Morbidity and mortality among heart failure patients in Galicia, N.W. Spain: the GALICAP study

Abstract Objective Characterization of current morbidity and mortality among heart failure (HF) outpatients in Galicia (N.W. Spain), together with their main determinants. Design Prospective multicentre study involving 149 primary care physicians. Setting Primary care physicians selected randomly from among all (1959) primary care physicians in Galicia. Patients Clinical and epidemiological information for 1195 outpatients with HF were collected in 2006, with a mean follow-up of 6.5±1.5 months. Main outcome measures Survival rates were calculated by Cox's proportional hazard model. Results Mean patient age was 76 years, 48% were male, 82% had a history of arterial hypertension, and 32% ischaemic cardiopathy. Echocardiography had been performed in 67%, showing preserved systolic function in 61%. Ninety-two (8%) died during follow-up [74 (80%) of them from cardiac causes], and 313 (29%) were re-admitted to hospital [230 (73%) of them for cardiac reasons]. Multivariate analysis identified the following independent predictors of cardiovascular death and/or readmission: ischaemic cardiopathy [hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.29–4.40], stroke (HR 1.79, CI 1.18–2.73), oedema (HR 1.49, CI 1.10–2.03), anaemia (HR 1.66, CI 1.21–2.27), deteriorated systolic function (HR 1.62, CI 1.19–2.20), and previous cardiovascular admissions (HR 2.33, CI 1.67–3.24). Residence in the Barbanza district was identified as an independent predictor of survival free from cardiovascular admission (HR 0.56, CI 0.37–0.86). Conclusion Morbidity and mortality are currently high among Galician HF patients, and their best single predictor is previous hospitalization for cardiovascular reasons.