CLINICAL RESEARCH: HEART FAILURE
Clinical Presentation, Management, and In-Hospital Outcomes of Patients Admitted With Acute Decompensated Heart Failure With Preserved Systolic Function
A Report From the Acute Decompensated Heart Failure National Registry (ADHERE) Database
Clyde W. Yancy, MD, FACC*,*,
Margarita Lopatin, MS ,
Lynne Warner Stevenson, MD, FACC ,
Teresa De Marco, MD, FACC ,
Gregg C. Fonarow, MD, FACC|| for the ADHERE Scientific Advisory Committee and Investigators
* Division of Cardiology, Department of Medicine, University of Texas Southwest Medical Center, Dallas, Texas
Department of Biostatistics, Scios Inc., Fremont, California
Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
|| Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, California
Manuscript received March 25, 2005;
revised manuscript received August 17, 2005,
accepted September 8, 2005.
* Reprint requests and correspondence: Dr. Clyde W. Yancy, University of Texas Southwest Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9047. (Email: Clyde.Yancy{at}UTSouthwestern.edu).
OBJECTIVES: The aims of this analysis were to describe the clinical characteristics, management, and outcomes of patients hospitalized for acute decompensated heart failure (HF) with preserved systolic function (PSF).
BACKGROUND: Clinically meaningful characteristics of these patients have not been fully studied in a large database.
METHODS: Data from >100,000 hospitalizations from the Acute Decompensated Heart Failure National Registry (ADHERE) database were analyzed.
RESULTS: Heart failure with PSF was present in 50.4% of patients with in-hospital assessment of left ventricular function. When compared with patients with systolic dysfunction, patients with PSF were more likely to be older, women, and hypertensive and less likely to have had a prior myocardial infarction or be receiving an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker. In-hospital mortality was lower in patients with PSF compared with patients with systolic dysfunction (2.8% vs. 3.9%; adjusted odds ratio [OR]: 0.86; p = 0.005), but duration of intensive care unit stay and total hospital length of stay were similar. Serum creatinine >2 mg/dl was associated with increased in-hospital mortality in both systolic function groups (PSF: 4.8%; systolic dysfunction: 8.4%; p < 0.0001), and the most powerful predictors of in-hospital mortality in both groups were blood urea nitrogen >37 mg/dl (OR: 2.53; 95% confidence interval [CI]: 2.22 to 2.87) and systolic blood pressure  125 mm Hg (OR: 2.58; 95% CI: 2.33 to 2.86).
CONCLUSIONS: Heart failure with PSF is common and is characterized by a unique patient profile. Event rates are worrisome and reflect a need for more effective management strategies.
|
Abbreviations and Acronyms
| | ACE = angiotensin-converting enzyme | | ADHERE = Acute Decompensated Heart Failure National Registry | | ARB = angiotensin II receptor blocker | | BP = blood pressure | | BUN = blood urea nitrogen | | CART = classification and regression tree | | CI = confidence interval | | HF = heart failure | | LV = left ventricular | | OR = odds ratio | | PSF = preserved systolic function |
|
This article has been cited by other articles:
|
|
|
|
 
M Panella, S Marchisio, M L Demarchi, L Manzoli, and F Di Stanislao
Reduced in-hospital mortality for heart failure with clinical pathways: the results of a cluster randomised controlled trial
Qual. Saf. Health Care,
October 1, 2009;
18(5):
369 - 373.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. B. Somaratne, C. Berry, J. J.V. McMurray, K. K. Poppe, R. N. Doughty, and G. A. Whalley
The prognostic significance of heart failure with preserved left ventricular ejection fraction: a literature-based meta-analysis
Eur J Heart Fail,
September 1, 2009;
11(9):
855 - 862.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. T. Chan
A critical look at acute decompensated heart failure from a nephrologist's perspective
Nephrol. Dial. Transplant.,
July 1, 2009;
24(7):
2024 - 2026.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Hsich, E. Z. Gorodeski, R. C. Starling, E. H. Blackstone, H. Ishwaran, and M. S. Lauer
Importance of Treadmill Exercise Time as an Initial Prognostic Screening Tool in Patients With Systolic Left Ventricular Dysfunction
Circulation,
June 30, 2009;
119(25):
3189 - 3197.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Nieuwlaat, L. W. Eurlings, J. G. Cleland, S. M. Cobbe, P. E. Vardas, A. Capucci, J. L. Lopez-Sendon, J. G. Meeder, Y. M. Pinto, and H. J.G.M. Crijns
Atrial fibrillation and heart failure in cardiology practice: reciprocal impact and combined management from the perspective of atrial fibrillation: results of the Euro Heart Survey on atrial fibrillation.
J. Am. Coll. Cardiol.,
May 5, 2009;
53(18):
1690 - 1698.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Setoguchi, A. Nohria, J. A. Rassen, L. W. Stevenson, and S. Schneeweiss
Maximum potential benefit of implantable defibrillators in preventing sudden death after hospital admission because of heart failure
Can. Med. Assoc. J.,
March 17, 2009;
180(6):
611 - 616.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gheorghiade and P. S. Pang
Acute heart failure syndromes.
J. Am. Coll. Cardiol.,
February 17, 2009;
53(7):
557 - 573.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Rudolph, H. Abdel-Aty, S. Bohl, P. Boye, A. Zagrosek, R. Dietz, and J. Schulz-Menger
Noninvasive detection of fibrosis applying contrast-enhanced cardiac magnetic resonance in different forms of left ventricular hypertrophy relation to remodeling.
J. Am. Coll. Cardiol.,
January 20, 2009;
53(3):
284 - 291.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Quinones
Role of echocardiography in predicting onset of heart failure in patients with stable coronary artery disease: is the whole greater than the sum of its parts?
J. Am. Coll. Cardiol. Img.,
January 1, 2009;
2(1):
21 - 23.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Okura, Y. Takada, A. Yamabe, T. Kubo, K. Asawa, T. Ozaki, H. Yamagishi, I. Toda, M. Yoshiyama, J. Yoshikawa, et al.
Age- and Gender-Specific Changes in the Left Ventricular Relaxation: A Doppler Echocardiographic Study in Healthy Individuals
Circ Cardiovasc Imaging,
January 1, 2009;
2(1):
41 - 46.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Ray, S. Delerme, P. Jourdain, and C. Chenevier-Gobeaux
Differential diagnosis of acute dyspnea: the value of B natriuretic peptides in the emergency department
QJM,
November 1, 2008;
101(11):
831 - 843.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur. Heart J.,
October 1, 2008;
29(19):
2388 - 2442.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, A. W. Hoes, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur J Heart Fail,
October 1, 2008;
10(10):
933 - 989.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Bukowska, U. Lendeckel, A. Krohn, G. Keilhoff, S. t. Have, K. H. Neumann, and A. Goette
Atrial fibrillation down-regulates renal neutral endopeptidase expression and induces profibrotic pathways in the kidney
Europace,
October 1, 2008;
10(10):
1212 - 1217.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Di Tullio
Diastolic Dysfunction: Does Ethnicity Matter?
J. Am. Coll. Cardiol.,
September 16, 2008;
52(12):
1022 - 1023.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Lombardo, T. V Bridgeman, N. De Michelis, and M. Nunez
An academic medical centre's programme to develop clinical pathways to manage health care: focus on acute decompensated heart failure
Intl J Care Pathw,
September 1, 2008;
12(2):
45 - 55.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Maisel, W. F. Peacock, N. McMullin, R. Jessie, G. C. Fonarow, J. Wynne, and R. M. Mills
Timing of Immunoreactive B-Type Natriuretic Peptide Levels and Treatment Delay in Acute Decompensated Heart Failure: An ADHERE (Acute Decompensated Heart Failure National Registry) Analysis
J. Am. Coll. Cardiol.,
August 12, 2008;
52(7):
534 - 540.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Shah and M. Gheorghiade
Heart Failure With Preserved Ejection Fraction: Treat Now by Treating Comorbidities
JAMA,
July 23, 2008;
300(4):
431 - 433.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. W. Stevenson
Challenges for the Basis of Practice in Heart Failure
Circ Heart Fail,
May 1, 2008;
1(1):
81 - 83.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Lindqvist, G. Wikstrom, and A. Waldenstrom
The use of E/Em and the time interval difference of isovolumic relaxation (TIVRT-IVRTm) in estimating left ventricular filling pressures
Eur J Heart Fail,
May 1, 2008;
10(5):
490 - 497.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Dhar, D. Koul, and G. E. D'Alonzo Jr
Current Concepts in Diastolic Heart Failure
J Am Osteopath Assoc,
April 1, 2008;
108(4):
203 - 209.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Zannad, W. G. Stough, B. Pitt, J. G.F. Cleland, K. F. Adams, N. L. Geller, C. Torp-Pedersen, B.-A. Kirwan, and F. Follath
Heart failure as an endpoint in heart failure and non-heart failure cardiovascular clinical trials: the need for a consensus definition
Eur. Heart J.,
February 1, 2008;
29(3):
413 - 421.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J.V. McMurray, P. E. Carson, M. Komajda, R. McKelvie, M. R. Zile, A. Ptaszynska, C. Staiger, J. M. Donovan, and B. M. Massie
Heart failure with preserved ejection fraction: Clinical characteristics of 4133 patients enrolled in the I-PRESERVE trial
Eur J Heart Fail,
February 1, 2008;
10(2):
149 - 156.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Cotter, M. Metra, O. Milo-Cotter, H. C. Dittrich, and M. Gheorghiade
Fluid overload in acute heart failure -- Re-distribution and other mechanisms beyond fluid accumulation
Eur J Heart Fail,
February 1, 2008;
10(2):
165 - 169.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. Milo-Cotter, G. Cotter, B. D. Weatherley, K. F. Adams, E. Kaluski, N. Uriel, C. M. O'Connor, and G. M. Felker
Hyponatraemia in acute heart failure is a marker of increased mortality but not when associated with hyperglycaemia
Eur J Heart Fail,
February 1, 2008;
10(2):
196 - 200.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. M. Givertz, B. M. Massie, T. K. Fields, L. L. Pearson, H. C. Dittrich, and on behalf of the CKI-201 and CKI-202 Investigators
The Effects of KW-3902, an Adenosine A1-Receptor Antagonist,on Diuresis and Renal Function in Patients With Acute Decompensated Heart Failure and Renal Impairment or Diuretic Resistance
J. Am. Coll. Cardiol.,
October 16, 2007;
50(16):
1551 - 1560.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. J. Paulus, C. Tschope, J. E. Sanderson, C. Rusconi, F. A. Flachskampf, F. E. Rademakers, P. Marino, O. A. Smiseth, G. De Keulenaer, A. F. Leite-Moreira, et al.
How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology
Eur. Heart J.,
October 2, 2007;
28(20):
2539 - 2550.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. L. Martin, T. Supaporn, H. H. Chen, S. M. Sandberg, Y. Matsuda, M. Jougasaki, and J. C. Burnett Jr.
Distinct roles for renal particulate and soluble guanylyl cyclases in preserving renal function in experimental acute heart failure
Am J Physiol Regulatory Integrative Comp Physiol,
October 1, 2007;
293(4):
R1580 - R1585.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Adamopoulos, F. Zannad, R. Fay, A. Mebazaa, A. Cohen-Solal, L. Guize, Y. Juilliere, and F. Alla
Ejection fraction and blood pressure are important and interactive predictors of 4-week mortality in severe acute heart failure
Eur J Heart Fail,
September 1, 2007;
9(9):
935 - 941.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. C. Fonarow, W. G. Stough, W. T. Abraham, N. M. Albert, M. Gheorghiade, B. H. Greenberg, C. M. O'Connor, J. L. Sun, C. W. Yancy, J. B. Young, et al.
Characteristics, Treatments, and Outcomes of Patients With Preserved Systolic Function Hospitalized for Heart Failure: A Report From the OPTIMIZE-HF Registry
J. Am. Coll. Cardiol.,
August 21, 2007;
50(8):
768 - 777.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. C. Fonarow, W. F. Peacock, C. O. Phillips, M. M. Givertz, M. Lopatin, and for the ADHERE Scientific Advisory Committee and I
Admission B-Type Natriuretic Peptide Levels and In-Hospital Mortality in Acute Decompensated Heart Failure
J. Am. Coll. Cardiol.,
May 15, 2007;
49(19):
1943 - 1950.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gheorghiade and G. C. Fonarow
Systolic Blood Pressure and Outcomes in Patients Hospitalized With Acute Heart Failure--Reply
JAMA,
February 28, 2007;
297(8):
808 - 809.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. M. Kessler
Examining the Concept of Preserved Systolic Function
J. Am. Coll. Cardiol.,
December 19, 2006;
48(12):
2599 - 2600.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. E. Dostal and L. E. Watson
Understanding Diastolic Heart Failure With Preserved Ejection Fraction: Choosing the Right Model
Hypertension,
May 1, 2006;
47(5):
830 - 832.
[Full Text]
[PDF]
|
|
|
|
