title: Clinical presentation, management and outcomes in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF).
abstract: OBJECTIVE
  We performed a survey on acute heart failure (AHF) in nine countries in four continents. We aimed to describe characteristics and management of AHF among various countries, to compare patients with de novo AHF versus patients with a pre-existing episode of AHF, and to describe subpopulations hospitalized in intensive care unit (ICU) versus cardiac care unit (CCU) versus ward.
  
  
  RESULTS
  Data from 4,953 patients with AHF were collected via questionnaire from 666 hospitals. Clinical presentation included decompensated congestive HF (38.6%), pulmonary oedema (36.7%) and cardiogenic shock (11.7%). Patients with de novo episode of AHF (36.2%) were younger, had less comorbidities and lower blood pressure despite greater left ventricular ejection fraction (LVEF) and were more often admitted to ICU. Overall, intravenous (IV) diuretics were given in 89.7%, vasodilators in 41.1%, and inotropic agents (dobutamine, dopamine, adrenaline, noradrenaline and levosimendan) in 39% of cases. Overall hospital death rate was 12%, the majority due to cardiogenic shock (43%). More patients with de novo AHF (14.2%) than patients with a pre-existing episode of AHF (10.8%) (p = 0.0007) died. There was graded mortality in ICU, CCU and ward patients with mortality in ICU patients being the highest (17.8%) (p < 0.0001).
  
  
  CONCLUSIONS
  Our data demonstrated the existence of different subgroups based on de novo or pre-existing episode(s) of AHF and the site of hospitalization. Recognition of these subgroups might improve management and outcome by defining specific therapeutic requirements.
authors.affiliation: Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland. ferenc.follath@usz.ch
authors.forename: F
authors.initials: F
authors.lastname: Follath
authors.forename: M B
authors.initials: MB
authors.lastname: Yilmaz
authors.forename: J F
authors.initials: JF
authors.lastname: Delgado
authors.forename: J T
authors.initials: JT
authors.lastname: Parissis
authors.forename: R
authors.initials: R
authors.lastname: Porcher
authors.forename: E
authors.initials: E
authors.lastname: Gayat
authors.forename: Nigel
authors.initials: N
authors.lastname: Burrows
authors.forename: A
authors.initials: A
authors.lastname: McLean
authors.forename: F
authors.initials: F
authors.lastname: Vilas-Boas
authors.forename: A
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D038622:Internationality; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011795:Surveys and Questionnaires