Öz
Amaç: Güncel tedavi kılavuzlarında kalp yetersizliğinde mortalite azaltan girişim ve tedavi yöntemleri ayrıntılı olarak önerilmektedir. Bir tersiyer merkez olarak, kliniğimizde gerçek klinik pratikte kalp yetersizliğinde tedavi yaklaşımı ve uluslararası kılavuzların önerilerine ne kadar uyulduğu, takip durumu tespit etmeye amaçlanmıştır.
Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi (EÜTF) Hastanesi Kardiyoloji Kliniğine, 2009 ile 2010 tarihleri arasında kalp yetersizliği kliniği ile yatırılıp tedavi edilen olguların, klinik verilerinin uluslararası kılavuzlarla uyumunun retrospektif olarak değerlendirilmesi ve 5 yıllık bir sürede takibin araştırılması amaçlanmıştır. Çalışmanın gerçek klinik uygulamayı yansıtmasını sağlamak amacıyla retrospektif kohort yöntemin kullanılması uygun görülmüştür.
Bulgular: Çalışmaya, kalp yetersizliği tanısı ile yatırılarak tedavi edilmiş olan 496 hasta alınmıştır. Yeni kalp yetersizliği tanısı 121 (%24,4) hasta, kronik kalp yetersizliği tanısı 375 (%75,6) hasta alınmıştır. Akut kalp yetersizliği klinik tablosu en çok Akciğer ödemi (%77) ile başvurmuştur. Kalp yetersizliği etiyolojisi olarak en çok iskemik kalp yetersizliği (%49,2) saptanmıştır
Erkek cinsiyetin dominant (%67,7) olduğu bulunmuştur. Yaş ortalaması 65,62±14,48 olarak bulunmuştur. Kalp yetersizliğinde kullanılan ilaçların taburculuk gününde kullanımı artsa bile, 5 yıllık dönemde oranlarının belirgin düştüğü bulunmuştur. Hastanede ortalama yatış süresi 11,26±9,26 gün ve mortalite yüksek (%9,5) bulunmuştur. En sık komplikasyon enfeksiyon (%18,2) olduğu saptanmıştır. Beş yıllık dönemde tekrar hastaneye yatış oranı %88,2 ve toplam ölüm oranı %44,5 bulunmuştur.
Sonuç: kalp yetersizliği tanısı alan hastaların kardiyovasküler koruma hedeflerinin gerisinde olduğu, uluslararası kılavuzlarca önerilen kalp yetersizliği tedavilerinin yeterli verilemediği görülmüştür. Takipte de ilaç kullanım oranları belirgin düşmekle beraber en sık tekrardan hastaneye yatış ve mortalite nedeni pnömoni olduğu saptanmıştır
Anahtar Kelimeler
kalp yetersizliği kılavuz önerilen tedavi tersiyer merkez komplikasyonlar takip
Kaynakça
- Ponikowski P, Voors AA, Anker SD, et al. ESC Scientific Document Group. 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. Eur Heart J. 2016 Jul 14; 37 (27): 2129-200.
- Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016 Jun; 13 (6): 368-78.
- Sciatti E, Dallapellegrina L, Metra M, Lombardi CM. New drugs for the treatment of chronic heart failure with a reduced ejection fraction: What the future may hold. J Cardiovasc Med (Hagerstown). 2019 Oct; 20 (10): 650-9.
- Nieminen MS, Brutsaert D, Dickstein K, et al. EuroHeart Survey Investigators; Heart Failure Association, European Society of Cardiology. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006 Nov; 27 (22): 2725-36.
- Adams Jr KF, Fonarow GC, Emerman CL, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 2005; 149: 209-16.
- Sato N, Kajimoto K, Asai K. Et al. Acute decompensated heart failure syndromes (ATTEND) registry. A prospective observational multicenter cohort study: Rationale, design, and preliminary data Am Heart J 2010; 159: 949-55.
- Anguita Sánchez M; Clinical Characteristics, Treatment and Short-Term Morbidity and Mortality of Patients With Heart Failure Followed in Heart Failure Clinics. Results of the BADAPIC Registry Rev Esp Cardiol 2004; 57 (12): 1159.
- Lale Tokgözoğlu, Ergün Barış Kaya, Çetin Erol, et al. EUROASPIRE III: a comparison between Turkey and EuropeTürk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2010; 38 (3): 164-72.
- Ovidiu Chioncel, Dragos Vinereanu. The Romanian Acute Heart Failure Syndromes (RO-AHFS) RegistryAm Heart J 2011; 162: 142-53.
- Zannad F, Mebazaa A, Juilliere Y, et al. Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: the EFICA study. Eur J Heart Fail 2006; 8:697-705.
- Abraham WT, Fonarow GC, Albert NM, et al. Predictors of inhospitalmortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol 2008; 52: 347-56.
- Abaci A. Management of cardiovascular risk factors for primary prevention: evaluation of Turkey results of the EURIKA study. Turk Kardiyol Dern Ars. 2012 Mar; 40 (2): 135-42.
- Fonarow GC, Srikanthan P, Costanzo MR, et al. An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108 927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J 2007; 153: 74.
- Felker GM, Adams Jr KF, Gattis WA, et al. Anemia as a risk factor and therapeutic target in heart failure. J Am Coll Cardiol 2004; 44: 959-66.
- World Health Organization. Iron deficiency anemia, assessment, prevention, and control: report of a WHO Scientific Group. Geneva, Switzerland: World Health Organization; 2001. Available from www.who.int.
- Wolney de Andrade Martins. Influenza and Pneumococcal Vaccination in Heart Failure - a little Applied Recommendation Arq Bras Cardiol 2011; 96 (3): 240-5.
- Ankeet S. Bhatt, Adam D. DeVore, Adrian F. Hernandez, et al. Can Vaccinations Improve Heart Failure Outcomes? J Am Coll Cardiol HF. 2017 Mar, 5 (3) 194-203
Öz
Aim: Treatment methods decreasing mortality in heart failure (HF) are provided in detail by updated guidelines. We aimed to provide true data in our department about the applicability of guidelines into clinical practice on management of HF patients and their follow-up status.
Materials and Methods: We retrospectively assessed the clinical data of patients hospitalized with HF between 2009 and 2010 in our hospital. All the collected data were used to assess the applicability of guidelines and follow-up status for a 5-year time period. A retrospective assessment was preferred in order to reflect the real clinical practice.
Results: There were 496 patients hospitalized for HF between January 2009 and January 2010. New onset and chronic HF were diagnosed in 24.4% and 75.6% respectively. The most common scenario of acute HF was pulmonary oedema (77%). Ischemic heart disease was the predominant etiology (49.2%). The median age of patients was 65.62±14.48 and 67.7% of them were male. HF therapies increased from admission to discharge, but decreased during follow-up. Median length of stay was 11.26±9.26 days and in hospital mortality 9.5%. The most common complication was infection (18.2%). During follow-up, hospitalization rate was 88.2% and long-term mortality 44.5%.
Conclusion: Patients with HF are far away from the cardiovascular prevention targets. The evidence-based therapy recommended by the guidelines was not sufficiently provided. The high rehospitalization and in hospital mortality rate was linked to high rate of pneumonia
Anahtar Kelimeler
heart failure guideline recommended therapy tertiary medical center complications follow-up
Kaynakça
- Ponikowski P, Voors AA, Anker SD, et al. ESC Scientific Document Group. 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. Eur Heart J. 2016 Jul 14; 37 (27): 2129-200.
- Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016 Jun; 13 (6): 368-78.
- Sciatti E, Dallapellegrina L, Metra M, Lombardi CM. New drugs for the treatment of chronic heart failure with a reduced ejection fraction: What the future may hold. J Cardiovasc Med (Hagerstown). 2019 Oct; 20 (10): 650-9.
- Nieminen MS, Brutsaert D, Dickstein K, et al. EuroHeart Survey Investigators; Heart Failure Association, European Society of Cardiology. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006 Nov; 27 (22): 2725-36.
- Adams Jr KF, Fonarow GC, Emerman CL, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 2005; 149: 209-16.
- Sato N, Kajimoto K, Asai K. Et al. Acute decompensated heart failure syndromes (ATTEND) registry. A prospective observational multicenter cohort study: Rationale, design, and preliminary data Am Heart J 2010; 159: 949-55.
- Anguita Sánchez M; Clinical Characteristics, Treatment and Short-Term Morbidity and Mortality of Patients With Heart Failure Followed in Heart Failure Clinics. Results of the BADAPIC Registry Rev Esp Cardiol 2004; 57 (12): 1159.
- Lale Tokgözoğlu, Ergün Barış Kaya, Çetin Erol, et al. EUROASPIRE III: a comparison between Turkey and EuropeTürk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2010; 38 (3): 164-72.
- Ovidiu Chioncel, Dragos Vinereanu. The Romanian Acute Heart Failure Syndromes (RO-AHFS) RegistryAm Heart J 2011; 162: 142-53.
- Zannad F, Mebazaa A, Juilliere Y, et al. Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: the EFICA study. Eur J Heart Fail 2006; 8:697-705.
- Abraham WT, Fonarow GC, Albert NM, et al. Predictors of inhospitalmortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol 2008; 52: 347-56.
- Abaci A. Management of cardiovascular risk factors for primary prevention: evaluation of Turkey results of the EURIKA study. Turk Kardiyol Dern Ars. 2012 Mar; 40 (2): 135-42.
- Fonarow GC, Srikanthan P, Costanzo MR, et al. An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108 927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J 2007; 153: 74.
- Felker GM, Adams Jr KF, Gattis WA, et al. Anemia as a risk factor and therapeutic target in heart failure. J Am Coll Cardiol 2004; 44: 959-66.
- World Health Organization. Iron deficiency anemia, assessment, prevention, and control: report of a WHO Scientific Group. Geneva, Switzerland: World Health Organization; 2001. Available from www.who.int.
- Wolney de Andrade Martins. Influenza and Pneumococcal Vaccination in Heart Failure - a little Applied Recommendation Arq Bras Cardiol 2011; 96 (3): 240-5.
- Ankeet S. Bhatt, Adam D. DeVore, Adrian F. Hernandez, et al. Can Vaccinations Improve Heart Failure Outcomes? J Am Coll Cardiol HF. 2017 Mar, 5 (3) 194-203
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 13 Eylül 2021 |
| Gönderilme Tarihi | 6 Şubat 2021 |
| Yayımlandığı Sayı | Yıl 2021Cilt: 60 Sayı: 3 |
