BACKGROUND: Echocardiography is recommended for all patients with a clinical diagnosis of heart failure (HF). Management of HF in daily practice differs from guidelines. AIM: To evaluate the prognostic impact of echocardiography in patients hospitalized for a first episode of HF. METHODS: Consecutive patients (n=799) hospitalized for a first episode of HF were prospectively enrolled during 2000. Propensity scores and multivariable analyses were used to reduce the imbalance in baseline covariates between the Echo and No-Echo groups. RESULTS: During hospitalization, echocardiography was not performed in 151 patients (19%). Patients in the No-Echo group were older, more likely to be female, less frequently admitted to cardiology departments, and had lower rates of life-saving drugs prescribed at discharge. After adjustment for covariates of prognostic importance, use of echocardiography was associated with lower relative risk of three-year overall mortality (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.48-0.78, p<0.001) and cardiovascular mortality (HR 0.52, 95% CI 0.39-0.70, p<0.001). The three-year relative survival of the Echo group (observed/expected survival) was higher than that of the No-Echo group. Using propensity scores, the performance of echocardiography during hospitalization remained related to reduced three-year overall mortality (HR 0.55, 95% CI 0.39-0.79, p=0.001) and cardiovascular mortality (HR 0.59, 95% CI 0.37-0.95, p=0.03). CONCLUSION: Echocardiography is still underused in elderly patients with HF. Use of echocardiography appears to be associated with more intensive medical therapy and improved outcome.
BACKGROUND: Echocardiography is recommended for all patients with a clinical diagnosis of heart failure (HF). Management of HF in daily practice differs from guidelines. AIM: To evaluate the prognostic impact of echocardiography in patients hospitalized for a first episode of HF. METHODS: Consecutive patients (n=799) hospitalized for a first episode of HF were prospectively enrolled during 2000. Propensity scores and multivariable analyses were used to reduce the imbalance in baseline covariates between the Echo and No-Echo groups. RESULTS: During hospitalization, echocardiography was not performed in 151 patients (19%). Patients in the No-Echo group were older, more likely to be female, less frequently admitted to cardiology departments, and had lower rates of life-saving drugs prescribed at discharge. After adjustment for covariates of prognostic importance, use of echocardiography was associated with lower relative risk of three-year overall mortality (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.48-0.78, p<0.001) and cardiovascular mortality (HR 0.52, 95% CI 0.39-0.70, p<0.001). The three-year relative survival of the Echo group (observed/expected survival) was higher than that of the No-Echo group. Using propensity scores, the performance of echocardiography during hospitalization remained related to reduced three-year overall mortality (HR 0.55, 95% CI 0.39-0.79, p=0.001) and cardiovascular mortality (HR 0.59, 95% CI 0.37-0.95, p=0.03). CONCLUSION: Echocardiography is still underused in elderly patients with HF. Use of echocardiography appears to be associated with more intensive medical therapy and improved outcome.
Authors: Daniel Modin; Morten Sengeløv; Peter Godsk Jørgensen; Niels Eske Bruun; Flemming Javier Olsen; Maria Dons; Thomas Fritz Hansen; Jan Skov Jensen; Tor Biering-Sørensen Journal: ESC Heart Fail Date: 2017-10-11