Survival in Mediterranean ambulatory patients with chronic heart failure. A population-based study.
OBJECTIVE
Scarce research has been performed in ambulatory patients with chronic heart failure in the Mediterranean area. Our aim was to describe survival trends in our target population and the impact of prognostic factors.


METHODS
We carried out a population-based retrospective cohort study in Catalonia (north-east Spain) of 5659 ambulatory patients (60% women; mean age 77 [10] years) with incident chronic heart failure. Eligible patients were selected from the electronic patient records of primary care practices from 2005 and were followed-up until 2007.


RESULTS
During the follow-up period deaths occurred in 950 patients (16.8%). Survival after the onset of chronic heart failure at 1, 2, and 3 years was 90%, 80%, 69%, respectively. No significant differences in survival were found between men and women (P=.13). Cox proportional hazard modelling confirmed an increased risk of death with older age (hazard ratio=1.06; 95% confidence interval, 1.06-1.07), diabetes mellitus (hazard ratio=1.53; 95% confidence interval, 1.33-1.76), chronic kidney disease (hazard ratio=1.73; 95% confidence interval, 1.45-2.05), and ischemic heart disease (hazard ratio=1.18; 95% confidence interval, 1.02-1.36). Hypertension (hazard ratio=0.73; 95% confidence interval, 0.64-0.84) had a protective effect.


CONCLUSIONS
Service planning and prevention programs should take into consideration the relatively high survival rates found in our area and the effect of prognostic factors that can help to identify high risk patients.
Radboud University Nijmegen, Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands; Instituto Universitario Avedis Donabedian, Universitat Autònoma de Barcelona, Barcelona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; Translab Research Group, Department de Ciències Mèdiques, Universitat de Girona, Girona, Spain. Electronic address: eva.frigola@gmail.com.
Eva
E
Frigola-Capell
Departamento de Cardiología, Hospital del Mar, Barcelona, Spain; Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Municipal d' Investigació Mèdica, Barcelona, Spain.
Josep
J
Comin-Colet
Subdirecció General de Serveis Sanitaris, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain; Escuela Andaluza de Salud Pública, Granada, Spain.
Josep
J
Davins-Miralles
Servicio de Epidemiología Clínica y Salud Pública, IIB Sant Pau, CIBERESP, Universitat Autònoma de Barcelona, Barcelona, Spain.
Ignasi J
IJ
Gich-Saladich
Radboud University Nijmegen, Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
Michel
M
Wensing
Institut Català de la Salut, Barcelona, Spain.
Jose M
JM
Verdú-Rotellar
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D011153:Population; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis
CHF; Epidemiology; Epidemiología; Heart failure; Insuficiencia cardiaca; PCPs; Población; Population; Prognosis; Pronóstico; Supervivencia; Survival; chronic heart failure; primary care practices