The disparity is noted by the investigators to illustrate the heterogeneity of acute HF, and warn that an ‘all-comers’ approach in either everyday management or clinical trials may well explain the failure of the large majority of treatments tested in this clinical condition.
The current European guidelines for the diagnosis and treatment of HF propose a stratification of patients admitted for acute HF, but validation in a real clinical setting has never been done. ‘The ESCHF Pilot Survey,’ the investigators add, ‘provides a contribution defining the prevalence of the different clinical profiles and their related outcomes.’
The EURObservational Research Programme was started in August 2008 to provide a better understanding of cardiology practice in Europe based on ‘robust’ data collection and to establish a professional research centre based at the European Heart House. As such, the programme aims to improve the Euro Heart Survey programme begun in 1999.
This heart failure pilot survey, which was presented in detail at a Symposium on Monday by Professor Aldo Maggioni from the ANMCO Research Center in Florence, derived data from 156 centres in 12 European countries selected to represent the different health systems and care attitudes across Europe. The study was conducted by the Heart Failure Association in association with the local cardiology societies of the participating countries.
A total of 5118 patients were included in the survey, which took place between October 2009 and May 2010; 1892 (37%) were admitted for acute HF and 3226 (63%) for chronic HF. As expected, co-morbidities were more frequent in patients admitted for acute HF, whereas the rate of implanted devices was more common in patients with chronic HF. More than half the patients with acute HF had an ischaemic aetiology, confirmed by coronary angiography in 64% of cases.
In patients with chronic HF, an ischaemic aetiology accounted for just 40% of the cases. One of the aims of the pilot study, said Maggioni, was to test the feasibility of such a hospital network and database as a reliable source of answers to ‘relevant clinical questions’. And already, one conclusion drawn from the survey’s picture of drug use is that the number of patients treated with appropriate doses is, at best, ‘suboptimal’.
‘Thus,’ say the investigators, ‘there is a need to develop strategies to improve the management of patients with chronic HF through specific, focused management programmes. This is a common finding of all registries on HF, confirming the gap between the information generated by randomized controlled trials, performed in selected populations carefully monitored over time, and those provided by observational research reflecting routine clinical practice.’
Pursuing the same theme, the investigators found that only one-third of patients with a clinical profile suited to an implantable cardioverter defibrillator were actually implanted, and only one fifth with cardiac resynchronisation therapy. ‘This,’ said the investigators, ‘is clearly another gap between recommendations and the actual clinical practice that should be considered in the future.’