Precipitating factors and decision-making processes of short-term worsening heart failure despite "Optimal" treatment (from the IN-CHF registry)

This study sought to prospectively assess which factors were related to sho rt-term worsening heart failure (HF) leading to or not to hospital admissio n, in long-term outpatients followed by cardiologists. The subsequent decis ion-making process was also analyzed. The study population consisted of 2,7 01 outpatients enrolled in the registry of the Italian Network on Congestiv e Heart Failure (IN-CHF) and followed by 133 cardiology centers (19% of all existing Italian cardiology centers). Clinical and follow-up data were col lected by local trained clinicians; 215 patients (80%) had short-term decom pensation (on average 2 months after the index outpatient Visit). Multivari ate analysis showed that previous hospitalization, long duration of symptom s, ischemic etiology, atrial fibrillation, higher functional class (New Yor k Heart Association classification III to IV), higher heart rate, and low s ystolic blood pressure were independently associated with HF destabilizatio n. Poor compliance (21%) and infection (12%) were the most frequent precipi tating factors, but a precipitating factor was not identified in 400% of th e patients. Poor compliance was more common in women, but no other clinical characteristics emerged as being related with a specific precipitating fac tor. Fifty-seven percent of the patients with a short-term recurrence of wo rsening HF required hospital admission; infusion treatment with inotropes a nd/or vasodilators was necessary in 19%. of them. Long-term therapy was cha nged in 48% of the patients. Thus, in ambulatory HF patients, short-term wo rsening HF can be predicted according to the clinical characteristics on an outpatient basis. Nearly 1/3 of precipitating factors can be prevented. Pa tient education and avoidance of inappropriate treatment may reduce the num ber of relapses. (C) 2001 by Excerpta Medica, Inc.