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Revista chilena de cardiología

On-line version ISSN 0718-8560

Abstract

CASTRO, Pablo et al. Influence of social and cultural factors in the late course of patients with congestive heart failure. Rev Chil Cardiol [online]. 2009, vol.28, n.1, pp.51-62. ISSN 0718-8560.

Aim: to evaluate de impact of social and cultural (S-C) factors in the care and course of patients with congestive heart failure (CHF) enrolled in the ICARO study (national registry for patients with heart failure). Methods: Patients were enrolled from 2006 through 2008. They were discharged from 14 hospitals participating in the prospectively designed ICARO study. Late mortality was obtained from the national Identification registry. Optimal medical therapy was defined as the use of a betablocker in addition to any of the following: ACE inhibitors, ARA II, combination of hydralazine and nitrates, or spironolactone. Statistical analysis included Students t test, chi square and Kaplan Meir and Log-rank testing, as appropriate. Results: Patients with a low S-C level were older (71 ± 11 vs 66 ± 15 years, p<0.01), more frequently females (52.2% vs 26.1%, p<0.01) and most of them belonged in the FONASA health insurance system (90%). Ischemic heart disease was more prevalent in the high S-C level (34.5 vs 16.6%) and hypertension in the low S-C level (30.3 vs 16.6%). ARA II rather than ACE inhibitors were more commonly used in the high S-C level; ACE inhibitors, betablockers, spironolactone, hydralazine-nitrates, amiodarone and anticoagulation were less frequently used in the low S-C level. After discharge a more intensive treatment of heart failure was observed; however, this was less seen in the low S-C level. Patients with decreased left ventricular ejection fraction were similarly treated in both groups. An optimal therapy for CHF was used in 43.7%, 43.3% and 51.1% in S-C levels low, intermediate and high, respectively (NS). Independent predictors for late mortality were age>70 years (HR 2.71 (Cl 1.55-3.03), low S-C level (HR 1.57, Cl 1.17 - 2.09), EF<50% (HR 1.49, Cl 1.04-2.14) and absence of optimal medical therapy at discharge (HR 0.52, Cl 0.41-0.66). Late survival was markedly lower in the low S-C level (median 761 ± 47.9 vs 975 ± 82.3, p=0.02). Conclusion: CHF patients with a low S-C level are specially vulnerable. These results help stress the need for interventions to guarantee equal access of the population to health care and to improve adherence to CHF management guidelines.

Keywords : Heart failure; social factors; epidemiology.

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