Heart Failure
Conditions
Keywords
systolic dysfunction, diastolic dysfunction, mortality, treatment, heart rate
Brief summary
Having heart failure means the heart is unable to pump blood around the body effectively. This reduces life expectancy and hinders normal daily activities. Heart failure affects about one million people in the UK; it is a major cause of death but it is often undetected and under-treated. If diagnosed and treated properly, the symptoms of heart failure can be well controlled and the length and quality of life can be improved. Two drugs (called ACE-inhibitors and beta-blockers) help patients to live longer and suffer fewer consequences of heart failure. These drugs should be offered to all patients although this does not happen consistently for a variety of reasons. Doctors specialising in heart failure may help patients make better informed decisions about treatments and other aspects of care. The purpose of this research is to explore the diagnosis, management and outcome of patients with heart failure who are referred to the one stop diagnostic heart failure clinic between Jan 2002 and Dec 2007. This study will provide vital information about diagnosis, initiation and titration of evidence based medication in the hospital, their follow in the primary care and subsequent patient outcome in terms of mortality.
Detailed description
Case notes of all the patients who were referred to the one stop diagnostic heart failure clinic during the period (Jan 2002- Dec 2007) will be reviewed and subjects who were found to have signs and symptoms of the Heart failure will be identified. This cohort of patients will be further analysed and divided on the basis of Echocardiography (special scan of the heart that looks at the contraction, relaxation, and the flow of blood in the heart chambers) results into two groups. 1. Those who have impaired contraction (systolic) function of there Left ventricle (left side chamber of the heart) 2. Those who have normal contraction (systolic) function of the left ventricle. Case notes of these patients will then be studied in detail with regards to their initial presentation, clinical examination, Electrocardiogram (electrical tracing of the heart) and chest X ray (picture of the heart and lungs) report. These will be co-related with the findings and report of the Echocardiogram. Once the diagnosis is established, uptake of evidence based medications (beta blockers, ACE inhibitors, spironolactone) and their titration up to the target dose at subsequent follow up visits in the heart failure clinic will be examined. B) Phase 2 (General practice/ surgery phase) This part of the study will be conducted at the GP surgery of the identified patient. This will involve accessing the data held at the GP practice with regards to 1. Was heart failure treatment continued after discharge from the hospital clinic? 2. If medications continued then for how long? 3. If medications discontinued then why and by whom (Hospital/GP)? 4. Current medications and the doses 5. Admissions to the hospital if any? 6. Any other co morbidities developed since discharge for the HF clinic? 7. Outcome in terms of mortality 8. The cause of death as specified on the death certificate
Interventions
None listed
Sponsors
Study design
Eligibility
Inclusion criteria
* 18 years and over attending heart failure clinic between 01/01/2002- 31/12/07
Exclusion criteria
* less than 18 years. Pregnant females
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| All Cause Mortality | Patients would be followed up for average of 7 years |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cardiovascular Mortality | Patients would be followed up for average of 7years | — |
| Admission to Hospital for Any Cause | During the follow up period of 7 years | Number of patients admitted to the hospital will be recorded |
Countries
United Kingdom
Participant flow
Recruitment details
Patients referred to the one stop diagnostic heart failure clinic from Jan 2002 to Dec 2007, were followed up till Aug 2011.
Participants by arm
| Arm | Count |
|---|---|
| Systolic Dysfunction patients having left ventricular systolic dysfunction on echocardiography | 268 |
| Distolic Heart Failure patients with clinical heart failure and preserved LV systolic dysfunction | 241 |
| Total | 509 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 2 | 2 |
Baseline characteristics
| Characteristic | Distolic Heart Failure | Systolic Dysfunction | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 220 Participants | 219 Participants | 439 Participants |
| Age, Categorical Between 18 and 65 years | 21 Participants | 49 Participants | 70 Participants |
| Age, Continuous | 78 years STANDARD_DEVIATION 8 | 74 years STANDARD_DEVIATION 10 | 76 years STANDARD_DEVIATION 10 |
| Region of Enrollment United Kingdom | 241 participants | 268 participants | 509 participants |
| Sex: Female, Male Female | 157 Participants | 104 Participants | 261 Participants |
| Sex: Female, Male Male | 84 Participants | 164 Participants | 248 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
All Cause Mortality
Time frame: Patients would be followed up for average of 7 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Systolic Dysfunction | All Cause Mortality | 163 participants |
| Distolic Heart Failure | All Cause Mortality | 118 participants |
Admission to Hospital for Any Cause
Number of patients admitted to the hospital will be recorded
Time frame: During the follow up period of 7 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Systolic Dysfunction | Admission to Hospital for Any Cause | 189 participants |
| Distolic Heart Failure | Admission to Hospital for Any Cause | 158 participants |
Cardiovascular Mortality
Time frame: Patients would be followed up for average of 7years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Systolic Dysfunction | Cardiovascular Mortality | 113 participants |
| Distolic Heart Failure | Cardiovascular Mortality | 51 participants |