title: Acute decompensated heart failure patients admitted to critical care units: insights from ASCEND-HF.
abstract: BACKGROUND
  Little is known about global patterns of critical care unit (CCU) care and the relationship with outcomes in patients with acute decompensated heart failure (ADHF). Whether a ward or a CCU admission is associated with better outcomes is unclear.
  
  
  METHODS
  Patients in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial were initially hospitalized in a ward or CCU (coronary or intensive care unit). Sites were geographically classified: Asia-Pacific (AP), Central Europe (CE), Latin America (LA), North America (NA), and Western-Europe (WE). The primary outcome of 30-day all-cause mortality or all-cause hospital readmission was adjusted using a two-stage multivariable logistic regression model with a generalized estimated equation that took sites within each country as a nested random factor.
  
  
  RESULTS
  Overall, 1944 (38.2%) patients were admitted to a CCU and 3150 (61.8%) to a ward, and this varied by region: 50.6% AP, 63.3% CE, 60.7% WE, 22.1% LA, and 28.6% NA. The 30-day death or readmission rate was 15.2% in ward patients and 17.0% in CCU patients (risk-adjusted Odds Ratio [OR] 1.44: 95% CI, 1.14-1.82). Compared with CCU patients in NA (24.1% 30-day event rate), the primary outcomes were: AP (10.4%, Odds Ratio [OR] 0.63; 95% confidence Interval [CI], 0.35 to 1.15), CE (10.4%, OR 0.56: 95% CI, 0.31 to 1.02), LA (22.4%, OR 0.60: 95% CI, 0.11 to 3.32), and WE (11.2%, OR 0.63, 95% CI, 0.25 to 1.56). No regional differences in 30-day mortality were observed; however, 30-day readmission rates were highest in NA sites.
  
  
  CONCLUSIONS
  Management of patients with ADHF varies significantly, and after adjustment, CCU care was associated with higher risk of early mortality, not explained by international differences. These findings may help to improve the early decisions regarding risk stratification of patients hospitalized with ADHF.
authors.affiliation: Divisions of Critical Care and Cardiology, University of Alberta, Edmonton, Alberta, Canada; Canadian Vigour Center, Edmonton, Alberta, Canada. Electronic address: sv9@ualberta.ca.
authors.forename: Sean
authors.initials: S
authors.lastname: van Diepen
authors.affiliation: Canadian Vigour Center, Edmonton, Alberta, Canada.
authors.forename: Mohua
authors.initials: M
authors.lastname: Podder
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Canadian Vigour Center, Edmonton, Alberta, Canada.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Westerhout
authors.affiliation: Canadian Vigour Center, Edmonton, Alberta, Canada; Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstong
authors.affiliation: Western Infirmary, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Zubin J
authors.initials: ZJ
authors.lastname: Eapen
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.affiliation: Cleveland Clinic, OH, USA.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Canadian Vigour Center, Edmonton, Alberta, Canada; Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
mesh_terms: D000208:Acute Disease; D000368:Aged; D003422:Critical Care / Q000379:methods / Q000639:trends*; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D010359:Patient Readmission / Q000639:trends
keywords: Coronary care unit; Critical care; Heart failure; Intensive care unit; Outcomes