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Impact of echocardiography in patients hospitalized for heart failure: a prospective observational study
Christophe Tribouilloy1, Dan Rusinaru, Haïfa Mahjoub
1INSERM ERI 12, Department of Cardiovascular Disease, France and University Hospital Amiens, avenue René-Laënnec, Amiens cedex 1, France. tribouilloy.christophe@chu-amiens.fr
Insights
Echocardiography use in first-time heart failure (HF) hospitalizations is linked to better survival. This diagnostic tool is underused, especially in elderly patients, despite its prognostic benefits.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Public Health
Background:
- Echocardiography is recommended for heart failure (HF) patients.
- Clinical practice often deviates from HF management guidelines.
Purpose of the Study:
- To assess the prognostic impact of echocardiography in patients hospitalized for their first HF episode.
Main Methods:
- Prospective enrollment of 799 patients hospitalized for a first HF episode in 2000.
- Utilized propensity scores and multivariable analyses to adjust for baseline differences between groups with and without echocardiography.
Main Results:
- Echocardiography was not performed in 19% of patients.
- After adjustment, echocardiography use was associated with significantly lower 3-year overall mortality (HR 0.61) and cardiovascular mortality (HR 0.52).
- The echocardiography group demonstrated higher 3-year relative survival.
Conclusions:
- Echocardiography remains underutilized in elderly HF patients.
- Echocardiography use correlates with more aggressive medical therapy and improved patient outcomes.
Background:
Echocardiography is recommended for all patients with a clinical diagnosis of heart failure (HF). Management of HF in daily practice differs from guidelines.
Aim:
To evaluate the prognostic impact of echocardiography in patients hospitalized for a first episode of HF.
Methods:
Consecutive patients (n=799) hospitalized for a first episode of HF were prospectively enrolled during 2000. Propensity scores and multivariable analyses were used to reduce the imbalance in baseline covariates between the Echo and No-Echo groups.
Results:
During hospitalization, echocardiography was not performed in 151 patients (19%). Patients in the No-Echo group were older, more likely to be female, less frequently admitted to cardiology departments, and had lower rates of life-saving drugs prescribed at discharge. After adjustment for covariates of prognostic importance, use of echocardiography was associated with lower relative risk of three-year overall mortality (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.48-0.78, p<0.001) and cardiovascular mortality (HR 0.52, 95% CI 0.39-0.70, p<0.001). The three-year relative survival of the Echo group (observed/expected survival) was higher than that of the No-Echo group. Using propensity scores, the performance of echocardiography during hospitalization remained related to reduced three-year overall mortality (HR 0.55, 95% CI 0.39-0.79, p=0.001) and cardiovascular mortality (HR 0.59, 95% CI 0.37-0.95, p=0.03).
Conclusion:
Echocardiography is still underused in elderly patients with HF. Use of echocardiography appears to be associated with more intensive medical therapy and improved outcome.
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