Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: The EPICAL study

OBJECTIVES Characterize the incidence, clinical and etiologic features and outcomes of advanced congestive heart failure. BACKGROUND This condition is frequent; severe and costly, yet no population -based epidemiological data are available that take into account modern adv ances in diagnosis and therapy. Published by EIsevier Science Inc. METHODS The EPICAL (EPidemiologie de l'Insuffisance Cardiaque Avancee en Lo rraine) study was based on a comprehensive registration of patients with AC HF (defined as hospital admission for presence of NYHA class III or IV symp toms, radiological and/or clinical signs of pulmonary congestion and/or sig ns of peripheral edema, left ventricular ejection fraction <30% or a cardio thoracic ratio >60%) in patients aged 20-80 years during year 1994, in the community of the Lorraine region in France (n = 1,592,263), Average follow- up for readmission to hospital and mortality was 18 months (12-24 months). RESULTS From 2,576 registered patients, 499 were enrolled into the study am ong which, 358 were new presentations. This represents a crude incidence ra te of 225 per million. 46.3% had a coronary heart disease. One-year mortali ty rate was 35.4% and the rate of mortality and/or readmission to hospital was 81%. Patients were admitted to hospital 2.05 times per year (64% of the se for worsening heart failure), spending 27.6 days per year in hospital. T wenty received a heart transplant (4%). On discharge, 74.8% were using ACE inhibitors and 49.6% digitalis. CONCLUSIONS Mortality and hospitalization rate of advanced CHF remain very high despite recent therapeutic progress. Major therapeutic and managed-car e research is required. (C) 1999 by the American College of Cardiology.