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Acute decompensated heart failure patients admitted to critical care units: insights from ASCEND-HF.

Abstract：

BACKGROUND:Little is known about global patterns of critical care unit (CCU) care and the relationship with outcomes in patients with acute decompensated heart failure (ADHF). Whether a ward or a CCU admission is associated with better outcomes is unclear. METHODS:Patients in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial were initially hospitalized in a ward or CCU (coronary or intensive care unit). Sites were geographically classified: Asia-Pacific (AP), Central Europe (CE), Latin America (LA), North America (NA), and Western-Europe (WE). The primary outcome of 30-day all-cause mortality or all-cause hospital readmission was adjusted using a two-stage multivariable logistic regression model with a generalized estimated equation that took sites within each country as a nested random factor. RESULTS:Overall, 1944 (38.2%) patients were admitted to a CCU and 3150 (61.8%) to a ward, and this varied by region: 50.6% AP, 63.3% CE, 60.7% WE, 22.1% LA, and 28.6% NA. The 30-day death or readmission rate was 15.2% in ward patients and 17.0% in CCU patients (risk-adjusted Odds Ratio [OR] 1.44: 95% CI, 1.14-1.82). Compared with CCU patients in NA (24.1% 30-day event rate), the primary outcomes were: AP (10.4%, Odds Ratio [OR] 0.63; 95% confidence Interval [CI], 0.35 to 1.15), CE (10.4%, OR 0.56: 95% CI, 0.31 to 1.02), LA (22.4%, OR 0.60: 95% CI, 0.11 to 3.32), and WE (11.2%, OR 0.63, 95% CI, 0.25 to 1.56). No regional differences in 30-day mortality were observed; however, 30-day readmission rates were highest in NA sites. CONCLUSIONS:Management of patients with ADHF varies significantly, and after adjustment, CCU care was associated with higher risk of early mortality, not explained by international differences. These findings may help to improve the early decisions regarding risk stratification of patients hospitalized with ADHF.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

van Diepen S,Podder M,Hernandez AF,Westerhout CM,Armstong PW,McMurray JJ,Eapen ZJ,Califf RM,Starling RC,O'Connor CM,Ezekowitz JA

doi

10.1016/j.ijcard.2014.11.007

subject

Has Abstract

pub_date

2014-12-20 00:00:00

pages

840-6

issue

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(14)02149-4

journal_volume

177

pub_type

杂志文章,多中心研究,随机对照试验

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Acute decompensated heart failure patients admitted to critical care units: insights from ASCEND-HF.