Geraldine Gillies

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.

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.