title: Temporal trends in survival and hospitalizations in outpatients with chronic systolic heart failure in 1995 and 1999.
abstract: Abstract Background Community and hospital studies have suggested that survival of patients with heart failure (HF) has increased; however, the causes of the improvement and the hospital readmission rates remain undetermined. Methods and Results We compared survival and hospital admission rates in 2 cohorts enrolled in a national registry of outpatients with HF secondary to left ventricular (LV) systolic dysfunction referred to cardiology centers in 1995 (n = 712) and 1999 (n = 603). One year after enrollment, 163 of 1315 patients (12%) were dead. Survival rates were 85% in the 1995 versus 91% in the 1999 cohort. Older age, New York Heart Association (NYHA) class III-IV, anemia, hyponatremia, hypotension, and a lower LV ejection fraction (LVEF) were associated to an increased risk of all-cause mortality by multivariate analysis. Furthermore a significant independent cohort effect was observed: the adjusted risk of death was 1.30 (95% CI 1.16-1.45) for the 1995 versus 1999 cohort (survival difference adjusted P = .0067). The proportion of patients admitted to hospital declined significantly in 1999 versus 1995, for all causes (20% versus 27%, P = .006), for cardiac causes (16% versus 22%, P = .002), and for worsening congestive heart failure (8% versus 15%, P = .0005). Survival free from HF admission was 69% in 1995 versus 84% in 1999 (adjusted P = .0001); NYHA class III-IV, hypotension, diuretics and a lower LVEF were associated to an increased risk of this combined end point by multivariate analysis, as well as the enrollment year (relative risk 1.38, 95% CI 1.22-1.56, P = .0039). Conclusion In a national cardiologic registry of outpatients with systolic HF, survival improved and hospital admissions decreased over a 4-year period. These results underscore the importance of networking and the careful implementation of practice guidelines to elevate standards of care.
authors.affiliation: Cardiovascular Medicine, Department of Cardiovascvular and Internal Medicine, Riuniti Hospital, Bergamo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.forename: Renata
authors.initials: R
authors.lastname: De Maria
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
authors.forename: Lucio
authors.initials: L
authors.lastname: Gonzini
authors.forename: Marco
authors.initials: M
authors.lastname: Gorini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cacciatore
authors.forename: Antonello
authors.initials: A
authors.lastname: Gavazzi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.forename: Maurizio
authors.initials: M
authors.lastname: Porcu
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
mesh_terms: D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000453:epidemiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015988:Cohort Effect; D015331:Cohort Studies; D018572:Disease-Free Survival; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology; D007022:Hypotension / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics