Evolutive profile and prognosis factors of chronic heart failure in a Tunisan center.

BACKGROUND: Therapeutic approach of heart failure (HF) has evolved considerably to improve the prognosis that remains dark .The purpose of our study was to analyze the evolution of the  ejection fraction (FE) heart failure  and to identify predictors  factors of mortality and re-hospitalization. METHODS: Our study is prospective including 200 consecutive cases of HF patients with EF ≤ 40% during the period from 2012 to 2015. Clinical, para-clinical, evolultive  data were collected at admission and atb3 months. The main study  criteria is the occurrence of a major event:  cardiac death and or rehospitalization for HF. RESULTS: The mean age of  our patients was 56 + - 12. with male predominance.  Ischemic etiology was the main causes  (45%). All patients had  pharmacological treatment of HF , 88% patients were put on ACE inhibitors, 91% on beta-blockers(BB)  and 49% on spiranolactone, loop diuretics were prescribed in 95% of cases. The optimal dose was reached for the main molecules (IEC, BB and spiranolactone) only in  respectively  12%, 15% and 10% patients  . Myocardial revascularization was performed in 36 patients (40%). Among  the 45 patients with  valvulopathy   surgical treatment  was indicatetd for   _ patients(17%).  A  cardiac resynchronization theray   with defibrillator  was implanted in 30 patients, an automatic defibrillator without resynchronization was implanted   in 15 patients (7.5%). No patients  from our study had  a cardiac  transplantation or rehabilitation.Hospital and  3-months  mortality was   5% and 17.5% respectively, .Hospitalization rate was 36% and was highest in the first three months after discharge.  The multi-variable analysis  revealed four independent mortality factors:  diabetes,  EF , ischemic etiology, and TAPSE.  Age, stage IV dyspnea, atrial fibrillation , and SLG <-12.were independent predictors  factors of rehospitalization. CONCLUSION: is a serious  disease associated   with  poor prognosis despite advanced therapeutics.