Clinical characteristics and mortality of heart failure. INCAex study

Background and objectivesHeart failure is responsible for a major part of hospital health expenditure and the third cause of cardiovascular death. To describe the evolution of clinical features, and factors related to prognosis of patients admitted due to decompensated heart failure in a region of Extremadura during a period 10 years.Patients and methodsObservational, retrospective and single center study of consecutive patients admitted due to decompensated heart failure in a general hospital in the province of Badajoz, during the period 2000–2009.ResultsA total of 2220 patients with mean age of 76.3 (SD ± 10.1), 54% being female, were included in the study. Stratified into four periods (30 months each), a significant increase in patients over 75 years (55% vs. 71%; P < .001), as well as an increase in the prescription of beta blockers at discharge (12% vs. 34%, P < .001), statins (8% vs. 31%; P < .001), and oral anticoagulants (13% vs. 25%; P < .001) were observed. Hospital mortality significantly decreased from 13 to 8% (P < .01), and from 30 to 23% (P < .01) at one-year follow-up. Age (HR per year = 1.04 [95% CI: 1.02–1.05]), diabetes (HR = 1.35 [95% CI: 1.11–1.66]) and chronic renal failure (HR = 1.49 [95% CI: 1.18–1.87]) were identified as independent predictors of all-cause mortality at one year of follow-up.ConclusionsTotal mortality in patients with decompensated heart failure has declined significantly over the last decade, despite the increasing age. Age, diabetes and chronic renal failure were independent predictors of total mortality at one year. Oral anticoagulation was a protective factor.

ResumenAntecedentes y objetivosLa insuficiencia cardiaca es la causante del mayor gasto sanitario en hospitalización y la tercera causa de mortalidad cardiovascular. Fue nuestro objetivo determinar la evolución de las características clínicas, y los factores relacionados con el pronóstico en pacientes ingresados por insuficiencia cardiaca en un área de salud de Extremadura durante 10 años.Pacientes y métodosEstudio observacional, retrospectivo y unicéntrico en pacientes consecutivos ingresados por insuficiencia cardiaca descompensada en un Hospital General de la provincia de Badajoz en el período 2000/2009.ResultadosSe incluyeron 2.220 pacientes con una edad media de 76,3 (DE ± 10,1) años, 54% mujeres. Estratificados en 4 períodos de 30 meses, se observó: un significativo incremento de los pacientes mayores de 75 años (55 al 71%; p < 0,001) y al alta una mayor prescripción de bloqueadores beta (12 al 34%; p < 0,001), estatinas (8 al 31%; p < 0,001), y anticoagulantes orales (13 al 25%; p < 0,001). La mortalidad intrahospitalaria disminuyó del 13 al 8% (p < 0,01) y al año del 30 al 23% (p < 0,01). Fueron predictores independientes de mortalidad al año la edad (HR = 1,04 [IC del 95%: 1,02 to 1,05]), la diabetes (HR = 1,35 [IC del 95%: 1,11 to 1,66]) y la insuficiencia renal (HR = 1,49 [IC del 95%: 1,18 to 1,87]).ConclusionesLa mortalidad ha disminuido significativamente en la década a pesar del incremento de la edad. La edad, la diabetes y la insuficiencia renal crónica resultaron predictores independientes de mortalidad al año. La anticoagulación resultó protectora.