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Quality of heart failure treatment treated by residential cardiologists -The HeartFailureBavaria Project

Session Poster Session 2

Speaker Fabian Bisenius

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Treatment
  • Session type : Poster Session

Authors : F Bisenius (Wuerzburg,DE), KJ Osterziel (Amberg,DE), H Steinert (Nuernberg,DE), H Stroemer (Wuerzburg,DE), J Brandl (Wuerzburg,DE), M Hanke (Wuerzburg,DE), S Silber (Muenchen,DE), C Malsch (Wuerzburg,DE), G Ertl (Wuerzburg,DE), S Frantz (Wuerzburg,DE), P Heuschmann (Wuerzburg,DE), S Stoerk (Wuerzburg,DE)

Authors:
F Bisenius1 , KJ Osterziel2 , H Steinert3 , H Stroemer4 , J Brandl4 , M Hanke1 , S Silber5 , C Malsch1 , G Ertl1 , S Frantz6 , P Heuschmann7 , S Stoerk1 , 1University Hospital Wuerzburg, Comprehensive Heart Failure Center - Wuerzburg - Germany , 2Cardiopraxis.com - Amberg - Germany , 3Residential Cardiology Nuernberg - Nuernberg - Germany , 4Residential Cardiology Wuerzburg - Wuerzburg - Germany , 5kardiologische-praxis.com - Muenchen - Germany , 6University Hospital Wuerzburg, Department of Internal Medicine I - Wuerzburg - Germany , 7University of Wuerzburg, Institute of Clinical Epidemiology and Biometry - Wuerzburg - Germany ,

On behalf: HeartFailureBavaria Study Group

Citation:

Background & Purpose:
The quality of heart failure (HF) therapy in the hospital setting is fairly well known through clinical trials and registries, but largely undescribed in the setting of primary care and residential cardiology. HeartFailureBavaria was initiated as a network project aiming to describe characteristics and quality of care in patients with HF treated by resident cardiologists in the German healthcare setting.

Methods:
106 resident cardiologists across Bavaria agreed to characterize their consecutive HF patients on a structured case report form focussing on HF type and severity, comorbidities, diagnostic assessment, and interventional and medical treatment. Periodic benchmark reports were issued to the project group.

Results:
Between 5/2014 and 12/2016, 70 cardiologists contributed information on 5497 patients with a cardiologically confirmed diagnosis of HF for the present analysis: median age 72 years; 66% male; NYHA II/III/IV in 50/36/5%; LVEF <40% (i.e., HFrEF)/40-49% (i.e., HFmrEF)/=50% (i.e., HFpEF) in 29/29/42% of patients, respectively; sinus rhythm 60%; atrial fibrillation 29%; median heart rate 71 bpm; median QRS interval 118 ms. Frequent comorbidities were: hypertension 74%, coronary heart disease (CHD) 51%, hyperlipidemia 50%, valvular heart disease 32%, diabetes 28%, renal insufficiency 25%, COPD 12%.

Pharmacotherapy in groups of LVEF (<40/40-49/=50%) was ACEi 69/65/57%, ARB 23/29/30%, betablocker 90/87/80%, MRA 64/48/27%, diuretics 88/75/71%, glycoside 14/10/13%, ivabradine 6/4/2% (all p<0.005, respectively). Patients aged <72 years vs. older patients received more often MRA (52% vs. 39%), triple therapy with ACEi/ARB, betablocker and MRA (46% vs. 32%), and antiplatelet therapy (54% vs. 44%); by contrast, older patients more often received diuretics (83% vs. 68%), and anticoagulation (56% vs. 33%; all p<0.001, respectively). Men and women with HFrEF were treated similarly, except for men in NYHA class III receiving betablockers more often than women: 92% m vs. 84% w, p=0.004. However, when considering all patients of all types of HF, men received individual substance classes and their combination more often (about 4-10% more often) than women, with the exception of diuretics (both sexes treated similarly) and glycosides (6% more often in women).

Device therapy and interventions were: ICD 14%, CRT-D 9%, CRT-P 1%, PCI 29%, CABG 16%. The ratio of implanted to indicated devices was 0.54 for ICD (indication criteria: NYHA II/III, CHD, LVEF=35%), and 0.32 to 0.42 for CRT (depending on the applied indication criteria).

Conclusion:
HF patients cared for by residential cardiologists exhibited a good level of adherence to pharmacotherapy guidelines, without major gender-specific differences. There remains potential for improving cardiac device therapy. Despite lacking evidence how to optimally treat patients with HFpEF (and HFmrEF), utilization of respective substance classes was very similar to HFrEF patients.

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