The prognosis of patients with chronic heart failure, depending on adherence to observation in a specialized heart failure treatment center

Actuality. The risk of death of patients with chronic heart failure (CHF) after acute decompensation of heart failure (ADHF) is directly related to the quality of the treatment of CHF after discharge from the hospital. In order to achieve the maximum effect of therapy in patients with CHF, experts in Europe and the USA recommend the creation of centers of specialized medical care for patients with CHF.
Objective: to determine the risks of general, cardiovascular mortality and death from ADHF in patients with CHF during two years of observation, depending on their adherence to observation in a specialized center for the treatment of chronic heart failure (center CHF). Materials and methods. The study consistently included 942 patients with CHF after ADHF. The adherence of patients to follow up in center CHF was analyzed and 4 groups were distinguished: group 1 (n = 313) included patients who were observed continuously for two years; group 2 (n = 382) included patients who, after discharge, had never been observed in the center CHF; group 3 (n = 197) consisted of patients who were monitored at center CHF during the first year and then discontinued, and group 4 (n = 49) united patients who, when included in the study, abandoned observation, but after a year began to be constantly observed during the second year center CHF. Results. Statistically significant differences in age were registered only between groups 1 and 2 (69.6+9.9 and 71.8+11 years, respectively, р_1/2=0.006). The overall mortality over the 2 years of follow-up was significantly higher in group 2 (32.4%) versus group 1 (1.2%, OR=3.8, 95% CI 2.5–5.7; p_1/2<0.001 ); compared with group 3 (9.1%, OR=4.8, 95% CI 2.8–8.1; p_2/3<0.001) and group 4 (8,2%, OR = 5.4, 95% CI 1.9-15.3; p_2/4=0.0005). Cardiovascular mortality (CVM) for 2 years of follow-up was significantly higher in group 2 versus group 1 (8.1% and 1.3% of cases, OR=6.8, 95% CI 2.4–19.5; p_1/2<0.001), as well as in comparison with group 3 (CVM 3% for 2 years, OR=2.8, 95% CI 1.1-6.8; p_2/3=0.02). CVM in group 4 (6.1%) was 5 times higher in comparison with group 1 (OR=5.0, 95% CI 1.1-23.2; p_1/4=0.02). The risks of death from ADHF over the 2 years of follow-up were significantly higher in group 2 (16.4%) compared with all groups: with group 1 (6.4%) OR=2.9, 95% CI 1.7-4, 9, p_1/2<0.001; with group 3 (5.1%) OR=3.7, 95% CI 1.8-7.3, p_2/3<0.001; and with group 4 (2%) OR=9.5, 95% CI 1.3-69.7, p_2/4= 0.008. The combined endpoint (CVM and death from ADHF in 2 years of follow-up) was also significantly higher in group 2 (24.5%) compared with all compared groups: group 1 (7.7%), OR=3.9, 95% CI 2.4-6.3, p_1/2<0.001; group 3 (8.1%), OR=3.7, 95% CI 2.1-6.5, p_2/3<0.001; and group 4 (8.2%), OR=3.7, 95% CI 1.3-10.4; p_2/4=0.01. Conclusion. Surveillance of patients with CHF after an episode of ADHF in a specialized center CHF, both for a long time (two years) and partially during the first year of observation, reduces the risk of all-cause death, CVM and death from ADHF.

1. Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Fomin I.V., Badin Yu.V., Polyakov D.S. et al. Etiological causes of CHF formation in the European part of the Russian Federation (hospital stage). Russian Heart Failure Journal. 2011;12 (6):333–8. DOI: 10.18087/rhfj.2011.6.1589

2. Correction to “Rehospitalization in a National Population of Home Health Care Patients with Heart Failure”. Health Services Research. 2017;52(5):1958–60. DOI: 10.1111/1475-6773.12761

3. Okumura N, Jhund PS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL et al. Importance of Clinical Worsening of Heart Failure Treated in the Outpatient Setting: Evidence from the Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in HeartFailure Trial (PARADIGM-HF). Circulation. 2016;133(23):2254–62. DOI: 10.1161/CIRCULATIONAHA.115.020729

4. Desai AS, Stevenson LW. Rehospitalization for Heart Failure: Predict or Prevent? Circulation. 2012;126(4):501–6. DOI: 10.1161/CIRCULATIONAHA.112.125435

5. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G et al. Executive Summary: Heart Disease and Stroke Statistics – 2010 Update: A Report from the American Heart Association. Circulation. 2010;121(7):948–54. DOI: 10.1161/CIRCULATIONAHA.109.192666

6. Setoguchi S, Stevenson LW, Schneeweiss S. Repeated hospitalizations predict mortality in the community population with heart failure. American Heart Journal. 2007;154(2):260–6. DOI: 10.1016/j.ahj.2007.01.041

7. Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K et al. Angiotensin–Neprilysin Inhibition in Acute Decompensated Heart Failure. New England Journal of Medicine. 2019;380(6):539–48. DOI: 10.1056/NEJMoa1812851

8. Di Tano G, De Maria R, Gonzini L, Aspromonte N, Di Lenarda A, Feola M et al. The 30-day metric in acute heart failure revisited: data from IN-HF Outcome, an Italian nationwide cardiology registry. European Journal of Heart Failure. 2015;17(10):1032–41. DOI: 10.1002/ejhf.290

9. Crespo-Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G et al. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology: Advanced heart failure: HFA position statement. European Journal of Heart Failure. 2018;20(11):1505–35. DOI: 10.1002/ejhf.1236

10. Chun S, Tu JV, Wijeysundera HC, Austin PC, Wang X, Levy D et al. Lifetime Analysis of Hospitalizations and Survival of Patients Newly Admitted with Heart Failure. Circulation: Heart Failure. 2012;5(4):414–21. DOI: 10.1161/CIRCHEARTFAILURE.111.964791

11. Russo MJ, Gelijns AC, Stevenson LW, Sampat B, Aaronson KD, Renlund DG et al. The Cost of Medical Management in Advanced Heart Failure During the Final Two Years of Life. Journal of Cardiac Failure. 2008;14(8):651–8. DOI: 10.1016/j.cardfail.2008.06.005

12. 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 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

13. Stewart S. Financial aspects of heart failure programs of care. European Journal of Heart Failure. 2005;7(3):423–8. DOI: 10.1016/j.ejheart.2005.01.001

14. McAlister FA, Stewart S, Ferrua S, McMurray JJJV. Multidisciplinary strategies for the management of heart failure patients at high risk for admission. Journal of the American College of Cardiology. 2004;44(4):810–9. DOI: 10.1016/j.jacc.2004.05.055

15. Sochalski J, Jaarsma T, Krumholz HM, Laramee A, McMurray JJV, Naylor MD et al. What Works In Chronic Care Management: The Case Of Heart failure. Health Affairs. 2009;28(1):179–89. DOI: 10.1377/hlthaff.28.1.179

16. Mareev V.Yu., Ageev F.T., Arutyunov G.P., Koroteev A.V., Mareev Yu.V., Ovchinnikov A.G. et al. SEHF, RSC and RSMSIM national guidelines on CHF diagnostics and treatment (fourth revision) Approved at the SEHF Congress on December 7, 2012, at the SEHF Board of Directors meeting on March 31, 2013, and at the RSC Congress on September 25, 2013. Russian Heart Failure Journal. 2013;14(7):379–472. DOI: 10.18087/rhfj.2013.7.1860

17. Mareev V.Yu., Fomin I.V., Ageev F.T., Arutiunov 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

18. Polyakov D.S., Fomin I.V., Valikulova F.Yu., Vaisberg 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 Failure Journal. 2016;17 (5):299–305. DOI: 10.18087/rhfj.2016.5.2239

19. Vinogradova N.G. City Center for the Treatment of Chronic Heart Failure: the organiza-tion of work and the effectiveness of treatment of patients with chronic heart failure. Kardiologiia. 2019;59(2S):31–9. DOI: 10.18087/cardio.2621

20. Vinogradova N.G. Effectiveness of specialized medical care in patients with chronic heart failure. Russian Heart Failure Journal. 2017;18(2):122–32. DOI: 10.18087/rhfj.2017.2.2313

21. Stewart S, Carrington MJ, Marwick T, Davidson PM, Macdonald P, Horowitz J et al. The WHICH? trial: rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients. European Journal of Heart Failure. 2011;13(8):909–16. DOI: 10.1093/eurjhf/hfr048

22. Stewart S, Horowitz JD. Specialist Nurse Management Programmes: Economic Benefits in the Management of Heart Failure. Pharmaco Economics. 2003;21(4):225–40. DOI: 10.2165/00019053-200321040-00001

23. Strömberg A, Mårtensson J, Fridlund B, Levin L-A, Karlsson J-E, Dahlström U. Nurse-led heart failure clinics improve survival and selfcare behaviour in patients with heart failure: results from a prospective, randomised trial. European Heart Journal. 2003;24(11):1014–23. PMID: 12788301

24. Riley JP, Astin F, Crespo-Leiro MG, Deaton CM, Kienhorst J, Lambrinou E et al. Heart Failure Association of the European Society of Cardiology heart failure nurse curriculum: Heart failure nurse curriculum. European Journal of Heart Failure. 2016;18(7):736–43. DOI: 10.1002/ejhf.568

25. Von Scheidt W, Zugck C, Pauschinger M, Hambrecht R, Bruder O, Hartmann A et al. Characteristics, management modalities and outcome in chronic systolic heart failure patients treated in tertiary care centers: results from the EVIdence based TreAtment in Heart Failure (EVITAHF) registry. Clinical Research in Cardiology. 2014;103(12):1006–14. DOI: 10.1007/s00392-014-0743-x