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Real life heart failure, a heterogeneous population benefiting from a specialized multidisciplinary programme

Session Poster Session 4

Speaker Francisco Adragao

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Multidisciplinary Interventions
  • Session type : Poster Session

Authors : I Egidio Sousa (Lisbon,PT), I Lopes Da Costa (Lisbon,PT), I Nabais (Lisbon,PT), F Pulido Adragao (Portimão,PT), P Moniz (Lisbon,PT), S Quintao (Lisbon,PT), L Fernandes (Lisbon,PT), C Osana (Lisbon,PT), L Campos (Lisbon,PT), I Araujo (Lisbon,PT), C Fonseca (Lisbon,PT)

Authors:
I Egidio Sousa1 , I Lopes Da Costa2 , I Nabais3 , F Pulido Adragao4 , P Moniz1 , S Quintao1 , L Fernandes1 , C Osana1 , L Campos1 , I Araujo1 , C Fonseca1 , 1Hospital de Sao Francisco Xavier - Lisbon - Portugal , 2Hospital de São José - Lisbon - Portugal , 3Hospital de Cascais - Lisbon - Portugal , 4Centro Hospitalar do Algarve EPE - Portimão - Portugal ,

Citation:

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(IM) mainly reports HF with preserved ejection fraction(HFpEF).
Purpose: To evaluate demographics, clinical characteristics and acute management(AM) of a non-selected population hospitalized in an Acute Heart Failure Unit with a multidisciplinary team.
Methods: Retrospective study of consecutive hospitalizations due to decompensated HF 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 etiologies were hypertensive(48.6%), ischemic(44.2%) and valvular(26%). 93% patients had chronic HF. Most decompensation were due to arrhythmias(26%), infection(24.9%), 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 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 stay: 8,1days, mortality 6%. Population had high multimorbidity, the most common: arterial hypertension (75.6%), atrial fibrillation (6.2%), chronic Kidney disease (56.4%), diabetes (42.5%). 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 IM). 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, AM tends to be similar as most patients are congestive at admission. All groups had similar number of comorbidities, requiring 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 and international data.

HFrEF HFmrEF HFpEF
Population 89 (49.2%) 12 (6.6%) 80 (44.2%)
Male 60 (67.4%) 7 (58.3%)

33 (41.3%)

Number of comorbidities (average) 5.3 4.8 5.6

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