The management, early and one year outcome in hospitalized patients with heart failure: A national heart failure survey in Israel - HFSIS 2003

Background: Despite improved management of heart failure patients, their prognosis remains poor. Objectives: To characterize hospitalized HF patients and to identify factors that may affect their short and long-term outcome in a national prospective survey. Methods: We recorded stages B-D according to the American College of Cardiology/American Heart Association definition of HF patients hospitalized in internal medicine and cardiology departments in all 25 public hospitals in Israel. Results: During March-April 2003, 4102 consecutive patients were recorded. Their mean age was 73 ± 12 years and 57% were males; 75.3% were hypertensive, 50% diabetic and 59% dyslipidemic; 82% had coronary artery disease, 33% atrial fibrillation, 41% renal failure (creatinine ≥ 1.5 mg/dl), and 49% anemia (hemoglobin ≤ 12 g/dl). Mortality rates were 4.7% in-hospital, 7.6% at 30 days, 18.7% at 6 months and 28.1% at 12 months. Multiple logistic regression analysis revealed that increased 1 year mortality rate was associated with NYHA III-IV (odds ratio 2.07, 95% confidence interval 1.78-2.41), age (for 10 year increment) (OR 1.41, 95% Cl 1.31-1.52), renal failure (1.79, 1.53-2.09), anemia (1.50, 1.29-1.75), stroke (1.50, 1.21-1.85), chronic obstructive pulmonary disease (1.25, 1.04-1.50) and atrial fibrillation (1.20, 1.02-1.40). Conclusions: This nationwide heart failure survey indicates a high risk of long-term mortality and the urgent need to develop more effective management strategies for patients with heart failure discharged from hospitals.