Characteristics and treatment of patients with heart failure admitted to a cardiology department in 2002 and 2016

Aim. To investigate the difference in characteristics of patients admitted to the Tomsk National Research Medical Center with a diagnosis of heart failure (HF) in 2002 and 2016.

Methods. Medical charts of all patients hospitalised in a single centre, with a diagnosis of HF, were included. Two three‑month periods were compared from January 2002 (n=210) and January 2016 (n=378).

Results. Fewer patients with HF had symptoms or required diuretics in 2016 (63 % vs 98,6 %, p<0.001). During this period the percentage of patients with HFpEF increased from 58.6 % to 74.1 % (p=0.001) whereas those with HFrEF remained similar (19.5 % vs 14.0 %, p=0.1) and those with HFmrEF declined (21.9 % vs 11,9 %, p=0.007). In patients with HFrEF the prescription of ACEi / ARB remained similar (80.4 vs 88 %, p=0.3), beta‑blockers increased from 68 to 85 % (p=0.03) and aldosterone antagonists from 9.7 to 49 % (p<0.001).

Conclusion. Prescription rates for prognostic medications in HFrEF improved in 2016. The substantial percentage of patients diagnosed with HFpEF without symptoms or diuretic raises the question of whether a diagnosis of HF was appropriate in some cases.

1. Belenkov Y. N., Mareev V. Y., Ageev F. T., Fomin I. V., Badin Y. V., Polyakov D. S. et al. Veritable prevalence of CHF in the European part of Russian Federation (EPOCHA trial, hospital stage). Russian Heart FailureJournal. 2011;12(2):63-8. DOI: 10.18087/rhfj.2011.2.1510

2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and 5. treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129-200. DOI: 10.1093/eurheartj/ehw128

3. Fomin I. V. Chronic heart failure in Russian Federation: what do we know and what to do. Russian journal of cardiology. 2016;8:7-13. DOI: 10.15829/1560-4071-2016-8-7-13

4. Van Riet EES, Hoes AW, Wagenaar KP, Limburg A, Landman MAJ, Rutten FH. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review: Prevalence of heart failure and ventricular dysfunction. European Journal of Heart Failure. 2016;18(3):242-52. DOI: 10.1002/ejhf.483

5. Bleumink GS, Knetsch AM, Sturkenboom MCJM, Straus SMJM, Hofman A, Deckers JW et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. European Heart Journal. 2004;25(18):1614-9. DOI: 10.1016/j.ehj.2004.06.038

6. Kraiem N., Polyakov D. S., Fomin I. V., Vinogradova N. G., Valikulova F. Yu., Vaysberg A. R. et al. Transthyretin amyloidosis in a cohort of old and very old patients with chronic heart failure. Kardiologiia. 2018;58(S2):25-32. DOI: 10.18087/cardio.2439

7. Mareev Yu. V., Mareev V. Yu. Characteristics and treatment of hospitalized patients with CHF. Kardiologiia. 2017;17(S4):20-30. DOI:10.18087/cardio.2433]

8. Pfeffer MA, Claggett B, Assmann SF, Boineau R, Anand IS, Clausell N et al. Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. Circulation. 2015;131(1):34-42. DOI: 10.1161/CIRCULATIONAHA.114.013255

9. Kristensen SL, Kober L, Jhund PS, Solomon SD, Kjekshus J, Mc Kelvie RS et al. International Geographic Variation in Event Rates in Trials of Heart Failure with Preserved and Reduced Ejection Fraction. Circulation. 2015;131(1):43-53. DOI: 10.1161/CIRCULATIONAHA.114.012284

10. Garganeeva A. A., PchelnikovA. V., Teplyakov A. T., Karpov R. S. Epidemiology and treatment of chronic heart failure in real practice. Results of the Tomsk Regional Program on chronic heart failure. Cardiovascular Therapy and Prevention. 2004;3(6-2):60-5.

11. Mareev V. Yu., Fomin I. V., Ageev F. T., Arutyunov G. P., Begrambekova Yu. L., Belenkov Yu. N. et al. Clinical guidelines. Chronic heart failure (CHF). Russian Heart Failure Journal. 2017;18(1):3-40. DOI: 10.18087/rhfj.2017.1.2346

12. McKee PA, Castelli WP, McNamara PM, Kannel WB. The Natural History of Congestive Heart Failure: The Framingham Study. New England Journal of Medicine. 1971;285(26):1441-6. DOI: 10.1056/NEJM197112232852601

13. Lopatin Yu. M. Randomized Controlled Trials in Patients with Heart Failure in Russia Following the Study TOPCAT: What Awaits us in the Future. Kardiologiia. 2017;17(8):47-50. DOI: 10.18087/cardio.2017.10025

14. Garganeeva A. A., Okrugin S. A., Borel’ K. N., Kuzheleva E. A., Parshin E. A. Myocardial infarction at the border of two centuries: demographic and social tendencies. Clinical medicine. 2016;94(6):463-6. DOI: 10.18821/0023-2149-2016-94-6-463-466

15. Loukianov M. M., Boytsov S. A., Yakushin S. S., Martsevich S. Yu., Vorobyev A. N., Zagrebelnyy A. V. et al. Concomitant cardiovascular diseases and antihypertensive treatment in outpatient practice (by the RECVASA Registry data). Rational Pharmacotherapy in Cardiology. 2016;12(1):4-15. DOI: 10.20996/1819-6446-2016-12-1-4-15

16. Shavarova E. K., Babaeva L. A., Padaryan S. S., Soseliya N. N., Lukina O. I., Milto A. S. Chronic Heart Failure: Clinical Guidelines and Real Clinical Practice. Rational Pharmacotherapy in Cardiology. 2016;12(6):631-7. DOI: 10.20996/1819-6446-2016-12-6-631-637

17. Polyakov D. S., Fomin I. V., Valikulova F. Yu., Vaysberg A. R., Kraiem N., Badin Yu. V. et al. The EPOCH-CHF epidemiological program:decompensated chronic heart failure in real-life clinical practice (EPOCH-D-CHF). Russian Heart FailureJournal. 2016;17 (5):299-305. DOI: 10.18087/rhfj.2016.5.2239

18. Arutyunov A. G., Dragunov D. O., Arutyunov G. P., Rylova A. K., Pashkevich D. D., Viter K. V. et al. First open study of syndrome of acute decompensation of heart failure and concomitant diseases in Russian Federation: independent registry ORAKUL. Kardiologiia. 2015;55(5):12-21. DOI: 10.18565/cardio.2015.5.12-21

19. Shah KS, Xu H, Matsouaka RA., Bhatt DL, Heidenreich PA, Hernandez AF et al. Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction. Journal of the American College of Cardiology. 2017;70(20):2476-86. DOI: 10.1016/j.jacc.2017.08.074

20. Kramer DG, Trikalinos TA, Kent DM, Antonopoulos GV Konstam MA, UdelsonJE. Quantitative Evaluation ofDrug or Device Effects on Ventricular Remodeling as Predictors of Therapeutic Effects on Mortality in Patients with Heart Failure and Reduced Ejection Fraction. Journal of the American College of Cardiology. 2010;56(5):392-406. DOI: 10.1016/j.jacc.2010.05.011

21. Maggioni AP, Anker SD, Dahlstrom U, Filippatos G, Ponikowski P, Zannad F et al. Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure LongTerm Registry. EuropeanJournal of Heart Failure. 2013;15(10):1173-84. DOI: 10.1093/eurjhf/hft134

22. Chioncel O, Mebazaa A, Harjola V-P, Coats AJ, Piepoli MF, Crespo-Leiro MG et al. Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry: Outcome of patients hospitalized for acute heart failure. EuropeanJournal of Heart Failure. 2017;19(10):1242-54. DOI: 10.1002/ejhf.890

23. Komajda M, Lapuerta P, Hermans N, Gonzalez-JuanateyJR, van Veld-huisen DJ, Erdmann E et al. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. European Heart Journal. 2005;26(16):1653-9. DOI: 10.1093/eurheartj/ehi251

24. Heidenreich PA, Hernandez AF, Yancy CW, Liang L, Peterson ED, Fon-arow GC. Get with The Guidelines program participation, process of care, and outcome for Medicare patients hospitalized with heart failure. Circulation. Cardiovascular Quality and Outcomes. 2012;5(1): 37-43. DOI: 10.1161/CIRCOUTCOMES.110.959122

25. Boytsov S. A., Luk’yanov M. M., Yakushin S. S., Martsevich S. Yu., Vorobyov A. N., Zagrebelny A. V. et al. Cardiovascular diseases registry (RECVAZA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatient-polyclinic practice. Cardiovascular Therapy and Prevention. 2014;13(6):44-50.. DOI: 10.15829/1728-8800-2014-6-44-50