title: Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study.
abstract: BACKGROUND
  Little is known about the epidemiology of acute decompensated heart failure (ADHF) in patients admitted to intensive and coronary care units (ICU/CCU). Observational data may improve disease management and guide the design of clinical trials.
  
  
  OBJECTIVE
  EFICA is an observational study of the clinical profile, management and survival of ADHF patients admitted to ICU/CCU.
  
  
  METHODS
  The study included 599 patients admitted to 60 ICU/CCUs across France. Relevant data was recorded during hospitalisation. Survival was assessed at 4 weeks and 1 year.
  
  
  RESULTS
  The main cause of ADHF was ischaemic heart disease (61%); 29% of patients had cardiogenic shock. Mortality was 27.4% at 4 weeks and 46.5% at 1 year, increasing to 43.2% and 62.5%, respectively, when including pre-admission deaths. Shock patients had the highest [57.8% vs. 15.2% without shock (p < 0.001)] and patients with hypertension and pulmonary oedema had the lowest 4-week mortality: (7%). Pre-admission NYHA class III-IV heart failure, not initial clinical presentation, influenced 1-year mortality.
  
  
  CONCLUSIONS
  ADHF is a heterogeneous syndrome. Based on initial clinical presentation, three entities with distinct features and outcome may be described: cardiogenic shock, pulmonary oedema with hypertension, and 'decompensated' chronic heart failure. This should be taken into account in future observational studies, guidelines and clinical trials.
authors.affiliation: Department of Cardiology, University Hospital of Nancy, France. f.zannad@chu-nancy.fr
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Yves
authors.initials: Y
authors.lastname: Juillière
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.forename: Louis
authors.initials: L
authors.lastname: Guize
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.forename: Pierre
authors.initials: P
authors.lastname: Rougé
authors.forename: Patrick
authors.initials: P
authors.lastname: Blin
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Barlet
authors.forename: Laurence
authors.initials: L
authors.lastname: Paolozzi
authors.forename: Catherine
authors.initials: C
authors.lastname: Vincent
authors.forename: Michel
authors.initials: M
authors.lastname: Desnos
authors.forename: Kamran
authors.initials: K
authors.lastname: Samii
mesh_terms: D000368:Aged; D005260:Female; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D016019:Survival Analysis; D013577:Syndrome