C. Blanton¹, G. O'Driscoll², R. Hendricks³, M. Hobbs⁴ & P. Langton¹*.

Departments of Cardiology, Fremantle³, Royal Perth² & Sir Charles Gairdner¹ Hospitals and Department of Public Health⁴, University of WA, Perth

Aims:  Current guidelines for the management of heart failure emphasise triple therapy with ACE inhibitors, diuretics and Beta-blockers (+digoxin).  Previous surveys have suggested that medical therapy is under .utilised.  The prevalence of significant co-morbid disease(s) which may contra-indicate optimal therapy is unknown.

Methods:  Two databases were examined for the coded diagnoses of heart failure and a variety of co‑-morbidities.  Individual patient linked data for metropolitan teaching hospitals (WA linked Database) from 1980 to 1995 was searched.  This cohort (No 1) included all patients with a primary diagnosis of heart failure, and any other diagnoses in the previous 4 years.  The second cohort (No 2) consisted of data for all patient admissions to one teaching hospital between 1996 & 1999.  This database was searched for heart failure codes as a primary or secondary diagnosis, as well as for co-morbid codes.

Results:  Respiratory disease was present in 9-15% of subjects, but was reversible in only ~60%.  Renal co‑-morbidities were present in ~15%.  Acute renal disease may contra-indicate ACE inhibitor therapy, however most patients with chronic renal impairment should receive this therapy.  Diabetes is very prevalent in patients with heart failure.

Conclusions:  Significant co-morbidity is present in patients admitted with heart failure.  However, only a small proportion of these patients would be expected to have contra-indications to optimal medical pharmaco-therapy.

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