Advanced heart failure

Abstract

Approximately 5 to 10% of patients with clinical heart failure is situated in the stage of advanced heart failure, which is characterized by the persistence of normal life limit symptoms in spite of adequate medical treatment adapted for primary heart disease, associated with severe deterioration of the sistolic ventricular function, in general with a <30 % fraction of ejection.
A retrospective and observational study was completed between January 2005 to December 2006, in which patients with heart failure were hospitalized at Hospital de Clínicas, Medical Clinic services in order to determine the frequency of advanced heart failure. The criteria of admission were patients with persistent shortnes of breath, functional type III or IV, <30% EF, frequent hospital admissions, hiponatremy (<130mEq/l), pulmonary hypertension, arterial hypotension, kidney insufficiency, and signs of peripheral hipoperfusión.
Of a whole of 210 patients hospitalized, 22 patients (10.5 %) were in advanced heart failure stage, 18 (82 %) of them were men, 17 (77 %) with precedent of cardiopathy for more than 5 years, 19 patients (86 %) with adequated treatment for primary heart failure. Admitted with CF IV 21 (95.5 %), 17 (77%) with > 90mmHg sistolic pressure, 20 (90 %) with subcrackling and 19 patients (86.5 %) with creatininemia major to 2mg/dl. Ecocardiography demostrated that 22 patients (100 %) presented a fraction of ejection of the left ventricle equal or less to 30 % with pulmonary hypertension, 7 (32%) of them slight, 14 (64%) moderate and 1 patient (4%) severe.