European Heart Journal Advance Access originally published online on June 28, 2005
European Heart Journal 2005 26(21):2251-2258; doi:10.1093/eurheartj/ehi383
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The death rate among hospitalized heart failure patients with normal and depressed left ventricular ejection fraction in the year following discharge: evolution over a 10-year period
Servicio de Cardiologia y Unidad Coronaria, Hospital Clinico Universitario de Santiago, Travesia Choupana s/n, 15706 Santiago de Compostela, Spain
Received 3 January 2005; revised 19 May 2005; accepted 26 May 2005; online publish-ahead-of-print 28 June 2005.
* Corresponding author. Tel: +34 981 950757; fax: +34 981 950985. E-mail address: jose.ramon.gonzalez.juanatey{at}sergas.es
Aims To investigate whether changes in clinical characteristics and treatment strategies between 1991 and 2001 have had an impact on the survival of patients hospitalized with congestive heart failure (CHF) and whether those with normal left ventricular ejection fraction (LVEF
50%) differ in this respect from those with depressed LVEF.
Methods and results We studied 1482 patients who had been admitted to the Cardiology Service of a tertiary Spanish hospital in the last 10 years with CHF. Among the 1110 for whom LVEF was evaluated, the prevalence of normal LVEF rose from 37% in the period 1991–96 (Period 1) to 47% in the period 2000–2001 (Period 3). The intensity of both diagnostic and therapeutic measures also increased during this 10-year period. The 1-year survival rate remained virtually unchanged in the whole group of patients, being 82, 84, and 82% in Periods 1, 2 (1997–99), and 3, respectively, even though the prognosis of patients with depressed LVEF (<50%) improved significantly, with 1-year survival rates of 76, 77, and 84% in Periods 1, 2, and 3, respectively; the normal LVEF group had decreasing 1-year survival rates of 88, 86, and 81% in Periods 1, 2, and 3, respectively, although the increased risk of death was not statistically significant.
Conclusion Although in our centre the death rate among hospitalized CHF patients with depressed LVEF during the first year after discharge has tended to fall over the past 10 years, application of current clinical guidelines has led to no such decrease for patients with normal LVEF. This situation points to a need to reconsider the diagnostic and therapeutic strategy to be employed with this latter group of patients.
Key Words: Heart failure • Left ventricular systolic function • Evolution of the prognosis
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