Precipitating factors for systolic and diastolic heart failure: a four-year follow-up of 192 patients.

OBJECTIVES To investigate precipitating factors for systolic and diastolic heart failure. DESIGN Prospective study. PATIENTS AND METHODS The study population consisted of 192 patients with heart failure treated for 536 episodes of acute decompensation of heart failure from 1998 to 2002. The patients were classified as having systolic or diastolic heart failure, and grouped according to aetiology and precipitating factors. RESULTS Coronary heart disease was the most common cause of systolic heart failure, whereas rheumatic heart disease was the most frequent cause of diastolic heart failure. The most important precipitating factors in systolic heart failure were infections (38%), arrhythmias (35%), and vascular causes (24%), whereas the precipitating factors in diastolic heart failure were infections (50%), arrhythmias (46%), and uncontrolled hypertension (26%). Avoidable precipitating factors in systolic and diastolic heart failure were noted in 34% and 68% of cases, respectively. CONCLUSIONS Better patient education and better follow-up of patients by physicians according to the most recent guidelines may decrease the frequency of heart failure events and consequent morbidity and mortality.