title: Impact of clinical characteristics and management on the prognosis of unselected heart failure patients.
abstract: OBJECTIVE
  Heart failure (HF) is a major public health issue. This study conducted a real-life analysis of the impact of clinical characteristics and medical management of HF on its prognosis.
  
  
  METHODS
  Analysis was based on the EGB ("Echantillon Généraliste des Bénéficiaires") database. A cohort comprising 1825 adult patients with a first admission for HF between 2009 and 2011 was created and followed until June 2013 (median 22.3 [7.7-34.5] months) for survival analysis.
  
  
  RESULTS
  Mean age was 77.3 ± 13.2 years (53 % ≥80 years). The overall incidence of HF admission was 117 [112-122] per 100,000 population with a marked increase in patients >80 years (1297 [1217-1348]). At discharge, only 8 % of patients received recommended combination of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), beta-blockers (BB) and mineralocorticoid receptor antagonists (MRA). Only prescription levels of BB and vitamin K antagonists, at discharge, increased during the study period. In-hospital mortality was 9 % and survival was 71.6 %[69.5-73.6] and 52.0 %[49.4-54.6] at 12 and 36 months, respectively. In multivariate analysis, female gender [HR:0.78 (0.67-0.91), p = 0.001], ACEi/ARB + BB + MRA [0.41 (0.28-0.60), p < 0.001] and ACEi/ARB + BB [0.47 (0.39-0.57) p < 0.001] treatments were associated with improved survival, conversely to age 70-79 [1.90 (1.20-3.00), p = 0.003] and ≥80 [3.50 (2.30-5.40), p < 0.001], cardiogenic shock [3.00 (2.10-4.40), p < 0.001], acute pulmonary edema [1.70 (1.10-2.50), p = 0.01], denutrition [1.80 (1.45-2.24), p < 0.001], dilated cardiomyopathy [1.20 (1.00-1.40), p = 0.02] and in-hospital acute renal failure [1.36 (1.05-1.78), p = 0.002].
  
  
  CONCLUSIONS
  These real-life HF data provide insight into prognostic factors and "real-world" pharmacological management in this unselected HF population, confirming the benefit of ACEi/ARB + BB ± MRAs on patient survival.
authors.affiliation: Clermont Université, ISIT-CaVITI, BP 10448, 63001, Clermont-Ferrand, France, reschalier@chu-clermontferrand.fr.
authors.forename: Romain
authors.initials: R
authors.lastname: Eschalier
authors.forename: Chouki
authors.initials: C
authors.lastname: Chenaf
authors.forename: Aurélien
authors.initials: A
authors.lastname: Mulliez
authors.forename: Arab
authors.initials: A
authors.lastname: Yalioua
authors.forename: Guillaume
authors.initials: G
authors.lastname: Clerfond
authors.forename: Nicolas
authors.initials: N
authors.lastname: Authier
authors.forename: Charles
authors.initials: C
authors.lastname: Vorilhon
authors.forename: Bernard
authors.initials: B
authors.lastname: Citron
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.forename: Frédéric
authors.initials: F
authors.lastname: Jean
authors.forename: Géraud
authors.initials: G
authors.lastname: Souteyrand
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
authors.forename: Alain
authors.initials: A
authors.lastname: Eschalier
authors.forename: Jean-René
authors.initials: JR
authors.lastname: Lusson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D011379:Prognosis
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists