What is the clinical evidence from this study?

Study design: Observational. Population: Acute heart failure (n=1658). Primary outcome: In-hospital mortality.

What question did this study set out to answer?

To enhance understanding of acute heart failure epidemiology, management, and clinical outcomes in France.

November 27, 2012European Journal of Heart Failure167 citationsOpen Access

Current Aspects of the Spectrum of Acute Heart Failure Syndromes in a Real-Life Setting: The OFICA Study

DLDamien LogeartHeart Failure & Transplant RIRichard IsnardHeart Failure & Transplant MRMatthieu Resche‐RigonHeart Failure / Cardiomyopathy

Key Result

Acute heart failure in a real-life setting was associated with an in-hospital mortality of 8.2%, with age, blood pressure, and creatinine identified as independent predictors.

Key Points

To enhance understanding of acute heart failure epidemiology, management, and clinical outcomes in France.
Conducted an observational survey in 170 hospitals over one day, capturing unplanned AHF hospitalizations
Included 1658 patients with a median age of 79 years and various clinical characteristics
Assessed management practices including natriuretic peptide testing and echocardiography usage.
In-hospital mortality rate was 8.2%, with age, blood pressure, and creatinine as independent predictors
36% of patients had preserved LVEF, linked to specific characteristics and lower severity
Treatment included ACE inhibitors/ARBs (78%), beta-blockers (67%), and aldosterone inhibitors (27%) at discharge.

Study Design

Type

Observational (n=1,658)

Multicenter

Yes

Structured PICO

Population

1,658 patients with unplanned hospitalizations because of acute heart failure (AHF) in 170 hospitals throughout France, median age 79 years, 55% male.

Outcome

Epidemiological data, management, and clinical outcome (including in-hospital mortality and length of stay)hard clinical

This real-world survey highlights the high severity and heterogeneity of acute heart failure, with an 8.2% in-hospital mortality rate and suboptimal use of guideline-directed medical therapy and devices at discharge.

Abstract

AIMS: To improve knowledge of epidemiological data, management, and clinical outcome of acute heart failure (AHF) in a real-life setting in France. METHODS AND RESULTS: We conducted an observational survey constituting a single-day snapshot of all unplanned hospitalizations because of AHF in 170 hospitals throughout France (the OFICA survey). A total of 1658 patients (median age 79 years, 55% male) were included. Family doctors were the first medical contact in 43% of cases, and patients were admitted through emergency departments in 64% of cases. Clinical scenarios were mainly acutely decompensated HF (48%) and acute pulmonary oedema (38%) with similar clinical and biological characteristics as well as outcome. Characteristics were different and severity higher in both shock and right HF. Infection and arrhythmia were the most frequent precipitating factors (27% and 24% of cases); diabetes and chronic pulmonary disease were the most frequent co-morbidities (31% and 21%). Over 80% of patients underwent both natriuretic peptide testing and echocardiography. LVEF was preserved (>50%) in 36% of patients and associated with specific characteristics and lower severity. Median hospital stay was 13 days; in-hospital mortality was 8.2%, and independent predictors were age, blood pressure, and creatinine. Treatment at discharge in patients with reduced LVEF included ACE inhibitors/ARBs, beta-blockers, and aldosterone inhibitors in 78, 67, and 27% cases. Non-surgical devices were reported in <20% of potential candidates. CONCLUSION: This comprehensive survey analysing AHF in real life emphasizes the heterogeneous nature and overall high severity of AHF. It could be a useful tool to identify unsolved medical issues and improve outcome. TRIAL REGISTRATION: NCT01080937.

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