Aims The purpose of this study was to describe the clinical characteristics, management, and outcomes of acute heart failure (HF) patients from the Gulf acute heart failure registry (Gulf CARE). Methods and results Data from 5005 HF patients admitted to 47 hospitals in seven Gulf countries during February to November 2012 were analysed. Fifty‐five per cent of patients presented with acute decompensated chronic HF, while 45% had new‐onset HF. Mean age was 59 ± 15 years, 63% were males, and 83% were Gulf citizens. Co‐morbid conditions were hypertension (61%), diabetes mellitus (50%), CAD (47%), and atrial fibrillation or flutter (14%). The median LVEF was 35% (25–45%) with 69% presenting as HF with reduced EF (HFrEF). CAD was the most prevalent aetiology (53%) followed by idiopathic cardiomyopathy (18%), hypertensive heart disease (16%), and valvular heart disease (9%). At discharge, 71% and 78% of patients received beta‐blockers and ACE inhibitors/ARBs, respectively. Use of coronary intervention and device therapy was <10%. In‐hospital mortality was 6.3%. Re‐hospitalization and cumulative mortality at 3 and 12 months were 18%/13% and 40%/20%, respectively. Conclusions Gulf CARE results show that patients from this region are a decade younger than their Western counterparts, with a high prevalence of diabetes and HFrEF, and a lower prevalence of AF. Use of coronary intervention and device therapy was low, with high re‐hospitalization rates. Short‐ and long‐term mortality rates were similar to those of Western registries, but should be interpreted in the light of the younger age of Gulf CARE patients.

Background: The purpose of this study was to report the prevalence and the significance of clinically recognized chronic obstructive pulmonary disease (COPD) during acute coronary syndrome (ACS). Hypothesis: COPD in patients with ACS is associated with worse outcome. Methods: Data were derived from a prospective, multicenter, multinationalstudy of 8167 consecutive patients hospitalized with ACS from February to June 2007 in 6 Middle Eastern countries. Data were analyzed according to the presence or absence of COPD. Demographic, management, and in-hospital outcomes were compared. Results: The prevalence of COPD was 5.3%. When compared with non-COPD patients, COPD patients were older and more likely to have diabetes, hypertension, and dyslipidemia. Atypical presentations were more common in COPD patients (P = 0.001). COPD patients were less likely to be treated with thrombolytic therapy (P = 0.001), β-blockers (P = 0.001), and glycoprotein IIb/IIIa inhibitors, and more likely to receive angiotensin-converting enzyme (ACE) inhibitors. Although there was no difference in in-hospital mortality between the 2 groups, patients with COPD were more likely to have heart failure (P = 0.001). Despite the fact that COPD patients with ST-segment elevation myocardial infarction were less likely to receive thrombolytic therapy, they suffered more bleeding complications (2.8% vs 1%, P = 0.04), resulting in prolonged hospitalization. COPD was not an independent predictor of increased in-hospital mortality. Conclusions: In this large cohort of patients with ACS, the prevalence of COPD was 5·3%. Atypical presentation is common among COPD patients, and this may result in delayed therapy. ACS in COPD patients was associated with higher risk of heart failure and major bleeding complications without increased risk of in-hospital mortality.

J Clin Hypertens (Greenwich). The objective of this study was to evaluate the prevalence and effect of the metabolic syndrome (MetS) on patients with acute coronary syndrome (ACS) in six Middle Eastern countries using the new definition of MetS. Analysis of the Gulf Registry of Acute Coronary Events (Gulf RACE), which included 8716 consecutive patients hospitalized with ACS, was conducted and patients were divided into two groups: patients with and patients without the MetS. Overall, 46% of patients had MetS. Patients with MetS were more likely to be female and less likely to be smokers. In‐hospital mortality and cardiogenic shock were comparable between the two groups, although MetS patients were more likely to have congestive heart failure and recurrent ischemia. In ST‐elevation myocardial infarction, MetS was also associated with increased risk of recurrent myocardial infarction and stroke. Using the recent MetS definition, MetS is highly prevalent among Middle Eastern patients presenting with ACS. MetS is associated with higher‐risk profile characteristics and increased risk for development of heart failure and recurrent myocardial ischemia without an increase in hospital mortality. J Clin Hypertens (Greenwich). 2010;12:890–899.

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Background:The aim of this study was to assess and quantify the effects of indomethacin on cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO 2 ) in preterm infants undergoing treatment for a patent ductus arteriosus (PDA). Methods: CBF and CMRO 2 were measured before and after the first dose of a 3-d course of indomethacin to close hemodynamically significant PDA in preterm neonates. Indocyaninegreen (ICG) concentration curves were acquired before and after indomethacin injection to quantify CBF and CMRO 2 . results: Eight preterm neonates (gestational age, 27.6 ± 0.5 wk; birth weight, 992 ± 109 g; 6 males:2 females) were treated at a median age of 4.5 d (range, 4-21 d). Indomethacin resulted in an average CBF decrease of 18% (pre-and post-CBF = 12.9 ± 1.3 and 10.6 ± 0.8 ml/100 g/min, respectively) and an OEF increase of 11% (pre-and post-OEF = 0.38 ± 0.02 and 0.42 ± 0.02, respectively) but no significant change in CMRO 2 (pre-and post-CMRO 2 = 0.83 ± 0.07 and 0.76 ± 0.07 ml O 2 /100 g/min, respectively). Corresponding mean blood pressure (BP), arterial oxygen saturation (S a O 2 ), heart rate, and endtidal carbon dioxide tension levels remained unchanged. conclusion: Indomethacin resulted in significant reduction in CBF but did not alter CMRO 2 because of a compensatory increase in OEF.

To describe prevalence and impact of peripheral arterial disease (PAD) in patients with acute coronary syndrome (ACS), data were collected over 5 months from 6 Middle Eastern countries. Patients were divided into 2 groups (with and without PAD). Out of 6705 consecutive ACS patients, PAD was reported in 177 patients. In comparison to non-PAD, PAD patients were older and more likely to have cardiovascular risk factors. They were more likely to have high Killip class, high GRACE risk score, and non-ST elevation ACS (NSTEACS) at presentation. Thrombolytics, antiplatelet use, and coronary intervention were comparable in both groups. When presented with ST-elevation myocardial infarction (STEMI), patients with PAD had worse outcomes, while in NSTEACS; PAD was associated with higher rate of heart failure in comparison to non-PAD patients. In diabetics, PAD was associated with 2-fold increase in mortality when compared to non-PAD (P = 0.028). After adjustment, PAD was associated with high mortality in STEMI (adjusted OR 2.6; 95% CI 1.23–5.65, P = 0.01). Prevalence of PAD in ACS in the Gulf region is low. Patients with PAD and ACS constitute a high risk group and require more attention. PAD in patients with STEMI is an independent predictor of in-hospital death.

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In this large cohort of patients with ACS, HTN was an independent predictor of heart failure and was associated with an increased rate of in-hospital mortality in STEMI only.