Congestive Heart Failure Due to Diastolic or Systolic Dysfunction: Frequency and Patient Characteristics in an Ambulatory Setting

Diller, Philip; Smucker, Douglas R.; David, B. S.; Graham, Robert J.

doi:10.1001/archfami.8.5.414

Cited by 38 publications

(20 citation statements)

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“…Nevertheless, it plays an important role in the control of the heart rate of patients with atrial fibrillation [50]. In EPICA, one-third of patients with CHF and systolic dysfunction were on digoxin, which is similar to that observed in other studies [32,33,41]. Digoxin was also prescribed to 9% of patients with preserved ventricular function although only half of them had atrial fibrillation.…”

Section: Discussionsupporting

confidence: 74%

Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy

Ceia

Fonseca

Mota

et al. 2004

European J of Heart Fail

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Background: Chronic heart failure (CHF) is common and is frequently managed by primary care physicians (PCPs). Despite the European Society of Cardiology (ESC) Guidelines, standard treatments for CHF are frequently underutilised, particularly in primary care. Aim: To evaluate current drug therapy for CHF in adults with HF diagnosed according to ESC guidelines in the context of the EPICA study. Aetiological features and therapy relevant comorbidities were also analysed. Methods: EPICA was a community-based epidemiological study conducted in mainland Portugal. The study involved 365 primary care physicians, who evaluated 6300 primary care attendees aged over 25 years. CHF was diagnosed by clinical and echocardiography criteria according to ESC guidelines. Results: Total of 551 cases of CHF were identified, with a mean age of 65F9 years. The estimated overall prevalence of CHF in the Portuguese population was 4.4%; 1.3% with and 1.7% without left ventricular systolic dysfunction (LVSD). There are 6,280,792 people aged N25 years in Portugal, which extrapolates to 261,400 cases of heart failure. About 80% of patients had a history of hypertension, 39% had a history of coronary artery disease and 15% had atrial fibrillation. Only 58% of patients were on angiotensin-converting enzyme (ACE) inhibitors and 7% on beta-blockers. The type of ventricular dysfunction, age and presence of renal failure had little effect on prescription rates. Diuretics were prescribed in 78%. Thiazides were used more frequently in those with preserved systolic function and frusemide in those with left ventricular systolic dysfunction. Digoxin was prescribed more often to patients with than without left ventricular systolic dysfunction (34% vs. 17%; p=0.02). Long-acting nitrates were prescribed to 20% and amiodarone to 8% of patients. Conclusion: The EPICA study, as in other studies in primary care in Europe, particularly the IMPROVEMENT study, suggests that greater efforts are required to improve training of primary care teams in the management of CHF.

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Section: Discussionsupporting

confidence: 74%

Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy

Ceia

Fonseca

Mota

et al. 2004

European J of Heart Fail

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“…In Montreal, in 1999, 85% of the hospitalizations for CHF were for people 65 years of age and older (33). Furthermore, the similarities in age distribution between men and women in these clinics is surprising, because epidemiological studies have shown that CHF develops later in life in women (30), who are older at diagnosis (34) and at first CHF hospitalization (13,35). We observed that only 27% of the patients in this study were women, even though the crude prevalence of CHF is similar between the sexes (28,(36)(37)(38).…”

Section: Discussionmentioning

confidence: 64%

“…The lower proportion of women and the relatively young age of patients in our study suggest that referral to these clinics may serve as a selection filter that excludes older patients with CHF, who are more often women (25)(26)(27)(28) and frequently present with preserved systolic function CHF (1,29,30). These clinics do not accept patients who are cognitively impaired or are unable to attend appointments regularly, which may explain the mean age of the patients (65 years), and is considerably younger than the average age of 75 years in epidemiological studies (25,31,32).…”

Section: Discussionmentioning

confidence: 87%

Are there sex-related differences in specialized, multidisciplinary congestive heart failure clinics?

Houde

Feldman

Pilote

et al. 2007

Canadian Journal of Cardiology

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C ongestive heart failure (CHF) is the most common cause of hospital admissions in people 65 years of age and older (1). Women represent more than one-half of these CHF hospitalizations (2); thus, it is important to determine whether there are sex-related inequities in the referral and follow-up of CHF patients. A sex-related bias in access to services has been documented in coronary artery disease (3-8) and, to a lesser extent, in CHF (9-12).In the past decade, new developments in treatment have led to improvements in CHF survival, decreased hospital admissions and improved quality of life (13,14). To implement these new treatment regimens, and to account for the growing number of cases and hospitalizations, specialized, multidisciplinary CHF clinics have been established. Benefits of these clinics include reduction in emergency room visits, hospitalization frequency and length of stay, together with reduced cost of care and improvement in quality of life; moreover, there is now some evidence to support their impact on survival (15-20). However, it is unclear whether men and women are equally enrolled in such case management programs, and whether they derive the same benefits. Thus, the purpose of the present study was to evaluate possible sex-related BACKGROUND: Specialized, multidisciplinary clinics improve service provision and reduce morbidity for patients with congestive heart failure (CHF). Although sex-related differences in access to cardiac health services have been reported, it remains unclear whether there are sex-related differences in the use of these specialized services. OBJECTIVES: To evaluate possible sex-related differences in severity at entry into specialized, multidisciplinary clinics, and compare prescription patterns between male and female patients at these clinics. METHODS: Data were obtained from the electronic clinical files of 765 CHF patients newly admitted to any of three main CHF clinics in Montreal, Quebec. Univariate and multivariate models were used to compare differences between sexes. RESULTS: Only 27.1% of patients were female. The mean age (± SD) of the women in the present study was similar to that of the men (64±16 years versus 65±13 years, respectively). Left ventricular ejection fraction at entry for patients with reduced systolic function was comparable between sexes. The New York Heart Association functional class at entry was similar among men and women with systolic dysfunction. However, among patients with preserved systolic function, women were more symptomatic, with a higher functional class at entry (adjusted OR 2.52, 95% CI 1.18 to 5.38). Prescription profiles were similar for men and women. CONCLUSION: Entry into a clinic may be delayed for women with preserved systolic function CHF. However, clinic referral patterns and disease management appeared to be similar among both men and women with systolic dysfunction CHF.

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“…In this series, patients with preserved systolic function were older, more often women, less likely to have coronary artery disease, and more likely to suffer from hypothyroidism. Diller et al [17] also found sex-related trends in their community-based ambulatory practice study. Thus, women were more likely to suffer from a later onset of heart failure than men, and this was more likely diastolic in origin.…”

Section: Introductionmentioning

confidence: 84%

“…Of this cohort, 55% had normal ventricular function, and 80% had either normal or only mildly depressed ventricular function. Diller et al[17] retrospectively reviewed 136 subjects from a community-based family practice office and reported a 40% prevalence of diastolic heart failure. Dauterman et al[18•] evaluated a statewide random sample of 1720 California Medicare patients who were hospitalized for heart failure.…”

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confidence: 99%

Is heart failure with preserved systolic function an overlooked enigma?

et al. 2002

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Heart failure with preserved systolic function, or diastolic heart failure, represents the neglected other half of the pandemic of heart failure. Unlike previously held beliefs, diastolic heart failure carries with it the same connotation of morbidity and mortality as systolic heart failure, particularly in the elderly. Due to lack of standards in application of the diagnosis of diastolic heart failure, studies are difficult to interpret due to heterogeneity in the clinical criteria applied to the patient enrollment. It is imperative that preventive efforts be implemented in high-risk groups, and screening measures with newer biomarkers be considered for identifying underlying structural heart disease in order to employ preventive therapy early in the course of illness. No evidence-based therapeutic strategy to reduce morbidity and mortality has been established, even after the diagnosis of diastolic heart failure is manifest. Current therapy targets lusitropic abnormalities in the realm of impaired relaxation, abnormal diastolic compliance, avoidance of tachycardia, and restoration of atrial booster pump function. Outcomes-based placebo-controlled clinical trials are currently underway to define appropriate therapeutic strategies in diastolic heart failure.

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Congestive Heart Failure Due to Diastolic or Systolic Dysfunction: Frequency and Patient Characteristics in an Ambulatory Setting

Abstract: Congestive heart failure is a heterogeneous condition in this family practice setting, and diastolic dysfunction heart failure occurs frequently. Further study of the natural history and treatment of diastolic dysfunction heart failure should be performed in the primary care setting.

Cited by 38 publications

References 0 publications

Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy

Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy

Are there sex-related differences in specialized, multidisciplinary congestive heart failure clinics?

Is heart failure with preserved systolic function an overlooked enigma?

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