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European Heart Journal Advance Access originally published online on April 7, 2006
European Heart Journal 2006 27(10):1207-1215; doi:10.1093/eurheartj/ehi845
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Nationwide survey on acute heart failure in cardiology ward services in Italy

Luigi Tavazzi1,*, Aldo P. Maggioni2, Donata Lucci2, Giuseppe Cacciatore3, Gerardo Ansalone4, Fabrizio Oliva5, Maurizio Porcu6 on behalf of the Italian survey on Acute Heart Failure Investigators

1 Department of Cardiology, IRCCS Policlinico S. Matteo, Piazzale Golgi, 2-27100 Pavia, Italy
2 ANMCO Research Center, Florence, Italy
3 Department of Cardiology, Ospedale S. Giovanni Addolorata, Rome, Italy
4 Department of Cardiology, Ospedale Madre Giuseppina Vannini, Rome, Italy
5 Department of Cardiology, Ospedale Niguarda, Milan, Italy
6 Department of Cardiology, Ospedale S. Michele Brotzu, Cagliari, Italy

Received 28 March 2005; revised 23 February 2006; accepted 9 March 2006; online publish-ahead-of-print 7 April 2006.

* Corresponding author. Tel: +39 0 55 5001703; fax: +39 0 55 583400.E-mail address: centro_studi{at}anmco.it

Aims Chronic heart failure (HF) is recognized as an important public health problem but little attention has been focused on acute-stage HF.

Methods and results Nationwide, prospective, observational study setting 206 cardiology centres with intensive cardiac care units. During 3 months, 2807 patients diagnosed as having de novo acute HF (44%) or worsening chronic HF (56%) were enrolled. Acute pulmonary oedema was the presenting clinical feature in 49.6% of patients, cardiogenic shock in 7.7%, and worsened NYHA functional class in 42.7% of cases. Anaemia (Hb<12 g/dL) was present in 46% of patients, renal dysfunction (creatinine ≥1.5 mg%) in 47%, and hyponatraemia (≤136 mEq/L) in 45%. An ejection fraction (EF)>40% was found in 34% of cases. Intravenous diuretics, nitrates, and inotropes were given to 95, 51, and 25% of patients, respectively. The median duration of hospital stay was 9 days. In-hospital mortality rate was 7.3%. Older age, use of inotropic drugs, elevated troponin, hyponatraemia, anaemia, and elevated blood urea nitrogen were independent predictors of all-cause death; prior revascularization procedures and elevated blood pressure were indicators of a better outcome. The rehospitalization rate within 6 months was 38.1%, all-cause mortality from discharge to 6 months was 12.8%.

Conclusion Acute HF is an ominous condition, needing more research activity and resources.

Key Words: Heart failure • Acute heart failure • Survey • Observational research • Inotropes • Nitrates


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