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European Heart Journal 2003 24(5):442-463; doi:10.1016/S0195-668X(02)00823-0
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The EuroHeart Failure survey programme—a survey on the quality of care among patients with heart failure in Europe

Part 1: patient characteristics and diagnosis

J.G.F Clelanda,*, K Swedbergb, F Follathc, M Komajdad, A Cohen-Solale, J.C Aguilarf, R Dietzg, A Gavazzih, R Hobbsi, J Korewickij, H.C Madeirak, V.S Moiseyevl, I Predam, W.H van Gilstn, J Widimskyo for the Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology, N Freemantlep, Joanne Eastaughp and J Masonq

a Department of Cardiology, University of Hull, Castle Hill Hospital, Castle Road, Kingston upon Hull HU16 5JQ, UK;b Göteborg, Sweden;c Zurich, Switzerland;d Paris, France;e Clichy, France;f Valencia, Spain;g Berlin, Germany;h Bergamo, Italy;i Birmingham, UK;j Warsaw, Poland;k Lisbon, Portugal;l Moscow, Russia;m Budapest, Hungary;n Groningen, The Netherlands;o Prague, Czech Republic;p Department of Primary Care & General Practice, University of Birmingham, UK;q Newcastle, UK

Received November 8, 2002; accepted November 20, 2002 * Corresponding author. Tel.: +44-1482-624084; fax: +44-1482-624085
E-mail address: j.g.cleland{at}hull.ac.uk

Background The European Society of Cardiology (ESC) has published guidelines for the investigation of patients with suspected heart failure and, if the diagnosis is proven, their subsequent management. Hospitalisation provides a key point of care at which time diagnosis and treatment may be refined to improve outcome for a group of patients with a high morbidity and mortality. However, little international data exists to describe the features and management of such patients. Accordingly, the EuroHeart Failure survey was conducted to ascertain if appropriate tests were being performed with which to confirm or refute a diagnosis of heart failure and how this influenced subsequent management.

Methods The survey screened consecutive deaths and discharges during 2000–2001 predominantly from medical wards over a 6-week period in 115 hospitals from 24 countries belonging to the ESC, to identify patients with known or suspected heart failure.

Results A total of 46,788 deaths and discharges were screened from which 11,327 (24%) patients were enrolled with suspected or confirmed heart failure. Forty-seven percent of those enrolled were women. Fifty-one percent of women and 30% of men were aged >75 years. Eighty-three percent of patients had a diagnosis of heart failure made on or prior to the index admission. Heart failure was the principal reason for admission in 40%. The great majority of patients (>90%) had had an ECG, chest X-ray, haemoglobin and electrolytes measured as recommended in ESC guidelines, but only 66% had ever had an echocardiogram. Left ventricular ejection fraction had been measured in 57% of men and 41% of women, usually by echocardiography (84%) and was <40% in 51% of men but only in 28% of women. Forty-five percent of women and 22% of men were reported to have normal left ventricular systolic function by qualitative echocardiographic assessment. A substantial proportion of patients had alternative explanations for heart failure other than left ventricular systolic or diastolic dysfunction, including valve disease. Within 12 weeks of discharge, 24% of patients had been readmitted. A total of 1408 of 10,434 (13.5%) patients died between admission and 12 weeks follow-up.

Conclusions Known or suspected heart failure comprises a large proportion of admissions to medical wards and such patients are at high risk of early readmission and death. Many of the basic investigations recommended by the ESC were usually carried out, although it is not clear whether this was by design or part of a general routine for all patients being admitted regardless of diagnosis. The investigation most specific for patients with suspected heart failure (echocardiography) was performed less frequently, suggesting that the diagnosis of heart failure is still relatively neglected. Most men but a minority of women who underwent investigation of cardiac function had evidence of moderate or severe left ventricular dysfunction, the main target of current advances in the treatment of heart failure. Considerable diagnostic uncertainty remains for many patients with suspected heart failure, even after echocardiography, which must be resolved in order to target existing and new therapies and services effectively.

Key Words: Heart failure • Survey • Diagnosis • Mortality • Re-admission


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Eur J Heart Fail, August 1, 2007; 9(8): 776 - 786.
[Abstract] [Full Text] [PDF]


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CirculationHome page
W. L. Miller, K. A. Hartman, M. F. Burritt, D. E. Grill, R. J. Rodeheffer, J. C. Burnett Jr, and A. S. Jaffe
Serial Biomarker Measurements in Ambulatory Patients With Chronic Heart Failure: The Importance of Change Over Time
Circulation, July 17, 2007; 116(3): 249 - 257.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
M. Komajda, O. Hanon, M. Hochadel, F. Follath, K. Swedberg, A. Gitt, and J. G.F. Cleland
Management of octogenarians hospitalized for heart failure in Euro Heart Failure Survey I
Eur. Heart J., June 1, 2007; 28(11): 1310 - 1318.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
M. Metra, P. Ponikowski, K. Dickstein, J. J.V. McMurray, A. Gavazzi, C.-H. Bergh, A. G. Fraser, T. Jaarsma, A. Pitsis, P. Mohacsi, et al.
Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology
Eur J Heart Fail, June 1, 2007; 9(6-7): 684 - 694.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
L. Luthje, D. Vollmann, T. Drescher, P. Schott, D. Zenker, G. Hasenfuss, and C. Unterberg
Intrathoracic impedance monitoring to detect chronic heart failure deterioration: Relationship to changes in NT-proBNP
Eur J Heart Fail, June 1, 2007; 9(6-7): 716 - 722.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
N. K. Khan, K. M. Goode, J. G.F. Cleland, A. S. Rigby, N. Freemantle, J. Eastaugh, A. L. Clark, R. de Silva, M. J. Calvert, K. Swedberg, et al.
Prevalence of ECG abnormalities in an international survey of patients with suspected or confirmed heart failure at death or discharge
Eur J Heart Fail, May 1, 2007; 9(5): 491 - 501.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
D. A. Pascual-Figal, J. A. Hurtado-Martinez, B. Redondo, M. J. Antolinos, J. A. Ruiperez, and M. Valdes
Hyperuricaemia and long-term outcome after hospital discharge in acute heart failure patients
Eur J Heart Fail, May 1, 2007; 9(5): 518 - 524.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
P. Jourdain, G. Jondeau, F. Funck, P. Gueffet, A. Le Helloco, E. Donal, J. F. Aupetit, M. C. Aumont, M. Galinier, J. C. Eicher, et al.
Plasma Brain Natriuretic Peptide-Guided Therapy to Improve Outcome in Heart Failure: The STARS-BNP Multicenter Study
J. Am. Coll. Cardiol., April 24, 2007; 49(16): 1733 - 1739.
[Abstract] [Full Text] [PDF]


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JAMAHome page
M. A. Konstam, M. Gheorghiade, J. C. Burnett Jr, L. Grinfeld, A. P. Maggioni, K. Swedberg, J. E. Udelson, F. Zannad, T. Cook, J. Ouyang, et al.
Effects of Oral Tolvaptan in Patients Hospitalized for Worsening Heart Failure: The EVEREST Outcome Trial
JAMA, March 28, 2007; 297(12): 1319 - 1331.
[Abstract] [Full Text] [PDF]


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JAMAHome page
M. Gheorghiade, M. A. Konstam, J. C. Burnett Jr, L. Grinfeld, A. P. Maggioni, K. Swedberg, J. E. Udelson, F. Zannad, T. Cook, J. Ouyang, et al.
Short-term Clinical Effects of Tolvaptan, an Oral Vasopressin Antagonist, in Patients Hospitalized for Heart Failure: The EVEREST Clinical Status Trials
JAMA, March 28, 2007; 297(12): 1332 - 1343.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
P. Corell, F. Gustafsson, M. Schou, J. Markenvard, T. Nielsen, and P. Hildebrandt
Prevalence and prognostic significance of atrial fibrillation in outpatients with heart failure due to left ventricular systolic dysfunction
Eur J Heart Fail, March 1, 2007; 9(3): 258 - 265.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
M. Lainscak, J. G.F. Cleland, M. J. Lenzen, F. Follath, M. Komajda, and K. Swedberg
International variations in the treatment and co-morbidity of left ventricular systolic dysfunction: Data from the EuroHeart Failure Survey
Eur J Heart Fail, March 1, 2007; 9(3): 292 - 299.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
U. Elkayam, P. Hatamizadeh, and M. Janmohamed
The Challenge of Correcting Volume Overload in Hospitalized Patients With Decompensated Heart Failure
J. Am. Coll. Cardiol., February 13, 2007; 49(6): 684 - 686.
[Full Text] [PDF]


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Eur J Heart FailHome page
O. Milo-Cotter, K. F. Adams, C. M. O'Connor, N. Uriel, E. Kaluski, G. M. Felker, B. Weatherley, Z. Vered, and G. Cotter
Acute heart failure associated with high admission blood pressure -- A distinct vascular disorder?
Eur J Heart Fail, February 1, 2007; 9(2): 178 - 183.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
M. Schaufelberger and A. Rosengren
Heart failure in different occupational classes in Sweden
Eur. Heart J., January 2, 2007; 28(2): 212 - 218.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
M. Lainscak, W. Doehner, and S. D. Anker
Metabolic disturbances in chronic heart failure: A case for the "macho" approach with testosterone?!
Eur J Heart Fail, January 1, 2007; 9(1): 2 - 3.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
J. G.F. Cleland, A. P. Coletta, A. T. Abdellah, M. Nasir, N. Hobson, N. Freemantle, and A. L. Clark
Clinical trials update from the American Heart Association 2006: OAT, SALT 1 and 2, MAGIC, ABCD, PABA-CHF, IMPROVE-CHF, and percutaneous mitral annuloplasty
Eur J Heart Fail, January 1, 2007; 9(1): 92 - 97.
[Abstract] [Full Text] [PDF]



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