Korean Circ J.  2011 Jul;41(7):363-371. 10.4070/kcj.2011.41.7.363.

Characteristics, Outcomes and Predictors of Long-Term Mortality for Patients Hospitalized for Acute Heart Failure: A Report From the Korean Heart Failure Registry

• Choi DJ
• Han S
• Jeon ES
• Cho MC
• Kim JJ
• Yoo BS
• Shin MS
• Seong IW
• Ahn Y
• Kang SM
• Kim YJ
• Kim HS
• Chae SC
• Oh BH
• Lee MM
• Ryu KH
• KorHF Registry

• KMID: 2225099
• DOI: http://doi.org/10.4070/kcj.2011.41.7.363

Abstract

BACKGROUND AND OBJECTIVES
Acute heart failure (AHF) is associated with a poor prognosis and it requires repeated hospitalizations. However, there are few studies on the characteristics, treatment and prognostic factors of AHF. The aims of this study were to describe the clinical characteristics, management and outcomes of the patients hospitalized for AHF in Korea.
SUBJECTS AND METHODS
We analyzed the clinical data of 3,200 hospitalization episodes that were recorded between June 2004 and April 2009 from the Korean Heart Failure (KorHF) Registry database. The mean age was 67.6+/-14.3 years and 50% of the patients were female.
RESULTS
Twenty-nine point six percent (29.6%) of the patients had a history of previous HF and 52.3% of the patients had ischemic heart disease. Left ventricular ejection fraction (LVEF) was reported for 89% of the patients. The mean LVEF was 38.5+/-15.7% and 26.1% of the patients had preserved systolic function (LVEF > or =50%), which was more prevalent in the females (34.0% vs. 18.4%, respectively, p<0.001). At discharge, 58.6% of the patients received beta-blockers (BB), 53.7% received either angiotensin converting enzyme-inhibitors or angiotensin receptor blockers (ACEi/ARB), and 58.4% received both BB and ACEi/ARB. The 1-, 2-, 3- and 4-year mortality rates were 15%, 21%, 26% and 30%, respectively. Multivariate analysis revealed that advanced age {hazard ratio: 1.023 (95% confidence interval: 1.004-1.042); p=0.020}, a previous history of heart failure {1.735 (1.150-2.618); p=0.009}, anemia {1.973 (1.271-3.063); p=0.002}, hyponatremia {1.861 (1.184-2.926); p=0.007}, a high level of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) {3.152 (1.450-6.849); p=0.004} and the use of BB at discharge {0.599 (0.360-0.997); p=0.490} were significantly associated with total death.
CONCLUSION
We present here the characteristics and prognosis of an unselected population of AHF patients in Korea. The long-term mortality rate was comparable to that reported in other countries. The independent clinical risk factors included age, a previous history of heart failure, anemia, hyponatremia, a high NT-proBNP level and taking BB at discharge.

Keyword

Heart failure; Registries; Outcome

MeSH Terms

Anemia
Angiotensin Receptor Antagonists
Angiotensins
Female
Heart
Heart Failure
Hospitalization
Humans
Hyponatremia
Korea
Multivariate Analysis
Myocardial Ischemia
Natriuretic Peptide, Brain
Peptide Fragments
Prognosis
Registries
Risk Factors
Stroke Volume
Angiotensin Receptor Antagonists
Angiotensins
Natriuretic Peptide, Brain
Peptide Fragments

Figure

• 

  Fig. 1 The five-year follow-up results according to different gender. The five-year survival rate was 61% and 69% for the male (red line) and female (blue line), respectively.

Reference

1. Jessup M, Brozena S. Heart failure. N Engl J Med. 2003. 348:2007–2018.

2. Levy D, Kenchaiah S, Larson MG, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002. 347:1397–1402.

3. Studies of left ventricular dysfunction (SOLVD): rationale, design and methods: two trials that evaluate the effect of enalapril in patients with reduced ejection fraction. Am J Cardiol. 1990. 66:315–322.

4. Franciosa JA, Abraham WT, Fowler M, et al. Rationale, design, and methods for a Coreg (carvedilol) Heart Failure Registry (COHERE): COHERE Participant Physicians. J Card Fail. 2000. 6:264–271.

5. Pocock SJ, Wang D, Pfeffer MA, et al. Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J. 2006. 27:65–75.

6. Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology: developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008. 29:2388–2442.

7. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993. 88:107–115.

8. Mosterd A, Cost B, Hoes AW, et al. The prognosis of heart failure in the general population: the Rotterdam Study. Eur Heart J. 2001. 22:1318–1327.

9. Kawashiro N, Kasanuki H, Ogawa H, Matsuda N, Hagiwara N. Clinical characteristics and outcome of hospitalized patients with congestive heart failure: results of the HIJC-HF registry. Circ J. 2008. 72:2015–2020.

10. Fonarow GC, Heywood JT, Heidenreich PA, Lopatin M, Yancy CW. Temporal trends in clinical characteristics, treatments, and outcomes for heart failure hospitalizations, 2002 to 2004: findings from Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2007. 153:1021–1028.

11. Fonarow GC, Corday E. Overview of acutely decompensated congestive heart failure (ADHF): a report from the ADHERE registry. Heart Fail Rev. 2004. 9:179–185.

12. Echols MR, Felker GM, Thomas KL, et al. Racial differences in the characteristics of patients admitted for acute decompensated heart failure and their relation to outcomes: results from the OPTIME-CHF trial. J Card Fail. 2006. 12:684–688.

13. Massie BM, Shah NB. Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management. Am Heart J. 1997. 133:703–712.

14. Adams KF Jr, Fonarow GC, Emerman CL, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005. 149:209–216.

15. Komajda M, Follath F, Swedberg K, et al. The EuroHeart Failure Survey programme: a survey on the quality of care among patients with heart failure in Europe: part 2: treatment. Eur Heart J. 2003. 24:464–474.

16. Cleland JG, Swedberg K, Follath F, et al. The EuroHeart Failure survey programme: a survey on the quality of care among patients with heart failure in Europe: part 1: patient characteristics and diagnosis. Eur Heart J. 2003. 24:442–463.

17. McClellan WM, Flanders WD, Langston RD, Jurkovitz C, Presley R. Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population-based study. J Am Soc Nephrol. 2002. 13:1928–1936.

18. Rudiger A, Harjola VP, Müller A, et al. clinical pre-sentation, one-year mortality and prognostic factors. Eur J Heart Fail. 2005. 7:662–670.

19. McAlister FA, Ezekowitz J, Tonelli M, Armstrong PW. Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation. 2004. 109:1004–1009.

20. Tavazzi L, Maggioni AP, Lucci D, et al. Nationwide survey on acute heart failure in cardiology ward services in Italy. Eur Heart J. 2006. 27:1207–1215.

21. Kearney MT, Fox KA, Lee AJ, et al. Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure. J Am Coll Cardiol. 2002. 40:1801–1808.

22. Logeart D, Thabut G, Jourdain P, et al. Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure. J Am Coll Cardiol. 2004. 43:635–641.

23. Fonarow GC, Abraham WT, Albert NM, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med. 2008. 168:847–854.

24. Tsuchihashi-Makaya M, Hamaguchi S, Kinugawa S, et al. Characteristics and outcomes of hospitalized patients with heart failure and reduced vs preserved ejection fraction: report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J. 2009. 73:1893–1900.