title: Acute heart failure registry from high-volume university hospital ED: comparing European and US data.
abstract: BACKGROUND
  Acute heart failure (AHF) is associated with a poor prognosis.
  
  
  OBJECTIVE
  The objectives of this study are to describe mechanisms of AHF and to identify the predictors for all-cause mortality by patients admitted for hospitalization by emergency departments (EDs) as well as to compare European and American data.
  
  
  METHODS
  We designed a prospective registry of consecutively admitted patients for AHF to a high-volume university hospital ED during a 1-year period (n=202; age, 75±11 years; 51% men; ejection fraction, 38%±15%).
  
  
  RESULTS
  The major causes of AHF were coronary artery disease, often with concomitant mitral regurgitation, hypertension, or atrial fibrillation (>90% of cases). At admission, 24.9% of patients had preserved ejection fractions (>50%); and only 7.7% fulfilled the definition of diastolic AHF. The 30-day and long-term mortality (median follow-up, 793 days) were 20.3% and 31.0%, respectively. A low systolic blood pressure (P=.006), reduced ejection fraction (P=.044), and low serum hemoglobin level (P<.01) emerged as the strongest predictors of all-cause mortality. In patients with AHF without acute myocardial infarction (MI) (63.9%), prescription, at discharge, of statins (P<.05) was independently associated with all-cause mortality.
  
  
  CONCLUSIONS
  The patient's blood pressure, ejection fraction, and hemoglobin values, at admission, were identified as the strongest predictors of all-cause mortality. In AHF not triggered by acute MI, long-term use of statins may be associated with reduced survival. The prevalence of diastolic AHF is low. The American AHF population had similar baseline characteristics; needed fewer intensive care unit admissions; had a better 30 days of prognosis, lower incidence of MI, and de novo AHF diagnoses. In a similar subgroup, we observed similar incidences of inotropic support and mechanical ventilation. Our results could not be generalized to all patients with AHF admitted to US EDs.
authors.affiliation: Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady in Prague, Czech Republic. karasek@fnkv.cz
authors.forename: Jiri
authors.initials: J
authors.lastname: Karasek
authors.forename: Petr
authors.initials: P
authors.lastname: Widimsky
authors.forename: Petr
authors.initials: P
authors.lastname: Ostadal
authors.forename: Hana
authors.initials: H
authors.lastname: Hrabakova
authors.forename: Martin
authors.initials: M
authors.lastname: Penicka
mesh_terms: D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D006454:Hemoglobins / Q000032:analysis; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000502:physiology; D014481:United States / Q000453:epidemiology
chemical_list: D006454:Hemoglobins