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.
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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 |
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