Acute heart failure - challenge of the 21st century

Non-invasive prognostic factors and the quality of life in patients hospitalized for acute heart failure.

Project leader: Ondřej Ludka, MD, Ph.D.

The hospitalization frequency for acute heart failure in west countries population has increasing tendency during the last 20 years. In 2003 the EuroHeart Failure survey estimated the lenght of hospitalization stay to be 11 days[1]. One-year in-hospital mortality varies from 29%[2] to 46%[3] and approximately 45% of patients are re-hospitalized within one year after first hospitalization discharge[4]. Thus early recognition of high-risk patient and the prognosis determination is important in the medical care as well as for the optimalization of hospitalization management.

The purpose of this project is to monitor all patients admitted at the Department of Cardiology of the University Hospital in Brno with primary diagnosis of acute heart failure and the treatment with furosemid requiring. The already established database AHEAD with more detailed parameters incorporated will be the basis for the data recording in this prospective study.

Primary aim of this study is to determine the most important and easily gained prognostic factors within the group of the biochemical markers and the parameters measured by transthoracic echocardiography for the identification of high-risk patients with heart failure.

We are also interested in the concentrations of BNP and NT-proBNP at the time of patient’s admission and discharge. The prognostic importance of their concentration variability haven’t been assessed in any broader patients cohort yet, thus we decided to search for correlations between natriuretic peptids concentration and other clinical outputs, especially results from echocardiographical examinations laying the emphasis on parameters describing both the systolic and diastolic function.

Moreover, we will pay attention to the patient’s quality of life. The health status reported by patients themself using disease-specific questionnaires (Minnesota Living with Heart Failure Questionnaire, Seattle Angina Questionnaire, MRC Dyspnoea Scale) and general health-status measuring questionnares (EQ-5D, Short Form 12v2 Health Survey) will be put into correlation with the clinical results. The data about the socio-demographic background of the patients will be collected as well.

Thus, the primary objectives of this study can be stated as follow:

  • To indentify the most important prognostic factors for early recognition of high-risk patients from the set of echocardiographical parameters.
  • To find out correlation between echocardiographical parameters and the changes in concentration of BNP and NT-proBNP during hospitalization.
  • To assess the quality of life in patients with heart failure.

References

  1. Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, Dietz R, Gavazzi A, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, van Gilst WH, Widimsky J, Freemantle N, Eastaugh J, Mason J, Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology.. 2003. The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 24(5):442-463.
  2. Cowie MR, Mosterd A, Wood DA, Deckers JW, Poole-Wilson PA, Sutton GC, Grobbee DE. 1997. The epidemiology of heart failure. Eur Heart J 18(2):208-225.
  3. Rudiger A, Harjola VP, Müller A, Mattila E, Säila P, Nieminen M, Follath F. 2005. Acute heart failure: clinical presentation, one-year mortality and prognostic factors. Eur J Heart Fail 7(4):662-670.
  4. Zannad F, Mebazaa A, Juillière Y, Cohen-Solal A, Guize L, Alla F, Rougé P, Blin P, Barlet MH, Paolozzi L, Vincent C, Desnos M, Samii K, Investigators. E. 2006. Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study. Eur J Heart Fail 8(7):697-705.
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