Supervivencia de pacientes con insuficiencia cardiaca en atención primaria

OBJECTIVE: To describe survival of patients with chronic heart failure (HF) followed up in primary care (PC) and analyse the effect of sex, age, clinical and health services factors, and income levels on survival. DESIGN: Longitudinal observational study of a retrospective cohort of patients with information extracted from electronic medical records. SETTING: PC Area 7 of the Community of Madrid. PARTICIPANTS: Patients 24 year and older with at least one visit to PC in 2006. PRINCIPAL MEASUREMENT: Incident cases of HF followed up from 2006 to 2010 or until death. Survival analysis with Kaplan-Meier and Cox proportional hazard multivariate regression. RESULTS: A total of 3,061 cases were identified in a cohort of 227,984 patients. The survival rate was 65% at 5 years, with 519 patients dying with a median survival of 49 months. Factors associated with increased risk of mortality were, age (HR = 1.04, 1.03-1.05), and having a diagnosis of ischemic heart disease (HR = 1.45, 1.15- 1.78), or diabetes (HR = 1.52, 1.17-1.95). Factors with a significant protective effect were: female sex (HR = 0.72, 0.59-0.86), non-pensioner (HR = 0.43, 0.23-0.84), having received the influenza vaccine annually (HR = 0.01, 0.00-0.06), prescribed lipid-lowering drugs (HR = 0.78, 0.61-0.99) or ACE inhibitors (HR = 0.73, 0.60-0.88), and blood tests having been requested (HR = 0.97, 0.95-1.00), X-rays (HR = 0.81, 0.74-0.88), or electrocardiograms (HR = 0.90, 0.81-0.99) in PC. CONCLUSIONS: Data from patients with HF followed up in PC indicate that their survival is better than that obtained in other countries, supporting the argument of a better evolution of HF in Mediterranean countries.