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Global Differences in Characteristics, Precipitants, and Initial Management of Patients Presenting With Acute Heart Failure

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dc.contributor.author Filippatos, Gerasimos
dc.contributor.author Angermann, Christiane
dc.contributor.author Cleland, John
dc.contributor.author Lam, Carolyn
dc.contributor.author Dahlström, Ulf
dc.contributor.author Dickstein, Kenneth
dc.contributor.author Ertl, Georg
dc.contributor.author Hassanein, Mahmoud
dc.contributor.author Hart, Kimberly
dc.contributor.author Lindsell, Christopher
dc.contributor.author Perrone, Sergio
dc.contributor.author Guerin, Tadhg
dc.contributor.author Ghadanfar, Mathieu
dc.contributor.author Schweizer, Anja
dc.contributor.author Obergfell, Achim
dc.contributor.author Collins, Sean
dc.date.accessioned 2021-03-01T03:34:12Z
dc.date.available 2021-03-01T03:34:12Z
dc.date.issued 2020-04-01
dc.identifier.other 10.1001/jamacardio.2019.5108
dc.identifier.uri https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990673/
dc.identifier.uri http://repositorio.hospitalelcruce.org/xmlui/handle/123456789/1085
dc.description Fil: Perrone SV. Hospital El Cruce, Florencio Varela, Lezica Cardiovascular Institute, Sanctuary of the Trinidad Miter; Buenos Aires, Argentina. es_AR
dc.description Fil: Filippatos, G. University of Cyprus School of Medicine. Cyprus; Greece. en
dc.description Fil: Angermann CE. Comprehensive Heart Failure Center, University Hospital, Department of Medicine I-Cardiology, University of Würzburg, Würzburg; Germany. en
dc.description Fil: Cleland JGF. Robertson Centre for Biostatistics and Clinical Trials, Institute of Health & Well-Being, University of Glasgow, Glasgow; United Kingdom. en
dc.description Fil: Lam CSP. National Heart Centre Singapore; Singapore. en
dc.description Fil: Dahlström U. Department of Cardiology, Department of Medical and Health Sciences, Linkoping University, Linkoping; Sweden. en
dc.description Fil: Ertl G. Comprehensive Heart Failure Center, University Hospital, Department of Medicine I-Cardiology, University of Würzburg, Würzburg; Germany. en
dc.description Fil: Hassanein M. Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria; Egypt. en
dc.description Fil: Hart KW. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; United States en
dc.description Fil: Lindsell CJ. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; United State en
dc.description Fil: Guerin T. Novartis Ireland Ltd, Dublin; Ireland. en
dc.description Fil: Ghadanfar M. Novartis Pharma AG, Basel; Switzerland. en
dc.description Fil: Schweizer A. Novartis Pharma AG, Basel; Switzerland en
dc.description Fil: Obergfell A. Novartis Pharma AG, Basel; Switzerland. en
dc.description Fil: Collins SP. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; United State en
dc.description.abstract IMPORTANCE: Acute heart failure (AHF) precipitates millions of hospital admissions worldwide, but previous registries have been country or region specific. OBJECTIVE: To conduct a prospective contemporaneous comparison of AHF presentations, etiologic factors and precipitants, treatments, and in-hospital outcomes among global regions through the International Registry to Assess Medical Practice with Longitudinal Observation for Treatment of Heart Failure (REPORT-HF). DESIGN, SETTING, AND PARTICIPANTS: A total of 18 553 adults were enrolled during a hospitalization for AHF. Patients were recruited from the acute setting in Western Europe (WE), Eastern Europe (EE), Eastern Mediterranean and Africa (EMA), Southeast Asia (SEA), Western Pacific (WP), North America (NA), and Central and South America (CSA). Patients with AHF were approached for consent and excluded only if there was recent participation in a clinical trial. Patients were enrolled from July 23, 2014, to March 24, 2017. Statistical analysis was conducted from April 18 to June 29, 2018; revised analyses occurred between August 6 and 29, 2019. MAIN OUTCOMES AND MEASURES: Heart failure etiologic factors and precipitants, treatments, and in-hospital outcomes among global regions. RESULTS: A total of 18 553 patients were enrolled at 358 sites in 44 countries. The median age was 67.0 years (interquartile range [IQR], 57-77), 11 372 were men (61.3%), 9656 were white (52.0%), 5738 were Asian (30.9%), and 867 were black (4.7%). A history of HF was present in more than 50% of the patients and 40% were known to have a prior left-ventricular ejection fraction lower than 40%. Ischemia was a common AHF precipitant in SEA (596 of 2329 [25.6%]), WP (572 of 3354 [17.1%]), and EMA (364 of 2241 [16.2%]), whereas nonadherence to diet and medications was most common in NA (306 of 1592 [19.2%]). Median time to the first intravenous therapy was 3.0 (IQR, 1.4-5.6) hours in NA; no other region had a median time above 1.2 hours (P < .001). This treatment delay remained after adjusting for severity of illness (P < .001). Intravenous loop diuretics were the most common medication administered in the first 6 hours of AHF management across all regions (65.4%-89.9%). Despite similar initial blood pressure across all regions, inotropic agents were used approximately 3 times more often in SEA, WP, and EE (11.3%-13.5%) compared with NA and WE (3.1%-4.3%) (P < .001). Older age (odds ratio [OR], 1.0; 95% CI, 1.00-1.02), HF etiology (ischemia: OR, 1.65; 95% CI, 1.11-2.44; valvular: OR, 2.10; 95% CI, 1.36-3.25), creatinine level greater than 2.75 mg/dL (OR, 1.85; 95% CI, 0.71-2.40), and chest radiograph signs of congestion (OR, 2.03; 95% CI, 1.39-2.97) were all associated with increased in-hospital mortality. Similarly, younger age (OR, -0.04; 95% CI, -0.05 to -0.02), HF etiology (ischemia: OR, 0.77; 95% CI, 0.26-1.29; valvular: OR, 2.01; 95% CI, 1.38-2.65), creatinine level greater than 2.75 mg/dL (OR, 1.16; 95% CI, 0.31-2.00), and chest radiograph signs of congestion (OR, 1.02; 95% CI, 0.57-1.47) were all associated with increased in-hospital LOS. CONCLUSIONS AND RELEVANCE: Data from REPORT-HF suggest that patients are similar across regions in many respects, but important differences in timing and type of treatment exist, identifying region-specific gaps in medical management that may be associated with patient outcomes. es_AR
dc.language.iso en es_AR
dc.relation.ispartofseries JAMA Cardiol;2020 Apr 1;5(4):401-410
dc.subject Insuficiencia Cardíaca es_AR
dc.subject Mortalidad hospitalaria es_AR
dc.subject Salud global es_AR
dc.title Global Differences in Characteristics, Precipitants, and Initial Management of Patients Presenting With Acute Heart Failure es_AR
dc.type Article es_AR


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