HEART FAILURE IN REAL LIFE, A HETEROGENEOUS POPULATION BENEFITING FROM A SPECIALIZED MULTIDISCIPLINARY PROGRAMME
Doenças cardiovasculares - Comunicação
Congresso ID: CO212 - Resumo ID: 923
Hospital São Francisco Xavier
Inês Egídio de Sousa, Inês Lopes da Costa, Inês Nabais, Francisco Adragão, Patrícia Moniz, Susana Quintão, Lúcia Fernandes, Célia Osana, Luís Campos, Inês Araújo, Cândida Fonseca
Introduction: Heart failure(HF) is a public health problem, affecting a diversified population, growing in prevalence despite therapy and prevention advances. Most Cardiology departments’ registries describe predominantly HF with reduced ejection fraction (HFrEF), while Internal Medicine mainly reports HF with preserved ejection fraction (HFpEF).
Objective: To evaluate demographics, clinical characteristics and acute management of a non-selected population hospitalized in an Acute Heart Failure Unit (AHFU) with a multidisciplinary team.
Methods: Retrospective study of consecutive hospitalizations due to decompensated HF in an AHFU, over one year.
Results: Of 181 hospitalizations, 55.2% were men, mean age 76 years. Most patients (77.3%) were admitted from the emergency room and 12.1% were admitted from our Day Hospital(DH). 50.8% had non-HErEF (HEpEF 44.2% and HF with mid-range ejection fraction (HFmrEF) 6.6%) and 49.2% HErEF. The most frequent aetiologies of HF were hypertensive (48.6%), ischemic (44.2%) and valvular (26%). Most of the patients had decompensation of chronic HF (93%). Most decompensations were due to arrhythmias (26%), infection (24.9%) and medication non-adherence (24.9%). Patients were admitted in NYHA classes III (35.4%) or IV (64.6%), and at discharge the majority (70.7%) were in class II. Most patients were on B profile (95.6%) requiring IV diuretics; of these 14.4% evolved to C profile requiring inotropics, 9.4% of which on levosimendan. Mean in-AHFU stay was 8,1 days, and mortality 6%. Population had high multimorbidity, with an average of 6 comorbidities: arterial hypertension (75.6%), atrial fibrillation (6.2%), chronic Kidney disease (56.4%), diabetes (42.5%), among others. After discharge, 87.7% were referred to DH, 76,5% HF consultation and 45.7% other speciality evaluation (22.2% Pneumology, 16% Cardiology, 4.3% Nephrology, Endocrinology and Internal Medicine). Readmission at 30 days was 12.5% (52.4% due to decompensated HF) and mortality 5.3% (45.4% due to HF).
Conclusion: results support epidemiologic data, where HErEF tend to be as prevalent as non-HErEF. Despite differences, acute management tends to be similar as most patients are congestive at admission. All groups had high multimorbidity, requiring a multidisciplinary approach. A specialized and structured HF Program allows integrated care, with systematic and differentiated approach, reflected on our short hospital stay and mortality, inferior to national (9.6 days and 12.5% in 2014, respectively) and international data.
Objective: To evaluate demographics, clinical characteristics and acute management of a non-selected population hospitalized in an Acute Heart Failure Unit (AHFU) with a multidisciplinary team.
Methods: Retrospective study of consecutive hospitalizations due to decompensated HF in an AHFU, over one year.
Results: Of 181 hospitalizations, 55.2% were men, mean age 76 years. Most patients (77.3%) were admitted from the emergency room and 12.1% were admitted from our Day Hospital(DH). 50.8% had non-HErEF (HEpEF 44.2% and HF with mid-range ejection fraction (HFmrEF) 6.6%) and 49.2% HErEF. The most frequent aetiologies of HF were hypertensive (48.6%), ischemic (44.2%) and valvular (26%). Most of the patients had decompensation of chronic HF (93%). Most decompensations were due to arrhythmias (26%), infection (24.9%) and medication non-adherence (24.9%). Patients were admitted in NYHA classes III (35.4%) or IV (64.6%), and at discharge the majority (70.7%) were in class II. Most patients were on B profile (95.6%) requiring IV diuretics; of these 14.4% evolved to C profile requiring inotropics, 9.4% of which on levosimendan. Mean in-AHFU stay was 8,1 days, and mortality 6%. Population had high multimorbidity, with an average of 6 comorbidities: arterial hypertension (75.6%), atrial fibrillation (6.2%), chronic Kidney disease (56.4%), diabetes (42.5%), among others. After discharge, 87.7% were referred to DH, 76,5% HF consultation and 45.7% other speciality evaluation (22.2% Pneumology, 16% Cardiology, 4.3% Nephrology, Endocrinology and Internal Medicine). Readmission at 30 days was 12.5% (52.4% due to decompensated HF) and mortality 5.3% (45.4% due to HF).
Conclusion: results support epidemiologic data, where HErEF tend to be as prevalent as non-HErEF. Despite differences, acute management tends to be similar as most patients are congestive at admission. All groups had high multimorbidity, requiring a multidisciplinary approach. A specialized and structured HF Program allows integrated care, with systematic and differentiated approach, reflected on our short hospital stay and mortality, inferior to national (9.6 days and 12.5% in 2014, respectively) and international data.