title: Acute heart failure with and without acute coronary syndrome: clinical correlates and prognostic impact (From the HEARTS registry).
abstract: BACKGROUND
  Little is know about the outcomes of acute heart failure (AHF) with acute coronary syndrome (ACS-AHF), compared to those without ACS (NACS-AHF).
  
  
  METHODS
  We conducted a prospective registry of AHF patients involving 18 hospitals in Saudi Arabia between October 2009 and December 2010. In this sub-study, we compared the clinical correlates, management and hospital course, as well as short, and long-term outcomes between AHF patients with and without ACS.
  
  
  RESULTS
  Of the 2609 AHF patients enrolled, 27.8 % presented with ACS. Compared to NACS-AHF patients, ACS-AHF patients were more likely to be old males (Mean age = 62.7 vs. 60.8 years, p = 0.003, and 73.8 % vs. 62.7 %, p < 0.001, respectively), and to present with De-novo heart failure (56.6 % vs. 28.1 %, p < 0.001). Additionally they were more likely to have history of ischemic heart disease, diabetes, dyslipidemia, and less likely to have chronic kidney disease (p < 0.001 for all comparisons). The prevalence of severe LV systolic dysfunction (EF < 30 %) was higher in ACS-AHF patients. During hospital stay, ACS-AHF patients were more likely to develop shock (p < 0.001), recurrent heart failure (p = 0.02) and needed more mechanical ventilation (p < 0.001). β blockers and Angiotensin Converting Enzyme inhibitors were used more often in ACS-AHF patients (p = 0.001 and, p = 0.004 respectively). ACS- AHF patients underwent more coronary angiography and had higher prevalence of multi-vessel coronary artery disease (p < 0.001 for all comparisons). The unadjusted hospital and one-month mortality were higher in ACS-AHF patients (OR = 1.6 (1.2-2.2), p = 0.003 and 1.4 (1.0-1.9), p = 0.026 respectively). A significant interaction existed between the level of left ventricular ejection fraction and ACS-AHF status. After adjustment, ACS-AHF status was only significantly associated with hospital mortality (OR = 1.6 (1.1-2.4), p = 0.019). The three-years survival following hospital discharge was not different between the two groups.
  
  
  CONCLUSIONS
  AHF patients presenting with ACS had worse hospital prognosis, and an equivalent long-term survival compared to AHF patients without ACS. These findings underscore the importance of timely recognition and management of AHF patients with concomitant ACS given their distinct presentation and underlying pathophysiology compared to other AHF patients.
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.
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: Prince Sultan Cardiac Center, Hafouf, 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. tkashour@gmail.com.|Cardiac Sciences, King Khalid University Hospital, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Saudi Arabia. tkashour@gmail.com.
authors.forename: Tarek S
authors.initials: TS
authors.lastname: Kashour
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000208:Acute Disease; D000368:Aged; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute coronary syndrome complications/mortality/physiopathology; Heart failure complications/mortality/physiopathology; Hospital Mortality; Prospective Studies; Saudi Arabia/epidemiology