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Type: Journal article
Title: Caveat anicula! Beware of quiet little old ladies Demographic features, pharmacotherapy, readmissions and survival in a 10-year cohort of patients with heart failure and preserved systolic function
Author: Wong, T.
Clark, R.
Dundon, B.
Philpott, A.
Molaee, P.
Shakib, S.
Citation: Medical Journal of Australia, 2010; 192(1):9-13
Publisher: Australasian Med Publ Co Ltd
Issue Date: 2010
ISSN: 0025-729X
Statement of
Dennis T Wong, Robyn A Clark, Benjamin K Dundon, Andrew Philpott, Payman Molaee and Sepehr Shakib
Abstract: OBJECTIVE: To determine whether heart failure with preserved systolic function (HFPSF) has different natural history from left ventricular systolic dysfunction (LVSD). DESIGN AND SETTING: A retrospective analysis of 10 years of data (for patients admitted between 1 July 1994 and 30 June 2004, and with a study census date of 30 June 2005) routinely collected as part of clinical practice in a large tertiary referral hospital. MAIN OUTCOME MEASURES: Sociodemographic characteristics, diagnostic features, comorbid conditions, pharmacotherapies, readmission rates and survival. RESULTS: Of the 2961 patients admitted with chronic heart failure, 753 had echocardiograms available for this analysis. Of these, 189 (25%) had normal left ventricular size and systolic function. In comparison to patients with LVSD, those with HFPSF were more often female (62.4% v 38.5%; P = 0.001), had less social support, and were more likely to live in nursing homes (17.9% v 7.6%; P < 0.001), and had a greater prevalence of renal impairment (86.7% v 6.2%; P = 0.004), anaemia (34.3% v 6.3%; P = 0.013) and atrial fibrillation (51.3% v 47.1%; P = 0.008), but significantly less ischaemic heart disease (53.4% v 81.2%; P = 0.001). Patients with HFPSF were less likely to be prescribed an angiotensin-converting enzyme inhibitor (61.9% v 72.5%; P = 0.008); carvedilol was used more frequently in LVSD (1.5% v 8.8%; P < 0.001). Readmission rates were higher in the HFPSF group (median, 2 v 1.5 admissions; P = 0.032), particularly for malignancy (4.2% v 1.8%; P < 0.001) and anaemia (3.9% v 2.3%; P < 0.001). Both groups had the same poor survival rate (P = 0.912). CONCLUSIONS: Patients with HFPSF were predominantly older women with less social support and higher readmission rates for associated comorbid illnesses. We therefore propose that reduced survival in HFPSF may relate more to comorbid conditions than suboptimal cardiac management.
Keywords: Humans; Propanolamines; Carbazoles; Antihypertensive Agents; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Stroke Volume; Treatment Failure; Length of Stay; Patient Readmission; Risk Factors; Retrospective Studies; Cohort Studies; Comorbidity; Sex Factors; Ventricular Function, Left; Time Factors; Social Support; Aged; Australia; Female; Male; Heart Failure, Diastolic
Rights: © The Medical Journal of Australia 2010
RMID: 0020100180
DOI: 10.5694/j.1326-5377.2010.tb03393.x
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Appears in Collections:Pharmacology publications

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