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Intensive Care Medicine

, Volume 37, Issue 4, pp 619–626 | Cite as

Clinical presentation, management and outcomes in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF)

  • F. Follath
  • M. B. Yilmaz
  • J. F. Delgado
  • J. T. Parissis
  • R. Porcher
  • E. Gayat
  • Nigel Burrows
  • A. Mclean
  • F. Vilas-Boas
  • A. Mebazaa
Original

Abstract

Purpose

We performed a survey on acute heart failure (AHF) in nine countries in four continents. We aimed to describe characteristics and management of AHF among various countries, to compare patients with de novo AHF versus patients with a pre-existing episode of AHF, and to describe subpopulations hospitalized in intensive care unit (ICU) versus cardiac care unit (CCU) versus ward.

Methods and results

Data from 4,953 patients with AHF were collected via questionnaire from 666 hospitals. Clinical presentation included decompensated congestive HF (38.6%), pulmonary oedema (36.7%) and cardiogenic shock (11.7%). Patients with de novo episode of AHF (36.2%) were younger, had less comorbidities and lower blood pressure despite greater left ventricular ejection fraction (LVEF) and were more often admitted to ICU.

Overall, intravenous (IV) diuretics were given in 89.7%, vasodilators in 41.1%, and inotropic agents (dobutamine, dopamine, adrenaline, noradrenaline and levosimendan) in 39% of cases. Overall hospital death rate was 12%, the majority due to cardiogenic shock (43%). More patients with de novo AHF (14.2%) than patients with a pre-existing episode of AHF (10.8%) (p = 0.0007) died. There was graded mortality in ICU, CCU and ward patients with mortality in ICU patients being the highest (17.8%) (p < 0.0001).

Conclusions

Our data demonstrated the existence of different subgroups based on de novo or pre-existing episode(s) of AHF and the site of hospitalization. Recognition of these subgroups might improve management and outcome by defining specific therapeutic requirements.

Keywords

Acute heart failure syndromes Classification Management Prognosis Therapy 

Notes

Acknowledgments

All coauthors would like to thank Patrick Cepon, Helen Smith, Ches Manly and Melinda Swan for their support. MB Yilmaz received a grant from TUBITAK (Turkey).

Conflict of interest

Abbott funded the ALARM-HF survey; data were acquired by IMS. Analyses were performed by Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, APHP; Université Paris 7; INSERM - UMR-S 717, Paris France by RP and EG. AM, JP, FVB, JFD and FF received honorarium from Abbott for lectures and/or consulting.

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • F. Follath
    • 1
  • M. B. Yilmaz
    • 2
    • 3
  • J. F. Delgado
    • 4
  • J. T. Parissis
    • 5
  • R. Porcher
    • 6
  • E. Gayat
    • 6
  • Nigel Burrows
    • 7
  • A. Mclean
    • 8
  • F. Vilas-Boas
    • 9
  • A. Mebazaa
    • 10
    • 11
  1. 1.Department of Internal MedicineUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of CardiologyCumhuriyet University School of MedicineSivasTurkey
  3. 3.INSERM U942Hospital LariboisièreParisFrance
  4. 4.Heart Failure and Transplant Unit, Cardiology DepartmentHospital Doce de OctubreMadridSpain
  5. 5.Heart Failure Clinic and Second Cardiology DepartmentAttikon University HospitalAthensGreece
  6. 6.Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, APHPUniversité Paris 7ParisFrance
  7. 7.IMS Health S.p.AMilanItaly
  8. 8.Department of Intensive Care Medicine, Nepean HospitalUniversity of SydneyPenrithAustralia
  9. 9.Cardiology Division and Heart Failure and Transplantation ProgramHospital EspanholSalvadorBrazil
  10. 10.Department of Anesthesiology and Critical Care MedicineHospital Lariboisière APHPParisFrance
  11. 11.Université Paris Diderot Paris 7ParisFrance

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