Temporal trends in clinical characteristics, treatments, and outcomes for heart failure hospitalizations, 2002 to 2004: findings from Acute Decompensated Heart Failure National Registry (ADHERE)

• Published in: The American heart journal Vol. 153; no. 6; pp. 1021 - 1028
• Main Authors: Fonarow, Gregg C., MD, Heywood, J. Thomas, MD, Heidenreich, Paul A., MD, MS, Lopatin, Margarita, MS, Yancy, Clyde W., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-06-2007; Elsevier; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Blood pressure; Cardiology. Vascular system; Cardiovascular; Clinical outcomes; Comorbidity; Demography; Dopamine; Family medical history; Female; Heart; Heart failure; Heart Failure - classification; Heart Failure - mortality; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospital Mortality - trends; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Hypertension - epidemiology; Length of Stay - statistics & numerical data; Logistic Models; Male; Medical sciences; Morbidity; Mortality; Patients; Pulmonary Disease, Chronic Obstructive - epidemiology; Quality Indicators, Health Care - classification; Quality Indicators, Health Care - statistics & numerical data; Registries; Survival Rate; Treatment Outcome; Trends; United States - epidemiology; Variables; Ventilation; United States; United States > US; Heart failure; Prognosis; Trend; Cardiovascular disease; Hospitalization; Phlebology; Symptomatology; Treatment; 2004; Heart disease; Specific registry; 2002; Evolution; Circulatory system; Cardiology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2007.03.012

Background The purpose of this study was to assess temporal trends in clinical characteristics, treatments, quality indicators, and outcomes for heart failure (HF) hospitalizations. Methods Characteristics, treatments, quality measures, and inhospital outcomes were measured over 12 consecutive quarters (January 2002 to December 2004) using data from 159 168 enrollments from 285 ADHERE hospitals. Results Baseline characteristics were similar or showed only modest changes, and severity of illness by logistic regression was unchanged over all 12 quarters. Inhospital treatment changed significantly over time with inotrope use decreasing from 14.7% to 7.9% ( P < .0001). Discharge instructions increased 133%; smoking counseling, 132%; left ventricular function measurement, 8%; and β-blocker use, 29% (all P < .0001). Clinical outcomes improved over time, including need for mechanical ventilation, which decreased 5.3% to 3.4% (relative risk 0.64, P < .0001); length of stay (mean), 6.3 to 5.5 days; and mortality, 4.5% to 3.2% (relative risk 0.71, P < .0001). Conclusions Over a 3-year period, demographics and clinical characteristics were relatively similar, but significant changes in intravenous therapy, enhancements in conformity to quality-of-care measures, increased administration of evidence-based HF medications, and substantial improvements in inhospital morbidity and mortality were observed during hospitalization for HF.