CLINICAL STUDIES
Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL study
Faiez Zannad, MD, PhD*  ,
Serge Briancon, MD ,
Yves Juilliere, MD*,
Paul-Michel Mertes, MD*,
Jean-Pierre Villemot, MD*,
François Alla, MD,
Jean-Marc Virion, MSc and the EPICAL Investigators
* Cardiology and Cardiac Surgery Departments, Nancy, France
Centre d’Investigation Clinique (CIC) INSERM-CHU, Nancy, France
Service d’Informatique Médicale Epidémiologie et Statistiques (SIMES), Centre Hospitalo-Universitaire, Nancy, France
Manuscript received April 2, 1998;
revised manuscript received September 23, 1998,
accepted November 2, 1998.
Reprint requests and correspondence: Dr. Faiez Zannad, CIC INSERM-CHU CO n° 34, 54035 Nancy Cedex, France
cic{at}chu-nancy.fr
OBJECTIVES
Characterize the incidence, clinical and etiologic features and outcomes of advanced congestive heart failure.
BACKGROUND
This condition is frequent, severe and costly, yet no population-based epidemiological data are available that take into account modern advances in diagnosis and therapy.
METHODS
The EPICAL (EPidémiologie de l’Insuffisance Cardiaque Avancée en Lorraine) study was based on a comprehensive registration of patients with ACHF (defined as hospital admission for presence of NYHA class III or IV symptoms, radiological and/or clinical signs of pulmonary congestion and/or signs of peripheral edema, left ventricular ejection fraction <30% or a cardiothoracic ratio >60%) in patients aged 20–80 years during year 1994, in the community of the Lorraine region in France (n = 1,592,263). Average follow-up for readmission to hospital and mortality was 18 months (12–24 months).
RESULTS
From 2,576 registered patients, 499 were enrolled into the study among which, 358 were new presentations. This represents a crude incidence rate of 225 per million. 46.3% had a coronary heart disease. One-year mortality rate was 35.4% and the rate of mortality and/or readmission to hospital was 81%. Patients were admitted to hospital 2.05 times per year (64% of these for worsening heart failure), spending 27.6 days per year in hospital. Twenty received a heart transplant (4%). On discharge, 74.8% were using ACE inhibitors and 49.6% digitalis.
CONCLUSIONS
Mortality and hospitalization rate of advanced CHF remain very high despite recent therapeutic progress. Major therapeutic and managed-care research is required.
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Abbreviations and Acronyms
| | ACE | = angiotensin converting enzyme | | CABG | = coronary artery bypass graft | | CHD | = coronary heart disease | | CHF | = congestive heart failure | | CI | = confidence interval | | CTR | = cardiothoracic ratio | | EPICAL | = EPidémiologie de l’Insuffisance Cardiaque Avancée en Lorraine | | LVEF | = left ventricular ejection fraction | | MI | = myocardial infarction |
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