Participation in cardiac rehabilitation after hospitalisation for heart failure: a report from the BIO-HF registry

Objective: Participation in cardiac rehabilitation (CR) after hospitalisation for heart failure (HF) is estimated to be low, but specific data for Belgium are lacking. Therefore, we wanted to evaluate attendance after HF hospitalisation compared to patients after cardiac surgery or acute coronary syndrome (ACS). Moreover, the improvement in exercise capacity was compared with the other patient groups. Methods and results: Patients who were hospitalized for HF (n = 428), cardiac surgery (n = 358) or ACS (n = 467) in a single hospital, were prospectively included between January 2010 and May 2012. After hospitalisation for HF only 9% participated, compared to 29% after ACS and 56% after cardiac surgery. Non-participants in HF were older, more frequently women (P < 0.01) and had a better left ventricular ejection fraction (P < 0.05). In addition, they had more frequently atrial fibrillation and problems to walk independently (P < 0.01). At the start of the CR, HF patients had a worse clinical status and exercise capacity than patients after cardiac surgery or ACS (all P < 0.001). However, exercise training resulted in a significant improvement in each group separately (all P < 0.001) and the relative improvement in exercise capacity in HF was comparable with the other groups. Conclusions: Only 9% of HF patients participated in CR after hospitalisation. Age, female gender, a relatively well-preserved ventricular function and atrial fibrillation seem to impede attendance to CR. However, HF patients can have as much improvement in exercise capacity as other patient populations, suggesting that more effort is needed to increase participation in CR among HF patients

Gender differences in the management and outcome of atrial fibrillation complicating acute heart failure

Background: Little is known about sex differences in the prevalence, treatment, and outcome of atrial fibrillation complicating acute heart failure. Methods and Results: Among 957 patients (429 women, 528 men), included in the BIO-HF registry, 45.2% (n = 194) of the women and 45.1% (n = 238) of the men were admitted with atrial fibrillation. The primary end point was a composite of 1-year all-cause mortality and hospitalization for heart failure. Adjusted 1-year mortality and hospitalization rates were similar between sexes (women 38.5%, men 36.0%; OR for female gender: 1.1, 95% CI 0.65-1.86; P = .71. A significant interaction between female sex and age (P = .002) was observed; with worse prognosis for women <75 years (OR 7.17, 95% CI 1.79-28.66; P = .005) compared with men <75 years. No sex differences in in-hospital treatment, restoration of sinus rhythm (16.5% in women vs 14.2% in men; P = .58), or in-hospital mortality (5.7% in women vs 6.7% in men; P = .69) were observed. Conclusions: Among patients hospitalized with acute heart failure, no sex differences in the prevalence and management of atrial fibrillation were observed. In-hospital mortality and the composite of 1-year mortality and rehospitalization were not different between sexes, but a significant sex-age interaction was observed, with worse outcome in women <75 years versus men <75 years of age

Clinical characteristics and short-term outcome of patients admitted with heart failure in Belgium : results from the BIO-HF registry

Aims: Hospitalization for acute decompensated heart failure (HF) is associated with poor outcome. As specific data for Belgium are currently not available, the aim of the Belgian BIO-HF registry is to evaluate the clinical characteristics, in-hospital mortality and outcomes after discharge of patients hospitalized for acute HF. Methods and results: This is a prospective observational cohort study conducted in 2 Belgian hospitals. For the current analysis, the first 904 patients who were enrolled between 2008 and 2012 were selected for assessment of clinical characteristics and short-term outcome (all-cause mortality and all-cause mortality + rehospitalization 3 months after discharge). Mean age of patients was 77 years (51% >= 80 years), 44% were women and 64% had an eGFR = 50%. In-hospital mortality was 7.1% with a mortality of 22% in the subgroup of patients with a creatinine >= 2 mg/dl and systolic blood pressure <= 110 mmHg on admission. Three months after discharge, the all-cause mortality rate was 7.6% and the all-cause mortality or hospitalization for HF 18.3%. Multivariate Cox regression analysis revealed eGFR, COPD, absence of beta blockers and atrial fibrillation at discharge (all P < 0.05)as independent predictors of all-cause mortality. Conclusions: In this Belgian registry of mainly elderly patients admitted with acute HF, a relatively preserved EF and a reduced kidney function were present in the majority of patients. In-hospital and short-term mortality after discharge remain high and are mainly related to the presence of co-morbidities such as renal failure and COPD. Co-morbidities should be the focus for future efforts to improve the dire outcome of these patients