Internal and Emergency Medicine

, Volume 6, Issue 3, pp 235–239 | Cite as

In-hospital management of heart failure: in 10 years we have improved, but not enough

  • Sonia Ferretto
  • Chiara Dalla Valle
  • Sonia Cukon Buttignoni
  • Luca Brugnaro
  • Giovanni Maria Boffa
IM - Original

Abstract

It is well recognized that the majority of patients with heart failure (HF) are admitted to General Medicine Departments (GMDs), and that the recommendations of the international guidelines for the treatment of HF are often incorrectly applied in hospital practice. We evaluated the treatment of patients with HF discharged from a single hospital over a period of 10 years. The study population comprised two series of patients who were discharged from six GMDs of a single hospital with the diagnosis of HF in the first 2 months of 1998 and 2008. The patients were also divided in two groups on the basis of the type of HF, systolic or diastolic. In 10 years, the number of patients who were discharged with the diagnosis of HF increased, the median age rose from 79 to 82 years and diastolic has become the more common type of HF. The prevalence of comorbidities rose significantly. There was an increased use of ACE-inhibitors and betablockers, and a reduction of digoxin and nitrates. The mortality decreased from 16.7% in 1998 to 9.6% in 2008 (p < 0.02) and hospitalizations became shorter (p < 0.05) considering patients with systolic HF (EF ≤ 45%) the median age rose from 74 to 79 years old (p < 0.01). We recorded an increasing use of betablockers, a reduction in the prescription of digoxin. The percentage of Diastolic HF rose from 55.7% in 1998 to 65.0% in 2008 (p < 0.001). The median age of these patients changed from 79 to 82 years old (p < 0.05). In 10 years, the clinical characteristics and management of HF patients who are hospitalized have changed. Pharmacological treatment has improved, but it still remains far from being adequately compliant with guideline recommendations.

Keywords

Heart failure Medical therapy Guidelines Systolic Diastolic 

References

  1. 1.
    O’Connell JB (2000) The economic burden of heart failure. Clin Cardiol 23(Suppl 3):III6–10PubMedCrossRefGoogle Scholar
  2. 2.
    Steward S (2005) Financial aspects of heart failure programs of care. Eur J Heart Fail 7:423–428CrossRefGoogle Scholar
  3. 3.
    Murdoch DR, Love MP, Robb SD, McDonagh TA, Davie AP, Ford I, Capewell S, Morrison CE, McMurray JJ (1998) Importance of heart failure as cause of death. Changing contribution of overall mortality and coronary heart disease mortality in Scotland 1979–1992. Eur Heart 19:1829–1835CrossRefGoogle Scholar
  4. 4.
    Senni M, Tribouilloy CM, Rodeheffer RJ, Jacobsen SJ, Evans JM, Bailey KR, Redfield MM (1999) Congestive heart failure in the community: trends in incidence and survival in a 10-year period. Arch Intern Med 159:29–34PubMedCrossRefGoogle Scholar
  5. 5.
    MacIntyre K, Capewell S, Steward S, Chalmers JW, Boyd J, Finlayson A, Redpath A, Pell JP, McMurray JJ (2000) Evidence of improving prognosis in heart failure: trends in case fatality in 66 547 patients hospitalized between 1986 and 1995. Circulation 102:1126–1131PubMedGoogle Scholar
  6. 6.
    Blackledge HM, Tomlinson J, Squire IB (2003) Prognosis for patients newly admitted to hospital with heart failure: survival trends in 12,220 index admissions in Leicestershire 1993–2001. Heart 89:615–620PubMedCrossRefGoogle Scholar
  7. 7.
    Velagaleti RS, Pencina MJ et al (2008) Long-term trends in the incidence of Heart Failure after myocardial infarction. Circulation 118:2057–2062PubMedCrossRefGoogle Scholar
  8. 8.
    Ezekowitz JA, Kaul P, Bakal JA (2009) Declining In-Hospital mortality and increasing Heart Failure Incidence in elderly patients with first myocardial infarction. J Am Coll Cardiol 53:13–20PubMedCrossRefGoogle Scholar
  9. 9.
    Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC Guidelines for the diagnosis and treatment of Acute and Chronic Heart Failure 2008. Eur Heart J 29:2388–3244PubMedCrossRefGoogle Scholar
  10. 10.
    Cowie MR, Mosterd A, Wood DA et al (1997) The epidemiology of heart failure. Eur Heart J 18:208–225PubMedGoogle Scholar
  11. 11.
    Gottdiener JS, Arnold AM, Aurigemma GP et al (2000) Predictors of congestive heart failure in the elderly: the cardiovascular health study. J Am Coll Cardiol 35:1628–1637PubMedCrossRefGoogle Scholar
  12. 12.
    Pulignano G, Del Sindaco D, Gavazzi L et al (2002) Clinical features and outcomes of elderly outpatients with heart failure followed up in hospital cardiology units: data from a large nationwide cardiology database (IN-HF Registry). Am Heart J 143:45–55PubMedCrossRefGoogle Scholar
  13. 13.
    Brown AM, Cleland JGF (1998) Influence of concomitant disease on patterns of hospitalization in patients with heart failure discharged from Scottish hospitals in 1995. Eur Heart J 19:1063–1069PubMedCrossRefGoogle Scholar
  14. 14.
    Bellotti P, Badano LP, Acquarone N et al (2001) Specialty-related differences in the epidemiology, clinical profile, management and outcome of patients hospitalized for heart failure: the OSCUR study. Eur Heart J 22:596–604PubMedCrossRefGoogle Scholar
  15. 15.
    Di Lenarda A, Scherillo M, Maggioni AP et al (2003) Current presentation and management of heart failure in cardiology and internal medicine hospital units: a tale of two worlds—the TEMISTOCLE study. Am Heart J 146:e12PubMedCrossRefGoogle Scholar
  16. 16.
    ACC/AHA Task Force (2009) Focused update: ACCF/AHA guidelines for the diagnosis and management of Heart Failure in adults. Circulation 119:1977–2016CrossRefGoogle Scholar
  17. 17.
    Costantino G, Rusconi AM, Duca PG, Guzzetti S, Bossi I, Del Medico M, Pisano G, Bulgheroni M, Solbiati M, Furlan R, Montano N (2009) Eligibility criteria in heart failure randomized controlled trials: a gap between evidence and clinical practice. Intern Emerg Med 4(2):117–122PubMedCrossRefGoogle Scholar
  18. 18.
    Auerbach AD, HamelMB, Davis RB (2000) Resource use and survival of patients hospitalised with congestive heart failure: differences in care by specialty of attending physician. Ann Intern Med 132:191–200PubMedGoogle Scholar
  19. 19.
    Buttignoni SC, Crosato M, Boffa GM (2001) Il trattamento dello scompenso cardiaco in un’azienda ospedaliera del Nord-Est. Ann Ital Med Int 16:26–31PubMedGoogle Scholar
  20. 20.
    Masoudi FA, Havranek EP, Smith G et al (2003) Gender, age and heart failure with preserved left ventricular systolic function. J Am Coll Cardiol 41:217–223PubMedCrossRefGoogle Scholar
  21. 21.
    Owan TE, Hodge DO, Herges RM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251–259PubMedCrossRefGoogle Scholar
  22. 22.
    Hung MJ, Cherng WJ, Kuo LT, Wang CH (2002) Effect of verapamil in elderly patients with left ventricular diastolic dysfunction as a cause of congestive heart failure. Int J Clin Pract 56:57–62PubMedGoogle Scholar
  23. 23.
    Yancy CW, Lopatin M, MS, Stevenson LW et al., ADHERE Scientific Advisory Committee and Investigators (2006) Clinical presentation, management, and in-hospital outcome of patients admitted with acute decompensated Heart Failure with preserved systolic function. J Am Coll Cardiol 47:76–84Google Scholar
  24. 24.
    Shah SJ, Gheorghiade M (2008) Heart failure with preserved ejection fraction. Treat now by treating comorbidities. JAMA 300:431–432PubMedCrossRefGoogle Scholar
  25. 25.
    Packer M, O’Connor CM, Ghali JK, Prospective Randomized Amlodipine Survival Evaluation Study Group et al (1996) Effect of amlodipine on morbidity and mortality in severe chronic heart failure. N Engl J Med 335:1107–1114PubMedCrossRefGoogle Scholar
  26. 26.
    Udelson JE, DeAbate CA, Berk M et al (2000) Effects of amlodipine on exercise tolerance, quality of life, and left ventricular function in patients with heart failure from left ventricular systolic dysfunction. Am Heart J 139:503–510PubMedCrossRefGoogle Scholar
  27. 27.
    Maisel A (2006) The coming of age of natriuretic peptides: the emperor does have clothes. J Am Coll Cardiol 47:61–64PubMedCrossRefGoogle Scholar
  28. 28.
    Tang WH, Francis GS, Morrow DA, Newby LK, Cannon CP, Jesse RL et al (2007) National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: clinical utilization of cardiac biomarker testing in heart failure. Circulation 116:e99–e109PubMedCrossRefGoogle Scholar
  29. 29.
    Braunwald E (2008) Boimarkers in heart failure. N Engl J Med 358:2148–2159PubMedCrossRefGoogle Scholar
  30. 30.
    Donadini MP, Squizzato A, Dentali F, Ageno W (2009) Prognostic stratification of chronic heart failure in elderly population: are cardiopulmonary tests and BNP really valuable? Intern Emerg Med 4(4):353–354PubMedCrossRefGoogle Scholar
  31. 31.
    Scardovi AB, De Maria R, Celestini A, Coletta C, Aspromonte N, Perna S, Parolini M, Ricci R (2008) Prognostic value of brain natriuretic peptide and enhanced ventilatory response to exercise in patients with chronic heart failure. Intern Emerg Med 3(4):331–337PubMedCrossRefGoogle Scholar

Copyright information

© SIMI 2010

Authors and Affiliations

  • Sonia Ferretto
    • 1
  • Chiara Dalla Valle
    • 1
  • Sonia Cukon Buttignoni
    • 2
  • Luca Brugnaro
    • 1
  • Giovanni Maria Boffa
    • 1
  1. 1.Department of Cardiologic, Thoracic and Vascular Sciences, Director Prof. S. IlicetoUniversity of PaduaPaduaItaly
  2. 2.Division of CardiologyHospital of ConeglianoVenetoItaly

Personalised recommendations