Classifying patients with acute heart failure: Presentation treatment and outcome. A ten country survey of acute heart failure management (ALARM-HF)

Folláth, Ferenc; Delgado, Juan; Mebazaa, A.; Parissis, John; Vilas-Boas, Fábio; Smith, Helen; McLean, Adam

doi:10.1016/s1567-4215(08)60175-7

Cited by 4 publications

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“…The ALARM‐HF survey included a total of 4953 patients (France n = 588, Germany n = 617, Italy n = 679, Spain n = 700, UK n = 623, Greece n =255, Turkey n = 628, Mexico n = 601, and Australia n = 262), admitted to 666 hospitals of different sizes and types and managed by either cardiologists ( n = 655) or ICU physicians ( n = 287). The clinical characteristics of the whole cohort of AHF patients have already been presented 9. Thirty‐five per cent of the patients needed ICU/Coronary Care Unit (CCU) management.…”

Section: Resultsmentioning

confidence: 99%

“…The clinical characteristics of the whole cohort of AHF patients have already been presented. 9 Thirty-five per cent of the patients needed ICU/Coronary Care Unit (CCU) management. APE and ADHF were the most common presentations, affecting 37 and 39% of the total patient population, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Registries such as ADHERE and OPTIMIZE‐HF recruited few critically ill patients and therefore had low overall in‐hospital mortality rates (about 4%) 1,2. Thus, the percentages of APE and cardiogenic shock were lower in these registries compared with ALARM‐HF, which recruited more severe AHF patients with an overall in‐hospital death rate of 12% 9. The most recent EHFS II reported that 16% of the AHF patients present with APE, which is lower than in ALARM‐HF.…”

Section: Discussionmentioning

confidence: 99%

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Acute pulmonary oedema: clinical characteristics, prognostic factors, and in‐hospital management

Parissis

Nikolaou

Mebazaa

et al. 2010

European J of Heart Fail

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Aims Acute pulmonary oedema (APE) is the second, after acutely decompensated chronic heart failure (ADHF), most frequent form of acute heart failure (AHF). This subanalysis examines the clinical profile, prognostic factors, and management of APE patients (n = 1820, 36.7%) included in the Acute Heart Failure Global Survey of Standard Treatment (ALARM‐HF). Methods and results ALARM‐HF included a total of 4953 patients hospitalized for AHF in Europe, Latin America, and Australia. The final diagnosis was made at discharge, and patients were classified according to European Society of Cardiology guidelines. Patients with APE had higher in‐hospital mortality (7.4 vs. 6.0%, P = 0.057) compared with ADHF patients (n = 1911, 38.5%), and APE patients exhibited higher systolic blood pressures (P < 0.001) at admission and higher left ventricular ejection fraction (LVEF, P < 0.01) than those with ADHF. These patients also had a higher prevalence of diabetes (P < 0.01), arterial hypertension (P < 0.001), peripheral vascular disease (P < 0.001), and chronic renal disease (P < 0.05). They were also more likely to receive intravenous (i.v.) diuretics (P < 0.001), i.v. nitrates (P < 0.01), dopamine (P < 0.05), and non‐invasive ventilation (P < 0.001). Low systolic blood pressure (P < 0.001), low LVEF (<0.05), serum creatinine ≥1.4 mg/dL (P < 0.001), history of cardiomyopathy (P < 0.05), and previous cardiovascular event (P < 0.001) were independently associated with increased in‐hospital mortality in the APE population. Conclusion APE differs in clinical profile, in‐hospital management, and mortality compared with ADHF. Admission characteristics (systolic blood pressure and LVEF), renal function, and history may identify high‐risk APE patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Acute pulmonary oedema: clinical characteristics, prognostic factors, and in‐hospital management

Parissis

Nikolaou

Mebazaa

et al. 2010

European J of Heart Fail

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“…The structure of the AHEAD main registry is closest to the structure of EHFS II [1], FIN-AKVA [16] and ALARM-HF [11]; the systematic stratification of patients with AHF was based on the guidelines of ESC [3] and the whole spectrum of patients with AHF was covered. The average age of patients with AHF is in the range of 69 to 75 years; women hospitalized for AHF were significantly older than the men.…”

Section: Discussionmentioning

confidence: 99%

Baseline characteristics and hospital mortality in the Acute Heart Failure Database (AHEAD) Main registry

et al. 2011

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IntroductionThe prognosis of patients hospitalized with acute heart failure (AHF) is poor and risk stratification may help clinicians guide care. The objectives of the Acute Heart Failure Database (AHEAD) registry are to assess patient characteristics, etiology, treatment and outcome of AHF.MethodsThe AHEAD main registry includes patients hospitalized for AHF in seven centers with a Catheterization Laboratory Service in the Czech Republic. The data were collected from September 2006 to October 2009. The inclusion criteria for the database adhere to the European guidelines for AHF (2005) and patients were systematically classified according to the basic syndromes, type and etiology of AHF.ResultsOf 4,153 patients, 12.7% died during hospitalization. The median length of hospitalization was 7.1 days. Mean age of patients was 71.5 ± 12.4 years; men were younger (68.6 ± 12.4 years) compared to women (75.5 ± 11.5 years) (P < 0.001). De-novo heart failure was seen in 58.3% of the patients. According to the classification of heart failure syndromes, acute decompensated heart failure (ADHF) was reported in 55.3%, hypertensive AHF in 4.4%, pulmonary edema in 18.4%, cardiogenic shock in 14.7%, high output failure in 3.3%, and right heart failure in 3.8%. The mortality of cardiogenic shock was 62.7%, of right AHF 16.7%, of pulmonary edema 7.1%, of high output HF 6.1%, whereas the mortality of hypertensive AHF or ADHF was < 2.5%. According to multivariate analyses, low systolic blood pressure, low cholesterol level, hyponatremia, hyperkalemia, the use of inotropic agents and norepinephrine were predictive parameters for in-hospital mortality in patients without cardiogenic shock. Severe left ventricular dysfunction and renal insufficiency were predictive parameters for mortality in patients with cardiogenic shock. Invasive ventilation and age over 70 years were the most important predictive factors for mortality in both genders with or without cardiogenic shock.ConclusionsThe AHEAD Main registry provides up-to-date information on the etiology, treatment and hospital outcomes of patients hospitalized with AHF. The results highlight the highest risk patients.

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“…Therefore, inotropes are indicated for the treatment of all cardiac patients with clinical conditions characterized by peripheral hypoperfusion and fluid retention resulting from impaired cardiac contractility. Although these agents benefit cardiac patients by improving CO, they have been also associated with arrhythmogenesis, increased myocardial oxygen demands, myocardial ischemia and damage (2).…”

mentioning

confidence: 99%

Review and update on inotropes and vasopressors: Evidence-based use in cardiovascular diseases

Kalçık¹,

Gürsoy²

2015

Curr Res Cardiol

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Patients in the intensive care unit frequently develop low-output syndromes due to cardiac dysfunction, myocardial injury and activation of inflammatory cascades. Pharmacological agents, including vasodilators, inotropes and vasopressors, are frequently used in the critical care setting for the management of unstable cardiac patients. These medications are used to elicit varying effects on vascular resistance, myocardial contractility and heart rate to achieve desired hemodynamic and clinical end points. Conventional inotropic agents appear to be useful in restoring hemodynamic parameters and improving peripheral organ perfusion, but they can increase short-term and long-term mortality in these patients. Novel inotropes may be promising in the management of cardiogenic shock patients without serious adverse effects. The present review summarizes the current knowledge about the pathophysiology and evidence-based use of conventional and novel inotropic agents in various clinical scenarios associated with cardiovascular diseases.

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Classifying patients with acute heart failure: Presentation treatment and outcome. A ten country survey of acute heart failure management (ALARM-HF)

Cited by 4 publications

References 0 publications

Acute pulmonary oedema: clinical characteristics, prognostic factors, and in‐hospital management

Acute pulmonary oedema: clinical characteristics, prognostic factors, and in‐hospital management

Baseline characteristics and hospital mortality in the Acute Heart Failure Database (AHEAD) Main registry

Review and update on inotropes and vasopressors: Evidence-based use in cardiovascular diseases

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