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Real life heart failure population: somewhat different from the reports?
Session:
Painel 2 - Insuficiência Cardíaca 8
Speaker:
Laura Moreira
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Laura Moreira; Sara Trevas; Diogo Faustino; Pedro Custódio; Ana Rita Barradas; Gonçalo Lopes Da Cunha; Tiago Pacheco; Marta Roldão; Bruno M. Rocha; Luis Campos; Célia Henriques; Inês Araújo; Cândida Fonseca
Abstract
<p>Heart Failure (HF) is a prevalent syndrome with multisystemic interactions that yield high morbimortality. Its holistic, systematic and integrated approach by a muldisciplinary team plays a key role in optimizing the associated prognosis. Most series address HF with reduced ejection fraction (HFrEF) patients, more frequent in Cardiology departments. Perception tells us that real life is far different from these data.</p> <p>The authors conducted a retrospective analysis of patients admitted in an Acute Heart Failure (AHF) Unit that treats all patients regardless of their ejection fraction (EF), over 3 years. A demographic analysis was conducted, with HF characterization according to EF, etiology, decompensating factors, hemodynamic profile and previous New York Heart Association (NYHA) class.</p> <p>There were 354 patients consecutively admitted with AHF, medium age: 76,3 ±11.4 (20.7-97.1) y, 54,6% male. 48.6% were HFpEF, 10.3% HF with intermediate (HFmEF) and 40.6% HFrEF. There were 20 in-hospital deaths (5.6% of in-hospital mortality), 50% male. Only 5 deaths occurred in HF with preserved ejection fraction (HFpEF) patients, although there was no statistically significant association with HFpEF or HFrEF and in hospital death (Pearson chi-square=1.832, p=.176). In the 334 survivor patients, there were 118 readmissions with average time to first readmission of 251.9±261.9 (5-1112) days, 49.5% were HFpEF, 9.9% were HFmEF and 39.6% were HFrEF (0.9% of missing data). No association was found between HFpEF and readmission (Person chi-square 2.871, p =0.09). The most frequent etiology was ischemia, in 31.8%, followed by hypertension and valvular disease (22.2 and 7.5%, respectively). Most admissions occurred in context of therapeutic insufficiency or non-compliance, in about one third of cases, and the following most frequent causes were infection (25.2%) and tachydysritmias (23.1%). Assessing NYHA class before admission, 56.5% were class II, 16.2% class I and 13.8% class III. The most observed clinical profile at admission was the B-profile (89.2%), followed by C (7.2%) and L (1.5%). After discharge, there were 117 deaths, with medium time-to-death 327.7±275.8 (4-1243) days, corresponding to a mortality rate of 33%, and. In the first 120 days, there was a statistically significant association with C-profile (Fisher test, p=.014).</p> <p>This non-selected AHF population confirms the perception, as well as the epidemiological data, that, in real life, HFpEF is more prevalent than HFrEF. In-hospital mortality and length of stay are in line with scientific literature. Long-term mortality is still high despite admission in an AHF Unit and systematic enrolement in a HF management programme with a multidisciplinary approach.</p>
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