Cor Vasa 2005, 46(4)

Care of hospitalized patients with chronic heart failure (Euro Heart Failure Survey - CR).

Jakub Čech^1,*, Hana Rosolová¹, Otto Mayer jr.¹, Jaroslav Šimon¹, Růžena Jandová², Jiří Widimský sen.², Jindřich Špinar³, Kateřina Linhartová⁴

¹ Centrum preventivní kardiologie, II. interní klinika, Univerzita Karlova-Lékařská fakulta v Plzni, Plzeň

² Klinika kardiologie, Institut klinické a experimentální medicíny, Praha

³ I. interní-kardiologická klinika, Fakultní nemocnice Brno-Bohunice, Brno

⁴ I. interní klinika, Univerzita Karlova-Lékařská fakulta v Plzni, Plzeň, Česká republika

Introduction:
Chronic heart failure (CHF) is the main cause of morbidity and mortality in our population and one of the most frequent reasons for hospitalization in patients over 60 years of age. Guidelines of the European Society of Cardiology for the diagnosis and treatment of CHF were published in 1995-1997 and updated in 2001; the Czech version dates back to 1998, and was also updated in 2001.

Aim:
To compare differences in the use of methods of examination and therapeutic procedures in CHF patients hospitalized in departments of cardiology and departments of medicine of university hospitals.

Method:
All admitted patients were registered in participating centers for five weeks. Using pre-defined criteria, patients with CHF or with asymptomatic left ventricular dysfunction were selected no matter whether or not the condition was the primary cause of admission. Differences in medical history data, use of available methods of examination, and use of therapy between patients hospitalized in specialist departments of cardiology and in departments of medicine were assessed. The P2 test and Student's unpaired t-test were used for analysis.

Results:
Overall, data from 574 patients were evaluated; of which number 199 were assessed in departments of cardiology and 375 in departments of medicine. Patients assessed in departments of cardiology were significantly younger - 58 ± 11 years vs. 75 ± 10 years (p < 0.001), with their medical records including more often, CHD 65% vs. 50% (p < 0.001), cardiomyopathy, 32% vs. 3% (p < 0.001) and heart valve disease, 50% vs. 35.2% (p < 0.01) whereas, in departments of medicine, arterial hypertension without evidence of CHD was present more often, 28% vs. 13% (p < 0.001). Patients in departments of cardiology had echocardiography performed more often, 88% vs. 63% (p < 0.001). No significant difference was seen among patients receiving ACE inhibitors, diuretics, digoxin and acetylsalicylic acid. Patients in departments of cardiology tended to receive spironolactone, 52% vs. 21% (p < 0.001) as well as betalytic agents, 53% vs. 26% (p < 0.001) more often. No significant difference was observed in mortality during hospitalization in departments of cardiology or medicine.

Conclusion:
Patients hospitalized in departments of cardiology were younger, were examined using better techniques, and received more comprehensive therapy compared with those hospitalized in departments of medicine. They were mostly patients undergoing cardiac surgery procedures or coronary angioplasty. Individuals hospitalized in departments of medicine tended to be older patients with a variety of associated conditions. CHF therapy in these patients was not always comprehensive; this was due to some drugs being contraindicated to other associated conditions or for fear of polypragmasia related to polymorbidity. However, results of the Euro Heart Failure study in the CR were on average comparable with those reported from most other developed European nations.

Keywords: Chronic heart failure; Recommended procedures; Cardiomyopathy; Coronary heart disease; Echocardiography; ACE inhibitors; Beta-blockers; Spironolactone

Published: April 1, 2005  Show citation