Heart failure in patients with coronary heart disease: Prevalence, characteristics and guideline implementation – Results from the German EuroAspire IV cohort

Abstract

BackgroundAdherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation.MethodsPatients from the German sample of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to 36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease; C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) were considered.Results509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%), and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with lower LVEF due to less thorough MRA prescription.ConclusionsIn our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2) disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor antagonists.Trial registrationThis is a cross-sectional analysis of a non-interventional study. Therefore, it was not registered as an interventional trial.

The Effect of Influenza Vaccination on Mortality and Risk of Hospitalization in Patients With Heart Failure: A Systematic Review and Meta-analysis

“…However, most of the studies included in our analysis were adjusted using the propensity score matching system, which adds validity to our results. Second, lower ejection fraction and higher New York Heart Association (NYHA) class are independent predictors of increased mortality in patients with heart failure [39, 40]. In our meta-analysis, influenza seemed to increase the mortality of patients with heart failure, but only 2 of the included studies reported the ejection fraction or the NYHA class of their patients.…”

“…Finally, in 2 of the included studies, the study population consisted of both heart failure patients and patients with chronic heart disease. Although it is known that a large part of heart failure diagnosis is secondary to chronic heart disease like hypertension and coronary heart disease [42], it would be ideal to compare the effect of influenza vaccination exclusively in a heart failure population and have undiluted results.…”

Combination of PBMC miR-19b-5p, miR-221, miR-25-5p and hypertension correlates with increased risk of heart failure in coronary heart disease patients

“…Heart failure (HF), affecting more than 2% individuals around the world, is a grave outcome in CHD patients ( 3 ). Moreover, high prevalence of HF as well as high hospital admission and mortality rates associated with HF has made it a compelling problem in the management of CHD patients ( 4 ). CHD patients with HF can exhibit several typical symptoms such as breathlessness, orthopnea, paroxysmal nocturnal dyspnea, and fatigue, whereas a considerable proportion of HF patients are misdiagnosed as having exacerbation of chronic obstructive pulmonary disease, atypical pneumonia, or other diseases with alike symptoms, which has led to diagnosis-related problems in clinical practice ( 5 ).…”

Determinan Stres, Ansietas, Dan Depresi Pada Pasien Penyakit Jantung Koroner Di Rsud DR Saiful Anwar Malang

“…Kondisi kronik yang ditemukan pada pasien PJK, seperti gagal jantung, juga meningkatkan risiko terjadinya depresi (Konrad et al, 2016). Sebanyak 44.2% pasien PJK mengalami gagal jantung (Morbach et al, 2017). Satu dari dua pasien gagal jantung dilaporkan mengalami depresi (Mbakwen, Aina, & Amadi, 2016).…”