Background: The ADHERE is designed to study characteristics, management, and outcomes in a broad sample of patients hospitalized with acute decompensated heart failure. Heart failure is a leading cause of hospitalizat...Background: The ADHERE is designed to study characteristics, management, and outcomes in a broad sample of patients hospitalized with acute decompensated heart failure. Heart failure is a leading cause of hospitalization for adults older than 65 years in the United States. Most available data on these patients are limited by patient selection criteria and study design of clinical trials and single- center studies. Methods: Participating hospitals identify patients with a primary or secondary discharge diagnosis of heart failure. Medical history, management, treatments, and health outcomes data are collected through review of medical records and entered into a database via secure web browser technology. Results: As of January 2004, data on 107 362 patients have been received from 282 participating hospitals. Of enrollees with available analyzable data(N=105 388 from 274 hospitals), the mean age was 72.4(± 14.0), and 52% were women. The most common comorbid conditions were hypertension(73% ), coronary artery disease(57% ), and diabetes(44% ). Evidence of mild or no impairment of systolic function was found in 46% of patients. Inhospital mortality was 4.0% and the median hospital length of stay was 4.3 days. Conclusions: The ADHERE demonstrates both the feasibility and significant implications of gathering representative data on large numbers of patients hospitalized with heart failure. Initial data provided important insights into the clinical characteristics and patterns of care of these patients. Ongoing registry work will provide the framework for improved treatment strategies for patients hospitalized with decompensated heart failure.展开更多
Context: Estimation of mortality risk in patients hospitalized with acute decompensated heart failure(ADHF) may help clinicians guide care. Objective: To develop a practical user-friendly bedside tool for risk stratif...Context: Estimation of mortality risk in patients hospitalized with acute decompensated heart failure(ADHF) may help clinicians guide care. Objective: To develop a practical user-friendly bedside tool for risk stratification for patients hospitalized with ADHF. Design, Setting, and Patients: The Acute Decompensated Heart Failure National Registry(ADHERE) of patients hospitalized with a primary diagnosis of ADHF in 263 hospitals in the United States was queried with analysis of patient data to develop a risk stratification model. The first 33 046 hospitalizations(derivation cohort; October 2001-February 2003) were analyzed to develop the model and then the validity of the model was prospectively tested using data from 32 229 subsequent hospitalizations(validation cohort; March-July 2003). Patients had a mean age of 72.5 years and 52%were female. Main Outcome Measure: Variables predicting mortality in ADHF. Results: When the derivation and validation cohorts are combined, 37 772(58%) of 65 275 patient-records had coronary artery disease. Of a combined cohort consisting of 52 164 patient-records, 23 910(46%) had preserved left ventricular systolic function. In-hospital mortality was similar in the derivation(4.2%) and validation(4.0%) cohorts. Recursive partitioning of the derivation cohort for 39 variables indicated that the best single predictor for mortality was high admission levels of blood urea nitrogen(≥43 mg/dL [15.35 mmol/L]) followed by low admission systolic blood pressure(< 115 mm Hg) and then by high levels of serum creatinine(≥2.75 mg/dL [243.1 μmol/L]). A simple risk tree identified patient groups with mortality ranging from 2.1%to 21.9%. The odds ratio for mortality between patients identified as high and low risk was 12.9(95%con-fidence interval, 10.4-15.9) and similar results were seen when this risk stratification was applied prospectively to the validation cohort. Conclusions: These results suggest that ADHF patients at low, intermediate, and high risk for in-hospital mortality can be easily identified using vital sign and laboratory data obtained on hospital admission. The ADHERE risk tree provides clinicians with a validated, practical bedside tool for mortality risk stratification.展开更多
文摘Background: The ADHERE is designed to study characteristics, management, and outcomes in a broad sample of patients hospitalized with acute decompensated heart failure. Heart failure is a leading cause of hospitalization for adults older than 65 years in the United States. Most available data on these patients are limited by patient selection criteria and study design of clinical trials and single- center studies. Methods: Participating hospitals identify patients with a primary or secondary discharge diagnosis of heart failure. Medical history, management, treatments, and health outcomes data are collected through review of medical records and entered into a database via secure web browser technology. Results: As of January 2004, data on 107 362 patients have been received from 282 participating hospitals. Of enrollees with available analyzable data(N=105 388 from 274 hospitals), the mean age was 72.4(± 14.0), and 52% were women. The most common comorbid conditions were hypertension(73% ), coronary artery disease(57% ), and diabetes(44% ). Evidence of mild or no impairment of systolic function was found in 46% of patients. Inhospital mortality was 4.0% and the median hospital length of stay was 4.3 days. Conclusions: The ADHERE demonstrates both the feasibility and significant implications of gathering representative data on large numbers of patients hospitalized with heart failure. Initial data provided important insights into the clinical characteristics and patterns of care of these patients. Ongoing registry work will provide the framework for improved treatment strategies for patients hospitalized with decompensated heart failure.
文摘Context: Estimation of mortality risk in patients hospitalized with acute decompensated heart failure(ADHF) may help clinicians guide care. Objective: To develop a practical user-friendly bedside tool for risk stratification for patients hospitalized with ADHF. Design, Setting, and Patients: The Acute Decompensated Heart Failure National Registry(ADHERE) of patients hospitalized with a primary diagnosis of ADHF in 263 hospitals in the United States was queried with analysis of patient data to develop a risk stratification model. The first 33 046 hospitalizations(derivation cohort; October 2001-February 2003) were analyzed to develop the model and then the validity of the model was prospectively tested using data from 32 229 subsequent hospitalizations(validation cohort; March-July 2003). Patients had a mean age of 72.5 years and 52%were female. Main Outcome Measure: Variables predicting mortality in ADHF. Results: When the derivation and validation cohorts are combined, 37 772(58%) of 65 275 patient-records had coronary artery disease. Of a combined cohort consisting of 52 164 patient-records, 23 910(46%) had preserved left ventricular systolic function. In-hospital mortality was similar in the derivation(4.2%) and validation(4.0%) cohorts. Recursive partitioning of the derivation cohort for 39 variables indicated that the best single predictor for mortality was high admission levels of blood urea nitrogen(≥43 mg/dL [15.35 mmol/L]) followed by low admission systolic blood pressure(< 115 mm Hg) and then by high levels of serum creatinine(≥2.75 mg/dL [243.1 μmol/L]). A simple risk tree identified patient groups with mortality ranging from 2.1%to 21.9%. The odds ratio for mortality between patients identified as high and low risk was 12.9(95%con-fidence interval, 10.4-15.9) and similar results were seen when this risk stratification was applied prospectively to the validation cohort. Conclusions: These results suggest that ADHF patients at low, intermediate, and high risk for in-hospital mortality can be easily identified using vital sign and laboratory data obtained on hospital admission. The ADHERE risk tree provides clinicians with a validated, practical bedside tool for mortality risk stratification.
