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Natural history and patterns of current practice in heart failure. The Studies of Left Ventricular Dysfunction
M G Bourassa1, O Gurné, S I Bangdiwala
1Montreal Heart Institute, Montreal, Quebec, Canada.
Insights
This large registry study found that ischemic heart disease is the primary cause of heart failure in most patients. While mortality was similar, Black patients experienced more hospital admissions for heart failure compared to White patients.
Area of Science:
- Cardiology
- Public Health
Background:
- Heart failure and left ventricular dysfunction affect millions globally.
- Understanding the etiology and outcomes of heart failure is crucial for effective management.
Purpose of the Study:
- To analyze the characteristics, etiology, and 1-year outcomes of a large cohort of patients with heart failure.
- To investigate disparities in heart failure causes and outcomes between racial groups.
Main Methods:
- The Studies of Left Ventricular Dysfunction (SOLVD) Registry enrolled 6,273 patients.
- Patients were followed for vital status and hospital admissions at 1 year.
- Etiology of heart failure was determined, and demographic and clinical factors were analyzed.
Main Results:
- Ischemic heart disease was the predominant cause (70%), with significant racial differences (73% White vs. 36% Black).
- Hypertensive heart disease was more common in Black patients (32% vs. 4% White).
- 1-year mortality was 18%; 27% experienced death or hospitalization for heart failure. Factors like age, ejection fraction, diabetes, atrial fibrillation, and female gender influenced outcomes. Black patients had more heart failure hospitalizations but similar mortality.
Conclusions:
- Ischemic heart disease is the leading cause of heart failure, but etiology varies significantly by race.
- While 1-year mortality rates for heart failure are comparable across races, Black patients face higher hospitalization rates.
- Age, ejection fraction, comorbidities, and gender are key predictors of heart failure outcomes.
Abstract:
A total of 6,273 consecutive relatively unselected patients with heart failure or left ventricular dysfunction, or both (mean age 62 +/- 12 years, mean ejection fraction 31 +/- 9%), were enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) Registry over a period of 14 months. All patients were followed up for vital status and hospital admissions at 1 year. Ischemic heart disease was the underlying cause of failure or dysfunction in approximately 70% of patients, whereas hypertensive heart disease was considered to be primarily involved in only 7%. There were striking differences in the etiology of heart failure among blacks and whites: 73% of whites had an ischemic etiology of failure versus only 36% of blacks; 32% of blacks had a hypertensive condition versus only 4% of whites. The total 1-year mortality rate was 18%; 19% of patients had hospital admissions for heart failure and 27% either died or had a hospital admission for congestive heart failure during the 1st year of follow-up. Factors related to 1-year mortality or hospital admission for congestive heart failure included age, ejection fraction, diabetes mellitus, atrial fibrillation and female gender. There was no difference in mortality associated with congestive heart failure among blacks and whites, but hospital admissions for heart failure were more frequent in blacks. Digitalis and diuretic agents were the drugs most often used in these patients, who were often taking many medications in relation to severity of congestive heart failure symptoms and ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)