Temporal variation in the prognosis and treatment of advanced heart failure - before and after 2000.

Abstract:

BACKGROUND:The treatment of heart failure has evolved in recent decades suggesting that survival is increasing. OBJECTIVE:To verify whether there has been improvement in the survival of patients with advanced heart failure. METHODS:We retrospectively compared the treatment and follow-up data from two cohorts of patients with systolic heart failure admitted for compensation up to 2000 (n = 353) and after 2000 (n = 279). We analyzed in-hospital death, re-hospitalization and death in 1 year of follow-up. We used Mann-Whitney U test and chi-square test for comparison between groups. The predictors of mortality were identified by regression analysis through Cox proportional hazards model and survival analysis by the Kaplan-Meier survival analysis. RESULTS:The patients admitted until 2000 were younger, had lower left ventricular impairment and received a lower proportion of beta-blockers at discharge. The survival of patients hospitalized before 2000 was lower than those hospitalized after 2000 (40.1% vs. 67.4%; p<0.001). The independent predictors of mortality in the regression analysis were: Chagas disease (hazard ratio: 1.9; 95% confidence interval: 1.3-3.0), angiotensin-converting-enzyme inhibitors (hazard ratio: 0.6; 95% confidence interval: 0.4-0.9), beta-blockers (hazard ratio: 0.3; 95% confidence interval: 0.2-0.5), creatinine ≥ 1.4 mg/dL (hazard ratio: 2.0; 95% confidence interval: 1.3-3.0), serum sodium ≤ 135 mEq/L (hazard ratio: 1.8; 95% confidence interval: 1.2-2.7). CONCLUSIONS:Patients with advanced heart failure showed a significant improvement in survival and reduction in re-hospitalizations. The neurohormonal blockade, with angiotensin-converting-enzyme inhibitors and beta-blockers, had an important role in increasing survival of these patients with advanced heart failure.

journal_name

Arq Bras Cardiol

authors

Carlo CH,Cardoso JN,Ochia ME,Oliveira MT Jr,Ramires JA,Pereira-Barretto AC

doi

10.5935/abc.20140050

subject

Has Abstract

pub_date

2014-05-01 00:00:00

pages

495-504

issue

5

eissn

0066-782X

issn

1678-4170

pii

S0066-782X2014005040050

journal_volume

102

pub_type

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