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Management of Heart Failure with Preserved and Impaired Systolic Function: The New Zealand Heart Failure Registry
404
Heart, Lung and Circulation 2011;20:376–419
Abstracts
ABSTRACTS
ted with heart failure. Compliance was reported in 85% (1062/1245). Medications on discharge
Patient numbers (%)
ACE inhibitors ARBs B-blockers Aldosterone antagonist Diuretics
975/1346 (72%) 136/1346 (10%) 1046/1346 (78%) 446/1346 (33%) 1314/1346 (98%)
Conclusions: NZHFR results compare favourably with international data with an evidence based approach to management and low readmission rates. doi:10.1016/j.hlc.2011.03.075 Management of Elderly and Non-elderly Patients with Heart Failure Admissions: The New Zealand Heart Failure Registry V. Pera 1,∗,a , R. Troughton 2,a , M. Lund 3,a , R. Doughty 4,a , G. Devlin 1,a 1 Waikato
Background: The majority of heart failure admissions are elderly, with few comparative studies existing between elderly (E) and non-elderly (NE) heart failure management. We report our experience with the New Zealand Heart Failure Registry (NZHFR). Methods: The NZHFR is a national, prospective, observational web-based registry. We compared characteristics, treatments and outcomes between E (≥75 years) and NE (<75 years). Results: A total of 1410 patients are enrolled in NZHFR, between July 2006 and February 2011, with 90-day follow up data available in 89% (1255/1410). There were 703 E patients (mean age 84.3 years, 52% males) and 707 in NE group (mean age 60 years, 74% males). Fewer patients in E group had Echo {68% (481/703) vs. 85% (600/707), P < 0.0001} with fewer E reported to have LV systolic dysfunction with LVEF < 50% (41% vs. 73%, P < 0.0001). Discharge medications and outcomes are shown in table. Discharge medications
Elderly
Non-elderly
P value
Diuretics ACE-I/ARBs Beta blockers Aldosterone antagonists
649/660 (98%) 498/660 (75%) 499/660 (76%) 163/660 (25%)
672/694 (97%) 617/694 (89%) 552/694 (80%) 283/694 (41%)
0.070 <0.0001 0.089 <0.0001
On behalf of the NZHFR Investigators.
Elderly
Non-elderly
P value
Median length of stay In-hospital mortality Mortality at 90-day follow up Hospital readmission at 90-days
6 days
7 days
6% (43/703)
2% (13/707)
<0.0001
16% (100/632)
9% (56/623)
0.0003
14% (91/632)
16% (99/623)
0.479
Conclusions: E patients are more likely to have preserved LV systolic function and receive less ACE-I/ARBs and aldosterone antagonists than NE. In addition, a higher in-hospital and 90-day mortality, but similar readmission rates to NE are noted. doi:10.1016/j.hlc.2011.03.076 Management of Heart Failure with Preserved and Impaired Systolic Function: The New Zealand Heart Failure Registry
Hospital, Hamilton, New Zealand Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand 2 Christchurch
a
Outcomes
V. Pera 1,∗,a , R. Troughton 2,a , M. Lund 3,a , R. Doughty 4,a , G. Devlin 1,a 1 Waikato
Hospital, Hamilton, New Zealand Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand 2 Christchurch
Background: The incidence and management of heart failure with preserved systolic function (HFPSF) is unknown in New Zealand. We report our experience with the New Zealand Heart Failure Registry (NZHFR). Methods: NZHFR is a national, prospective, observational, web-based registry. We compared characteristics, treatments and outcomes of HFPSF and heart failure with impaired systolic function, with EF<50% (HFISF). Results: A total of 1420 patients were enrolled, between July 2006 and February 2011 with 1078 patients who had echocardiograms performed included in this analysis with 90-day follow up data available in 89% (959/1078). 807 patients had HFISF (mean age 67.4 years, 71% males) with 271 patients with HFPSF (mean age 77.6 years, 45% males). HFPSF had a higher prevalence of hypertension (62% vs. 49%, P = 0.0002) and atrial fibrillation (61% vs. 51%, P = 0.006) and lower prevalence of ischaemic heart disease (34% vs. 45%, P = 0.0022). Discharge medications and outcomes are shown in the table.
a
On behalf of the NZHFR Investigators.
Abstracts
Discharge medications
HFPSF
HFISF
P value
Diuretics ACE-I/ARBs Beta blockers Aldosterone antagonists
251/257 (98%) 189/257 (74%) 187/257 (73%) 56/257 (22%)
759/778 (98%) 685/778 (88%) 635/778 (82%) 301/778 (39%)
1.000 <0.0001 0.0032 <0.0001
P value
Outcomes
HFPSF
HFISF
Median length of stay In-hospital mortality Mortality at 90-day follow up Hospital readmission at 90-days
7 days
7 days
3% (29/807)
5% (14/271)
0.281
11% (83/719)
13% (31/240)
0.566
13% (91/719)
9% (22/240)
0.165
Conclusions: One in four heart failure admissions are with HFPSF in the NZHFR. Contributory causes and management are different to HFISF. No difference is noted in short term mortality or readmissions. doi:10.1016/j.hlc.2011.03.077 Ethnic Differences in Characteristics, Treatments and Outcomes of Patients Hospitalised for Heart Failure: New Zealand Heart Failure Registry Pera 1,∗,a ,
V. R. G. Devlin 1,a
Troughton 2,a ,
M.
Lund 3,a ,
R.
1 Waikato
Hospital, Hamilton, New Zealand Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand Background: Several studies report worse outcomes in Maori patients presenting with heart failure. We report our experience with the New Zealand Heart Failure Registry (NZHFR). Methods: NZHFR is a national, prospective, observational web-based registry. We compared management and outcomes between NZ Maori (M) and NZ European (E). Results: A total of 1149 patients were enrolled from July 2006 to February 2011, with 90-day follow up available in 89% (1022/1149). There were 316 M (mean age 60.5 years, 70% males) and 833 E (mean age 77.3 years, 60% males). The prevalence of severe valve disease and diabetes was higher in M (26% vs.19%, P = 0.014 and 46% vs. 29%, P < 0.0001 respectively). M were more likely to have On behalf of the NZHFR Investigators.
systolic dysfunction (87% vs. 69%, P < 0.0001). Discharge medications and outcomes are shown below. Discharge medications
Maori
European
P value
Diuretics ACE-I/ARBs Beta blockers Aldosterone antagonists
302/316 (96%) 271/316 (86%) 241/316 (76%) 128/316 (41%)
771/833 (93%) 630/833 (76%) 600/833 (72%) 236/833 (28%)
0.083 <0.0002 0.156 <0.0001
Outcomes
Maori
European
Median length of stay In-hospital mortality Mortality at 90-day follow up Hospital readmission at 90-days
7 days
6 days
3% (9/316)
5% (42/833)
0.147
10% (29/286)
14% (102/736)
0.118
14% (40/286)
16% (118/736)
0.440
P value
Conclusions: M present at a much younger age with HF and are more likely to have diabetes mellitus and severe valvular heart disease as contributory factors. Systolic dysfunction is more common in M. with more frequent use of ACE-I/ARB and Aldosterone antagonists. No difference is noted in short term mortality or readmissions. doi:10.1016/j.hlc.2011.03.078
Doughty 4,a ,
2 Christchurch
a
405
Pre-operative Risk Factors for Long-term Outcomes of Cardiac Surgery for Rheumatic Heart Disease (RHD) in the Young: An Oceania Cohort B. Remenyi 1,∗ , R. Webb 2 , P. Russell 3 , T. Gentles 1 , K. Finucane 1 , M. Lee 1 , N. Wilson 1 1 Green Lane Paediatric and Congenital Cardiac Services, Star-
ship Children’s Hospital, Auckland, New Zealand Infectious Diseases, Starship Children’s Hospital, Auckland, New Zealand 3 Auckland City Hospital, Auckland, New Zealand 2 Pediatric
Background: The long-term outcomes of cardiac surgery for RHD are unknown for young New Zealand and Pacific Island populations. This study aims to determine preoperative factors that impact on long-term survival and valve-related morbidity. Methods: A retrospective review of all 212 RHD patients under 20 years who underwent their first cardiac surgery between 1990 and 2006 at our institution. Sub-analysis was performed on 81 patients who underwent isolated mitral valve (MV) surgery.
ABSTRACTS
Heart, Lung and Circulation 2011;20:376–419
Heart, Lung and Circulation 2011;20:376–419
Abstracts
ABSTRACTS
ted with heart failure. Compliance was reported in 85% (1062/1245). Medications on discharge
Patient numbers (%)
ACE inhibitors ARBs B-blockers Aldosterone antagonist Diuretics
975/1346 (72%) 136/1346 (10%) 1046/1346 (78%) 446/1346 (33%) 1314/1346 (98%)
Conclusions: NZHFR results compare favourably with international data with an evidence based approach to management and low readmission rates. doi:10.1016/j.hlc.2011.03.075 Management of Elderly and Non-elderly Patients with Heart Failure Admissions: The New Zealand Heart Failure Registry V. Pera 1,∗,a , R. Troughton 2,a , M. Lund 3,a , R. Doughty 4,a , G. Devlin 1,a 1 Waikato
Background: The majority of heart failure admissions are elderly, with few comparative studies existing between elderly (E) and non-elderly (NE) heart failure management. We report our experience with the New Zealand Heart Failure Registry (NZHFR). Methods: The NZHFR is a national, prospective, observational web-based registry. We compared characteristics, treatments and outcomes between E (≥75 years) and NE (<75 years). Results: A total of 1410 patients are enrolled in NZHFR, between July 2006 and February 2011, with 90-day follow up data available in 89% (1255/1410). There were 703 E patients (mean age 84.3 years, 52% males) and 707 in NE group (mean age 60 years, 74% males). Fewer patients in E group had Echo {68% (481/703) vs. 85% (600/707), P < 0.0001} with fewer E reported to have LV systolic dysfunction with LVEF < 50% (41% vs. 73%, P < 0.0001). Discharge medications and outcomes are shown in table. Discharge medications
Elderly
Non-elderly
P value
Diuretics ACE-I/ARBs Beta blockers Aldosterone antagonists
649/660 (98%) 498/660 (75%) 499/660 (76%) 163/660 (25%)
672/694 (97%) 617/694 (89%) 552/694 (80%) 283/694 (41%)
0.070 <0.0001 0.089 <0.0001
On behalf of the NZHFR Investigators.
Elderly
Non-elderly
P value
Median length of stay In-hospital mortality Mortality at 90-day follow up Hospital readmission at 90-days
6 days
7 days
6% (43/703)
2% (13/707)
<0.0001
16% (100/632)
9% (56/623)
0.0003
14% (91/632)
16% (99/623)
0.479
Conclusions: E patients are more likely to have preserved LV systolic function and receive less ACE-I/ARBs and aldosterone antagonists than NE. In addition, a higher in-hospital and 90-day mortality, but similar readmission rates to NE are noted. doi:10.1016/j.hlc.2011.03.076 Management of Heart Failure with Preserved and Impaired Systolic Function: The New Zealand Heart Failure Registry
Hospital, Hamilton, New Zealand Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand 2 Christchurch
a
Outcomes
V. Pera 1,∗,a , R. Troughton 2,a , M. Lund 3,a , R. Doughty 4,a , G. Devlin 1,a 1 Waikato
Hospital, Hamilton, New Zealand Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand 2 Christchurch
Background: The incidence and management of heart failure with preserved systolic function (HFPSF) is unknown in New Zealand. We report our experience with the New Zealand Heart Failure Registry (NZHFR). Methods: NZHFR is a national, prospective, observational, web-based registry. We compared characteristics, treatments and outcomes of HFPSF and heart failure with impaired systolic function, with EF<50% (HFISF). Results: A total of 1420 patients were enrolled, between July 2006 and February 2011 with 1078 patients who had echocardiograms performed included in this analysis with 90-day follow up data available in 89% (959/1078). 807 patients had HFISF (mean age 67.4 years, 71% males) with 271 patients with HFPSF (mean age 77.6 years, 45% males). HFPSF had a higher prevalence of hypertension (62% vs. 49%, P = 0.0002) and atrial fibrillation (61% vs. 51%, P = 0.006) and lower prevalence of ischaemic heart disease (34% vs. 45%, P = 0.0022). Discharge medications and outcomes are shown in the table.
a
On behalf of the NZHFR Investigators.
Abstracts
Discharge medications
HFPSF
HFISF
P value
Diuretics ACE-I/ARBs Beta blockers Aldosterone antagonists
251/257 (98%) 189/257 (74%) 187/257 (73%) 56/257 (22%)
759/778 (98%) 685/778 (88%) 635/778 (82%) 301/778 (39%)
1.000 <0.0001 0.0032 <0.0001
P value
Outcomes
HFPSF
HFISF
Median length of stay In-hospital mortality Mortality at 90-day follow up Hospital readmission at 90-days
7 days
7 days
3% (29/807)
5% (14/271)
0.281
11% (83/719)
13% (31/240)
0.566
13% (91/719)
9% (22/240)
0.165
Conclusions: One in four heart failure admissions are with HFPSF in the NZHFR. Contributory causes and management are different to HFISF. No difference is noted in short term mortality or readmissions. doi:10.1016/j.hlc.2011.03.077 Ethnic Differences in Characteristics, Treatments and Outcomes of Patients Hospitalised for Heart Failure: New Zealand Heart Failure Registry Pera 1,∗,a ,
V. R. G. Devlin 1,a
Troughton 2,a ,
M.
Lund 3,a ,
R.
1 Waikato
Hospital, Hamilton, New Zealand Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand Background: Several studies report worse outcomes in Maori patients presenting with heart failure. We report our experience with the New Zealand Heart Failure Registry (NZHFR). Methods: NZHFR is a national, prospective, observational web-based registry. We compared management and outcomes between NZ Maori (M) and NZ European (E). Results: A total of 1149 patients were enrolled from July 2006 to February 2011, with 90-day follow up available in 89% (1022/1149). There were 316 M (mean age 60.5 years, 70% males) and 833 E (mean age 77.3 years, 60% males). The prevalence of severe valve disease and diabetes was higher in M (26% vs.19%, P = 0.014 and 46% vs. 29%, P < 0.0001 respectively). M were more likely to have On behalf of the NZHFR Investigators.
systolic dysfunction (87% vs. 69%, P < 0.0001). Discharge medications and outcomes are shown below. Discharge medications
Maori
European
P value
Diuretics ACE-I/ARBs Beta blockers Aldosterone antagonists
302/316 (96%) 271/316 (86%) 241/316 (76%) 128/316 (41%)
771/833 (93%) 630/833 (76%) 600/833 (72%) 236/833 (28%)
0.083 <0.0002 0.156 <0.0001
Outcomes
Maori
European
Median length of stay In-hospital mortality Mortality at 90-day follow up Hospital readmission at 90-days
7 days
6 days
3% (9/316)
5% (42/833)
0.147
10% (29/286)
14% (102/736)
0.118
14% (40/286)
16% (118/736)
0.440
P value
Conclusions: M present at a much younger age with HF and are more likely to have diabetes mellitus and severe valvular heart disease as contributory factors. Systolic dysfunction is more common in M. with more frequent use of ACE-I/ARB and Aldosterone antagonists. No difference is noted in short term mortality or readmissions. doi:10.1016/j.hlc.2011.03.078
Doughty 4,a ,
2 Christchurch
a
405
Pre-operative Risk Factors for Long-term Outcomes of Cardiac Surgery for Rheumatic Heart Disease (RHD) in the Young: An Oceania Cohort B. Remenyi 1,∗ , R. Webb 2 , P. Russell 3 , T. Gentles 1 , K. Finucane 1 , M. Lee 1 , N. Wilson 1 1 Green Lane Paediatric and Congenital Cardiac Services, Star-
ship Children’s Hospital, Auckland, New Zealand Infectious Diseases, Starship Children’s Hospital, Auckland, New Zealand 3 Auckland City Hospital, Auckland, New Zealand 2 Pediatric
Background: The long-term outcomes of cardiac surgery for RHD are unknown for young New Zealand and Pacific Island populations. This study aims to determine preoperative factors that impact on long-term survival and valve-related morbidity. Methods: A retrospective review of all 212 RHD patients under 20 years who underwent their first cardiac surgery between 1990 and 2006 at our institution. Sub-analysis was performed on 81 patients who underwent isolated mitral valve (MV) surgery.
ABSTRACTS
Heart, Lung and Circulation 2011;20:376–419