title: Temporal trends in clinical characteristics, treatments, and outcomes for heart failure hospitalizations, 2002 to 2004: findings from Acute Decompensated Heart Failure National Registry (ADHERE).
abstract: BACKGROUND
  The purpose of this study was to assess temporal trends in clinical characteristics, treatments, quality indicators, and outcomes for heart failure (HF) hospitalizations.
  
  
  METHODS
  Characteristics, treatments, quality measures, and inhospital outcomes were measured over 12 consecutive quarters (January 2002 to December 2004) using data from 159,168 enrollments from 285 ADHERE hospitals.
  
  
  RESULTS
  Baseline characteristics were similar or showed only modest changes, and severity of illness by logistic regression was unchanged over all 12 quarters. Inhospital treatment changed significantly over time with inotrope use decreasing from 14.7% to 7.9% (P < .0001). Discharge instructions increased 133%; smoking counseling, 132%; left ventricular function measurement, 8%; and beta-blocker use, 29% (all P < .0001). Clinical outcomes improved over time, including need for mechanical ventilation, which decreased 5.3% to 3.4% (relative risk 0.64, P < .0001); length of stay (mean), 6.3 to 5.5 days; and mortality, 4.5% to 3.2% (relative risk 0.71, P < .0001).
  
  
  CONCLUSIONS
  Over a 3-year period, demographics and clinical characteristics were relatively similar, but significant changes in intravenous therapy, enhancements in conformity to quality-of-care measures, increased administration of evidence-based HF medications, and substantial improvements in inhospital morbidity and mortality were observed during hospitalization for HF.
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, CA 90095, USA. gfonarow@mednet.ucla.edu
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Heywood
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Margarita
authors.initials: M
authors.lastname: Lopatin
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D019984:Quality Indicators, Health Care / Q000145:classification / Q000706:statistics & numerical data*; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology