The first Euro Heart Survey on Heart Failure was undertaken during 2000-2001 in 115 hospitals from 24 countries. Of 46,782 consecutive case notes of death or discharges (all causes) from internal medicine, geriatric, cardiology and cardiac surgery wards,10,701 (24%) were identified with suspected or confirmed heart failure.
Conclusion:
- Many of the recommended basic investigations were done, but echocardiography was performed less frequently than expected.
- In accordance with guidelines, the majority of heart failure patients with LVSD received an ACE-inhibitor, but betablockers were prescribed in only half of these patients.
- Even in trial eligible patients, betablockers were prescribed in half of the patients, and the recommended dose was prescribed in a small minority only.
- The application of diagnostic and therapeutic procedures varied largely between hospitals.
- Guidelines are mainly based on clinical trials in heart failure patients with LVSD, but almost half of the enrolled patients did not have LVSD.
The second Euro Heart Survey on Heart Failure was undertaken during 2004-2005. Patients hospitalized for AHF were recruited by 133 centres in 30 European countries. Mean age was 70 years, and 61% of patients were male. New-onset AHF (de novo AHF) was diagnosed in 37%, of which 42% was due to acute coronary syndromes (ACS). Clinical classification according to the guidelines divided AHF patients into (i) decompensated HF (65%), (ii) pulmonary oedema (16%), (iii) HF andhypertension (11%), (iv) cardiogenic shock (4%), and (v) right HF (3%). Coronary heart disease, hypertension,and atrial fibrillation were the most common underlying conditions. Valvular disorders were common, especially mitral regurgitation (MR) which was reported on echocardiography in 80% of patients. Median length of stay was 9 days, and in-hospital mortality 6.7%. At discharge, 80% of patients were on angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers, whereas 61% were taking beta-blocker medication.
Conclusion
- Decompensated HF is the most common clinical presentation of AHF patients.
- More than one-third of AHF patients do not have a previous history of HF, and new-onset HF is often caused byACS.
- Preserved systolic function is found in a substantial proportion of the patients.
- The prevalence of valvular dysfunction is strikingly high and contributes to the clinical presentation.
- The EHFS II on AHF verified that the use of evidence-based HF medication was well adopted to clinical practice.
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