Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Registry data with long term follow up of hospitalized patients with chronic heart failure
A. Begemann1, A. Schlichting1, A. Ujeyl2, J. Müller-Ehmsen3, N. Geßler1, P. Wohlmuth4, B. Markuse4, S. Willems1, M. W. Bergmann5
1Kardiologie, Asklepios Klinik St. Georg, Hamburg; 2Kardiologie, LANS Cardio Hamburg, Hamburg; 3am Klinikum Links der Weser, Kardiologisch-Angiologische Praxis, Bremen; 4Proresearch, AK St. Georg, Hamburg; 53. Med. Abteilung - Kardiologie, Pneumologie und Internistische Intensivmedizin, Asklepios Klinik Altona, Hamburg;

Background. The Prevalence of heart failure is about 1-2 % in the adult population and rises to ≥ 10 % among elderly patients (>70 years of age). We evaluated the effect of and adherence to guideline recommended therapy among a real world hospitalized patient population with underlying chronic heart failure in a prospective fashion with long term transtelephonic follow-up.

Methods. From March 2011 to August 2016 we enrolled 1342 hospitalized patients with underlying chronic heart failure in a prospective clinical registry in three expert centers in Hamburg. Guideline recommended therapy was established or optimized in all patients at baseline. All patients were treated according to current ESC-Guidelines at baseline. Patients were then followed by transtelephonic questionnaires at 1, 3, 6, 12 and 24 months.

Results. 1342 Patients (34% female) were included in the registry with a mean age of 72 ± 11 years.  Coronary artery disease was present in 65%, hypertension in 74%, and valvular disease in 51% of patients. 39% of patients had Diabetes mellitus.

The mean left ventricular ejection fraction (LVEF) was 34 ± 13% at baseline. 2% of patients presented with New York Heart Association (NYHA) class I, 16% with NYHA class II, 51% with NYHA class III and 31% with NYHA Class IV. 21% of patients had an implantable cardioverter defibrillator (ICD), 13% a pacemaker and 9% a cardiac resynchronization therapy (CRT) device at baseline. In 88% of patients worsening of heart failure was the reason for hospital admission, whereas in 12% it was due to myocardial infarction and in 3% due to arrhythmia. At baseline 82% of patients took ACE-inhibitors as recommended. This rate decreased to 69% after 2 years of follow-up.

An overall survival of 69.2% was seen after 2 years. Whereas 18.6% of deaths were due to cardiac disease, 21.3% were non-cardiac and 60.1% were of unknown cause. Sudden death occurred in 54.7%.

There was no significant difference in survival regarding an underlying coronary artery disease or gender.

The impact of LVEF and NYHA class status on survival was minimal and only significant with an increased risk of death in patients with NYHA class IV. There was also no significant correlation between rehospitalization rate and LVEF or NYHA functional class.

There was a significant survival benefit for patients taking ACE inhibitors as compared to those not taking ACE inhibitors (72,5% vs. 53,9%, p <0.001).

Conclusions. The current registry did not demonstrate a prognostic impact of LVEF in the range of NYHA functional class I-III. Only severely compromised patients with NYHA class IV had a significant lower survival rate. Non-compliance to medical therapy was associated with a significant worsening of survival compared to patients adherend to ACE inhibitor therapy. Our findings demonstrate that adherence to guideline recommendations is crucial for our heart failure patients.


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