Temporal trends in baseline characteristics and treatment
modalities of patients with heart failure at the University
Hospital Centre Split – where are we now?

    Authors

    Abstract

    **Introduction**: Heart failure (HF) is a complex clinical syndrome associated with high mortality, morbidity, and healthcare expenditures. (1, 2) We sought to determine temporal trends concerning baseline characteristics and treatment modalities of patients enrolled at our Center during two periods: 2008-2012 and 2018-2019 for which data were available. **Patients and Methods**: Patients admitted with the chief diagnosis of HF were stratified into two groups for the statistical analysis. The historic cohort comprised patients admitted during the period 2008-2012 (N=356) while the contemporary cohort (2018-2019) consisted of 108 patients. **Results**: Patients in the contemporary cohort were younger, had a significantly higher prevalence of non-ischemic cardiomyopathy, diabetes mellitus, more preserved renal function, higher hemoglobin, higher uric acid, and lower potassium levels compared to the historic cohort. On the other hand, distribution of sex, blood pressure at admission, the prevalence of atrial fibrillation, NYHA functional class, left ventricular ejection fraction and left end-diastolic diameters were similar in both groups (**Table 1**). As shown in **Figure 1A**, we observed a significant decline in the prevalence of HF with midrange ejection fraction in a contemporary cohort compared to a historic one (p2* | 49 ± 23 | 58 ± 25 | **<0.001*** | | **Uric acid**, *mmol/L* | 486 ± 172 | 535 ± 166 | **<0.001*** | | **Hemoglobin**, *g/L* | 126 ± 20 | 134 ± 20 | **<0.001*** | | Sodium, *mmol/L* | 138 ± 4.4 | 138 ± 3.7 | 0.762 | | **Potassium**, *mmol/L* | 4.5 ± 0.8 | 4.1 ± 0.5 | **<0.001*** | | Systolic blood pressure, *mmHg* | 137 ± 28 | 137 ± 29 | 0.145 | | Diastolic blood pressure, *mmHg* | 81 ± 15 | 81 ± 13 | 0.204 | [†] LVEDd-left ventricular end-diastolic diameter; LVEF-left ventricular ejection fraction; NYHA-New York Heart Association; eGFR-estimated glomerular filtration rate *denotes statistically significant result at p<0.05 level (Chi-square analysis or Student t-test were used for comparisons between two groups) FIGURE 1. A) Change in heart failure clinical phenotypes over time in two compared cohorts; B) Trends in pharmacotherapy use over time in two compared cohorts. ACE-Angiotensin-converting enzyme; ARB-angiotensin receptor blocker; HFmrEF-heart failure with midrange ejection fraction; HFpEF-heart failure with preserved ejection fraction; HFrEF-heart failure with reduced ejection fraction **Conclusions**: After the approximately 10-year timespan, we observed several changes in baseline characteristics of HF patients treated at our center. The most prominent change is the highest relative growth in the prevalence of HF with preserved ejection fraction. Likewise, the proportional use of life-prolonging pharmacotherapies and anticoagulation coverage (nowadays mostly direct oral anticoagulants) significantly improved over time.

    Keywords

    heart failure, pharmacotherapy, risk factors, temporal characteristics, inpatient

    DOI

    https://doi.org/10.15836/ccar2021.17

    Literature

    1. Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017 April;3(1):7–11. https://doi.org/10.15420/cfr.2016:25:2
    2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016 August;18(8):891–975. https://doi.org/10.1002/ejhf.592
    Cardiologia Croatica
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    Temporal trends in baseline characteristics and treatment
modalities of patients with heart failure at the University
Hospital Centre Split – where are we now?

    Extended Abstract
    Issue1-2
    Published
    Pages17-18
    PDF via DOIhttps://doi.org/10.15836/ccar2021.17
    heart failure
    pharmacotherapy
    risk factors
    temporal characteristics
    inpatient

    Authors

    Josip Anđelo Borovac*ORCIDUniversity of Split School of Medicine, Split, Croatia
    Joško BožićORCIDUniversity of Split School of Medicine, Split, Croatia
    Darko DuplančićORCIDUniversity of Split School of Medicine, Split, Croatia
    Zora Sušilović GrabovacORCIDUniversity Hospital Centre Split, Split, Croatia
    Duška GlavašORCIDUniversity of Split School of Medicine, Split, Croatia

    *Correspondence email: jborovac@mefst.hr

    Abstract

    **Introduction**: Heart failure (HF) is a complex clinical syndrome associated with high mortality, morbidity, and healthcare expenditures. (1, 2) We sought to determine temporal trends concerning baseline characteristics and treatment modalities of patients enrolled at our Center during two periods: 2008-2012 and 2018-2019 for which data were available. **Patients and Methods**: Patients admitted with the chief diagnosis of HF were stratified into two groups for the statistical analysis. The historic cohort comprised patients admitted during the period 2008-2012 (N=356) while the contemporary cohort (2018-2019) consisted of 108 patients. **Results**: Patients in the contemporary cohort were younger, had a significantly higher prevalence of non-ischemic cardiomyopathy, diabetes mellitus, more preserved renal function, higher hemoglobin, higher uric acid, and lower potassium levels compared to the historic cohort. On the other hand, distribution of sex, blood pressure at admission, the prevalence of atrial fibrillation, NYHA functional class, left ventricular ejection fraction and left end-diastolic diameters were similar in both groups (**Table 1**). As shown in **Figure 1A**, we observed a significant decline in the prevalence of HF with midrange ejection fraction in a contemporary cohort compared to a historic one (p2* | 49 ± 23 | 58 ± 25 | **<0.001*** | | **Uric acid**, *mmol/L* | 486 ± 172 | 535 ± 166 | **<0.001*** | | **Hemoglobin**, *g/L* | 126 ± 20 | 134 ± 20 | **<0.001*** | | Sodium, *mmol/L* | 138 ± 4.4 | 138 ± 3.7 | 0.762 | | **Potassium**, *mmol/L* | 4.5 ± 0.8 | 4.1 ± 0.5 | **<0.001*** | | Systolic blood pressure, *mmHg* | 137 ± 28 | 137 ± 29 | 0.145 | | Diastolic blood pressure, *mmHg* | 81 ± 15 | 81 ± 13 | 0.204 | [†] LVEDd-left ventricular end-diastolic diameter; LVEF-left ventricular ejection fraction; NYHA-New York Heart Association; eGFR-estimated glomerular filtration rate *denotes statistically significant result at p<0.05 level (Chi-square analysis or Student t-test were used for comparisons between two groups) FIGURE 1. A) Change in heart failure clinical phenotypes over time in two compared cohorts; B) Trends in pharmacotherapy use over time in two compared cohorts. ACE-Angiotensin-converting enzyme; ARB-angiotensin receptor blocker; HFmrEF-heart failure with midrange ejection fraction; HFpEF-heart failure with preserved ejection fraction; HFrEF-heart failure with reduced ejection fraction **Conclusions**: After the approximately 10-year timespan, we observed several changes in baseline characteristics of HF patients treated at our center. The most prominent change is the highest relative growth in the prevalence of HF with preserved ejection fraction. Likewise, the proportional use of life-prolonging pharmacotherapies and anticoagulation coverage (nowadays mostly direct oral anticoagulants) significantly improved over time.

    Literature

    1. 1.
      Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017 April;3(1):7–11.DOI
    2. 2.
      Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016 August;18(8):891–975.DOI