The management of patients with heart failure in a Slovenian community hospital: what has changed between 1997 and 2000?

BACKGROUND: Heart failure is a common and serious disease associated with poor prognosis. Despite the encouraging results of many clinical trials and the availability of published guidelines, epidemiological studies still show a gap between recommendations and clinical practice. There is a scarcity of data on changes in the management of patients hospitalized with heart failure. AIM: To investigate how evidence-based guidelines on heart failure are being followed in clinical practice in patients hospitalized for heart failure in a community hospital and whether there have been any changes during the period from 1997 to 2000.
METHODS: Two cohorts of patients with heart failure were studied. A retrospective analysis of medical charts from patients hospitalized for heart failure in 1997 was compared with a prospective registry (EuroHeart Failure survey) of patients hospitalized for heart failure during six consecutive weeks in April and May 2000. The data on diagnostic and therapeutic interventions during hospitalization in both periods were obtained from medical records.
RESULTS: We included 122 patients, aged 72 +/- 10 years, in 1997 and 126 patients, aged 73 +/- 12 years, in 2000. There was no significant difference in sex, NYHA class on admission, rate of recurrent hospitalizations, hospital stay (11.8 +/- 6.2 days vs. 12.8 +/- 9.6 days, respectively) or in-hospital mortality (17% vs. 16%). In the year 2000 significantly more patients had an echocardiography report than in 1997 (37% vs. 13%, p < 0.001), and they were significantly more often discharged with angiotensin-converting enzyme inhibitors (48% vs. 30%, p < 0.01) and beta-adrenergic blockers (9% vs. 2%, p = 0.04).
CONCLUSIONS: A considerable gap exists between evidence-based guidelines on heart failure and clinical practice in the management of patients with heart failure in a community hospital. There was some improvement between the two observed cohorts, but the recommendations were still not adequately implemented in the year 2000. Further improvement requires new hospital strategies for the management of heart failure and the creation of an outpatient setting.