J.G.F. Cleland

The Euro Heart Failure Survey of the EUROHEART survey programme. A survey on the quality of care among patients with heart failure in Europe

The EUROHEART programme is a rolling programme of cardiovascular surveys among the member nations of the European Society of Cardiology (ESC). These surveys will provide information on the nature of cardiovascular disease and its management. This manuscript describes a survey into the nature and management of heart failure.

Increasing awareness and improving the management of heart failure in Europe: The IMPROVEMENT of HF initiative

Previous reports suggest that patients with suspected heart failure are inadequately investigated and that patients who do have heart failure are sub‐optimally treated. Guidelines on the diagnosis and treatment of heart failure have been published by the European Society of Cardiology and provide a framework for the management of heart failure against which to judge current medical practice. Both primary care and hospital physicians are responsible for ensuring appropriate management of patients with heart failure. This programme concentrates on management of heart failure in primary care and is complementary to a similar exercise that will be conducted in 50 European regions (EUROHEART‐CHF).

A description of the clinical characteristics at baseline of patients recruited into the Carvedilol or Metoprolol European Trial (COMET)

Background & Aims: The COMET trial was a prospective, double-blind, randomised trial comparing carvedilol, a comprehensive adrenergic receptor antagonist, with metoprolol, a beta-1-selective agent in patients with heart failure and left ventricular systolic dysfunction. The trial showed a reduction in mortality with carvedilol that was consistent across subgroups. The purpose of this report is to describe in greater detail the heterogeneity of this population at baseline with particular reference to the impact of symptomatic severity, age and gender on patient characteristics.Methods: A descriptive report using data entered in the COMET study data-base.Results: The characteristics of the population studied were similar to those reported in previous trials of beta-blockers. Almost all patients were receiving diuretics and ACE inhibitors with few patients taking angiotensin receptor blockers. As expected, older patients had more co-morbidity. Older patients and women reported worse symptoms and poorer well-being despite similar ventricular dimensions and systolic dysfunction. NT-proBNP was higher in patients with more severe symptoms and older patients but not in women, although differences in NT-proBNP may have been confounded by differences in renal function.Conclusion: Age and gender, as well as the severity of cardiac dysfunction, appear to have an important effect on the severity of heart failure symptoms and patient ‘well-being’. This could have important implications for the relationship between symptoms and prognosis and therefore the way in which patients are selected for clinical trials and the goals of treatment. This will be the subject of further analyses.

93 Utility of NT‐BNP as a screening tool for cardiac dysfunction in patients with long‐standing diabetes mellitus

Background: Cardiac dysflmction (CD) is common in patients with long-standing diabetes mellitus and can lead to heart failure or sudden death. N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) may provide a screening method for the early detection and treatment of patients with CD but is confounded by renal dysfunction. Aim: To assess the utility of NT-proBNP for detecting CD in patients over 50 years of age with long-standing (> 10 years) diabetes. Method: A standard clinical history, current medications, height and weight were recorded for all patients. They underwent a blood test for NT-proBNP, routine haematology and biochemistry, lung function tests, 12-lead ECG and echocardiography. Results were compared with 100 normal subjects. Results: We invited 144 consecutive patients attending a long-term follow-up clinic for diabetes. 109 consented to participate. 37 patients had known IHD, 9 had LVEF 30, 46 had moderate or severe LVH, 5 had moderate or severe valve disease and 5 had a glomemlar filtration rate (GFR) of 330pg/ml, the 95th centile of the control group. An NT-proBNP cut-off value of 135 pg/ml provided a test specificity (SP) of 62% at a sensitivity (SN) of 100% (AUC 0.888) for the detection of LVEF<40%. Correction of NTproBNP for GFR and age improved test performance (SP = 68%, SN = 100%, AUC = 0.895) with a cut off value of 152 pg/ml. However, a better test performance was obtained using piecewise decision rules (see Table 1) for NT-proBNP and GFR (SP - 78%, SN = 100%). For a population of 1000, this would give a 42.7% reduction in false positive results from 349 (based on NT-proBNP only) to 149, with no increase in the number of false negatives. Table 1. Optimal Decision Rules for Detection of LVEF < 40% Decision rule Test result

96 Prevalence and prognosis of anaemiain post MI patients

94 Cardiovascular involvement in thalassemia major patients: WEBTHAL data analysis (a web based multicentric database) G. Derchi1, F. Formisano1, M. Lamagna1, R. Galanello2, P. Bina2, M.D. Cappellini3, A. Piga4, G. Quarta5, G.L. Forni1 1E.O. Ospedali Galliera, S.C. Cardiologia, Genova, Italy; 2Ospedale Regionale Microcitemico, Cagliari, Italy; 3Ospedale Policlinico IRCCS, Centro Anemie Congenite, Milano, Italy; 4Universita’ di Torino, Dipartimento di Scienze Cliniche e Biologiche, Torino, Italy; 5Ospedale A. Perrino, Dipartimento di Onco-Ematologia, Brindisi, Italy