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| Treatment performance factors affect the clinical outcomes for patients with acute heart failure based on large prospective hospital cohort registry |
| 연세대학교 원주의과대학 심장내과¹, Korean Acute Heart Failure (KorHF) Registry² |
| 윤영진¹, 안성균¹ , 김장영¹ , 이승환¹ , 윤정한¹ , 최경훈¹ , 유병수¹,², 이명묵², 오병희², 유규형², 김영조², 채성철², 전은석², 조명찬², 백상홍², 조명찬², 강석민², 그외 Investigators of Korean Acute Heart Failure (KorHF) Registry ² |
Background: There is possibility of some difference for clinical and prognostic outcome between the western and oriental patients with acute heart failure. The objectives of this study are to evaluate the overall adherence to the HF performance measures identified or modified by the ACC/AHA, and whether these performance factors affect the clinical outcomes for patients with acute HF. Methods: The data of Korean acute heart failure (KorHF) registry were prospectively collected from 2,115 patients with reduced left ventricular (LV) systolic function from 2005 and 2009. Performance measures were modified from an ‘ACC/AHA clinical performance measures for Adult HF’. These are defined as follows: evaluation of BNP or NT-pro BNP level at admission, angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB), beta blocker (BB) and aldactone use at discharge. Outcome measure was mortality. Results: Male was 55.3% and age was 66.6 ± 14.7 year. Risk factors were previous myocardial infarction (15.8%), hypertension (44.4%), diabetes (31.5), atrial fibrillation (21.7%), chronic renal failure (9.7%) and previous history of HF (28.8%). The evaluation of BNP or NT-pro BNP at admission was 83.4%. The prescriptions of ACEi/ARB, BB and aldactone at discharge were 67.6%, 42.8 % and 39.8%, respectively. The in-hospital mortality was 6.4%. Among the 1,977 survivor at discharge, the mortality was 13.6% during the follow-up (590.0 ± 414.6 days). By multivariate analysis including age, sex, evaluation of BNP and use of ACEi/ARB, BB, aldactone at discharge, age (hazard ratio(HR), 1.040; 95% confidence interval(CI), 1.028-1.051; p <0.001) and use of ACEi/ARB (HR, 0.630; 95% CI 0.469-0.847, p = 0.002) and BB (HR, 0.695; 95% CI 0.523-0.924, p = 0.012) at discharge were independently associated with mortality. Conclusion: Treatment performance measure including prescription of an ACEi/ARB and BB at discharge showed strong relationship to reduce the mortality. Assessment of quality of care in acute heart failure should focus on the use of these drugs.
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