Anne Sullivan

Anaemia in Heart Failure: A Prospective Evaluation of Clinical Outcome in a Community Population

INTRODUCTION Although anaemia is associated with an adverse prognosis in congestive heart failure (HF), the cause of the anaemia and its relationship to non-cardiac and cardiac complications needs to be better defined, particularly in a general community population. METHODS Clinical data were collected prospectively from 959 patients hospitalised with HF. RESULTS Thirty-eight percent (n=369) had anaemia (Hb<120 g/L), which was normochromic normocytic in 87.8%. Of those who had haematinic studies, 15.5% had a confirmed haematinic deficiency. Anaemic patients were of similar age to non-anaemic (79 vs 77 years) but were more likely to have elevated creatinine (48 vs 29%, p<0.001), hyponatremia (20 vs 15%, p=0.05), and LVEF>40% (49 vs 39%, p=0.004), and less likely to receive ACE inhibitors (72 vs 78%, p=0.04). At 12 months, anaemic patients had higher HF readmission rates (22.4 vs 15.7%, p=0.01), more multiple non-HF readmissions (12.4 vs 6.3%, p=0.001) and a higher mortality (16.4% vs 10.5%, p=0.01). CONCLUSION Anaemia is common (38%) in community patients hospitalised with HF, and is associated with increased HF and non-HF readmissions, and increased mortality. A haematinic deficiency was identified in 15.5% of patients. Anaemia is a common, multifactorial, but potentially treatable cause of adverse outcome in HF.

Symptom patterns, duration and responses in newly diagnosed patients with heart failure

This study investigated the symptom patterns and duration and associated predictors occurring prior to first heart failure (HF) admission. Data from the Managing Cardiac Function (MACARF) program from January to December 2007 were reviewed in relation to preadmission symptoms and contacts with health professionals. Patients (n = 242) were aged 78.7 years (SD 12 years), male (54%) and married (45%). Patients experienced up to seven symptoms (Mean 2.7, SD 1.4) for a median of 4.47 days (range 1-7) before admission, most commonly increased dyspnoea on exertion (88%), and for the shortest duration chest discomfort. Less than half (48%) contacted a health professional before hospitalization, most often a general practitioner (37%). The duration patients experienced before presenting to hospital was increased if they presented during business hours (beta = 2.68) or the evening (beta = 1.88) (and therefore less from midnight to 8:30 am), or with a change in symptom (beta = 1.4), whereas duration was reduced by chest discomfort (beta = -2.01) and older age (beta = -0.07). There is a significant time window during which patients and health professionals may detect and act on worsening HF symptoms. Newly diagnosed patients with HF need support to recognize and respond to these symptoms to avoid hospital admission.

Quality of life, social support and cognitive impairment in heart failure patients without diagnosed dementia.

Improving health-related quality of life (HRQL) is an important goal for heart failure (HF) patients, and understanding the factors that influence HRQL is essential to this process. We investigated the influence of social support and cognitive impairment on HRQL in community dwelling HF patients (n = 104) without diagnosed dementia. Patients were aged mean 80.93 years (SD 11.01) and were classified as New York Heart Association Class 1/II (45%) or III/IV (53%). Age, social support and cognition had important independent effects. Younger people had the most negative effects of HF in all areas of HRQL: emotional (B = -0.32), physical (B = -0.44) and overall (B = -1). Well-supported patients (general social support) had the least negative effect from HF on HRQL: emotional domain (B = -4.62) and overall (B = -11.72). Patients with normal cognition had more negative impact of HF on HRQL: physical domain (B = 5.51) and overall HRQL (B = 10.42). A clearer understanding of the relationships between age, social support and cognition and the effect on the impact of HF on HRQL is needed before interventions can be appropriately developed.

Titration of ACE Inhibitors and Beta Blockers in a Heart Failure Population

Background: Angiotensin converting enzyme (ACE) inhibitors and Beta blockers (BB) reduce hospitalisation and mortality in systolic heart failure (HF). While drug initiation has improved, titration to target doses remains suboptimal. Aims:We investigated the frequency and determinants of uptitration of ACE and (ARB) and BB 6 months postHF admission (January–June 2009) in the Management of Cardiac Function (MACARF) program patients. Methods: Of 155 patients, 116 (75%) were discharged on ACE/ARB and 98 (63%) on a BB. For this analysis, we excluded those at target dose at hospital discharge, EF> 40%, or those who died prior to 6 months.