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Title: Polish heart failure patient population enrolled in the Long Term Heart Failure Registry and the evaluation of the patient prognosis in the 1- year follow-up


INTRODUCTION Heart failure (HF) is becoming one of the greatest challenges to modern medicine, as well as a growing economic and social problem. Despite the progress that was made over the last two decades, the outlook for HF patients is still rather poor, with survival rate being worse than in the case of breast, colorectal or prostate cancer. The registries of heart failure patients conducted by ESC (Heart Failure Pilot Survey, Heart Failure Long Term Registry) are the first registries featuring such an extensive clinical database, thus enabling a thorough exploration of the heart failure issue. DISSERTATION OBJECTIVES The fundamental objective of the doctoral dissertation was to characterise the Polish population of heart failure patients enrolled in the Heart Failure Long Term Registry, as well as assess the subjects’ prognosis during a one-year follow-up. Additional objectives of the project included: 1. Describing the characteristics, clinical course and prognosis for three heart failure types (HFrEF, HPfEF, HFmrEF), with particular focus on heart failure with HFmrEF based on the Polish population of heart failure patients included in the Heart Failure Long Term Registry; 2. Exploring the similarities and differences of heart failure among the Polish patients affected by the condition compared to the patients included in the Heart Failure Long Term Registry in other ; European countries. METHODOLOGY ESC-HF Long Term Registry was a prospective, multi-centre, observational study conducted at 211 cardiology centres in 21 European and Mediterranean ESC member countries. The patients were recruited at the Sites on one regular day of the week for the subsequent 12 months, with patients being monitored for 12 months. 1202 patients were enrolled in the Polish part of ESC-HF Long Term Registry during the 1st phase of the registry between May 2011 and April 2013. Inclusion criteria: All outpatients and inpatients admitted to the Ward on a previously selected, given day of the week were invited to participate in the registry. Therefore, the following patients were enrolled in the study: - Outpatients with chronic heart failure diagnosed according to the clinical assessment of the responsible cardiology specialist at the participating sites - Patients hospitalised at the cardiology ward or cardiac intensive care unit due to acute heart failure requiring intravenous therapy Exclusion criteria: - Patient under 18 years of age - No patient’s written consent for participation in the registry Statistical analysis: Nominal variables were presented as sizes and percentages, while continuous variables as an average with standard deviation and median along with third and fourth quartile. The normality of distribution was tested using the Shapiro-Wilk ; test or the Kolmogorov-Smirnov and Lillefors tests in case of large sample size. Variance analysis or the Kruskal-Wallis test were used for comparison of continuous variables between the three EF groups. Nominal variables were compared using the Pearson's chi-squared test or Fisher’s exact test (using Monte Carlo simulation for tables larger than 3x3). Survival analysis was conducted with the use of the Kaplan-Meier estimator, while the survival curves were compared using the log-rank test. It was assumed that p<0.05 indicates statistical significance. RESULTS Patients with HFrEF constituted the largest group (61.15%), followed by HFmrEF (19.63) and HFpEF (19.22%) patients. Inpatients comprised the largest group among Polish participants (64.73%). Patients affected by HFpEF were hospitalised significantly more often (76.19%, p<0.001). Specific patient groups differed significantly with regard to age (p<0.001). Men constituted majority of patients (72.52%). Significant differences in gender distribution were observed depending on the HF type (p <0.001). Significant differences in BMI values and in systolic and diastolic blood pressure values were observed across the particular HF types. Ischemic heart disease constitutes the most frequent cause of heart failure (52.49%). There were significant differences in the etiology distribution between individual HF types (p <0.001). Th ; ere were significant differences in the distribution of prevalence of cigarette smoking addiction both currently and in the past and in the distribution of alcohol prevalence between the three types of HF. Among inpatients, 90.82% were admitted due to decompensated HF. Significant differences in the distribution of the clinical profile were found between 3 types of HF (p <0.001).There were no significant differences between all heart failure types regarding the frequency of use of inotropic agents, diuretics and nitrates. 88.23% of Polish patients enrolled in the registry received ACE/ARB. 39.89% of the patients achieved target drug dose. Beta-blockers were used by an average of 92.42% of the affected group. An average of 70.68% patients received aldosterone receptor antagonists, with 39.57% achieving the target dose. CRT was implanted in 9.52% of the affected, with indications for use occurring in 9.44% of the enrolled patients. ICD was implanted in 26.15% of the affected, with indications for use occurring in 21.39% of the enrolled patients. Total mortality during the one-year follow-up . was 11.18%. No significant differences were observed in total mortality between the three types of heart failure. In conclusion, within the framework of this study patients with HFrEF were younger than those with HFpEF; men were affected more frequently. HFrEF patients were less often hospi ; talised. BP values were significantly lower in this group. Ischemia was the prevailing cause among the patients with HFrEF. Natriuretic peptides level was higher in HFrEF patients. The increase of the left ventricular size was significantly larger in patients with HFrEF, which is linked to pathological cardiac electrical remodeling, more frequent LBBB co-occurrence and mitral valve insufficiency among these patients. Peripheral hypoperfusion and increased prevalence of venous thromboembolic disease were also observed more often. Patients with HFpEF were older than those affected by HFrEF and HFmrEF; more often they were women and were hospitalised. Hypertension and AF were also present more often within this patient group. Causes of hypertensive and valvular origin were found significantly more often. In patients with HFpEF, BMI and BP values were higher; these participants, however, were significantly less often addicted to nicotine and consumed alcohol less frequently. Left ventricular remodeling pattern in HFpEF was characterised by normal LV size and high prevalence of left ventricular hypertrophy and left atrial enlargement. Higher atrial fibrillation prevalence and presence of left atrial enlargement may suggest adverse left ventricular electrical remodeling within this group of patients. Uncontrolled hypertension was a significantly more frequent cause of hospitalisatio ; n among the HFpEF patients. MRAs and beta-blockers were less frequently administered to HFpEF patients in comparison to those with HFmrEF and HFrEF. Patients affected by HFpEF received calcium channel blockers significantly more often. Antiplatelet medications were significantly less often used in the HFpEF group, while anticoagulants were significantly more often administered to HFpEF patients in comparison to participants with other HF types. The group of patients HFmrEF fell between the patients with HFrEF and HFpEF, although with some exceptions. Myocardial infarction constituted the most frequent cause of hospitalisation in comparison with HFrEF and HFpEF patients; this group prevailed among outpatients. Ischemic heart disease was listed among most common causes. Prior myocardial infarction/ischemic heart disease constituted the prevalent comorbidities. CABG procedure was completed most often within this group. Furosemide was significantly less often administered to the patients with HFmrEF, with antiplatelet medication being used more frequently. CONCLUSIONS 1. The characteristics of the Polish population of patients included in the Heart Failure Long Term Registry varied depending on the type of heart failure in terms of demographic data, etiology, comorbidities, risk factors, physical examination, some laboratory parameters, electrocardiographic and echocardiographi ; c and pharmacotherapy. Despite this, the prognosis for the one year follow-up of the Polish population of patients with heart failure was not different between the three types of heart failure. 2. It was observed that patients with heart failure with midrange ejection fraction in the clinical-demographic profile, etiology, incidence of co-existing diseases, selected laboratory, electrocardiographic and echocardiographic parameters are classified between patients with heart failure with reduced ejection fraction and patients with heart failure with preserved ejection fraction. however, they are closer to patients with heart failure with reduced ejection fraction. 3. It has been demonstrated that the Polish population of patients with heart failure including its three types is similar in many clinical-demographic aspects to the European registry population. In comparison to the European registry population, ischemic etiology was more frequent in the Polish population of patients, beta blockers and aldosterone antagonists were more frequently used, target doses of basic groups of drugs recommended in heart failure were more often achieved, and lower overall mortality was observed in one year follow-up.

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2 - studia doktoranckie

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Wydział Lekarski


Gajos, Grzegorz

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May 23, 2022

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ZB-133527 May 23, 2022


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