[Clinical characteristics, treatment and short-term morbidity and mortality of patients with heart failure followed in heart failure clinics. Results of the BADAPIC Registry].

Sección de Insuficiencia Cardíaca, Trasplante y Otras Alternativas Terapéuticas, Sociedad Española de Cardiología, Madrid, Spain.
Revista Espa de Cardiologia (Impact Factor: 3.79). 01/2005; 57(12):1159-69. DOI: 10.1016/S1885-5857(06)60208-9
Source: PubMed


Despite recent improvements in therapy, heart failure is still associated with high mortality and hospitalization rates. New management strategies such as heart failure clinics could help to improve this situation.
We analyzed the clinical features, treatment, morbidity and mortality of 3909 patients with heart failure followed at 62 heart failure clinics in Spain in the last 3 years (BADAPIC Registry). Mean follow-up time was 13 +/- 4 months.
Mean age was 66 +/- 12 years (40% of the patients were older than 70 years), and 67% were male. Etiology was ischemic heart disease in 41% of the cases, systemic hypertension in 19%, idiopathic dilated cardiomyopathy in 17%, valvular disease in 17% and other in the remaining 6%. Left ventricular ejection fraction was < 45% in 68% of the patients. After inclusion in the BADAPIC Registry, 86% of the patients received diuretics, 37% received digoxin, 87% were given angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, 32% received spironolactone, 59% received beta blockers and 28% were given nitrates. Actuarial survival at 24 months was 87%, admission-free survival was 80% and event-free survival was 76%. Survival was similar in men and women, higher in patients younger than 70 years (P<.05), and slightly higher in those with left ventricular ejection fraction > 45% (P=.08).
The treatment received by patients included in the BADAPIC Registry closely approached the recommended standards. Their short-term survival rate was very high.

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    ABSTRACT: INTRODUCTION AND OBJECTIVE: The appropriate use of pharmacological treatment according to the indications in Clinical Guidelines reduces morbidity and mortality in patients with chronic heart failure (CHF). There are numerous studies regarding this in the hospital environment, but there are few studies done in Primary Care. The objective of this study is to evaluate the degree of compliance by Primary Care doctors to the Clinical Guidelines of the European Society of Cardiology in patients with CHF. METHODS: A descriptive, observational study on the use of indication-prescription drugs was conducted. Population and sample: Primary Care teams of the Leon Health Area (9 urban and 19 rural). The study population included patients with a diagnosis of New York Heart Association (NYHA) Grade II-IV chronic heart failure, from a register of 2047 with chronic heart failure patients treated by 97 Primary Care doctors. A proportional representative random sample of 474 patients from the urban and rural areas was studied. Main measurements: Adherence to the drugs recommended in the Clinical Guidelines was evaluated using two indicators; one overall, and another for drugs with a higher level of evidence (A1: angiotensin converting enzyme inhibitors-angiotensin II receptor antagonists [ACE-I/ARA-II], β-blockers [BB] and spironolactone). RESULTS: A total of 456 patients were studied, with a mean age of 78.4 years, and 53.1% females. Arterial hypertension (AHT) and ischaemic heart disease were present in 64.7% of patients. The mean comorbidity rate, excluding CHF, was 2.9. Around 40% were diagnosed a NYHA Grade 11-1V. The overall compliance rate (diuretics, ACE-I/ARA-II, β-blockers, spironolactone, digoxin, and oral anticoagulants) and rate of adherence to evidence-based ones was 55.2% and 44.6%, respectively. There was low compliance by 39.5%, and only 12.9% of patients showed perfect compliance with the drugs with a higher level of evidence, while to be less than 70 years-old, a history of ischaemia, AHT, and a hospital admission, were variables associated with better adherence to treatment. CONCLUSION: There is a low use of the drugs recommended by the Clinical Guidelines for heart failure, particularly of those with better evidence for reducing morbidity and mortality.
    SEMERGEN - Medicina de Familia 39(4):183-190.
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