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© 2006 European Society of Cardiology
Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study
a Department of Cardiology, University Hospital of Nancy, France
b Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisère, Paris, France
c Department of Cardiology, Beaujon Hospital, France
d Department of Cardiology, University Hospital of HEGP, France
e Department of Epidemiology, University Hospital of Nancy, France
f Department of Anesthesiology and Critical Care Medicine, University Hospital of Toulouse, France
g Icare, Massy, France
h Département de Pharmacologie, Université Victor Ségalen, Bordeaux 2, France
i Orion Pharma, France
* Corresponding author. CIC INSERM-CHU and Department of Cardiology, Hôpital Jeanne d'Arc, 54200 Toul, France. Tel.: +33 3 83 65 66 25; fax: +33 3 83 65 66 19 E-mail address: f.zannad{at}chu-nancy.fr (F.Zannad).
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Abstract |
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Background: Little is known about the epidemiology of acute decompensated heart failure (ADHF) in patients admitted to intensive and coronary care units (ICU/CCU). Observational data may improve disease management and guide the design of clinical trials.
Aims: EFICA is an observational study of the clinical profile, management and survival of ADHF patients admitted to ICU/CCU.
Methods: The study included 599 patients admitted to 60 ICU/CCUs across France. Relevant data was recorded during hospitalisation. Survival was assessed at 4 weeks and 1 year.
Results: The main cause of ADHF was ischaemic heart disease (61%); 29% of patients had cardiogenic shock. Mortality was 27.4% at 4 weeks and 46.5% at 1 year, increasing to 43.2% and 62.5%, respectively, when including pre-admission deaths. Shock patients had the highest [57.8% vs. 15.2% without shock (p<0.001)] and patients with hypertension and pulmonary oedema had the lowest 4-week mortality: (7%). Pre-admission NYHA class III–IV heart failure, not initial clinical presentation, influenced 1-year mortality.
Conclusion: ADHF is a heterogeneous syndrome. Based on initial clinical presentation, three entities with distinct features and outcome may be described: cardiogenic shock, pulmonary oedema with hypertension, and ‘decompensated’ chronic heart failure. This should be taken into account in future observational studies, guidelines and clinical trials.
Key Words: Epidemiology • Acute heart failure • Outcome • Cardiogenic shock • Hypertension • Pulmonary oedema
Received July 8, 2005; Revised October 4, 2005; Accepted January 3, 2006
Members of the steering committee all received honoraria from Orion for theifsr involvement in the project. A Mebazaa and A Cohen_Solal are respectively chairman and member of the steering committee for a randomised controlled trial comparing levosimendan and dobutamine in patients with acute heart failure.
1 Members listed at end of report.
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