A closer look at acute heart failure: Putting Portuguese and European data into perspective.
OBJECTIVE
Acute heart failure (AHF) is a heterogeneous clinical syndrome requiring urgent therapy. The prognosis is poor after the index hospitalization, with a high risk for rehospitalization and early death. The costs of managing AHF are thus increasing rapidly. A literature review was performed to gather and compare data on prevalence and treatment and to identify gaps in AHF management, based on European and Portuguese studies.


METHODS
A literature search from 1995 to 2014 was conducted in selected databases (BIOSIS Previews, EMBASE and Ovid MEDLINE).


CONCLUSIONS
Seven Portuguese and nine European studies were analyzed. The mean age of AHF patients was ≥65 years and 30-50% were women. Coronary artery disease (42.3% vs. 61.9%) and hypertension (53.3% vs. 76.7%) were identified as primary etiologies in Europe and in Portugal. Similar proportions of heart failure with preserved ejection fraction were found in the Portuguese (19.9-44.7%) and European (32.8-39.1%) studies. Overall, all-cause mortality rates were comparable (six months: 9.3-25.5% vs. 13.5-27.4%; one year: 15.9-31% vs. 17.4-46.5%), as was in-hospital mortality (5.5-14% vs. 3.8-12%) in Portuguese and European studies, respectively. Length of stay was comparable. The studies were performed in very different hospital settings and data on treatment were scarce.


CONCLUSIONS
Gaps were identified in treatment and clinical pathways of patients with AHF. Based on the results of this review, collection and investigation of data on the disease and treatment solutions, training in disease management, and improved organization of healthcare should be the subject of further investment.
Heart Failure Unit, Department of Internal Medicine and Day Hospital - Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal. Electronic address: mcandidafonseca@gmail.com.
Cândida
C
Fonseca
Heart Failure Unit, Department of Internal Medicine and Day Hospital - Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
Inês
I
Araújo
Heart Failure Unit, Department of Internal Medicine and Day Hospital - Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
Filipa
F
Marques
Medical Department, Novartis Farma, Porto Salvo, Portugal.
Daniel
D
Brás
Department of Internal Medicine, Centro Hospitalar de São João, Faculty of Medicine University of Porto, Oporto, Portugal.
Paulo
P
Bettencourt
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology
Acute heart failure; Acute phase treatment; Cardiovascular disease; Doença cardiovascular; Epidemiologia; Epidemiology; Heart failure; Insuficiência cardíaca; Insuficiência cardíaca aguda; Portugal; Registos; Registries; Tratamento da fase aguda