Clinical Features,Treatment Status And One-year Outcomes From 972 Patients With Heart Failure

Objective:The treatment and outcomes of Chinese hospitalized patients with heart failure(HF)have been reported previouly,but much less information obtained from outpatient clinics.The objective of this registry was to investigate the clinical features,medications and outcomes of patients with HF in "the real world".Methods:This study was a prospective,multicenter observational survey of patients with HF presenting to 24 hospitals with different grade in different regions across China.All outpatients and hospitalized patients with HF were enrolled consecutively.From December 2012 to November 2014 a total of 972 patients were included.The demographic characteristics,clinical information and medications were collected.Follow up was performed at one yaer after enrollment,and medication therapy was compared with baseline by paired t-test and Chi-square test.The primary end points were all-cause mortality,hospitalization due to heart failure and the composite of all-cause mortality or hospitalization due to heart failure.Univariate and multivariate Cox and Logistic regression models were used to evaluate risk factors of endpoint events.Results:The average age of enrolled patients was 65.6±13.1 years old,557 patients(57.3%)were male and 610 cases(62.8%)from outpatient clinics.The proportion of patients with hypertension,diabetes,myocardial infarction(or revascularization),and stroke were 59.1%,21.7%,25.2%and 16.9%,respectively.New York Heart Association(NYHA)class Ⅲ/Ⅳ accounted for 58%patients,with significantly more from hospitalized patients than outpatients(70.4%vs 50.8%,P<0.001).More than 90 percent of patients had symptom of dyspnea while climbing in both inpatients and outpatients,or in both patients with left ventricular ejection fraction(LVEF)<50%and>50%.The symptoms of dyspnea while walking on a level area,rest dyspnea and paroxysmal nocturnal dyspnea were found significantly more in hospitalized patients than outpatients(72.1%vs 56.9%,49.3%vs 31.3%,29.6%vs 15.1%,P<0.001),and in patients with LVEF<50%than>50%(67.5%vs 56.6,P<0.005,43.3%vs 35.1%,P<0.05;27.9%vs 15.0%,P<0.001).Electrocardiogram with atrial flutter or fibrillation were found in 227 patients(25.70%),and 53.4%patients showed LVEF<50%by echocardiography.Ischemic heart disease is the leading cause of heart failure(52.2%),followed by hypertension(16.9%),dilated cardiomyopathy(14.1%)and valvular heart disease(9.5%).At baseline,angiotensin blocker(ABs)[include angiotensin converting enzyme inhibitors(ACEI)and angiotensinⅡ receptor blockers(ARB)]were used in 65.7%patients(ACEI 34.3%,ARB 32.0%).Aspirin,diuretics andβ-blockers were used in 62.6%,60.5%and 60.0%patients,respectively.More than half of the patients took aldosterone antagonist.Thirty six percent patients received nitrates and 26.1%patients received digoxin.Compared with hospitalized patients,β-blocker was more likely to be used in outpatients(63.1%vs 54.7%,P<0.05).The usage of β-blockers(66.5%vs 60.5%,P<0.05),ACEI(45.4%vs 29.7%,P<0.001)and aldosterone antagonist(70.5%vs 47.0%,P<0.001)was apparently more in patients with LVEF<50%than those of LVEF>50%.The higher the baseline NYHA class for heart failure,the more usage of ACEI and aldosterone antagonist.At baseline,the target dose of β-blockers,ACEI and ARB were used in 5.2%,29.9%and 10.6%patients,respectively.More outpatients used the target dose of β-blockers(6.5%vs 2.5%,P<0.05)and ACEI(34.0%vs 25.1%,P<0.05)than hospitalized patients.Compared with baseline,anticoagulant was more administrated at one-year follow-up(11.6%vs 9.9%,P<0.05),.with β-blockers and ACEI remained the same,while ARB(30.2%vs 32.7%,P<0.05)and aldosterone antagonist(47.5%vs 53.6%,P<0.001)were less frequently used.Less ARB used were found in outpatients,while less aldosterone antagonist used in hospitalized patients.At one-year follow-up,only the patients used of target dose of ACEI increased(36.6%vs 29.9%,P<0.05),and Less patients with NHYA class Ⅲ/Ⅳ were found(29.1%vs 56.5%,P<0.001).The one-year all-cause mortality was 7.9%,the rate of hospitalization for heart failure and the composite end points was 30.2%and 33.9%,respectively.The rate of hospitalization for heart failure(37.2%vs 26%,P<0.001)and the incidence of composite end points(42%vs 29.1%,P<0.001)were higher in hospitalized patients than that of outpatients.Multivariate Cox regression analysis showed that diabetes mellitus,cigarette smoking,bilateral pleural effusion and nitrates use were independent risk factors for one-year all-cause mortality.Multivariate Logistic regression analysis showed that the independent risk factors of hospitalization for heart failure and all-cause mortality or hospitalization for heart failure were NYHA heart function class Ⅲ/Ⅳ,diabetes mellitus,the heart/chest ratio>0.5 in X-ray and chronic obstructive pulmonary disease(COPD).Conclusions:first of all,ischemic heart disease was the major cause of heart failure in China,and heart failure caused by dilated cardiomyopathy was more common than rheumatic valve heart disease.Secondly,the standardized medication use for patients with heart failure need to improved.Because low utilization rate of evidence based anti-heart failure medication,poor compliance,less use of target dose of beta blockers,ACE I and ARB were found.Thirdly,there were significant differences between inpatients and outpatients with heart failure in terms of symptoms,NYHA heart function classification,medications and outcomes.Therefore,in the future more attention should be paid to assess both inpatients and outpatients with heart failure so as to understand it comprehensively.