Characteristics and the prognosis of patients with acute heart failure in current clinical practice

PURPOSE: Analysis of predefined characteristics and outcomes in a non-selected population of patients hospitalized for acute heart failure (AHF) in Slovakia. METHODS: We conducted a nationwide prospective multicenter survey with 860 consecutive patients enrolled in 11 hospitals throughout Slovakia--two centres with a non-stop catheterization service, two central and 7 regional hospitals. Relevant data of 78 characteristics in 9 categories were collected during 3 months (between 1 May 2009 and 31 July 2009). There was a specific form designed for this survey. Collected data were then transferred into the electronic database and statistically analysed. RESULTS: Mean age was 72 years, 81% of patients were in NYHA class III/IV (52% male). The majority of patients were admitted with decompensated heart failure (68.4%), frequency of cardiogenic shock was 0.3%. New-onset AHF (AHF de novo) was diagnosed in 31.1%, of which 20.8% was due to acute coronary syndromes. Coronary heart disease was the predominant primary aetiology of AHF (67%), followed by almost equally represented hypertension (10.5%), valvular disease (10%) and dilated cardiomyopathy (9%). Hypertension was referred as the most frequent comorbidity (82%), followed by atrial fibrillation (48%), diabetes mellitus (42%), history of renal failure (31%) and with anaemia at admission (38%). Rales were the dominant physical sign (69.9%). Systolic blood pressure greater than 140 mm Hg was present in 37.8% and QRS length > 120 ms in 21.4% of patients. Preserved left ventricular ejection fraction (> or = 40%) was observed in 57% out of 70% documented cases in the whole survey. 23.3% of patients had a history of coronary angiography. 84.3% of patients received intravenous treatment, diuretics, nitrates and inotropes were given to 82.2%, 18% and 6%, respectively. The number of patients with cardiac resynchronization therapy (CRT), with or without defibrillator function, was 0.9%. Mean length of stay was 9.2 days and in-hospital mortality was 9.1%. At discharge, 76% of patients were on angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), 62% were using beta-blockers (BB), however the doses of drugs were lower then recommended values. CONCLUSIONS: Results of the survey are comparable with other observational studies, surveys and large registries. Although the percentage of patients with ACE-I/ARB and BB at discharge seems promising, there is still area for improvement in AHF patients health care.