9-Year Trend in the Management of Acute Heart Failure in Japan: A Report From the National Consortium of Acute Heart Failure Registries.

Background Acute heart failure ( AHF ) is a heterogeneous condition, and its characteristics and management patterns differ by region. Furthermore, limited evidence is available on AHF outside of Western countries. A project by the National Consortium of Acute Heart Failure Registries was designed to evaluate the trends over time in patient backgrounds, in-hospital management patterns, and long-term outcomes of patients with AHF over 9 years in Japan.

Trends and predictors of non-cardiovascular death in patients hospitalized for acute heart failure.

Background: Little information is available on non-cardiovascular (CV) death in acute heart failure (AHF) patients. The present study determined the incidence, time course, and factors associated with long-term non-CV death in AHF patients in a real-world setting.

Methods: The ATTEND registry, a nationwide, prospective observational multicenter cohort study, included 4842 consecutive patients hospitalized for AHF.

C-reactive protein level on admission and time to and cause of death in patients hospitalized for acute heart failure.

Aims: We analysed the association between C-reactive protein (CRP) levels measured on admission and timing and cause of death among patients hospitalized for acute heart failure (AHF).

Methods And Results: The ATTEND study prospectively registered 4777 hospitalized AHF patients with data on CRP levels on admission. Mortality risks were assessed by univariable and multivariable Cox proportional and non-proportional hazards models.

Serum sodium concentration, blood urea nitrogen, and outcomes in patients hospitalized for acute decompensated heart failure.

Background: This study investigated the association of a low serum sodium and elevated blood urea nitrogen (BUN) with outcomes in acute decompensated heart failure (HF) patients.

Methods: Of the 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 4438 patients discharged after hospitalization for acute decompensated HF were investigated to assess the association of a low serum sodium and/or elevated BUN at discharge with all-cause mortality. The patients were divided into four groups based on serum sodium (>136 or ≤136mEq/l) and BUN (<25 or ≥25mg/dl) at discharge.

Relationship of renal insufficiency and clinical features or comorbidities with clinical outcome in patients hospitalised for acute heart failure syndromes.

Background: Renal insufficiency is a well-known predictor of adverse events in patients with acute heart failure syndromes (AHFS). However, it remains unclear whether there are subgroups of AHFS patients in whom renal insufficiency is related to a higher risk of adverse events because of the heterogeneity of this patient population. Therefore, we investigated the relationship between renal insufficiency, clinical features or comorbidities, and the risk of adverse events in patients with AHFS.

Functional mitral regurgitation at discharge and outcomes in patients hospitalized for acute decompensated heart failure with a preserved or reduced ejection fraction.

Aims: The relationship between functional mitral regurgitation (FMR), left ventricular ejection fraction (EF), and outcomes is unclear in acute decompensated heart failure (HF) patients. The aim of this study was to evaluate the relationship between FMR and post-discharge outcomes in HF patients with a preserved or reduced EF.

Methods And Results: Of the 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 3357 patients were evaluated to assess the association among FMR (none, mild, or moderate/severe) at discharge, a preserved or reduced EF, and the primary endpoint (all-cause mortality and readmission for HF).

Heterogeneity of the prognostic significance of B-type natriuretic peptide levels on admission in patients hospitalized for acute heart failure syndromes.

Background: We hypothesized that variation in baseline characteristics of patients with acute heart failure syndromes (AHFS) affects the prognostic significance of B-type natriuretic peptide (BNP) levels because of heterogeneity of this patient population. We evaluated the association of elevated BNP levels on admission with an increased risk of adverse clinical outcomes in subgroups of patients hospitalized for AHFS.

Methods: This study included patients from the acute decompensated heart failure syndromes (ATTEND) study, a multicenter prospective cohort of 4501 AHFS patients with BNP data on admission.

eGFR and Outcomes in Patients with Acute Decompensated Heart Failure with or without Elevated BUN.

Background And Objectives: In patients with heart failure, the association of renal dysfunction and BUN levels with outcomes is unclear. The aim of our study was to investigate the association between the eGFR at discharge and outcomes in patients with heart failure with or without an elevated BUN level at discharge.

Design, Setting, Participants, & Measurements: Of 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes Registry, 4449 patients discharged alive after hospitalization for acute decompensated heart failure were investigated to assess the association of eGFR in the context of serum BUN level at discharge with all-cause mortality.

Incidence and predictors of in-hospital non-cardiac death in patients with acute heart failure.

Background: Patients with acute heart failure (AHF) commonly have multiple co-morbidities, and some of these patients die in the hospital from causes other than aggravated heart failure. However, limited information is available on the mode of death in patients with AHF. Therefore, the present study was performed to determine the incidence and predictors of in-hospital non-cardiac death in patients with AHF, using the Acute Decompensated Heart Failure Syndromes (ATTEND) registry Methods: The ATTEND registry included 4842 consecutive patients with AHF admitted between April 2007-September 2011.

Association of anemia and renal dysfunction with in-hospital mortality among patients hospitalized for acute heart failure syndromes with preserved or reduced ejection fraction.

Background: The aim of this study was to evaluate the association of anemia and renal dysfunction with in-hospital outcomes in acute heart failure syndromes patients with preserved or reduced ejection fraction.

Methods And Results: Of the 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 4693 patients were evaluated to investigate the association among anemia, renal dysfunction, a preserved or reduced ejection fraction and in-hospital mortality. They were divided into four groups based on hemoglobin and estimated glomerular filtration rate at admission.

Association of age and baseline systolic blood pressure with outcomes in patients hospitalized for acute heart failure syndromes.

Background: Baseline systolic blood pressure (SBP) is one of the most important prognostic indicators for patients with acute heart failure syndromes (AHFS). However, the association among age, baseline SBP, and outcomes of AHFS is unclear. This study was performed to evaluate the relation between baseline SBP and outcomes to increasing age in patients hospitalized for AHFS.

Relation of left ventricular ejection fraction and clinical features or co-morbidities to outcomes among patients hospitalized for acute heart failure syndromes.

The aim of this study was to evaluate the heterogeneity of the association of a preserved or reduced ejection fraction (EF) with the increased risk of outcomes among patients with acute heart failure syndromes. Of the 4,842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry in Japan, 4,720 patients were evaluated to investigate the association of EF and clinical features or co-morbidities with all-cause mortality after admission. The median follow-up period after admission was 519 (388 to 781) days.

Association between anemia, clinical features and outcome in patients hospitalized for acute heart failure syndromes.

Background: It remains unclear in which patients hospitalized for acute heart failure syndromes (AHFS) the presence of anemia increases the risk of morbidity or mortality because of the heterogeneity of this patient population. The aim of this study was to evaluate the influence of anemia on the clinical outcome in subgroups of patients hospitalized for AHFS.

Methods And Results: The study included patients from the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, a nationwide hospital-based prospective observational multicenter cohort of 4842 patients with AHFS admitted to 53 hospitals in Japan.

Prognostic impact of renal dysfunction does not differ according to the clinical profiles of patients: insight from the acute decompensated heart failure syndromes (ATTEND) registry.

Background: Renal dysfunction associated with acute decompensated heart failure (ADHF) is associated with impaired outcomes. Its mechanism is attributed to renal arterial hypoperfusion or venous congestion, but its prognostic impact based on each of these clinical profiles requires elucidation.

Methods And Results: ADHF syndromes registry subjects were evaluated (N = 4,321).

Associations of anemia and renal dysfunction with outcomes among patients hospitalized for acute decompensated heart failure with preserved or reduced ejection fraction.

Background And Objectives: The relationship among anemia, renal dysfunction, left ventricular ejection fraction, and outcomes of patients hospitalized for acute decompensated heart failure is unclear. The aim of this study was to evaluate the association between cardiorenal anemia syndrome and postdischarge outcomes in patients hospitalized for heart failure with a preserved or reduced ejection fraction.

Design, Setting, Participants, & Measurements: Of 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes Registry between April 1, 2007 and December 31, 2011, 4393 patients were evaluated to investigate the association among anemia, renal dysfunction, preserved or reduced ejection fraction, and the primary end point (mortality and readmission for heart failure since discharge).

Impact of pulmonary artery catheter on outcome in patients with acute heart failure syndromes with hypotension or receiving inotropes: from the ATTEND Registry.

Background: Randomized controlled trials concerning pulmonary artery catheters (PACs) use have yielded little evidence of their beneficial effects on survival. This study aimed to evaluate the association between PACs and in-hospital mortality in patients with acute heart failure syndromes (AHFS).

Methods: The Acute Decompensated Heart Failure Syndromes (ATTEND) Registry is a prospective, observational, multicenter cohort study performed in Japan, since April 2007.

Relationship between systolic blood pressure and preserved or reduced ejection fraction at admission in patients hospitalized for acute heart failure syndromes.

Background: Among patients with acute heart failure syndromes (AHFS), it has been reported that those with a reduced left ventricular ejection fraction (LVEF) tend to be hypotensive or normotensive, whereas those with a preserved LVEF tend to be hypertensive. However, it is unclear whether the systolic blood pressure (SBP) is actually associated with the LVEF in AHFS patients. Therefore, we evaluated the relationship between the SBP at admission and LVEF in patients hospitalized for AHFS.

Clinical features and outcome in hospitalized heart failure in Japan (from the ATTEND Registry).

Background: Hospitalized heart failure (HHF) is a critical issue in Japan. To improve its management and outcomes, the clinical features, in-hospital management, and outcomes should be analyzed to improve the guidelines for HHF.

Methods And Results: The acute decompensated heart failure syndromes (ATTEND) registry is the largest study of HHF in Japan.