Impact of echocardiography in patients hospitalized for heart failure: a prospective observational study.
BACKGROUND
Echocardiography is recommended for all patients with a clinical diagnosis of heart failure (HF). Management of HF in daily practice differs from guidelines.


OBJECTIVE
To evaluate the prognostic impact of echocardiography in patients hospitalized for a first episode of HF.


METHODS
Consecutive patients (n=799) hospitalized for a first episode of HF were prospectively enrolled during 2000. Propensity scores and multivariable analyses were used to reduce the imbalance in baseline covariates between the Echo and No-Echo groups.


RESULTS
During hospitalization, echocardiography was not performed in 151 patients (19%). Patients in the No-Echo group were older, more likely to be female, less frequently admitted to cardiology departments, and had lower rates of life-saving drugs prescribed at discharge. After adjustment for covariates of prognostic importance, use of echocardiography was associated with lower relative risk of three-year overall mortality (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.48-0.78, p<0.001) and cardiovascular mortality (HR 0.52, 95% CI 0.39-0.70, p<0.001). The three-year relative survival of the Echo group (observed/expected survival) was higher than that of the No-Echo group. Using propensity scores, the performance of echocardiography during hospitalization remained related to reduced three-year overall mortality (HR 0.55, 95% CI 0.39-0.79, p=0.001) and cardiovascular mortality (HR 0.59, 95% CI 0.37-0.95, p=0.03).


CONCLUSIONS
Echocardiography is still underused in elderly patients with HF. Use of echocardiography appears to be associated with more intensive medical therapy and improved outcome.
Tribouilloy
Christophe
C
INSERM ERI 12, Department of Cardiovascular Disease, France and University Hospital Amiens, avenue René-Laënnec, Amiens cedex 1, France. tribouilloy.christophe@chu-amiens.fr
Rusinaru
Dan
D
Mahjoub
Haïfa
H
Goissen
Thomas
T
Lévy
Franck
F
Peltier
Marcel
M
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014463:Ultrasonography