Abstract

CORRADI, Lucas et al. XVIII CONAREC Registry on Decompensated Heart Failure in Argentina. Rev. argent. cardiol. [online]. 2014, vol.82, n.6, pp.519-528. ISSN 1850-3748.

Background: Decompensate heart failure (DHF) is currently a major public health problem and a clinical condition that frequently appears in patients with chronic heart failure. In our country, several registries provide information on the characteristics and treatment of patients hospitalized for DHF in the last decades, including the 1998 and 2004 CONAREC registries. Despite the availability of drugs with proven efficacy for the treatment of chronic heart failure, DHF is an area where little progress has been made. There is need of definitions and characteristics of the population admitted to hospital to improve the prevention of these cases. Objective: The aim of this study was to describe the clinical characteristics of patients admitted for DHF in centers with Residence in Cardiology belonging to the Argentine Council of Cardiology Residents (CONAREC). Methods: A multicenter, prospective, observational, cross-sectional study was designed to include patients admitted with DHF as main diagnosis in the intensive care unit of 64 centers with cardiology residency associated to CONAREC in Argentina, during July and August 2011. A cross audit was performed in 20% of participating centers to verify loading of consecutive patients. Descriptive data were presented as frequency distributions for all the included study variables, and statistical significance was established using the chisquare test provided by SPSS 15.0 for Windows software package. Results: A total of 1,277 patients were included in the study. Mean age was 73 years (62-82) and 40.6% were women. The most prevailing conditions were hypertension in 80% of patients, diabetes in 31.4%, prior myocardial infarction in 24%, and chronic atrial fibrillation in 32.5%. The etiology was ischemic-necrotic in 34%, hypertensive in 18% and chagasic in 4%. History of heart failure included 52% of patients with previous DHF, 28% hospitalized for DHF during the last year, and prior ventricular function evaluation in 64%, 22% of whom had preserved left ventricular systolic function (ejection fraction > 55%). Systolic blood pressure at admission was 133±32.2 mm Hg. The most prevalent causes of decompensation were: progression of heart failure, infections, insufficient medication, and food transgressions. A cause for decompensation was identified in 75% of cases, with the following forms of presentation: congestion in 76% of patients, pulmonary edema in 20% and shock in 4%. Treatment at discharge included beta-blockers in 81% of cases, furosemide in 85%, ACEI/ARB II in 77%, antialdosterone agents in 51%, and digoxin in 16%. Median hospital stay was 6 days (4-10), and in-hospital mortality was 11%. Multivariate analysis showed the following independent predictors of mortality: use of inotropic drugs [OR 4.83 (95% CI 3.13-7.45)], normal functional class ≥ II [OR 2.16 (95% CI 1.10-4.23)], shock as presentation event [OR 2.08 (95% CI 1.01-4.29)] and history of renal failure [OR 1.80 (95% CI 1.21-2.7)]. Participating centers corresponded to the following regions: Center (27.5%), Argentine Great North (13.3%), New Cuyo (2.5%), Patagonia (2%), and Buenos Aires and CABA (54.4%). Conclusions: Decompensated heart failure is a disease with growing prevalence correlating with increased life expectancy, and consequently associated to an affected population of increasing average age. Despite improved treatment, decreased mortality has not been achieved. Hypertension represented a dominant condition, suggesting that a more intense patient education on this and other preventable factors is necessary. Use of drugs with proven beneficial effects at discharge was adequate though lower than in other registries, also indicating the need to support continuing medical education.

Keywords : Heart Failure; Hospitalization; Prognostic.

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