Akut Kalp Yetmezliğinde Uygulanan Tedavilerin Mortalite Üzerine Etkisi: Bir Gerçek Dünya Çalışması

Year 2022, Volume: 12 Issue: 1, 37 - 43, 01.04.2022

Fatih Köksal Mustafa Aldemir Fatih Levent Sadık Volkan Emren Cem Nazlı

Abstract

Amaç: Güncel tedavi uygulamalarıyla kronik sistolik kalp yetmezliği mortalitesinde azalma sağlanmıştır. Ancak akut kalp yetmezliğinde (AKY) mortalite hala yüksektir. Bizim çalışmamızda AKY hastalarında mortalite oranları ve mortalitenin ön gördürücülerinin neler olduğu araştırılmıştır.
Materyal ve Metot: Çalışmamız Mart 2009 ve Haziran 2013 tarihleri arasında AKY tansıyla yatırılan 805 hastayı içeren tek merkezli retrospektif bir çalışmadır. Çalışmadaki hastalar iki ana gruba ayrıldı: pulmoner ödemin eşlik ettiği ya da etmediği sağ kalp yetmezliği kliniği ile başvuran hastaları içeren (722 hasta – %89,7) dekompanze kalp yermezliği (DKY) grubu, sadece pumoner ödem klinği ile başvuran hastaları içeren (83 hasta – %10,3) pulmoner ödem grubu (PÖ). İki grup arasında hastalara ait değişkenler istatiksel olarak karşılaştırıldı. Etiyolojiye göre ayrılmış hasta gruplarının sağ kalım analizi yapıldı. En sonda da AKY de 2 yıllık mortaliteyi öngören bağımsız faktörler araştırıldı.
Bulgular: İki yıllık mortalite DKY grubunda PÖ grubundan daha fazlaydı (%51,4 ve %31,6 p<0,001). İskemik kardiyomiyopati, non iskemik kardiyomiyopati, korunmuş ejeksiyonlu kalp yetmezliği (kEFKY) hastalarında mortalite oranları sırasıyla %52,8, %39,6 ve %47,3 idi. (p: 0,389). İleri yaş, serebrovasküler olay öyküsü, anemi, hiponatremi, hipoalbuminemi, düşük sol ventrikül ejeksiyon fraksiyonu (SVEF), düşük sistolik kan basıncı 2 yıllık artmış mortaliteyi öngören bağımsız faktörler olarak bulunurken hastane yatışında beta bloker kullanımı mortaliteyi azaltan bağımsız faktör olarak bulundu.
Sonuç: Mortalite oranları farklı kalp yetmezliği gruplarında benzer saptandı. Çeşitli klinik ve laboratuvar parametreleri AKY de mortaliteyi artıran öngördürücüler olurken beta bloker ve anjiyotensin dönüştürücü enzim (ADE) inhibitör kullanımı mortaliteyi azaltan öngördürücüler oldu.

Keywords

mortalite, akut kalp yetmezliği, ACE inhibitörü, beta bloker

The Effect of the Practical Treatments for Acute Heart Failure on Mortality: A Real-World Study

Abstract

Aim: The mortality of chronic systolic heart failure has been decreased thanks to state-of-the-art therapy. However, the mortality rate is still high in acute heart failure (AHF). Our study was planned to investigate the mortality rates and predictors of mortality in AHF.
Material and Method: A single-center retrospective study was conducted on 805 patients hospitalized due to AHF between March 2009 and June 2013. The patients were separated into two main groups: the decompensated heart failure group (DHF), which comprised the patients with signs of right heart failure with or without pulmonary edema (722 patients – 89.7%), and the acute pulmonary edema group (PE) presenting only with pulmonary edema (83 patients – 10.3%). The two groups were compared for the patient-related variables. The survival analysis of the groups based on the etiology was performed. Finally, the independent predictors for 2-year mortality in AHF were investigated.
Results: The 2-year mortality rate was higher in DHF than in PE (51.4% vs. 31.6% p<0.001). The mortality rates of ischemic cardiomyopathy, nonischemic cardiomyopathy, and heart failure with preserved ejection fraction (HFpEF) were 52.8%, 39.6%, and 47.3%, respectively (p=0.389). Advanced age, previous cerebrovascular diseases, anemia, hyponatremia, hypoalbuminemia, lower left ventricular ejection fraction (LVEF), and lower systolic blood pressure predicted increased 2-year mortality independently. In contrast, usage of beta-blockers during hospitalization predicted reduced 2year mortality independently.
Conclusion: Mortality rate was similar between different heart failure types. Various laboratory and clinical parameters predict mortality, whereas beta-blockers and ACE inhibitors reduce mortality.

Keywords

mortality, acute heart failure, ACE inhibitors, beta blockers

References

• 1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128: e240–327.
• 2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129–200.
• 3. Tsutsui H, Isobe M, Ito H, Okumura K, Ono M, Kitakaze M, et al. JCS 2017/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure- digest version. Circ J. 2019;83:2084–184.
• 4. Braunwald, E. Heart failure. JACC Heart Fail. 2013;1(1):1–20. 5. Turner PL, Gazewood JD. Heart Failure with Preserved Ejection Fraction: Diagnosis and Management Am Fam Physician. 2017;96(9):582–88.
• 6. Butler J, Young JB, Abraham WT, Bourge RC, Adams KF Jr, Clare R, et al. Beta-blocker use and outcomes among hospitalized heart failure patients. J Am Coll Cardiol. 2006;47(12):2462–9.
• 7. Metra M, Torp-Pedersen C, Cleland JG, Di Lenarda A, Komajda M, Remme WJ, et al. Should beta-blocker therapy be reduced or withdrawn after an episode of decompensated heart failure? Results from COMET. Eur J Heart Fail. 2007;9(9):901–9.
• 8. Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, et al. Influence of betablocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZEHF program. J Am Coll Cardiol. 2008;52(3):190–9.
• 9. Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Konstam MA, et al. Acute heart failure syndromes: current state and framework for future research. Circulation 2005;112(25):3958–68.
• 10. Sciatti E, Vizzardi E, Bonadei I, Dallapellegrina L, Carubelli V. The role of heart rate and ivabradine in acute heart failure Monaldi Arch Chest Dis. 2019;89:1091.
• 11. Parenica J, Spinar J, Vitovec J, Widimsky P, Linhart A, Fedorc M, et al. Long-term survival following acute heart failure: the Acute Heart Failure Database Main registry (AHEAD Main). Eur J Intern Med. 2013;24(2):151–60.
• 12. Zannad F, Mebazaa A, Juillière Y, Cohen-Solal A, Guize L, Alla F, et al. Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study. Eur J Heart Fail 2006;8(7):697–705.
• 13. Abraham WT, Adams KF, Fonarow GC, Costanzo MR, Berkowitz RL, LeJemtel TH et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005;46(1):57–64.
• 14. Follath F, Yilmaz MB, Delgado JF, Parissis JT, Porcher R, Gayat E, et al. Clinical presentation, management and outcomes in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). Intensive Care Med. 2011;37(4):619–26.
• 15. Abraham WT, Fonarow GC, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, et al. Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol. 2008;52(5):347–56.
• 16. Maggioni AP, Dahlström U, Filippatos G, Chioncel O, Leiro MC, Drozdz J et al. EURObservational Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2010;12(10):1076–84.
• 17. Ng AC, Sindone AP, Wong HS, Freedman SB. Differences in management and outcome of ischemic and non-ischemic cardiomyopathy. Int J Cardiol. 2008;129(2):198–204.
• 18. Lourenço C, Saraiva F, Martins H, Baptista R, Costa S, Coelho L et al. Ischemic versus non-ischemic cardiomyopathy--are there differences in prognosis? Experience of an advanced heart failure center. Rev Port Cardiol. 2011;30(2):181–97.
• 19. Zhang ZH, Meng FQ, Hou XF, Qian ZY, Wang Y, Qiu YH, et al. Clinical characteristics and long-term prognosis of ischemic and non-ischemic cardiomyopathy. Indian Heart J. 2020;72(2):93–100.
• 20. Harjola VP, Follath F, Nieminen MS, Brutsaert D, Dickstein K, Drexler H, et al. Characteristics, outcomes, and predictors of mortality at 3 months and 1 year in patients hospitalized for acute heart failure. Eur J Heart Fail. 2010;12(3):239–48.
• 21. Bonilla-Palomas JL, Gámez-López AL, Moreno-Conde M, López-Ibáñez MC, Anguita-Sánchez M, Gallego de la Sacristana A, et al. Hypoalbuminemia in acute heart failure patients: causes and its impact on hospital and long-term mortality J Card Fail. 2014;20(5):350–8.
• 22. Gheorghiade M, Rossi JS, Cotts W, Shin DD, Hellkamp AS, Piña IL, et al. Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE trial. Arch Intern Med 2007;167(18):1998–2005.
• 23. Formiga F, Moreno-Gonzalez R, Chivite D, Yun S, Ariza A, Corbella X. Lower admission blood pressure as an independent predictor of 1-year mortality in elderly patients experiencing a first hospitalization for acute heart failure. Hellenic J Cardiol. 2019;60(4):224–29.
• 24. Tsimploulis A, Lam PH, Arundel C, Singh SN, Morgan CJ, Faselis C, et al. Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Preserved Ejection Fraction JAMA Cardiol. 2018;3(4):288–97.
• 25. Barlera S, Tavazzi L, Franzosi MG, Marchioli R, Raimondi E, Masson S et al. Predictors of Mortality in 6975 Patients With Chronic Heart Failure in the Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico-Heart Failure Trial. Circ Heart Fail. 2013;6(1):31–9.
• 26. Prins KW, Neill JM, Tyler JO, Eckman PM, Duval S. Effects of Beta–Blocker Withdrawal in Acute Decompensated Heart Failure:A Systematic Review and Meta–Analysis JACC Heart Fail 2015;3(8):647–53.