Acute coronary syndromes complicated by symptomatic and asymptomatic heart failure: does current treatment comply with guidelines?
BACKGROUND
Patients with acute coronary syndromes (ACS) complicated by heart failure (HF) are at increased risk of death. Treatment with angiotensin-converting enzyme inhibitors (ACEI), beta-blockers, and early invasive risk stratification are recommended for these patients.


OBJECTIVE
The purpose of the current study was to assess adherence to treatment guidelines of patients with ACS complicated by HF in Europe and the Mediterranean region.


RESULTS
Of the 10,484 patients who participated in Euro-Heart ACS survey, 9587 had known HF status and were without cardiogenic shock; 7058 (74%) did not have symptomatic HF and 2529 (26%) presented with or developed symptomatic HF during hospitalization. HF patients were older and had more cardiovascular risk factors. ACEI were more commonly used in HF patients (75% vs 56%, P < .01), whereas beta-blockers were less frequently used (75% vs 82%, P < .01). Coronary angiography and in hospital revascularization rates were lower among HF patients (42% vs 57% for coronary angiography, P < .01, and 32% vs 42% for revascularization, P < .01). Similar trends were noticed among patients with left ventricular dysfunction (symptomatic and asymptomatic).Adjusted in-hospital mortality risk was higher among patients with ACS complicated by symptomatic HF regardless of electrocardiographic type of ACS: (ST-elevation ACS, OR 2.5, 95% CI 1.6-3.9; non-ST-elevation ACS, OR 8.9,95% CI 4.5-17.7; undetermined-ECG ACS, OR 9.3, 95% CI 2.5-34).


CONCLUSIONS
Patients with ACS complicated by HF were at increased risk of dying. A relatively high percentage of HF patients were treated with ACEI and beta-blockers in accordance with current recommendations. Rates of coronary angiography and revascularization were significantly lower in ACS patients with HF versus those without HF, which potentially contributed to their worse mortality [corrected]
Haim
Moti
M
Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel.
Battler
Alexander
A
Behar
Solomon
S
Fioretti
Paolo M
PM
Boyko
Valentina
V
Simoons
Maarten L
ML
Hasdai
David
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D017023:Coronary Angiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000150:complications / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D017410:Practice Guidelines as Topic; D013318:Stroke Volume; D013577:Syndrome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors