Hartfalen in de dagelijkse praktijk: Patiëntenkenmerken, diagnostiek en behandeling

Objective. To describe the general characteristics, diagnosis and treatment of patients with heart failure, to compare patients in daily practice with participants in clinical trials, and to evaluate the application of the existing guidelines for the diagnosis and treatment of heart failure. Design. Observational study. Method. Data were collected from patients with heart failure who were admitted to a hospital in the period from 1 March to 31 August 2000. The inclusion criteria were: a clinical diagnosis of heart failure or treatment with a loop diuretic for any reason other than renal failure. This study was part of the EuroHeart survey on heart failure (115 European hospitals (24 countries), including 2 in the Netherlands). Results. Data were collected from a total of 101 patients in the Netherlands and 10,701 patients in all of Europe. The mean age in the Dutch group was 68 years and 43% were women. Ischaemic heart disease was present in 71%, valvular heart disease in 49% and hypertension in 35%. An ECG, chest X-ray and echocardiography were done in > 90% of the patients. Echocardiography was performed less often in older patients and in patients on non-cardiology wards. A systolic left-ventricle (LV) dysfunction was diagnosed in 64% of patients. Diuretics were used by 87%, angiotensin converting enzyme (ACE) inhibitors by 68%, beta-blockers by 32%, digitalis by 50%, calcium antagonists by 25% and spironolactone by 7%. The patients who were included in the Netherlands were comparable to patients included in the rest of Europe. There were important differences between the survey population and the participants in randomised clinical trials, for example in age, gender, and systolic LV dysfunction. Conclusion. Although the diagnostic procedures carried out in most heart failure patients were often in accordance with the guidelines, a significant proportion of the patients was treated only partly according to the guidelines. Considerable differences were observed between heart failure patients in daily practice and their counterparts in clinical trials.