HOSPITALIZED CONGESTIVE-HEART-FAILURE PATIENTS WITH PRESERVED VERSUS ABNORMAL LEFT-VENTRICULAR SYSTOLIC FUNCTION - CLINICAL CHARACTERISTICSAND DRUG-THERAPY

PURPOSE: TO compare clinical characteristics of and pharmacologic ther apy for hospitalized patients with congestive heart failure (CHF) and left ventricular systolic dysfunction or normal left ventricular systo lic function. PATIENTS AND METHODS: Medical records were reviewed for all patients discharged with a principal diagnosis of CHF from a unive rsity hospital and a community hospital between September 1, 1991 and August 31, 1992. Pertinent medical history items and prescribed drug t herapies at discharge were recorded for each patient's first calendar year admission. Patients were categorized as having either normal left ventricular systolic function or systolic dysfunction based on the re sults of echocardiography and radionuclide angiography or contrast ven triculogram. RESULTS: Of 298 patients with CHF, 92 (31%) had normal le ft ventricular systolic function. Patients with normal systolic functi on were older, were more often women, were less likely to have a histo ry of coronary artery disease, and were more likely to have a history of hypothyroidism than patients with systolic dysfunction. However, th e prevalence of clinical characteristics overlapped considerably betwe en the two groups. Among patients with systolic dysfunction, 79% were discharged on a therapeutic regimen of digoxin, 65% on an angiotensin- converting enzyme inhibitor, and 26% on either a beta-blocker or a cal cium channel blocker. Among patients with normal systolic function, 50 % were discharged on a regimen of a beta-blocker or a calcium channel blocker and 38% were discharged on digoxin. Twenty-six percent of pati ents with normal systolic function and without a history of atrial fib rillation were discharged on a digoxin regimen. CONCLUSION: Hospitaliz ed CHF patients with normal left ventricular systolic function and tho se with diminished left ventricular systolic function share many clini cal features. Since recommended drug therapy and prognosis differ, our data underscore the importance of diagnostic testing to assess left v entricular systolic function. Drug therapy for CHF patients provides a major challenge for quality-of-care improvement.