Patterns of intensive care unit admissions in patients hospitalized for heart failure: insights from the RO-AHFS registry.
OBJECTIVE
The present study aims to describe the epidemiology, baseline clinical characteristics, in-hospital management, and outcome of patients hospitalized for heart failure admitted directly or transferred to the ICU.


RESULTS
The Romanian Acute Heart Failure Syndromes (RO-AHFS) registry prospectively enrolled 3224 consecutive patients between January 2008 and May 2009 admitted with a primary diagnosis of heart failure. Participants were classified by ICU admission status (i.e. ICU+/ICU-). Independent clinical predictors of ICU admission and in-hospital mortality were identified using multivariable logistic regression analysis. Overall, 10.7% of patients required ICU level care, 32% as a direct ICU admission, with 68% as an ICU transfer during hospitalization. Patients admitted to the ICU had a mean age of 68.1 ± 11.3 years, 61% were men, 67% had an ischemic cause, and 44% presented with de-novo heart failure. ICU+ patients more frequently presented with low SBP and pulse pressure and abnormal renal function. Mechanical ventilation was required in 32.7% and intravenous inotropes were administered to 56.7% of ICU+ patients. ICU+ patients had higher in-hospital mortality compared to ICU- patients (17.3 vs. 6.5%). Patients admitted directly to the ICU had a 15.3% mortality rate compared to 18.4% in those transferred after admission. Age, serum sodium, SBP below 110 mmHg, and left-ventricular ejection fraction less than 45% were predictive of ICU admission, whereas for ICU+ patients, age, vasopressor, and mechanical ventilation utilization were predictive of mortality.


CONCLUSIONS
Patients admitted directly or transferred to the ICU are at a high risk of in-hospital mortality. Clinical variables commonly measured at the time of admission may facilitate disposition decision-making including early triage to the ICU.
aInstitute of Emergency for Cardiovascular Diseases 'Prof C.C. Iliescu', Bucuresti, Romania bDepartment of Medicine, Stanford University School of Medicine, Stanford, California, USA cUniversity Emergency Hospital, Bucuresti dEmergency Hospital 'Sf Spiridon', Iasi, Romania eVanderbilt University, Department of Emergency Medicine, Nashville, Tennessee fCenter for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Ovidiu
O
Chioncel
Andrew P
AP
Ambrosy
Daniela
D
Filipescu
Serban
S
Bubenek
Dragos
D
Vinereanu
Antoniu
A
Petris
Sean P
SP
Collins
Cezar
C
Macarie
Mihai
M
Gheorghiade
D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D014218:Triage
D002316:Cardiotonic Agents