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Cardiovascular Drugs and Therapy

, Volume 29, Issue 1, pp 89–98 | Cite as

Impact of Clinical Characteristics and Management on the Prognosis of Unselected Heart Failure Patients

  • Romain Eschalier
  • Chouki Chenaf
  • Aurélien Mulliez
  • Arab Yalioua
  • Guillaume Clerfond
  • Nicolas Authier
  • Charles Vorilhon
  • Bernard Citron
  • Bruno Pereira
  • Frédéric Jean
  • Géraud Souteyrand
  • Pascal Motreff
  • Alain Eschalier
  • Jean-René Lusson
ORIGINAL ARTICLE

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.

Keywords

Heart failure Epidemiology Management Therapeutics 

Notes

Acknowledgments

We thank Mr. Pierre Pothier for the editing of this manuscript.

Conflict of Interest

None

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Romain Eschalier
    • 1
    • 2
  • Chouki Chenaf
    • 3
  • Aurélien Mulliez
    • 4
  • Arab Yalioua
    • 2
  • Guillaume Clerfond
    • 1
    • 2
  • Nicolas Authier
    • 3
  • Charles Vorilhon
    • 1
    • 2
  • Bernard Citron
    • 2
  • Bruno Pereira
    • 4
  • Frédéric Jean
    • 2
  • Géraud Souteyrand
    • 1
    • 2
  • Pascal Motreff
    • 1
    • 2
  • Alain Eschalier
    • 3
  • Jean-René Lusson
    • 1
    • 2
  1. 1.Clermont Université, ISIT-CaVITIClermont-FerrandFrance
  2. 2.Cardiology DepartmentCHU Clermont-FerrandClermont-FerrandFrance
  3. 3.Pharmacology DepartmentCHU Clermont-FerrandClermont-FerrandFrance
  4. 4.Biostatistics Unit (Clinical Research and Innovation Direction)CHU Clermont-FerrandClermont-FerrandFrance

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