Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry

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Abstract

To evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice.

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EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population.

Markku Nieminen, Dirk Brutsaert, Kenneth Dickstein … (2006)

The objective of the EuroHeart Failure Survey II (EHFS II) was to assess patient characteristics, aetiology, treatment, and outcome of acute heart failure (AHF) in Europe in relation to the guidelines on the diagnosis and treatment of AHF published by the European Society of Cardiology. Patients hospitalized for AHF were recruited by 133 centres in 30 European countries. Three thousand five hundred and eighty patients were entered into the database by the end of August 2005. Mean age was 70 years, and 61% of patients were male. New-onset AHF (de novo AHF) was diagnosed in 37%, of which 42% was due to acute coronary syndromes (ACS). Clinical classification according to the guidelines divided AHF patients into (i) decompensated HF (65%), (ii) pulmonary oedema (16%), (iii) HF and hypertension (11%), (iv) cardiogenic shock (4%), and (v) right HF (3%). Coronary heart disease, hypertension, and atrial fibrillation were the most common underlying conditions. Arrhythmias, valvular dysfunction, and ACS were each present as precipitating factor in one-third of cases. Preserved left ventricular ejection fraction (> or =45%) was observed in 34%. Valvular disorders were common, especially mitral regurgitation (MR) which was reported on echocardiography in 80% of patients. Median length of stay was 9 days, and in-hospital mortality 6.7%. At discharge, 80% of patients were on angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers, whereas 61% were taking beta-blocker medication. Decompensated HF is the most common clinical presentation of AHF patients. More than one-third of AHF patients do not have a previous history of HF, and new-onset HF is often caused by ACS. Preserved systolic function is found in a substantial proportion of the patients. The prevalence of valvular dysfunction is strikingly high and contributes to the clinical presentation. The EHFS II on AHF verified that the use of evidence-based HF medication was well adopted to clinical practice.

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ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).

Kenneth Dickstein, Alain Cohen-Solal, Gerasimos Filippatos … (2008)

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HFSA 2010 Comprehensive Heart Failure Practice Guideline.

Heart Failure Society of America (2010)

Heart failure (HF) is a syndrome characterized by high mortality, frequent hospitalization, reduced quality of life, and a complex therapeutic regimen. Knowledge about HF is accumulating so rapidly that individual clinicians may be unable to readily and adequately synthesize new information into effective strategies of care for patients with this syndrome. Trial data, though valuable, often do not give direction for individual patient management. These characteristics make HF an ideal candidate for practice guidelines. The 2010 Heart Failure Society of America comprehensive practice guideline addresses the full range of evaluation, care, and management of patients with HF. Copyright 2010. Published by Elsevier Inc.

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Author and article information

Journal

Title: European Journal of Heart Failure

Abbreviated Title: European Journal of Heart Failure

Publisher: Oxford University Press (OUP)

ISSN: 13889842

Publication date Created: October 2013

Publication date (Print): October 2013

Publication date (Electronic): January 27 2014

Volume: 15

Issue: 10

Pages: 1173-1184

Affiliations

[1 ]ANMCO Research Center; Florence Italy

[2 ]Applied Cachexia Research, Department of Cardiology; Charité Medical School, Campus Virchow-Klinikum; Berlin Germany

[3 ]Department of Cardiology; Linkoping University Hospital; Linkoping Sweden

[4 ]Athens University Hospital Attikon; Athens Greece

[5 ]Department of Cardiology; Military Hospital; Wroclaw Poland

[6 ]Inserm, Centre d'Investigation Cliniques CIC 9501 and U961, CHU and Department of Cardiology; Nancy University; Nancy France

[7 ]Lady Davis Carmel Medical Centre; Israel

[8 ]Cardiology 1, Institut de Boli Cardiovasculare C.C. Iliescu; Bucuresti Romania

[9 ]Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Universitario A Coruña; La Coruña Spain

[10 ]Department of Cardiology; Medical University of Lodz; Lodz Poland

[11 ]Pauls Stradins Clinical University Hospital; Riga Latvia

[12 ]Clinical Hospital Mostar; Mostar Bosnia Herzegovina

[13 ]S. Francisco Xavier Hospital, New University of Lisbon; Lisbon Portugal

[14 ]Department of Cardiology; Medical University; Graz Austria

[15 ]University Hospital Lozenets; Sofia Bulgaria

[16 ]National Institute of Cardiovasc Diseases-NUSCH, Bratislava; Slovak Republic

[17 ]Alexandria University; Alexandria Egypt

[18 ]3rd Dept of Medicine, Faculty General Hospital; Charles University; Prague Czech Republic

[19 ]Department of Cardiology; Lithuanian University of Health Sciences; Kaunas Lithuania

[20 ]Division of Cardiology; University Clinic of Respiratory and Allergic Diseases Golnik; Golnik Slovenia

[21 ]Department of Cardiology, INSERM UMR 942; Lariboisière Hospital; Paris France

[22 ]Semmelweis University, Heart Center; Budapest Hungary

[23 ]Cattedra di Cardiologia, Dipartimento di medicina sperimentale ed applicata, Spedali Civili; Università di Brescia; Brescia Italy

[24 ]Department of Cardiology; Danderyd University Hospital; Stockholm Sweden

[25 ]Department of Cardiology; Clinical Centre of Serbia; Belgrade Serbia

[26 ]Turkey Yüksek Ihtisas Hospital, Cardiology Clinic; Ankara Turkey

[27 ]1st Cardiology Department; Athens University Medical School; Athens Greece

[28 ]Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation; Cotignola Italy

Article

DOI: 10.1093/eurjhf/hft134

PubMed ID: 23978433

SO-VID: b79891d5-5842-4adf-b296-fe88adf2c716

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http://doi.wiley.com/10.1002/tdm_license_1.1

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Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry

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Most cited references 28

EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population.

HFSA 2010 Comprehensive Heart Failure Practice Guideline.

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