Analysis of ambulatory heart failure management and its incidence on one-year survival.

ABSTRACT

AIM: To assess in a daily practice survey one-year survival in a cohort of patients with heart failure (HF) according to their clinical profiles and the way they were managed by cardiologists. METHODS AND RESULTS: A prospective observational survey was conducted in 1941 patients with HF followed up for one year. Results show high rates of prescription for ACE inhibitors, indicating that cardiologists take into account international recommendations. ACE inhibitors are prescribed at dosage levels approaching those recommended by the guidelines. However, beta-blocker prescription still shows a significant deficit and the prescribed doses are much lower than those currently recommended. The multifactorial modeling analysis showed that global heart failure (P=0.004), advanced NYHA class (P<0.001), renal failure (P<0.001) were predictive of poor outcome whereas an increased survival likelihood was observed in patients given ACE-inhibitor/beta-blocker combination compared with beta-blocker alone or ACE-inhibitor alone. CONCLUSION: The results from this study should enhance the prescription of ACE inhibitors and beta-blockers at effective doses in compliance with the guidelines. They also suggest that a synergic positive effect of the combination of these two therapeutic classes is observed in real life situations.