I. Leurs

Is the gap between guidelines and clinical practice in heart failure treatment being filled? Insights from the IMPACT RECO survey

Recent registries have shown that recommended drugs for the treatment of chronic heart failure (CHF) are under‐prescribed in daily practice.

Optimization of heart FailUre medical Treatment after hospital discharge according to left ventricUlaR Ejection fraction: the FUTURE survey.

BACKGROUND No clinical practice guidelines are available for the treatment of heart failure (HF) in patients with preserved left ventricular ejection fraction (LVEF). AIMS To determine how cardiologists manage medical treatment in HF patients after hospital discharge, according to LVEF. METHODS The FUTURE study was a cross-sectional survey conducted in HF outpatients by French private cardiologists between September 2007 and August 2008. Patients had to have been hospitalized within the previous 18 months with a diagnosis of HF. Clinical data and HF treatments (angiotensin-converting enzyme inhibitors [ACEIs], angiotensin receptor blockers [ARBs], beta-blockers, diuretics and aldosterone antagonists) were recorded retrospectively, with precise information on drug doses, at two successive time points (at hospital discharge and at the index consultation). HF treatment was compared in patients with reduced (less than or equal to 40%) versus preserved (more than 40%) LVEF. RESULTS Completed data were available for 1137 HF patients enrolled by 424 cardiologists. Mean patient age was 72±11 years; LVEF was reduced in 56% and preserved in 44%. The therapeutic approach was similar in the two groups, both at hospital discharge and at the index consultation. At the index consultation, HF treatment was: beta-blocker (74%); ACEI/ARB (83%); loop diuretic (86%); aldosterone antagonist (31%). The majority of patients (62%) received a beta-blocker plus an ACEI or an ARB; 56% reached more than or equal to 50% of the target dose for each treatment. There were no major differences in treatments and dosages between the groups with low and preserved LVEF. In 15% of cases where the drug dose was not increased, fear of adverse events was reported as the reason. CONCLUSION The FUTURE survey showed a similar approach to HF treatment irrespective of LVEF. Compared with previous studies, we saw an improvement in the use of recommended HF drugs, especially beta-blockers. However, achievement of target doses could be improved.

078 High prevalence of cognitive disorders in Heart Failure patients: results of the EFICARE survey

Background Some studies have suggested a high frequency of cognitive disorders in HF patients. Objective To determine the prevalence of cognitive disorders in chronic HF elderly patients. Methods We assessed in an observational study the cognitive function in consecutive HF outpatients followed by French cardiologists. Patients were included if they were aged ≥70 years, had chronic stable HF and have been hospitalized for HF in the last 12 months. Cognitive function was assessed by the largely used MIS (Memory Impairment Screen). Autonomy was assessed by IADL scale (Instrumental Activities of Daily Living). Results A total of 980 patients were enrolled by 291 cardiologists. Mean age was 79 ± 6 years and 66% were men. Feasibility of MIS was high and the test was performed successfully in 94% of patients by cardiologists. Cognitive disorders were observed in 46% of HF patients. Loss of autonomy was observed in 47% of elderly HF subjects and help by nurses at home was needed in 33% of patients. Patients with cognitive disorders were older (81 years vs 78 years, p Conclusions The prevalence of cognitive disorders was high (46%) in HF elderly patients. These patients were more frail than those with normal cognitive function. The results suggest a poorer prognosis in HF patients with cognitive disorders and justify a longitudinal follow up to determine the impact of cognition on morbi-mortality.