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.
INSERM ERI 12, Department of Cardiovascular Disease, France and University Hospital Amiens, avenue René-Laënnec, Amiens cedex 1, France. tribouilloy.christophe@chu-amiens.fr
Christophe
C
Tribouilloy
Dan
D
Rusinaru
Haïfa
H
Mahjoub
Thomas
T
Goissen
Franck
F
Lévy
Marcel
M
Peltier
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014463:Ultrasonography