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Prevalence and 1-year prognosis of transient heart failure following coronary revascularization

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Abstract

The occurrence of heart failure during the whole pre-discharge course of coronary revascularization, as far as its influence on subsequent prognosis, is poorly understood. The present study examined the effect of transient heart failure (THF) developing in the acute and rehabilitative phase on survival after coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI). Patients in the Italian survey on cardiac rehabilitation and secondary prevention after cardiac revascularization (ICAROS) were analyzed for THF, the latter being defined either as signs and symptoms consistent with decompensation or cardiogenic shock. ICAROS was a prospective, multicenter registry of 1,262 consecutive patients discharged from 62 cardiac rehabilitation (CR) facilities, providing data on risk factors, lifestyle habits, drug treatments, and major cardiovascular events (MACE) during a 1-year follow-up. Records were linked to the official website of the Italian Association of Cardiovascular Prevention and Rehabilitation (GICR-IACPR). The overall prevalence of pre-discharge THF was 7.6 %, with 69.8 % of cases in acute wards, 22.9 % during CR, and 7.3 % in both settings. THF affected more frequently patients with chronic cardiac condition (42.7 vs. 30.6 %; p < 0.05), age ≥75 years (33.3 vs. 23.1 %; p < 0.005), COPD (19.8 vs. 12.3 %; p < 0.05), and chronic kidney disease (17.7 vs. 7 %; p < 0.001). After discharge, THF patients showed good maintenance rates of RAAS modulators (90.6 %) and beta-blockers (83.3 %), while statin therapy significantly decreased from 81.3 to 64.6 % (p < 0.05). The pursuit of secondary prevention targets, as far as self-reported drug adherence, was not different among groups. Patients with THF had increased 1-year mortality (8.3 vs. 1.6 %, p < 0.001). Moreover, THF independently predicted adverse outcome with OR for recurrent events (mainly further episodes of decompensation) of 2.4 (CI 1.4–4.3). Patients who experienced THF after coronary revascularization had increased post-discharge mortality and cardiovascular events. Hemodynamic instability, rather than recurrent myocardial ischemia, seems to be linked with worse prognosis.

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Acknowledgments

ICAROS was supported by IFB STRODER with an unrestricted research grant

Conflict of interest

None.

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Authors and Affiliations

  1. Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy

    Marco Ambrosetti

  2. Cardiac Rehabilitation Unit, Department of Cardiology, ASL 3 Genovese, La Colletta Hospital, Arenzano, Italy

    Raffaele Griffo

  3. Division of Cardiac Rehabilitation, IRCCS Policlinico San Donato, Milan, Italy

    Roberto Tramarin

  4. Cardiac Rehabilitation Unit, Department of Medical and Surgical Critical Care, Careggi Hospital, University of Florence, Florence, Italy

    Francesco Fattirolli

  5. Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy

    Pier Luigi Temporelli

  6. Division of Cardiology, Spedali Civili, University of Brescia, Brescia, Italy

    Pompilio Faggiano

  7. Cardiology Unit, Dr Pederzoli Clinic, Peschiera del Garda, Italy

    Stefania De Feo

  8. Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy

    Anna Rita Vestri

  9. Division of Cardiology III, San Giovanni-Addolorata Hospital Complex, Rome, Italy

    Cesare Greco

  10. Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy

    Francesco Giallauria

  11. School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia

    Francesco Giallauria

Authors
  1. Marco Ambrosetti
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  2. Raffaele Griffo
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  3. Roberto Tramarin
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  4. Francesco Fattirolli
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  5. Pier Luigi Temporelli
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  6. Pompilio Faggiano
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  7. Stefania De Feo
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  8. Anna Rita Vestri
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  9. Francesco Giallauria
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  10. Cesare Greco
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Corresponding author

Correspondence to Marco Ambrosetti.

Additional information

For the ICAROS investigators. Members of the ICAROS Study Group are listed in Appendix.

Appendix: ICAROS Study Group

Appendix: ICAROS Study Group

C Ciglia L Mantini (Chieti), G Borrello ML Mazza (Catanzaro), C Chieffo A Scaglione (Napoli), G Furgi A Nicolino (Telese Terme), P Golino C Riccio (Caserta), G Partili (Eboli), C Vigorito (Napoli), P Corazzi M Gualerzi (Parma), S D’Cruz (Ponte dell’Olio), D Violi (Castelnuovo Monti), F Fattirolli C Burghisser (Firenze), C Giustarini (Volterra), C Macchi R Zipoli (Impruneta), M Provvidenza (Lido di Camaiore), A Scalzini (Cecina), G Ferrario MA Amado Eleas (Arco), C Sarno (Arco) F Anniboletti L Filippucci (Perugia), S Mandorla (Gualdo Tadino), PL Baroni (Garda), F Bellotto T Setzu (Cortina D’Ampezzo), F Bordin (Tiene), R Carlon (Cittadella), G Favretto (Motta di Livenza), E Mantovani (Camposanpiero), GM Mosele (Arcugnano), P Semprini (Rimini), S Urbinati (Bologna), F Di Mario (Nemi), A Galati A Rossetti (Roma), A Salustri E Cerquetani (Roma), G Tassoni (Roma), M Volterrani (Roma), L Corsiglia (Ruta di Camogli), F Acquistapace R Reggiani (Monza), M Ambrosetti M Passera (Cunardo), C Anzà M Baravelli (Castellanza), F Cobelli (Pavia), T Diaco (Rivolta d’Adda), O Febo G Riccardi (Montescano), M Ferratini (Milano), R Frizzelli (Bozzolo), P Gei A Proto (Ronco di Gussago), A Giordano E Zanelli (Lumezzane), N Jones (Seregno), G Malfatto (Milano), C Malinverni P Rocca (Seriate), R Pedretti R Vaninetti (Tradate), M Palvarini (Rho), R Tramarin (Cernusco sul Naviglio), A Schizzarotto P Abello (Somma Lombardo), P Calisi M Pianese (Arenzano), R Belardinelli (Ancona), E Bosimini M Tidu (Torino), P Giannuzzi PL Temporelli (Veruno), G Mazzucco P Delpero (Piossasco), F Soffiantino (Lanzo Torinese), B Ingignoli (Torino), D Scrutinio (Cassano Murge), G Polimeni (Taranto), L Sannia (Sassari), F Sarullo A Castello (Palermo).

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Ambrosetti, M., Griffo, R., Tramarin, R. et al. Prevalence and 1-year prognosis of transient heart failure following coronary revascularization. Intern Emerg Med 9, 641–647 (2014). https://doi.org/10.1007/s11739-013-1006-y

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  • DOI: https://doi.org/10.1007/s11739-013-1006-y

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