Impact of Clinical Characteristics and Management on the Prognosis of Unselected Heart Failure Patients
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.
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.
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].
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.
KeywordsHeart failure Epidemiology Management Therapeutics
We thank Mr. Pierre Pothier for the editing of this manuscript.
Conflict of Interest
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