmonary edema [1.70 (1.10-2.50), p = 0.01], denutrition [1.80 (1.45-2.24), p < 0.001], dilated cardiomyopathy [1.20 (1.00-1.40), p = 0.02] and in-hospital acute renal failure [1.36 (1.05-1.78), p = 0.002].

CONCLUSIONS: These real-life HF data provide insight into prognostic factors and "real-world" pharmacological management in this unselected HF population, confirming the benefit of ACEi/ARB + BB ± MRAs on patient survival.

DOI10.1007/s10557-015-6572-y
Alternate JournalCardiovasc Drugs Ther