Abstract 116: Improvements in the Medical Management and Survival of Patients Hospitalized with Heart Failure

Abstract

Background: Despite the availability of effective therapies, heart failure (HF) remains a highly prevalent, morbid and costly disease. Few data are available, however, describing long-term trends in the medical management and outcomes of patients hospitalized with acute decompensated heart failure (ADHF). Methods: We reviewed the medical records of 9,748 patients hospitalized with ADHF at all 11 central Massachusetts medical centers from 1995 to 2004, and abstracted information on patient’s demographic, clinical, and treatment characteristics. Mortality was calculated in-hospital and at 30 days and 1, 2, and 5 years after discharge. Results: Between 1995 and 2004 respectively, the use of recommended discharge medications including beta-blockers (26%; 74%), angiotensin pathway inhibitors (50%; 61%), statins (6%; 45%), and aspirin (40%; 63%) increased markedly, while the use of digoxin (55%; 33%), nitrates (68%; 47%), and calcium channel blockers (40%; 30%) declined significantly; nearly all patients received diuretics. Females, the elderly, and patients with chronic lung disease, anemia, incident HF, and multiple comorbidities were less likely to receive recommended medications than respective comparison groups. Between 1995 and 2004, in-hospital mortality decreased from 8.5% to 6.8%; 5-year survival increased from 19% to 28%, a relative improvement of 47%. Conclusion: The use of effective HF therapies increased markedly following the issuance of ACC-AHA guidelines for HF in 1995, with a concomitant increase in survival. Nonetheless, the prognosis for patients hospitalized with HF remains poor, as fewer than 1 in 3 patients survives 5 years. Opportunities exist to further improve the use of HF therapeutics.