In order to achieve the above, the committee has recognized the importance
- consulting non-cardiologists involved in the management of acute heart failure (internists, intensive-care specialists, emergency medicine physicians, anesthesiologists, general physicians…).
- building a relationship between different health-care professionals; involved in the management of acute heart failure (nurses, pharmacists, hospital administrators …).
Article of the Month
The Committee's article has been chosen by Dr Josep Masip, FESC, Associate Professor of Cardiology from the University of Barcelona
The Global Health and Economic Burden of Hospitalizations for Heart Failure: Lessons Learned From Hospitalized Heart Failure Registries
J Am Coll Cardiol. 2014;63(12):1123-1133
Andrew P. Ambrosy, Gregg C. Fonarow, Javed Butler, Ovidiu Chioncel, Stephen J. Greene, Muthiah Vaduganathan,
Savina Nodari, Carolyn S. P. Lam, Naoki Sato, Ami N. Shah, Mihai Gheorghiade
Dr Masip commented:
The paper analyzes data from 11 large international registries (ADHERE, ADHERE-AP, AHEAD, ALARM-HF, ATTEND, EFICA, EHFS II, ESC-HF, GWG-HF, IN-HF Outcome, OPTIMIZE-HF and RO-AHFS) of patients hospitalized for acute heart failure (AHF), including nearly 300.000 patients from Europe, Asia and America.
The mean age for AHF patients is 70-75 years, being somewhat lower in developing countries. An ischemic etiology is the most common cause of AHF, whereas uncontrolled hypertension, and/or valvular and congenital heart diseases are likely to be more common in the developing world. One-half of the patients will exhibit some degree of anemia and approximately 20% hyponatremia on admission, but the prevalence and the degree is higher and more severe in patients admitted to critical care units. One-third of the patients have chronic kidney disease and about 20% show severe renal impairment (GFR<30 ml/min/1.73 m2). Dyspnea at rest is reported in roughly one third of patients on admission; however, with provocation (i.e., exertion and orthopnea) this increases to close to 90%. The most widely accepted independent predictors of morbidity and mortality are age, cardiac and non-cardiac comorbidities, systolic blood pressure, renal function, serum sodium, hemoglobin, NP concentration, troponin, QRS duration, and evidence-based medication utilization.
Depending on how the EF is categorized, 50-60% of the population is classified as reduced ejection fraction (HFrEF). However, the true epidemiologic breakdown of AHF patients by EF is unknown. In contrast to HFrEF, HFpEF is poorly characterized as a clinical entity, and there are currently no available evidence-based therapies, although medical comorbidities should be treated accordingly. Data suggest that the proportion of AHF patients classified as HFpEF is growing and may exceed HFrEF in the future. Furthermore, approximately 70% and 40% of AHF patients, respectively, have a history of hypertension and atrial fibrillation, and the prevalence of these comorbidities is even higher in HFpEF.
The study analyzes the quality of data obtained from these registries, showing significant knowledge gaps. The main limitation is the relative paucity of data collected outside of North America and Western Europe, including only 15% of the world’s population, which prompts expansion to other regions. Patients are usually nonconsecutive and data should be standardized. Future studies ought to recruit longitudinal data including hospital course, the continuity of care and post-discharge outcomes, particularly at the early, most vulnerable phase. In addition to traditional endpoints (re-hospitalization and mortality), the burden of worsening AHF (i.e., quality of life impairment or functional limitations) would be captured. Future registries would allow a better understanding of this heterogeneous patient population, thus informing public policy decisions, and guiding basic, translational, and clinical research.
|Prof. A Mebazaa, FESC|
|C Mueller ||FESC (Basel, CH) ||G Ambrosio||FESC (Perugia, IT)||B Yilmaz||(Sivas, TR)|
|J Masip||FESC (Barcelona, ES)||J Spinar||FESC (Brno, CZ) ||H Skouri||(Beirut, LB)|
|A Arutyunov||(Moscow, RU)||V P Harjola||FESC (Helsinki, FI)||S Collins||SAEM|
(Des Plaines, US)
|M Banaszewski||FESC (Warsaw, PL)||A Ristic||(Belgrade, RS)|| || |
|S Anker||FESC (Berlin, DE) (ex-officio)|| || |
Mechanical Circulatory Support devices in heart failure - Programme- 27-28 April 2012 Wroclaw, Poland
International consensus on pre-hospital & initial management of acute heart failure - Common standpoints for emergency physicians and cardiologists - 15-16 March 2013 Munich, Germany
- Finalise the position paper on AHF "call for action" of the European Federation of Internal Medicine, the European Society of Emergency Medicine, the European Society of Intensive care Medicine, the primary care physicians WONCA and the Council of Cardiology Practice of the ESC.
- Publish the paper on "Recommendations for admission in CCU and ICU" involving same societies
- Conduct a survey on the impact of devices in the outcome in acute heart failure patients in conjunction with ESICM and European Society of Cardiac Surgeons
- Write a practical recommendation on "organ dysfunction" in acute heart failure in conjunction with ESICM