Comparison of therapy of heart failure patients in the Czech Republic and Europe. Data from the ESC Heart Failure Long-Term Registry
Abstract
Introduction: The ESC Heart Failure Long-Term Registry (ESC-HFLTR) is a prospective observational study which takes place in 211 cardiology centres of 21 European and Mediterranean countries, members of the European Society of Cardiology. Aim: To compare pharmacological and device therapy of both, the patients hospitalized for acute heart failure (HF) and the patients observed in outpatient clinics for chronic HF in the Czech Republic with published European-wide data.
Methods: Altogether 692 consecutive patients were included into the Czech part of HFLTR (5.6% of the whole registry) from May 2011 to April 2013. These patients were either admitted to hospital or examined in outpatient clinic for HF during one predefined day of the week.
The pharmacological and device therapy of 160 hospitalized (25.3%) and 532 ambulatory (74.7%) patients was analyzed statistically. The treatment of Czech ambulatory patients was finally compared with available data from the whole HFLTR.
Results: The Czech in-hospital patients were intravenously treated generally with furosemide (in 89.3%), less frequently with nitrates (in 21.9%) and occasionally with inotropic agents (in 15.0%). In comparison with therapy before the hospital admission the patients at discharge received more frequently diuretics (69.4 vs. 87.5%; p < 0.001) and mineralocorticoid receptor antagonist (MRA) (32.4 vs. 55.0%; p < 0.001).
The majority of Czech patients with chronic HF were treated according to current European guidelines. All prognostically relevant drugs used in HF were administered more often in the Czech HF population than in the whole HFLTR population (inhibitor of angiotensin converting enzyme or angiotensin receptor blocker in 92.8 vs. 89.2%; p = 0.018, betablocker in 95.1 vs. 88.9%; p < 0.001, MRA in 67.0 vs. 59.3%; p < 0.001, respectively).
The recommended target doses of these drugs were reached in about 20% of the Czech as well as the European HF patients. In addition, the Czech ambulatory HF patients underwent more often pacemaker implantation (47 vs. 42%; p = 0.028), mainly due to more frequently indicated resynchronization therapy (56 vs. 30.2%; p < 0.001).
Conclusion: Czech ambulatory HF patients are pharmacologically treated in accordance with current European HF guidelines and significantly better than the patients in the whole HFLTR. However, the recommended target doses were reached only in the minority of the patients.