State-of-the-Art Paper
The Global Health and Economic Burden of Hospitalizations for Heart Failure: Lessons Learned From Hospitalized Heart Failure Registries

https://doi.org/10.1016/j.jacc.2013.11.053Get rights and content
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Heart failure is a global pandemic affecting an estimated 26 million people worldwide and resulting in more than 1 million hospitalizations annually in both the United States and Europe. Although the outcomes for ambulatory HF patients with a reduced ejection fraction (EF) have improved with the discovery of multiple evidence-based drug and device therapies, hospitalized heart failure (HHF) patients continue to experience unacceptably high post-discharge mortality and readmission rates that have not changed in the last 2 decades. In addition, the proportion of HHF patients classified as having a preserved EF continues to grow and may overtake HF with a reduced EF in the near future. However, the prognosis for HF with a preserved EF is similar and there are currently no available disease-modifying therapies. HHF registries have significantly improved our understanding of this clinical entity and remain an important source of data shaping both public policy and research efforts. The authors review global HHF registries to describe the patient characteristics, management, outcomes and their predictors, quality improvement initiatives, regional differences, and limitations of the available data. Moreover, based on the lessons learned, they also propose a roadmap for the design and conduct of future HHF registries.

Key Words

acute
heart failure
hospitalization
inpatient
registry

Abbreviations and Acronyms

CCU
coronary care unit
ECG
electrocardiogram
EF
ejection fraction
HF
heart failure
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
HHF
hospitalized heart failure
ICU
intensive care unit
LOS
length of stay
NP
natriuretic peptide

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Dr. Fonarow has received research support from the National Heart, Lung, and Blood Institute (significant), Agency for Healthcare Research and Quality (significant), and Gambro (significant); and is a consultant for Novartis (significant), Medtronic (modest), and Johnson & Johnson (modest). Dr. Butler has received research support from the National Institutes of Health, Health Resources and Services Administration, European Commission, Amgen, Medtronic, Novartis, and Otsuka; and is a consultant for Alere, Bayer, BG Medicine, Celladon, CardioMEMS, Gambro, Medpace, Ono, Reate, Takeda, and Trevena. Dr. Lam has received research support from Boston Scientific, Medtronic, Vifor Pharma, and the National Medical Research Council of Singapore; and is a consultant for Bayer and Novartis. Dr. Sato has received research support from Roche Diagnostics Japan and Otsuka; and is a consultant for Novartis. Dr. Gheorghiade is a consultant for Abbott Laboratories, Astellas, AstraZeneca, Bayer Schering Pharma, Bayer HealthCare, Cardiorentis, CorThera, Cytokinetics, CytoPherx, DebioPharm, Errekappa Terapeutici, GlaxoSmithKline, Ikaria, Intersection Medical, Johnson & Johnson, Medtronic, Merck, Novartis Pharma, Ono Pharma USA, Otsuka Pharmaceuticals, Palatin Technologies, Pericor Therapeutics, Protein Design Laboratories, sanofi-aventis, Sigma Tau, Solvay Pharmaceuticals, Sticares InterACT, Takeda Pharmaceuticals, and Trevena Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.