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Mortality, morbidity and evidence-based management amongst patients in regional New Zealand with severe left ventricular systolic dysfunction (1997-2011). Original article.
MedLine Citation:
PMID:  23425443     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIMS: To investigate mortality, quality of life, hospitalisation and evidence-based medical and device management of severe left ventricular (LV) systolic dysfunction in a regional New Zealand setting. METHODS: A retrospective case series was undertaken of 1126 patients with a left ventricular ejection fraction (LVEF) <36% on transthoracic echocardiograms performed between October 1, 1997 and March 31, 2011 in Nelson-Marlborough District Health Board (NMDHB). All-cause mortality and hospitalisation data were analysed for all participants. Substudies were undertaken regarding pharmacotherapy, demographics, implantable cardioverter-defibrillator (ICD) implantation rates and quality of life based on the EQ-5D questionnaire and New York Heart Association (NYHA) class. RESULTS: Five-year cumulative survival was 44.5%. The mean annual medical admission rate was 204/100,000; 54.84% of which were re-admissions in the same year. Prescription rates for angiotensin converting enzyme (ACE) inhibitors/angiotensin-receptor blockers (ARBs), beta-blockers and spironolactone were 68.3%, 74.2% and 24.9% respectively with only 17.6%, 19.0% and 16.4% on maximum recommended doses. ICD devices were inserted in 11.5% of eligible patients. Quality of life was impaired in patients <70 years relative to the age-approximated New Zealand index population. Mean EQ-5D visual analogue score was 72.6±0.032 and self-reported NYHA class 2.09±0.107. CONCLUSION: Patients with severe LV systolic dysfunction in this regional New Zealand community experience similar mortality and first hospitalisation rates to those seen elsewhere in patients with clinical heart failure, but a greater number of re-admissions. Medical and device therapy utilisation was sub-optimal and quality of life impaired, together supporting the need for a dedicated heart failure service.
Authors:
Brian T Grainger; Steve White; Sarah Lake; Andrew Hamer; Nick Fisher; Tammy Pegg
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-21
Journal Detail:
Title:  Internal medicine journal     Volume:  -     ISSN:  1445-5994     ISO Abbreviation:  Intern Med J     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 The Authors. Internal Medicine Journal © 2013 Royal Australasian College of Physicians.
Affiliation:
Nelson Marlborough District Health Board, Private Bag 18, Tipahi St, Nelson, 7010, New Zealand.
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