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A decade of developments in chronic heart failure treatment: a comparison of therapy and outcome in a secondary and tertiary hospital setting

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Abstract

Aims

To investigate determinants and temporal developments of treatment strategies, 5-year survival and heart transplantation rates between patients treated at secondary and tertiary hospitals.

Methods and results

Baseline characteristics, treatment and follow-up data from 2,023 patients with chronic systolic heart failure due to ischaemic or dilated cardiomyopathy enrolled between 1995 and 2005 (996 patients treated at a secondary hospital vs. 1,027 patients treated at a tertiary hospital) were prospectively compared. Patients treated at the secondary hospital setting were twice as likely to have ischaemic cardiomyopathy compared to the tertiary hospital setting as the underlying cause of heart failure (59.7% vs. 33.0%, respectively) and were almost a decade older (mean age 65.2 vs. 56.7 years, respectively). The use of guideline-recommended therapy increased in both centres over time. In direct temporal comparison, both guideline-adherent pharmacological therapy and device therapy were implemented earlier at the tertiary hospital. Survival rates were significantly lower among patients treated at the secondary hospital (log-rank test P < 0.0001). The combined endpoint of all-cause mortality and heart transplantation, however, was not significantly different after adjustment for differences in baseline characteristics (P = 0.44).

Conclusion

This study demonstrates the marked disparity between the patient cohorts with chronic systolic heart failure presenting at secondary and tertiary hospitals. Though patient characteristics—particularly age, aetiology of heart failure and the time of implementation of pharmacological and device treatment of heart failure—differed significantly, after adjustment for differences in baseline characteristics, no substantial difference in the combined endpoint of all-cause mortality and HTX was found during the 5-year follow-up period.

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Abbreviations

ACE-I:

Angiotensin-converting enzyme inhibitor

ARB:

Angiotensin receptor blocker

BBL:

Beta-blocker

CRT:

Cardiac resynchronization therapy defibrillator

DCM:

Dilated cardiomyopathy

EF:

Ejection fraction

HD:

Heidelberg, Germany

HF:

Heart failure

HTX:

Heart transplantation

ICD:

Implantable cardioverter-defibrillator

ICM:

Ischaemic cardiomyopathy

LBBB:

Left bundle branch block

LU:

Ludwigshafen, Germany

MI:

Myocardial infarction

NTproBNP:

N-terminal pro-peptide of brain natriuretic peptide

NYHA:

New York Heart Association

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Acknowledgments

J. F. was supported by the Rahel Goitein-Straus Research Programme of the Medical Faculty Heidelberg.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Jennifer Franke, Christian Zugck, Jan Sebastian Wolter, Lutz Frankenstein, Philipp Ehlermann, Manfred Nelles & Hugo A. Katus

  2. Institut für Herzinfarktforschung at the University of Heidelberg, Ludwigshafen, Germany

    Matthias Hochadel & Jochen Senges

  3. Department of Cardiology, Heart Center Ludwigshafen, Ludwigshafen, Germany

    Ralph Winkler & Ralf Zahn

Authors
  1. Jennifer Franke
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  2. Christian Zugck
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  3. Jan Sebastian Wolter
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  6. Philipp Ehlermann
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  11. Jochen Senges
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Correspondence to Jennifer Franke.

Additional information

Hugo A. Katus and Jochen Senges share senior authorship.

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Franke, J., Zugck, C., Wolter, J.S. et al. A decade of developments in chronic heart failure treatment: a comparison of therapy and outcome in a secondary and tertiary hospital setting. Clin Res Cardiol 101, 1–10 (2012). https://doi.org/10.1007/s00392-011-0348-6

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  • DOI: https://doi.org/10.1007/s00392-011-0348-6

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