Fa. Mcalister et al., Insights into the contemporary epidemiology and outpatient management of congestive heart failure, AM HEART J, 138(1), 1999, pp. 87-94
Citations number
44
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objectives To evaluate the epidemiology, prognosis, and patterns of practic
e in patients with chronic congestive heart failure (CHF) treated and follo
wed at a specialized clinic.
Methods Prospective cohort study of consective patients referred to and fol
lowed up in a specialized heart failure clinic between September 1989 and M
arch 1996.
Results of the 628 patients referred, 566 were confirmed to have CHF. Mean
duration of follow-up was 518 +/- 490 days (range 1 to 2192 days). Vital st
atus was available for 99.3% of patients. Mean age at enrollment was 66 yea
rs, 68% were men, 67% had an ischemic cause of heart disease, and 78% had s
ystolic dysfunction. Patients with preserved systolic function were older,
more often female, had higher mean systolic blood pressures, and a lower pr
evalence of ischemic heart disease, ventricular arrhythmias, or impaired re
nal function when compared with those with systolic dysfunction (all P less
than or equal to .001). Although there was a significant negative trend in
survival with decreasing ejection fraction (P = .03), the survival experie
nce of those with CHF and preserved systolic function did not significantly
differ from those with systolic failure (P = .25). Multiple logistic regre
ssion analysis showed increased mortality risk was associated with increasi
ng age, New York Heart Association class IV, ischemic cause of disease, ele
vated serum creatinine level, use of diuretics, and systolic dysfunction, w
hereas use of P-blockers was associated with reduced risk.
Conclusions Our data suggest that a specialized outpatient clinic can impro
ve practice patterns in patients with CHF. The high mortality risk in CHF w
ith preserved systolic function suggests the need to find efficacious (and
effective) therapies for this condition.