Keywords
Patient Readmission
Guideline Adherence
Clinical Practice Guidelines
Treatment Compliance
How to Cite
Abstract
Introduction: adherence to management standards in heart failure such as the AHA´s Get With the Guidelines-Heart failure initiative can reduce readmissions and mortality. Objective: To describe the clinical characteristics of patients hospitalized for acute heart failure and to assess adherence to program quality standards of the Get With The Guidelines Program in a university hospital in Bogotá. Methods: observational, descriptive and retrospective HUN-ICA cohort study. 493 adult patients hospitalized for acute heart failure, between April 2016 to December 2018. Clinical variables, treatment, mortality, readmissions and adherence to program quality standards defined by the GWTG program criteria were evaluated. Results: 52,1 % of the population were women, mean age was 75 years, (67,8 %) cases of heart failure with LVEF > 40 %. The most common etiology of heart failure was hypertensive (58,5 %). The most frequent etiology of decompensation was infectious (28,8 %). Adherence to beta-blockers use increased in patients with reduced ejection fraction at discharge of 46 %, and to the use of mineralocorticoid receptor antagonists in 61,1 %, compared to admission. Discussion: the evaluated cohort presented a hemodynamic, clinical profile and adherence similar to colombian cohorts. Suboptimal doses of medication upon discharge justify the need for outpatient heart failure clinics. Conclusions: lower adherence for use and optimal doses of beta-blockers and mineralocorticoid receptor antagonists than GWTG cohort was found, with increased use of guidelines recommended pharmacological therapy between hospital admission and discharge.
References
Roth G, Abate D, Hassen K, Abay S, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019; 392(10159): 1789-1858. 2. Gómez E. Capítulo
Introducción, epidemiología de la falla cardiaca e historia de las clínicas de falla cardiaca en Colombia. Rev Colomb Cardiol. 2016; 23(S1): 6-12.
Ministerio de Salud y Protección Social. Dirección de Epidemiología y Demografía. Análisis de Situación de Salud (ASIS). Colombia, 2017.
Tamayo D, Rodriguez V, Rojas M, Rincón M, Franco C, Ibarra M, et al. Costos ambulatorios y hospitalarios de la falla cardiaca en dos hospitales de Bogotá. Acta Med Colomb. 2013; 38(4): 208-212.
Krantz MJ, Ambardekar AV, Kaltenbach L, Hernandez AF, Heidenreich PA, Fonarow GC. Patterns and predictors of evidence-based medication continuation among hospitalized heart failure patients (from Get with the Guidelines-Heart Failure). Am J Cardiol. 2011; 107(12): 1818-1823.
Mebazaa A, Davison B, Chioncel O, Cohen-Solal A, Diaz R, Filippatos G, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022; 400(10367): 1938-1952.
Senior JM, Saldarriaga C, Rendón JA. Descripción clínico-epidemiologica de los pacientes con falla cardiaca aguda que consultan al servicio de urgencias. Acta Med Colomb. 2011; 36(3): 125-129.
Ospina AV, Gamarra G. Características clínicas y epidemiológicas de la insuficiencia cardiaca en el Hospital Universitario Ramón González Valencia de Bucaramanga, Colombia. Salud UIS. 2004; 36(3): 125-131.
Lancheros A, Valencia Y, Chaves W. Insuficiencia cardíaca aguda: factores asociados con mortalidad Hospital de San José, julio 2007 - agosto 2008 Bogotá D.C. Colombia. Repert de Medicina y Cirugia. 2009; 18(3): 166-174.
Henao C, Benavides JM, Chaves W, Diaztagle JJ, Sprokel J, Hernández JI. Falla cardíaca descompensada: estratificación del riesgo de mortalidad intrahospitalaria hospital de San José de Bogotá DC. Repert de Medicina y Cirugia. 2011; 20(4): 251-258.
Saldarriaga C, González N, Ávila A. Diferencias de género en el tratamiento de la falla cardíaca. Rev Colomb Cardiol. 2014; 21(1): 27-32.
Chavez W, Diaztagle J, Sprockel J, Hernández J, Benavidez J, Henao D, et al. Factores asociados a mortalidad en pacientes con falla cardiaca descompensada. Acta Med Colomb. 2014; 39(4): 314-320.
Calderón L, Satizábal N, Rincón E, Olaya P, Florez N, Carrillo D, et al. Perfiles clínicos y hemodinámicos en pacientes con falla cardiaca aguda. Rev Colomb Cardiol. 2017; 24(5): 448-457.
Muñoz O, Sierra E, Zapata A, Isaza M, Muñoz M, Sánchez J, et al. Caracterización sociodemográfica y clínica de una población con falla cardíaca aguda: cohorte MED-ICA. Rev Colomb Cardiol. 2018; 25(3): 200-208.
Gómez JE, Saldarriaga CI, Echeverria LE, Luna P. Registro colombiano de falla cardiaca RECOLFACA: resultados. Rev Colomb Cardiol. 2021; 28(4): 334-344.
Fonarow GC, ADHERE Scientific Advisory Committee. The Acute Decompensated Heart Failure National Registry (ADHERE): opportunities to improve care of patients hospitalized with acute decompensated heart failure. Rev Cardiovasc Med. 2003; 4 (7): 21–30.
Spinar J, Parenica J, Vitovec J, Widimsky P, Linhart A, Fedorco M, et al. Baseline characteristics and hospital mortality in the Acute Heart Failure Database (AHEAD) Main registry. Crit Care. 2011; 15(6): R291.
Follath F, Yilmaz MB, Delgado JF, Parisis 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): 619-626.
Llorens P, Martín F, González J, Herrero P, Jacob J, Álvarez A, et al. Perfil clínico del paciente con insuficiencia cardiaca aguda atendido en los servicios de urgencias: Datos preliminares del Estudio EAHFE (Epidemiology Acute Heart Failure Emergency). Emergencias. 2008; 20(3): 154-163.
Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail. 2021; 23(3): 352-380.
Dokainish H, Teo K, Zhu J, Roy A, Alhabib KF, Elsayed A, et al. Heart Failure in Africa, Asia, the Middle East and South America: The INTER-CHF study. Int J Cardiol. 2016; 204: 133-141.
Arcos LC, Méndez A, Rojas IT, Torres SG, Tabares SC. Caracterización clínico epidemiológica de pacientes hospitalizados con diagnóstico de falla cardiaca descompensada con fracción de eyección reducida. Acta Med Colomb. 2020; 45(1): 1-9.
Fonarow GC. The role of in-hospitalization of cardioprotective therapies to improve treatment rates and clinical outcomes. Rev Cardiovasc Med. 2002; 3(suppl 3): S2-S10.
Chaves W, Diaztagle J, Vargas V, Mejía M, Sprockel J, Hernández J. Cumplimiento de guías en pacientes hospitalizados con falla cardiaca ¿Cómo estamos?. Acta Med Colomb. 2014; 39: 40-45.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Médicas UIS