title: Characterization of acute heart failure hospitalizations in a Portuguese cardiology department.
abstract: OBJECTIVE
  We describe the clinical characteristics, management and outcomes of patients hospitalized with acute heart failure in a south-west European cardiology department. We sought to identify the determinants of length of stay and heart failure rehospitalization or death during a 12-month follow-up period.
  
  
  RESULTS
  This was a retrospective cohort study including all patients admitted during 2010 with a primary or secondary diagnosis of acute heart failure. Death and readmission were followed through 2011. Of the 924 patients admitted, 201 (21%) had acute heart failure, 107 (53%) of whom had new-onset acute heart failure. The main precipitating factors were acute coronary syndrome (63%) and arrhythmia (14%). The most frequent clinical presentations were heart failure after acute coronary syndrome (63%), chronic decompensated heart failure (47%) and acute pulmonary edema (21%). On admission 73% had left ventricular ejection fraction <50%. Median length of stay was 11 days and in-hospital mortality was 5.5%. The rehospitalization rate was 21% and 24% at six and 12 months, respectively. All-cause mortality was 16% at 12 months. The independent predictors of rehospitalization or death were heart failure hospitalization during the previous year (Hazard ratio - HR - 3.177), serum sodium <135mmol/l on admission (HR 1.995) and atrial fibrillation (HR 1.791). Reduced left ventricular ejection fraction was associated with a lower risk of rehospitalization or death (HR 0.518).
  
  
  CONCLUSIONS
  Our patients more often presented new-onset acute heart failure, due to an acute coronary syndrome, with reduced left ventricular ejection fraction. Several predictive factors of death or rehospitalization were identified that may help to select high-risk patients to be followed in a heart failure management program after discharge.
authors.affiliation: Department of Cardiology, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Ana Catarina
authors.initials: AC
authors.lastname: Pinho-Gomes
authors.forename: José
authors.initials: J
authors.lastname: Silva Cardoso
authors.forename: Luís Filipe
authors.initials: LF
authors.lastname: Azevedo
authors.forename: Rui
authors.initials: R
authors.lastname: Almeida
authors.forename: Teresa
authors.initials: T
authors.lastname: Pinho
authors.forename: Maria Júlia
authors.initials: MJ
authors.lastname: Maciel
mesh_terms: D000208:Acute Disease; D000368:Aged; D002309:Cardiology; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000628:therapy*; D006748:Hospital Departments; D006760:Hospitalization; D006801:Humans; D008297:Male; D011174:Portugal; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Acute heart failure; Duração de internamento; Insuficiência cardíaca aguda; Length of stay; Management; Mortalidade; Mortality; Prognosis; Prognóstico; Re-hospitalization; Rehospitalização; Síndrome coronária aguda; Tratamento