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Changes in the causes of death in a heart failure unit in Spain along 17 years

Session Poster Session 1

Speaker Josep Lupon

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : P Moliner (Barcelona,ES), J Lupon (Barcelona,ES), M De Antonio (Barcelona,ES), M Domingo (Barcelona,ES), E Santiago-Vacas (Barcelona,ES), E Zamora (Barcelona,ES), J Santesmases (Barcelona,ES), C Diez-Quevedo (Barcelona,ES), MI Troya (Barcelona,ES), M Boldo (Barcelona,ES), S Altimir (Barcelona,ES), N Alonso (Barcelona,ES), B Gonzalez (Barcelona,ES), J Nunez (Valencia,ES), A Bayes-Genis (Valencia,ES)

Authors:
P Moliner1 , J Lupon1 , M De Antonio1 , M Domingo1 , E Santiago-Vacas1 , E Zamora1 , J Santesmases1 , C Diez-Quevedo1 , MI Troya1 , M Boldo1 , S Altimir1 , N Alonso1 , B Gonzalez1 , J Nunez2 , A Bayes-Genis2 , 1Germans Trias i Pujol University Hospital - Badalona (Barcelona) - Spain , 2University Hospital Clinic of Valencia - Valencia - Spain ,

Citation:

Background: Advances in heart failure (HF) treatment have achieved a reduction of death in HF patients in the last two decades. Indeed, not only mortality has been reduced but also the mode of death might have been modified through these years.

Purpose: To assess the causes of death in outpatients attended in a HF Unit since the year 2002 up to the year 2018.

Methods: Causes of death were classified as follows: progression of HF (worsening HF or treatment-resistant HF, in the absence of another cause); sudden death (any unexpected death, witnessed or not, of a previously stable patient with no evidence of worsening HF or any other known cause of death); acute myocardial infarction; stroke; procedural (post-diagnostic or post-therapeutic); other cardiovascular causes (e.g., rupture of an aneurysm, peripheral ischemia, or aortic dissection), and non-cardiovascular. Patients who died of unknown cause were excluded from the analysis. Fatal events were identified from the clinical records of patients with HF, hospital wards, the emergency room, general practitioners, or by contacting the patient’s relatives. Furthermore, data were verified from the databases of the Catalan and Spanish Health Systems. Trends on every cause of death were assessed by linear regression.

Results: Since August 2001 to May 2018, 2295 HF patients were admitted to the HF clinic (age 66.4 ± 12.8 years, 71% men, 49% from ischemic aetiology,  mean LVEF 35.2% ± 14). During the 17 years of the study, 1201 deaths were recorded. Seventy-eight patients (6.5% of deaths) were excluded due to unknown cause of death. The evolution in the mode of death by years is shown in the figure. Two trends were observed: a decrease in sudden death (p=0.05) and a very significant linear increase in non-cardiovascular causes of death (p<0.001). The decrease of sudden death was mainly driven from changes observed in the first 10 years (p=0.014); thereafter the incidence of sudden death remained stable (p=0.18). Remarkably we did not observe significant changes in HF progression as mode of death (p=0.17).

Conclusions: During the 17 years of the study, a very significant trend towards higher percentage of non-cardiovascular deaths was progressively observed. On the other hand, percentage of sudden death showed a gradual decrease, mainly driven from the changes observed in the first 10 years.

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