Original article
Long-term survival following acute heart failure: The Acute Heart Failure Database Main registry (AHEAD Main)

https://doi.org/10.1016/j.ejim.2012.11.005Get rights and content

Abstract

Background

The in-hospital mortality of patients with acute heart failure (AHF) is reported to be 12.7% and mortality on day 30 after admission 17.2%. Less information is known about the long-term prognosis of those patients discharged after hospitalization. As such, the aim of this study was to investigate long-term survival in a cohort of patients who had been hospitalized for AHF and then discharged.

Methods

The AHEAD Main registry includes 4153 patients hospitalized for AHF in 7 different medical centers, each with its own cathlab, in the Czech Republic. Patient survival rates were evaluated in 3438 patients who had survived to day 30 after admission, and were used as a measurement of long-term survival.

Results

The most common etiologies were acute coronary syndrome (32.3%) and chronic ischemic heart disease (20.1%). The survival rate after day 30 following admission was 79.7% after 1 year and 64.5% after 3 years. No statistically significant difference in syndromes was found in survival after day 30. Independent predictors of a worse prognosis were defined as follows: age > 70 years, comorbidities, severe left ventricular systolic dysfunction, valvular disease or ACS as an etiology of AHF. A better prognosis was defined for de-novo AHF patients, and those who were taking ACE inhibitors at the time of discharge. In a sub-analysis, high levels of natriuretic peptides were the most powerful predictors of high-risk, long-term mortality.

Conclusion

The AHEAD Main registry provides up-to-date information on the long-term prognosis of patients hospitalized with AHF. The 3-year survival of patients following day 30 of admission was 64.5%. Higher age, LV dysfunction, comorbidities and high levels of natriuretic peptides were the most powerful predictors of worse prognosis in long-term survival.

Introduction

Acute heart failure (AHF) is a syndrome which includes a wide range of etiologies, severity and clinical symptoms. The syndrome comprises numerous diagnoses, such as acute decompensation of chronic heart failure, acute failure of the right ventricle due to a massive pulmonary embolism, pulmonary edema during hypertensive crisis in patients with preserved systolic left ventricular function, or cardiogenic shock in patients with myocardial infarction and ST elevation. Because the study started in 2006, the guidelines for the diagnosis and treatment of AHF published by the European Society of Cardiology in 2005 [1] allowed for a systematic classification of patients with AHF on the basis of 6 syndromes (acute decompensated HF, hypertensive AHF, pulmonary edema, cardiogenic shock, high output HF and right heart failure) and according to etiologies and severity of AHF. This classification was later slightly modified in the 2008 guidelines [2] and recently updated in 2012 [3]. The hospital mortality of patients with AHF is reported to range from approximately 4% to 11% [4], [5], [6], [7]; the in-hospital mortality rate listed in the AHEAD Main registry was 12.7% [8]. Less information is known about the long-term prognosis of patients discharged following hospitalization due to AHF. Published results are based on either a limited number of patients or limited follow-up times [9], [10], [11], [12], [13], [14]. Randomized, controlled studies that follow AHF patients tend to evaluate selected patient cohorts.

The aim was to investigate long-term survival in a cohort of patients discharged following hospitalization for AHF. Although patients with acute heart failure are treated by hospital physicians, once discharged the follow-up is mostly performed by outpatient cardiologists, internists and general practitioners. For this reason, it would be valuable to highlight deficiencies in medication, as well as other negative prognostic markers, present at time of discharge.

Section snippets

Study population

The Acute Heart Failure Database registry (AHEAD) has already been described [8], [15]. Briefly, the AHEAD Main registry includes consecutive patients from 7 centers which have 24-hour cathlab service and centralized care for patients with acute coronary syndromes. The inclusion criteria for the database adhere to the European guidelines for AHF 2005. Hence, there must be the signs and symptoms of HF, confirmed left-ventricular dysfunction (systolic or diastolic) and/or positive response to

Baseline characteristics

The baseline characteristics of patients according to AHF syndrome are shown in Table 1. A total of 18.5% of patients were younger than 60 years of age and 25.4% were older than 80 years of age. When compared with other syndromes, younger patients fell into the group with right heart failure. The average weight (80 kg (70; 91)) and body mass index (BMI) (27.7 (24.8; 31.2)) were similar within all groups. 1.1% of patients were underweight (BMI < 18.5), 40.8% were overweight (BMI 25–29.9) and 32.4% of

Discussion

The AHEAD registry is one of the largest national observational prospective multicentre registries of patients hospitalized due to AHF with long-term follow-up. The distribution and characteristics of patients is systematic and based on ESC guidelines [1]. Unlike other registries evaluating hospital mortality or short-term follow-up, we consider long-term follow-up to be even more important. Patients were monitored for up to 4 years. The registry covers the whole spectrum of patients with AHF.

Conclusion

The AHEAD Main registry provides up-to-date information on the long-term prognosis of patients hospitalized for AHF. We have demonstrated that the highest mortality rate of discharged patients was during the first year following discharge. The 3-year survival rate of patients after day 30 post-admission was 64.5% and there was no significant difference among the groups in terms of varying AHF syndromes. High levels of natriuretic peptides were the most powerful predictors of high mortality risk

Learning points

  • The 3-year survival rate of discharged patients after acute heart failure attack was 64.5%.

  • The highest mortality rate of patients was during the first year following discharge.

  • There is no significant difference in long-term survival among AHF syndrome groups.

  • Patients with preserved LVEF > 50% had better one- and three-year survival in comparison to patients with depressed LVEF.

  • The most powerful, independent, negative prognostic factors of patients discharged after AHF included: age > 70 years, mild

Conflict of interests

The authors declare that there is no conflict of interest.

Source of funding

Supported by the European Regional Development Fund — Project of International Clinical Research Center, St. Anne's University Hospital Brno, Czech Republic (no.CZ.1.05/1.1.00/02.0123); and by the project (Ministry of Health, Czech Republic) for conceptual development of research organization 65269705 (University Hospital Brno, Brno, Czech Republic).

Acknowledgments

We thank the study's investigators for their contribution to this work and its findings.

Participating centers and investigators: St. Anne's Teaching Hospital, Brno: Tereza Mikusová, Klaudia Zidkova; Cardiocentre, Kralovské Vinohrady Teaching Hospital, Prague: Filip Rohac, Richard Fojt; Na Homolce Hospital, Prague: Petr Ostadal, Andreas Kruger; University Hospital, Olomouc: David Vindis; T. Bata Regional Hospital, Zlin: Zdenek Coufal, Petr Hrdy, Stanislava Penasova, Miroslav Bambuch; Institute

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