The second Euro Heart Survey on Heart Failure was undertaken during 2004-2005. Patients hospitalized for AHF were recruited by 133 centres in 30 European countries.
Mean age was 70 years, and 61% of patients were male. New-onset AHF (de novo AHF) was diagnosed in 37%, of which 42% was due to acute coronary syndromes (ACS). Clinical classification according to the guidelines divided AHF patients into (i) decompensated HF (65%), (ii) pulmonary oedema (16%), (iii) HF andhypertension (11%), (iv) cardiogenic shock (4%), and (v) right HF (3%).
Coronary heart disease, hypertension,and atrial fibrillation were the most common underlying conditions. Valvular disorders were common, especially mitral regurgitation (MR) which was reported on echocardiography in 80% of patients. Median length of stay was 9 days, and in-hospital mortality 6.7%. At discharge, 80% of patients were on angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers, whereas 61% were taking beta-blocker medication.
Expert committee
Markku Nieminen, Chairperson
D. Brutsaert, K. Dickstein, H. Drexler, F. Follath, V. Harjola, M. Komajda, J-L. Lopez-Sendon, P. Ponikowski, L. Tavazzi
Protocol Summary
Acute heart failure can ultimately lead to death. Most often it becomes chronic and lifelong medication is necessary. This survey has been designed to assess characteristics of patients with Heart Failure, estimate burden on health care and management of patients across Europe in relation to guidelines published by the European Society of Cardiology and other organisations.
Objectives of the survey:
Primary objectives:
- Etiology of heart failure in Europe. Patient characteristics will be described for different groups of underlying heart disease.
- Patient characteristics: the severity of the clinical condition will be classified according to the new guidelines.
- Diagnostic processes will be assessed.
- Therapy - oxygenation and respiratory care and all medications will be registered.
- The need and utilization of devices will be recorded.
- The incidence of different arrhythmias as a cause or as a concomitant problem is analyzed.
- Heart failure patients are treated in intensive care and on ward, sometimes in special clinics. The length of stay in different units will be recorded to estimate the cost of care for acute heart failure for the community.
- Rehospitalization and mortality - prognosis will be assessed at 3 months and at 1 year.
Subjects for subanalysis in acute heart failure:
- Biomarkers - the utilization of biomarkers (BNP, Nt-proBNP, hs-CRP) in acute heart failure can be evaluated.
- Acute coronary syndromes and heart failure – the survey will define the prevalence, treatment and prognosis of heart failure associated with ACS.
- Arrhythmias in heart failure - The survey aims to evaluate the prevalence and nature of arrhythmias inducing heart failure or induced by heart failure among the patient population enrolled.
- Heart failure in women and prognosis will be addressed. The etiologic and treatment specific questions can be assessed.
- Pacemakers and devices - an increasing number of HF patients have pacemakers, ICDs, and seldom LVADs. The prevalence of these can be estimated and the benefit of biventricular pacing and ICDs can be evaluated.
- ECG changes will be evaluated for risk stratification in HF patients.
- Cost of care – data will be collected to estimate the real cost of care, efficacy of treatment and treatment organization.
Conclusion
- Decompensated HF is the most common clinical presentation of AHF patients.
- More than one-third of AHF patients do not have a previous history of HF, and new-onset HF is often caused by ACS.
- Preserved systolic function is found in a substantial proportion of the patients.
- The prevalence of valvular dysfunction is strikingly high and contributes to the clinical presentation.
- The EHFS II on AHF verified that the use of evidence-based HF medication was well adopted to clinical practice.
References
The 
Main Manuscript reporting the results of this survey was published in Euro Heart Journal.
Review all Euro Heart Survey publications on Heart Failure.
The content of this article reflects the personal opinion of the
author/s and is not necessarily the official position of the
European Society of Cardiology.