Temporal variation in the prognosis and treatment of advanced heart failure - before and after 2000.
Arq Bras Cardiol
; 102(5): 495-504, 2014 May.
Article
em En, Pt
| MEDLINE
| ID: mdl-24759950
ABSTRACT
BACKGROUND:
The treatment of heart failure has evolved in recent decades suggesting that survival is increasing.OBJECTIVE:
To verify whether there has been improvement in the survival of patients with advanced heart failure.METHODS:
We retrospectively compared the treatment and follow-up data from two cohorts of patients with systolic heart failure admitted for compensation up to 2000 (n = 353) and after 2000 (n = 279). We analyzed in-hospital death, re-hospitalization and death in 1 year of follow-up. We used Mann-Whitney U test and chi-square test for comparison between groups. The predictors of mortality were identified by regression analysis through Cox proportional hazards model and survival analysis by the Kaplan-Meier survival analysis.RESULTS:
The patients admitted until 2000 were younger, had lower left ventricular impairment and received a lower proportion of beta-blockers at discharge. The survival of patients hospitalized before 2000 was lower than those hospitalized after 2000 (40.1% vs. 67.4%; p<0.001). The independent predictors of mortality in the regression analysis were Chagas disease (hazard ratio 1.9; 95% confidence interval 1.3-3.0), angiotensin-converting-enzyme inhibitors (hazard ratio 0.6; 95% confidence interval 0.4-0.9), beta-blockers (hazard ratio 0.3; 95% confidence interval 0.2-0.5), creatinine ≥ 1.4 mg/dL (hazard ratio 2.0; 95% confidence interval 1.3-3.0), serum sodium ≤ 135 mEq/L (hazard ratio 1.8; 95% confidence interval 1.2-2.7).CONCLUSIONS:
Patients with advanced heart failure showed a significant improvement in survival and reduction in re-hospitalizations. The neurohormonal blockade, with angiotensin-converting-enzyme inhibitors and beta-blockers, had an important role in increasing survival of these patients with advanced heart failure.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Insuficiência Cardíaca
/
Hospitalização
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do sul
/
Brasil
Idioma:
En
/
Pt
Ano de publicação:
2014
Tipo de documento:
Article