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150 J KARDIOL 2008; 15 (5–6)

ÖKG-Jahrestagung – Abstracts

More Benefit for Newly Admitted Patients to an Out-

patient Heart Failure Clinic in First Year 051

G. Gouya, M. Elhenicky, A. Hammer, S. Neuhold, M. Huelsmann, R. Pacher

Department of Clinical Pharmacology and Cardiology, Medical University of Vienna

Objectives Based on the ESC guidelines, heart failure patients

should be cared by a specialized out-patient unit. It is unclear

whether the same benefit is equally seen in newly referred patients

(comparable to a study population) compared to patients already

cared on long-term.

Methods and Results Variables of a cohort of 511 patients with

CHF were prospectively assessed (follow-up period of 12 months).

382 HF patients already treated on long-term (Group A) were com-

pared to 129 newly referred patients (Group B). With the exception

of age and heart rate, patients group were comparable. Group B

patients were more severe diseased (higher NYHA functional class

[p = 0.04], higher Minnesota Living with Heart Failure Score (38 ±

27 vs 28 ± 23; p = 0.001) and higher NT-proBNP (3387 ± 4483 vs

2250 ± 4384 pg/ml; p = 0.01) and had less pharmacological therapy

(patients on target dose of recommended HF-therapy 3 % vs 42 %).

A successful up-titration of recommended HF-therapy to target dos-

age was performed in 25 % cases of group B but only in 10 % of

group A (p < 0.0001). Cardiac resynchronization therapy was more

often implemented in group B (9 % vs 3 %; p = 0.02). These

resulted in a significant decrease of NT-proBNP at the end of the

follow-up period in group B (1074 ± 581 pg/ml; p = 0.04), whereas

NT-proBNP of group A did not change over time. All cause mortal-

ity was comparable in both groups.

Conclusion Our data implicate a special benefit for newly re-

ferred patients in respect of therapy and change in NT-proBNP if

managed by a specialized HF unit whereas only distinct patients

might profit from long-term specialized care.

Influence of Optimized Pharmacotherapy on Short-

Term Survival in Patients with Different Severities of

Chronic Heart Failure 053

G. Gouya, A. Hammer, M. Elhenicky, S. Neuhold, M. Huelsmann, R. Pacher

Department of Clinical Pharmacology and Cardiology, Medical University of Vienna

Objectives There is consensus that all patients with chronic heart

failure (CHF) should be treated with a combination of neurohumo-

ral antagonist therapy. The impact of optimized medical therapy on

short-term outcome in different severities of the disease is not clear

yet.

Methods and Results Variables of a cohort of 511 patients with

CHF of our specialized outpatient heart failure clinic were prospec-

tively assessed (follow-up period of 12 months). According to the

median value of NT-BNP of 882 pg/ml patients were stratified de-

pendent on the severity of heart failure: group 1 (low severity NT-

BNP ≤ median) and group 2 (high severity NT-BNP > median).

Moreover patients were classified in respect of achievement of an

optimized pharmacotherapy to recommended target dose of ACEI

(inhibitors of angiotensin

converting enzyme) or

ARB (angiotensin receptor

blockers) and beta-blockers

after 1 year. Demographics

and clinical data are shown

in Table 4. The impact of

optimized pharmacothera-

py to target dose on survi-

val was measured. Kaplan

Meier life time analysis

only showed a significant

reduction of mortality in

group 2 (2 % vs 11 %;

p < 0.01) after achievement

of optimized pharmaco-

therapy to recommended

target dose.

Conclusion Optimization of recommended neurohumoral anta-

gonist pharmacotherapy in chronic heart failure patients results in a

short-term survival benefit only in patients with severe heart failure

reflected by high NT-BNP levels.

Triage of an Asymptomatic Risk Population by NT-

proBNP to Exclude a Short-Term Risk for Cardiac

Events in Primary Care 054

G. Gouya, M. Elhenicky, A. Hammer, S. Neuhold, M. Huelsmann, R. Pacher

Department of Clinical Pharmacology and Cardiology, Medical University of Vienna

Objectives N-terminal pro brain natriuretic peptide (NT-proBNP)

is used as a screening tool in the diagnosis of different cardiac dis-

eases, mainly heart failure (HF). To determine the diagnostic prop-

erties of NT-proBNP for triage in asymptomatic high risk popula-

tion with hypertension, diabetes and ischemic heart disease (IHD)

(previous myocardial infarction excluded) this prospective commu-

nity cohort study in primary care was conducted.

Methods After clinical diagnosis of hypertension and/or diabetes

and/or IHD in patients without clinical signs and symptoms of any

heart disease the patients were tested for NT-proBNP levels by the

primary care physician. Patients were divided in group A (NT-

proBNP > 125 pg/ml) and group B (NT-proBNP < 125 pg/ml). Out-

come data were documented in both groups.

Results Of a cohort of 267 patients, 43 % were stratified to group

A and 57 % to group B. Follow-up period in both groups was 4.3 ±

2.2 months. Patients in group A were older (62 ± 12 vs 69 ± 10;

p < 0.0001). 44 % in group A versus 55 % in group B were male

(p = 0.05). Hypertension (94 %), diabetes (40 %) and IHD (22 %)

without previous MI were equally distributed in both groups. All

cause hospitalization (9 % vs 2 %; p = 0.007) and all over cardiac

hospitalization (p = 0.009) were significantly higher in group A

(hospitalization due to ischemic events was 0 vs 2.3 %; p = 0.04,

due to heart failure 0 vs 1.6 % and arrhythmia 0 vs 1.6 %; both p =

n. s.).

Conclusion Even on short-term NT-proBNP measurement is

helpful to identify high risk patients. More important is to safely

rule out a low risk population for patients’ triage. Thus, in primary

care NT-proBNP might be a valuable tool for decision making

about intensity of care in risk population.

NT-proBNP for Risk Stratification of Newly Presented

Symptomatic High Risk Patients in Primary Care 055

G. Gouya, A. Hammer, M. Elhenicky, S. Neuhold, M. Huelsmann, R. Pacher

Department of Clinical Pharmacology and Cardiology, Medical University of Vienna

Objectives N-terminal pro brain natriuretic peptide (NT-proBNP)

has emerged as interesting predictor of risk for mortality and hospi-

talization in patients with heart failure (HF). However, the optimal

use of NT-proBNP measurement for risk stratification of patients

Table 4: G. Gouya et al.

Group 1 Group 2 p

Target dose Target dose p Target dose Target dose p Group 1

achieved not achieved achieved not achieved vs.

(n = 108) (n = 111) (n = 82) (n = 112) Group 2

Age 57 ± 10 54 ± 16 n. s. 63 ± 11 61 ± 13 n. s. < 0.0001

Males (%) 84 69 < 0.01 79 72 n. s. n. s.

Heart rate (beats/min) 70 ± 13 69 ± 13 n. s. 78 ± 16 73 ± 14 < 0.05 < 0.0001

RR s 125 ± 18 125 ± 22 n. s. 126 ± 23 118 ± 22 < 0.05 < 0.05

NYHA I/II/III/IV (%) 31/35/34/0 31/41/25/3 n. s. 10/38/45/7 3/28/62/7 0.05 < 0.0001

Creatinin mg/dl 1.1 ± 0.3 1.2 ± 9.4 n. s. 1.3 ± 0.5 1.4 ± 0.6 n. s. < 0.0001

NT-BNP pg/ml 336 ± 249 295 ± 236 n. s. 3563 ± 5105 4845 ± 5413 n. s. < 0.0001

Coronary artery

disease (%) 33 36 n. s. 43 43 n. s. < 0.01

1 2 ... 7 8 9 10 11 12 13 14 15 16 17 ... 45 46

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