© 2004 European Society of Cardiology
Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy
a Department of Medical Therapeutics, Medical Sciences School New University of Lisbon, Portugal
b Serviço de Medicina, Hospital S. Francisco Xavier 1400 Lisboa, Portugal
c Department of Internal Medicine, Medical Sciences School New University of Lisbon, Lisbon, Portugal
d Department of Cardiology, Medical Sciences School New University of Lisbon, Lisbon, Portugal
e Serviço de Cardiologia, Hospital Pulido Valente 1750 Lisboa, Portugal
f EPICA Working Group Portugal
g Grupo de Investigação EPICA Av. António Augusto de Aguiar 128, 1050 Lisboa, Portugal
h Datamedica Ltd. Lisbon, Portugal
i Datamedica R. Garcia de Orta 70, 2 D, 1200 Lisboa, Potugal
* Corresponding author. Av. Grão Vasco 47-1° Esq. 1500-336 Lisboa, Portugal. Tel.: +351 21 760 45 73; fax: +351 21 301 7958.. E-mail address: fatima.ceia{at}sapo.pt
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Abstract |
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Background: Chronic heart failure (CHF) is common and is frequently managed by primary care physicians (PCPs). Despite the European Society of Cardiology (ESC) Guidelines, standard treatments for CHF are frequently underutilised, particularly in primary care.
Aim: To evaluate current drug therapy for CHF in adults with HF diagnosed according to ESC guidelines in the context of the EPICA study. Aetiological features and therapy relevant comorbidities were also analysed.
Methods: EPICA was a community-based epidemiological study conducted in mainland Portugal. The study involved 365 primary care physicians, who evaluated 6300 primary care attendees aged over 25 years. CHF was diagnosed by clinical and echocardiography criteria according to ESC guidelines.
Results: Total of 551 cases of CHF were identified, with a mean age of 65±9 years. The estimated overall prevalence of CHF in the Portuguese population was 4.4%; 1.3% with and 1.7% without left ventricular systolic dysfunction (LVSD). There are 6,280,792 people aged >25 years in Portugal, which extrapolates to 261,400 cases of heart failure. About 80% of patients had a history of hypertension, 39% had a history of coronary artery disease and 15% had atrial fibrillation. Only 58% of patients were on angiotensin-converting enzyme (ACE) inhibitors and 7% on beta-blockers. The type of ventricular dysfunction, age and presence of renal failure had little effect on prescription rates. Diuretics were prescribed in 78%. Thiazides were used more frequently in those with preserved systolic function and frusemide in those with left ventricular systolic dysfunction. Digoxin was prescribed more often to patients with than without left ventricular systolic dysfunction (34% vs. 17%; p=0.02). Long-acting nitrates were prescribed to 20% and amiodarone to 8% of patients.
Conclusion: The EPICA study, as in other studies in primary care in Europe, particularly the IMPROVEMENT study, suggests that greater efforts are required to improve training of primary care teams in the management of CHF.
Key Words: Heart failure • Primary care • Guidelines • Treatment
Received July 6, 2004; Accepted September 8, 2004
1 R. Salvador Barata Feyo n° 1 r/c-D.to2780-335 Oeiras, Portugal.
2 R do Loreto n° 34-3° 1200 Lisboa, Portugal.
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