01.12.2014 | Original Paper | Ausgabe 12/2014
Characteristics, management modalities and outcome in chronic systolic heart failure patients treated in tertiary care centers: results from the EVIdence based TreAtment in Heart Failure (EVITA-HF) registry
Clinical Research in Cardiology
- W. von Scheidt, C. Zugck, M. Pauschinger, R. Hambrecht, O. Bruder, A. Hartmann, M. Rauchhaus, R. Zahn, J. Brachmann, U. Tebbe, T. Neumann, R. H. Strasser, M. Böhm, S. Störk, M. Hochadel, P. Heidemann, J. Senges
Limited data exist regarding baseline characteristics and management of heart failure with reduced ejection fraction (EF) in tertiary care facilities.
EVITA-HF comprises web-based case report data on demography, comorbidities, diagnostic and therapy measures, quality of life, adverse events and 1-year follow-up of patients hospitalized for chronic heart failure and an ejection fraction of less than 40 %.
Between February 2009 and June 2011, a total of 1,853 consecutive, hospitalized patients (pts) were included in 16 centers in Germany. Mean age was 70 years, 76 % were male. Median EF was 30 %, and 63 % were in NYHA III/IV. Ischemic cardiomyopathy was present in 56 %, history of hypertension in 76 %, diabetes in 39 %, impaired renal function in 33 %, thyroid dysfunction in 12 %, and malignoma in 7 %. Sixty-eight percent of pts had a non-elective admission. Rhythm was sinus/atrial fibrillation or flutter/pacemaker in 64, 28 and 11 %, respectively. Median heart rate amounted to 80 bpm, median blood pressure to 122/74 mmHg. LBBB was present in 26 % of non-pacemaker pts. Eighteen percent had an ICD or CRT-D. Medication (admission vs. discharge) consisted of ACEI or ARB in 73 vs. 88 %, β-blocker in 71 vs. 89 %, mineral corticosteroid receptor antagonist (MRA) in 32 vs. 57 %, diuretics in 68 vs. 83 % (p < 0.001 for each). Forty-two percent of pts received a specific treatment procedure beyond pharmacotherapy, of these 48 % revascularization, 39 % device therapy, 14 % electrical cardioversion, 5 % ablation procedures, 9 % valvular procedures, 6 % iv inotropes, 1.8 % IABP or LVAD implantation. At discharge, 33 % of survivors had ICD- or CRT-D implants. One-year mortality amounted to 16.8 %, and death or rehospitalization to 56 %. NYHA class III/IV was found in 30 % (p < 0.001 vs. index admission), general health status was improved in 45 % and unchanged in 36 % of patients. Eighty-five percent of pts took ACEI or ARB, 86 % β-blockers, 47 % MRA, and 78 % diuretics (p < 0.001 vs. index discharge for all).
Patients with chronic heart failure and low ejection fraction represent an elderly and multimorbid population. While hospitalized, they experience a significant optimization of prognosis-relevant medication, revascularization and device therapy. After 1 year, mortality is moderate; drug adherence is high and NYHA status favourable. The EVITA-HF registry is able to reflect coherently the real-world management, efforts and follow-up in heart failure pts managed in tertiary care facilities.