title: Worsening heart failure in 'real-world' clinical practice: predictors and prognostic impact.
abstract: The aim of this study was to compare the clinical features, predictors, and clinical outcomes of patients hospitalized with acute heart failure (AHF), with and without worsening heart failure (WHF).
  
  
  
  We used data from a multicentre prospective registry of AHF patients created in Saudi Arabia. WHF was defined as recurrence of heart failure symptoms or signs-with or without cardiogenic shock. In-hospital short- and long-term outcomes, as well as predictors of WHF are described. Of the 2609 AHF patients enrolled, 33.8% developed WHF. WHF patients were more likely to have a history of heart failure and ischaemic heart disease. Use of intravenous vasodilators, inotropic agents, furosemide infusions, and discharge beta-blockers was significantly higher in WHF patients, while use of discharge ACE inhibitors was higher in patients without WHF. Length of hospital stay was significantly longer for WHF patients than for those without WHF [median (interquartile range) 13 (14) vs. 7 (7) days, P < 0.001]. In-hospital, 30-day, 1-year, and 2-year mortality rates were higher in WHF patients than in non-WHF patients. The adjusted odds ratios for in-hospital, 30-day, and 1-year mortality were 4.13 [95% confidence interval (CI) 2.74-6.20, P < 0.001], 3.17 (95% CI 2.21-4.56, P < 0.001), and 1.34 (95% CI 1.04-1.71, P = 0.021), respectively. The strongest predictors for WHF were having ischaemic cardiomyopathy, AHF with concomitant acute coronary syndrome, and low haemoglobin.
  
  
  
  In real-world clinical practice, WHF during hospitalization for AHF is a strong predictor for short- and intermediate-term mortality, and a cause for longer hospital stays.
authors.affiliation: Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Hussam
authors.initials: H
authors.lastname: AlFaleh
authors.affiliation: King Salman Heart Center, King Fahd Medical City, Riyadh, Saudi Arabia.|Cardiology Department Tanta University, Egypt.
authors.forename: Abdelfatah A
authors.initials: AA
authors.lastname: Elasfar
authors.affiliation: Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Anhar
authors.initials: A
authors.lastname: Ullah
authors.affiliation: Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Khalid F
authors.initials: KF
authors.lastname: AlHabib
authors.affiliation: Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hersi
authors.affiliation: King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Layth
authors.initials: L
authors.lastname: Mimish
authors.affiliation: Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
authors.forename: Ali
authors.initials: A
authors.lastname: Almasood
authors.affiliation: Madina Cardiac Center, Al Madina Al Monaoarah, Saudi Arabia.
authors.forename: Saleh
authors.initials: S
authors.lastname: Al Ghamdi
authors.affiliation: King Abdullah Medical City, Cardiac center, Makkah, Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Ghabashi
authors.affiliation: King Fahad General Hospital, Jeddah, Saudi Arabia.
authors.forename: Asif
authors.initials: A
authors.lastname: Malik
authors.affiliation: North West Armed Forces Hospital, Tabuk, Saudi Arabia.
authors.forename: Gamal A
authors.initials: GA
authors.lastname: Hussein
authors.affiliation: Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia.
authors.forename: Mushabab
authors.initials: M
authors.lastname: Al-Murayeh
authors.affiliation: National Guard Hospital, Jeddah, Saudi Arabia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abuosa
authors.affiliation: Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Waleed
authors.initials: W
authors.lastname: Al Habeeb
authors.affiliation: Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Tarek
authors.initials: T
authors.lastname: Kashour
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D018450:Disease Progression; D004232:Diuretics / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000008:administration & dosage*; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012529:Saudi Arabia / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D004232:Diuretics; D014665:Vasodilator Agents; D005665:Furosemide
keywords: Complications; Epidemiology; Heart failure; In-hospital mortality; Pathophysiology; Prospective studies; Worsening heart failure