Comparison of 18-Month Outcomes of Ambulatory Patients With Reduced (≤40%) Left Ventricular Ejection Fraction Treated in a Community-Based, Dedicated Heart Failure Clinic Versus Treated Elsewhere
| Autor: | Shlomo Birkenfeld, Henri Jino, Daniel Murninkas, Ester Yohananov, David Hasdai, Osnat Itzhaki Ben Zadok, Zaza Iakobishvili |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty New York Heart Association Class Time Factors Treatment outcome Adrenergic beta-Antagonists Electric Countershock Angiotensin-Converting Enzyme Inhibitors 030204 cardiovascular system & hematology Ventricular Function Left 03 medical and health sciences Angiotensin Receptor Antagonists 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine Israel Aged Mineralocorticoid Receptor Antagonists Retrospective Studies Community based Heart Failure Ejection fraction business.industry Retrospective cohort study Stroke Volume Odds ratio medicine.disease Survival Rate Treatment Outcome Heart failure Ambulatory Cardiology Female Guideline Adherence Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The American journal of cardiology. 123(7) |
| ISSN: | 1879-1913 |
| Popis: | We sought to examine the management and outcomes of ambulatory patients with heart failure and reduced ejection fraction in a community-based, dedicated clinic. Patients with left ventricular ejection fraction (LVEF) ≤40% were actively solicited to attend a community-based, dedicated clinic. Eligible patients who chose to decline constituted our control group. Of 552 patients with LVEF ≤40% (median age 73 years and median LVEF 35%), 304 (55%) agreed to attend the clinic. Patients with worse New York Heart Association class were more likely to attend the clinic (odds ratio 2.07 [1.45, 2.95], p0.001), whereas women were more likely to decline (odds ratio 0.63 [0.42, 0.93], p0.022). During 18 months of follow-up, patients in the dedicated clinic significantly improved their functional capacity (56% New York Heart Association 3 to 4 at baseline vs 27% at follow-up, p0.001) and LVEF (35% [interquartile range 25, 35] at baseline vs 35% (interquartile range 30, 40) at follow-up, p0.001). In comparison with patients managed routinely, patients treated in a dedicated clinic achieved better guideline-recommended pharmacological treatment (65% vs 85% receiving β blockers, p0.001, 65% vs 82% receiving renin-angiotensin inhibitors, p = 0.0006, 31% vs 45% receiving mineralocorticoid receptor antagonists, p0.001). During follow-up, electrical device implantation was similar (6% vs 7% of dedicated-HF-clinic patients, p = 0.700). Furthermore, overall survival was better in patients treated in the clinic (log rank p = 0.0006), even after censoring the first 4 months to account for potential bias (log rank p = 0.0232). In conclusion, management in a community-based, dedicated clinic compared with routine management was associated with augmented guideline-recommended treatment and improved survival. |
| Databáze: | OpenAIRE |
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