Acute heart failure patient profiles, management and in‐hospital outcome: results of the Italian Registry on Heart Failure Outcome

Abstract

AimsRegistries and surveys improve knowledge of the 'real world'. This paper aims to describe baseline clinical profiles, management strategies, and the in-hospital outcome of patients admitted to hospital for an acute heart failure (AHF) episode. Methods and results IN-HFOutcome is a nationwide, prospective, multicentre, observational study conducted in 61 Cardiology Centres in Italy. Up to December 2009, 5610 patients had been enrolled, 1855 (33%) with AHF and 3755 (67%) with chronic heart failure (CHF). Baseline and in-hospital outcome data of AHF patients are presented. Mean age was 72 + 12 years, and 39.8% were female. Hospital admission was due to new-onset heart failure (HF) in 43% of cases. Comorbid conditions were observed more frequently in the worsening HF group, while those with de novo HF showed a higher heart rate, blood pressure, and more preserved left ventricular ejection fraction (LVEF). Electrical devices were previously implanted in 13.3% of the entire group. Inotropes were administered in 19.4% of the patients. The median duration of hospital stay was 10 days (interquartile range 7-15). All-cause in-hospital death was 6.4%, similar in worsening and de novo HF. Older age, hypotension, cardiogenic shock, pulmonary oedema, symptoms of hypoperfusion, hyponatraemia, and elevated creatinine were independent predictors of all-cause death. ConclusionOur registry confirms that in-hospital mortality in AHF is still high, with a long length of stay. Pharmacological treatment seems to be practically unchanged in the last decades, and the adherence to HF guidelines concerning implantable cardioverter defibrillators/cardiac resynchronization therapy is still very low. Some AHF phenotypes are characterized by worst prognosis and need specific research projects.--

Elevated heart rate at 24–36h after admission and in-hospital mortality in acute in non-arrhythmic heart failure

“…Heart rate levels provide risk prediction independently of numerous other clinical (older age, lower blood pressure, prior history of ischemic heart disease) and laboratory (increased serum creatinine) variables previously demonstrated to be predictive of in-hospital outcomes [9]. Our findings are the first to demonstrate that including heart rate evaluation early after admission for acute non-arrhythmic HF in patients with non-severely ill conditions (i.e.…”

Hospital and 4‐Year Mortality Predictors in Patients With Acute Pulmonary Edema With and Without Coronary Artery Disease

“…Several investigators have reported on the in‐hospital mortality in patients with acute heart failure, which is an ample concept that includes acute decompensation of chronic heart failure, cardiogenic shock with or without pulmonary edema, right ventricular failure, and APE 3, 6, 14, 19, 20, 21. In these studies, mortality has varied from 6.4% to 17.2% and they have shown advanced age,6, 14, 19, 21 severe left ventricular dysfunction,14 acute coronary syndromes,14 admission blood pressure,6, 19, 21 renal failure,6, 19, 21 need for inotropics,19 and anemia19 as principal predictors.…”

“…In these studies, mortality has varied from 6.4% to 17.2% and they have shown advanced age,6, 14, 19, 21 severe left ventricular dysfunction,14 acute coronary syndromes,14 admission blood pressure,6, 19, 21 renal failure,6, 19, 21 need for inotropics,19 and anemia19 as principal predictors.…”

Variability in use of IV nitrates and diuretics in acute HF: a ‘virtual patient’ clinical decision-making study

“…Similar systems are in use in other countries or regions. In-hospital death rates are age related and typically range from 4% to 10% for patients with acute heart failure in database and registry studies (Figure 1.3), 3,4,9,10,33,40,[42][43][44][45][46]48,50,52,53 although higher rates have been observed in some analyses. 54,55 Short-term survival is also poor, with 1-year death rates typically between 20% and 40% (Figure 1.3).…”

“…Findings are consistent between health service data (Figure 1.1) and data from patient registries and other studies (Figure 1.2). 3,5,7,9,10,23,[38][39][40][41][42][43][44][45] The average length of a hospital stay has decreased by 1-2 days in European countries over the past 10 years. 22,23,27,28 In the USA, the average length of stay decreased from 5.6 days in 2001 to 5.3 days in 2009.…”