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Heart failure disease management program, its contribution to established pharmacotherapy and long-term prognosis in real clinical practice - retrospective data analysis.

Authors
  • Lazarova, Marie1
  • Lazar, Dusan2
  • Malek, Filip3
  • Vaclavik, Jan1
  • Taborsky, Milos1
  • Ignaszewski, Andrew4
  • 1 Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic. , (Czechia)
  • 2 Department of Biophysics, Faculty of Science, Palacky University Olomouc, Czech Republic. , (Czechia)
  • 3 Heart Failure Centre, Hospital Na Homolce, Prague, Czech Republic. , (Czechia)
  • 4 Department of Cardiology, Heart Function Clinics, St. Paul´s Hospital, Vancouver, Canada. , (Canada)
Type
Published Article
Journal
Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
Publication Date
Dec 01, 2019
Volume
163
Issue
4
Pages
318–323
Identifiers
DOI: 10.5507/bp.2018.059
PMID: 30305762
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The prognosis of patients with heart failure (HF) is still generally unfavorable. HF with reduced ejection fraction (HFrEF) patients reach target medication doses in very low percentages in daily clinical practice. HF disease management programs (DMP), including nurse and telemedicine support that facilitate achieving target medication doses, may improve the unfavorable prognosis. We retrospectively analyzed the data of 738 patients with HFrEF who were followed in a single HF center during the years 1975-2011, for 6.4 (median) years. DMP, nurse and telemedicine support is established at this center. The group achieved left ventricle (LV) recovery after the HF treatment. The median LV ejection fraction improved from 25.0% at baseline to 50.0% at the time of the latest data collection. The proportion of NYHA II, III and IV classes decreased from 27.6%, 30.2% and 29.7% to 26.6%, 7.2% and 0.1%, respectively while the proportion of NYHA class I increased from 12.5% to 66.1%. Median NT-proBNP decreased from 975.0 to 324.0 pg/mL. The survival of the patient group was favorable; 79.7% survived 18.1 years after diagnosis of HF. A high percentage of the patients received recommended target or higher than target doses of angiotensin-converting enzyme inhibitors (82.0%) and beta-blockers (78.1%). The established pharmacotherapy resulted from an effective DMP and this contributed to the favorable prognosis.

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