Current aspects of the spectrum of acute heart failure syndromes in a real‐life setting: the OFICA study

Abstract

AimsTo improve knowledge of epidemiological data, management, and clinical outcome of acute heart failure (AHF) in a real-life setting in France. Methods and resultsWe conducted an observational survey constituting a single-day snapshot of all unplanned hospitalizations because of AHF in 170 hospitals throughout France (the OFICA survey). A total of 1658 patients (median age 79 years, 55% male) were included. Family doctors were the first medical contact in 43% of cases, and patients were admitted through emergency departments in 64% of cases. Clinical scenarios were mainly acutely decompensated HF (48%) and acute pulmonary oedema (38%) with similar clinical and biological characteristics as well as outcome. Characteristics were different and severity higher in both shock and right HF. Infection and arrhythmia were the most frequent precipitating factors (27% and 24% of cases); diabetes and chronic pulmonary disease were the most frequent co-morbidities (31% and 21%). Over 80% of patients underwent both natriuretic peptide testing and echocardiography. LVEF was preserved (.50%) in 36% of patients and associated with specific characteristics and lower severity. Median hospital stay was 13 days; in-hospital mortality was 8.2%, and independent predictors were age, blood pressure, and creatinine. Treatment at discharge in patients with reduced LVEF included ACE inhibitors/ARBs, beta-blockers, and aldosterone inhibitors in 78, 67, and 27% cases. Non-surgical devices were reported in , 20% of potential candidates. ConclusionThis comprehensive survey analysing AHF in real life emphasizes the heterogeneous nature and overall high severity of AHF. It could be a useful tool to identify unsolved medical issues and improve outcome.

Characteristics and outcomes of heart failure hospitalization before implementation of a heart failure clinic: The PRECIC study

“…2,4 The mean age is similar to that reported in a recent French single-day survey in 170 hospitals of all patients hospitalized for acute HF, 13 but 10 years older than in a recent Portuguese study enrolling patients hospitalized for acute HF only in the cardiology department of the other tertiary university hospital in the city where our study took place. In that study 73.2% of patients had HFrEF, which reflects considerable differences between the two study populations and is evidence of how observational studies provide valuable information about acute HF managed in different clinical scenarios.…”

“…20,21 Our data on gender are in agreement with other reports showing that elderly patients hospitalized with HF are mainly women 22 and that patients with HFpEF are older and more often female than those with HFrEF. 1,5,6,8,13 HF patients managed by internists are more likely to have the characteristics of those managed by general practitioners. In the UK, the mean age of HF patients in general practice is 77 years, similar to that of our population.…”

“…1,3,4,13 It is known that patients with HFpEF are less likely to have coronary heart disease and more likely to have hypertension and AF than those with HFrEF. 5,6 We confirmed that ischemic HF patients more often had HFrEF.…”

Hospital and 4‐Year Mortality Predictors in Patients With Acute Pulmonary Edema With and Without Coronary Artery Disease

“…Several investigators have reported on the in‐hospital mortality in patients with acute heart failure, which is an ample concept that includes acute decompensation of chronic heart failure, cardiogenic shock with or without pulmonary edema, right ventricular failure, and APE 3, 6, 14, 19, 20, 21. In these studies, mortality has varied from 6.4% to 17.2% and they have shown advanced age,6, 14, 19, 21 severe left ventricular dysfunction,14 acute coronary syndromes,14 admission blood pressure,6, 19, 21 renal failure,6, 19, 21 need for inotropics,19 and anemia19 as principal predictors.…”

“…In these studies, mortality has varied from 6.4% to 17.2% and they have shown advanced age,6, 14, 19, 21 severe left ventricular dysfunction,14 acute coronary syndromes,14 admission blood pressure,6, 19, 21 renal failure,6, 19, 21 need for inotropics,19 and anemia19 as principal predictors.…”