Croatian Heart Failure Registry: Procedures and Treatment - three year results

Introduction: Heart failure (HF) is a widespread disease with high morbidity and mortality. Although the ESC guidelines for HF have been published several times, it seems they have been poorly applied in practice. Therefore, in October 2005 the Croatian Society of Cardiology established its own on-line Heart Failure Registry. Here are the three year results. Results: The study population consisted of 850 HF patients (18-98 yrs), mean age 76 (74± ; 11.8) yrs, mostly included in three University Hospitals: Rijeka, Split and Zagreb. There were 454 (53.4%) male patients, mean age 74 (71.6± ; 12.2) yrs, and 396 female patients (46.6%), mean age 79 (76.9± ; 10.6) yrs. Older than 75 yrs were 485 (57.1%) patients. Acute (de novo) HF was diagnosed in 239 (28.1 %) patients, while 588 (69.2 %) manifested as chronic HF. History of hypertension (AH) was recorded in 477 (56%) patients, atrial fibrillation (AF) or undulation (AU) in 384 (45%), coronary artery disease (CAD) in 319 (38%), diabetes (DM) in 298 (35%) patients, dilated cardiomyopathy (DC) in 218 (26%), valvular heart disease in 200 (24%), renal insufficiency in 126 (15%), and chronic obstructive pulmonary disease (COPD) in 123 (15%) patients. Former or actual smokers were almost 25.5 %. NYHA class III was recorded in 287 (33.8%) patients, NYHA class II in 183 (29.3%), and NYHA class IV in 121 or 19.4% patients. On ECG, at admission, atrial fibrillation or undulation was recorded in 345 (40.6%) patients, pace-maker in 29 (3.4%), LBBB in 109 (12.8%), and left ventricular hypertrophy in 123 (14.5%) patients. Cardiomegaly was detected on 497 (58.5%) chest x-rays. Echocardiography examination (ECHO) was performed in 56.5% patients. Mean LVED was 58.8± ; 12.5 mm, and mean LVEF was 44.7± ; 13.3%. Diastolic dysfunction was recorded in 171 (20.1%) patients. BNP and NT-pro BNP tests were performed in only 122 (14.4 %) patients with HF. The leading triggers of HF were arterial hypertension (AH) in 420 (49.4%) patients, atrial fibrillation (AF) or undulation (AU) in 366 (43.1%), valvular heart diseases in 246 (28.9%), acute coronary syndroma (ACS) in 135 (15.9%), infection in 118 (13.9%) and non compliance with heart therapy in 70 (8.2%) patients. Mean hospitalization time was 10± ; 7.7 days (1-57 d). In-hospital mortality was 12.2%. The most prescribed drugs at discharge were diuretics in 726 (85.4%) patients, ACE inhibitors (ACEI) in 403 (47.4%), beta blockers (BB) in 363 (42.7%), digoxin in 332 (39.1%), spironolactone (S) in 273 (32.1%), followed by oral nitrates in 94 (11.1%), amiodarone in 79 (9.3%), calcium channel blockers in 66 (7.7%) and AR blockers (ARB) in 38 (4.5%) patients. The daily dosage of ACEI was for lizinopril -7.2 mg, ramipril and trandolapril – 4.6 mg, fosinopril 5.3 mg, cilazapril 1.8 mg, and for BB: bisoprolol 2.7 mg, karvedilol 11.7 mg. Conclusion: Croatian patients with HF were in older age group (over 70 yrs). In NYHA class III and IV were more than half of the patients. The leading triggers of HF were AH and AF/AU, then coronary diseases and diabetes mellitus. Acute manifestations of HF were found in 1/3 of our patients. ECHO was applied with every second patient. Prescription of ACEI and BB (the drugs proven to prolong the life of HF patients according to Guidelines) were still underprescribed (and below the recommended target dose) as they were prescribed to less than half the patients of our Registry.