Journal Articles

Acute Decompensated Heart Failure Patients Admitted to Critical Care Units: Insights from ASCEND-HF

November 04, 2014

Acute Decompensated Heart Failure Patients Admitted to Critical Care Units: Insights from ASCEND-HFInternational Journal of Cardiology, Nov 3, 2014, Sean van Diepen, Divisions of Critical Care and Cardiology, University of Alberta, Edmonton, Alberta, Canada, Mohua Podder,  Vigour Center, Edmonton, Alberta, Canada, Adrian F. Hernandez, Clinical Research Institute, Duke University Medical Center, Durham, NC, USA, Cynthia M. Westerhout,  Vigour Center Alberta, Canada, Paul W. Armstong, Vigour Center, Edmonton, Alberta, Canada, John J.V. McMurray, Western Infirmary, University of Glasgow, Glasgow, Scotland, Zubin J. Eapen, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA, Robert M. Califf, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA, Randall C. Starling, Cleveland Clinic, OH, USA, Christopher M. O’Connor, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA, Justin A. Ezekowitz, Canadian Vigour Center, Edmonton, Alberta, Canada, 1SVD and JAE take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Acute Decompensated Heart Failure Patients Admitted to Critical Care Units: Insights from ASCEND-HF – International Journal of Cardiology

Abstract

Background

Little is known about global patterns of critical care unit (CCU) care and the relationship with outcomes in patients with acute decompensated heart failure (ADHF). Whether a ward or a CCU admission is associated with better outcomes is unclear.

Methods

Patients in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial were initially hospitalized in a ward or CCU (coronary or intensive care unit). Sites were geographically classified: Asia-Pacific (AP), Central Europe (CE), Latin America (LA), North America (NA), and Western-Europe (WE). The primary outcome of 30-day all-cause mortality or all-cause hospital readmission was adjusted using a two-stage multivariable logistic regression model with a generalized estimated equation that took sites within each country as a nested random factor.

Results

Overall, 1944 (38.2%) patients were admitted to a CCU, 3150 (61.8%) to a ward, and this varied by region: 50.6% AP, 63.3% CE, 60.7% WE, 22.1% LA, and 28.6% NA. The 30-day death or readmission rate was 15.2% in ward patients and 17.0% in CCU patients (risk-adjusted Odds Ratio [OR] 1.44: 95% CI, 1.14-1.82). Compared with CCU patients in NA (24.1% 30-day event rate), the primary outcomes were: AP (10.4%, Odds Ratio [OR] 0.63; 95% confidence Interval [CI], 0.35 to 1.15), CE (10.4%, OR 0.56: 95%CI, 0.31 to 1.02), LA (22.4%, OR 0.60: 95%CI, 0.11 to 3.32), WE (11.2%, OR 0.63, 95%CI, 0.25 to 1.56). No regional differences in 30-day mortality were observed; however, 30-day readmission rates were highest in NA sites.

Conclusions

Management of patients with ADHF varies significantly, and after adjustment, CCU care was associated with higher risk of early mortality, not explained by international differences. These finding may help to improve the early decisions regarding risk stratification of patients hospitalized with ADHF.

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