Survey on heart failure in Italian hospital cardiology units: Results of the SEOSI study

Abstract

Three hundred and fifty nine cardiology units participated in a study (SEOSI) coordinated by the Association of Italian Hospital Cardiologists (ANMCO). The aim of the study was to: (1) evaluate how many patients with suspected or known heart failure consecutively approach a hospital cardiology unit; (2) assess their clinical characteristics; (3) define the diagnostic-therapeutic processes set in motion by cardiologists; (4) evaluate the social and emotional impact of the disease on the patient. In 12 days, 3921 patients were enrolled. Mean age was 67±12 years (median 69); 49% of the patients were in NYHA class III–IV; atrial fibrillation was present in 27%; 35% of the cases were scheduled for hospital admission. Ischaemic heart disease was the primary cause of heart failure (42%); arterial hypertension accounted for 20%, idiopathic dilated cardiomyopathy for 15% and cardiac valve disease for 15%. A chest X-ray, ECG and echocardiogram were performed in 70–80% of cases; ambulatory ECG in 36% and exercise testing in 11%. ACE inhibitors were administered to 63·5% calcium antagonists to 19% and beta-blockers to 5·5%. No significant differences in drug prescription were noted in relation to NYHA classification. Multidrug use was common (3·6±1·6). Main advice was: salt restriction (47%) and rest (44%); physical activity and a formal exercise programme were prescribed to 10% and 5% of patients, respectively. Most patients were addressed to hospital follow-up. Thus, heart failure represents a heavy burden for hospital cardiology units. It can be estimated that about 190 000 patients with heart failure seek care at hospital cardiology units each year and about 65 000 are admitted as inpatients. Cardiologists are reasonably well oriented regarding both examinations required and the prescribing of drugs. Beta-blockers and physical exercise are prescribed very cautiously. The format of the present trial, characterized by brevity, simplicity and low cost, could be used as a tool to gain periodical information on several aspects of national health systems and physician behaviour.