Nationwide survey on acute heart failure in cardiology ward services in Italy.
OBJECTIVE
Chronic heart failure (HF) is recognized as an important public health problem but little attention has been focused on acute-stage HF.


RESULTS
Nationwide, prospective, observational study setting 206 cardiology centres with intensive cardiac care units. During 3 months, 2807 patients diagnosed as having de novo acute HF (44%) or worsening chronic HF (56%) were enrolled. Acute pulmonary oedema was the presenting clinical feature in 49.6% of patients, cardiogenic shock in 7.7%, and worsened NYHA functional class in 42.7% of cases. Anaemia (Hb<12 g/dL) was present in 46% of patients, renal dysfunction (creatinine > or =1.5 mg%) in 47%, and hyponatraemia (< or =136 mEq/L) in 45%. An ejection fraction (EF)>40% was found in 34% of cases. Intravenous diuretics, nitrates, and inotropes were given to 95, 51, and 25% of patients, respectively. The median duration of hospital stay was 9 days. In-hospital mortality rate was 7.3%. Older age, use of inotropic drugs, elevated troponin, hyponatraemia, anaemia, and elevated blood urea nitrogen were independent predictors of all-cause death; prior revascularization procedures and elevated blood pressure were indicators of a better outcome. The rehospitalization rate within 6 months was 38.1%, all-cause mortality from discharge to 6 months was 12.8%.


CONCLUSIONS
Acute HF is an ominous condition, needing more research activity and resources.
Tavazzi
Luigi
L
Department of Cardiology, IRCCS Policlinico S. Matteo, Piazzale Golgi, 2-27100 Pavia, Italy. centro_studi@anmco.it
Maggioni
Aldo P
AP
Lucci
Donata
D
Cacciatore
Giuseppe
G
Ansalone
Gerardo
G
Oliva
Fabrizio
F
Porcu
Maurizio
M
D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology