A multicentre cohort study of acute heart failure syndromes in Korea: rationale, design, and interim observations of the Korean Acute Heart Failure (KorAHF) registry

Abstract

Aims The Korean Acute Heart Failure registry (KorAHF) aims to evaluate the clinical characteristics, management, hospital course, and long‐term outcomes of patients hospitalized for acute heart failure syndrome (AHFS) in Korea. Methods and results This is a prospective observational multicentre cohort study funded by the Korea National Institute of Health. Patients hospitalized for AHFS in 10 tertiary university hospitals across the country have been consecutively enrolled since March 2011. The study is expected to complete the scheduled enrolment of 5000 patients some time in 2014, and follow‐up is planned through 2016. As of April 2012, the interim analysis of 2066 consecutive subjects was performed to understand the baseline characteristics of the population. The mean age was 69 ± 14 years; 55% were male; and 50% were de novo heart failure. The mean left ventricular ejection fraction (LVEF) was 40 ± 18%. Ischaemia was both the leading cause (38%) and the most frequent aggravating factor (26%) of AHFS. ACE inhibitors/ARBs and beta‐blockers were prescribed at discharge in 65% and 51% of the patients, respectively. In‐hospital mortality was 5.2%, and 0.9% of patients received urgent heart transplantation. Low blood pressure and azotaemia were the most important predictors of in‐hospital mortality. The post‐discharge 30‐day and 180‐day all‐cause mortality were 1.2% and 9.2%, respectively. Conclusions Our analysis reveals that the prognosis of AHFS in Korea is poor and that there are specific features, including lower blood pressures at admission and lower rates of heart failure related to hypertension, compared with other registries. Adherence to current guidelines should be improved.

Predictors of Mortality, Rehospitalization for Syncope and Cardiovascular Events in Patients With Cardiovascular Syncope

“…In patients with HF, the sBP on admission has been shown to be an important prognostic factor for in-hospital and post-discharge death. 8, 9 Indeed, in a cohort of Japanese patients with HF, low sBP was predictive of in-hospital death. 10 In addition, hypotension has been associated with short-term serious outcomes in patients presenting to emergency departments with syncope or near syncope.…”

Fate of Acute Heart Failure Patients With Mid-Range Ejection Fraction

“…The variables collected were previously described in the interim study. 7 Clinical events included all-cause death. Maintenance of HF medication was evaluated at the time of echocardiographic follow-up.…”

“…The rationale and design of the KorAHF registry have been published previously. 7 From the patients in the registry, patients with documented LVEF (n=5,103) were included in the present study. We excluded patients with HF that could only be corrected by surgical or interventional methods [valvular heart disease (n=730) or congenital heart disease (n=50)] and patients with HF routinely considered reversible [hypertensive cardiomyopathy (n=203), acute myocarditis (n=70), infiltrative cardiomyopathy (n=63), tachycardiainduced cardiomyopathy (n=541), thyroid disease-related cardiomyopathy (n=27), peripartum cardiomyopathy (n=22), stress-induced cardiomyopathy (n=92), or alcoholic cardiomyopathy (n=74)].…”

Optimal Use of Beta-Blockers for Congestive Heart Failure

“…32 Similarly, in the Korean Acute Heart Failure Registry (KorAHF), β-blockers were prescribed at discharge for only 51% of patients with AHF. 33 The main concern is that if β-blockers are discontinued in patients who are admitted with acute exacerbation of their CHF for fear of additional negative inotropic effects of β-blockers on the myocardium, the patients may be labeled as intolerant to β-blockers and therefore not be restarted on these agents. This worst-case scenario may be preventing patients who would otherwise benefit from this treatment from receiving β-blockers in either the short or long term.…”