Thai Acute Decompensated Heart Failure Registry (Thai ADHERE)

Abstract

Background

Heart Failure (HF) is the one of the malignant cardiac syndromes which has a high morbidity and mortality rate. In Thailand, HF is one of the major cardiovascular health problems and economic burdens disease. Thai ADHERE is the first HF registry in Thailand.

Objective

To assess patient with HF in Thailand in terms of patients’ characteristics, clinical presentation, causes of heart failure, and precipitating causes of heart failure, hospital course, management, and in-hospital outcomes.

Material and methods

Thai Acute Decompensated Heart Failure Registry or Thai ADHERE registry is a Phase IV, multicenter, observational, and open-label registry in 18 cardiac centers in Thailand using the US ADHERE protocol. Medical records of hospitalized patients with the principal discharge diagnosis of HF from March 2006 to November 2007 were validated and registered via an electronic web based system.

Results

There were 2041 HF admissions in 1612 patients with a median age of 67 years (mean 64 ± 14 years). Age >75 years was found in 24%, 49.6% were male patients, and 67% of these admissions had prior heart failure. Underlying diseases were hypertension [(HT) = 65%], coronary artery disease [(CAD) = 47%], dyslipidemia (50%), diabetes mellitus (47%), atrial fibrillation (24%) and chronic kidney disease (19%). Clinical features at presentation were dyspnea (97%), edema (60%), pulmonary rales (85%) and pulmonary congestion by chest X-ray (93%). Sixty-nine percent (69%) were in NYHA functional class IV and 44% had a left ventricular ejection fraction (LVEF) less than 40%. Common causes of heart failure were CAD (45%), valvular heart diseases (19%), cardiomyopathy (14%) and HT (12%). Precipitating causes of heart failure were heart disease itself 54% and 20% were related to inadequate diuretics and poor patient compliance with medications. Neurohormonal blockers (NHB) [angiotensin converting enzyme inhibitors (ACEI), angiotensinoge receptor blocker (ARB), aldosterone blocker (AA) and beta blockers (BB)], were given prior to hospitalization in comparison to at discharge in 26% vs. 35%, 12% vs. 12%, 13% vs. 17% and 26% vs. 24% respectively. In-hospital mortality rate was 5.5% and the median length of hospitalization was 7.5 days. Major causes of death were sepsis, worsening of heart failure, arrhythmic arrest and acute coronary syndrome. There was a higher mortality rate in those with poor LV systolic function compared to those with preserved LV systolic function (8.2% vs. 4.1%; p = .008). At discharge, 23% of the patients were asymptomatic while 69% had symptomatic improvement.

Conclusion

Thai ADHERE registry revealed that Thai patients hospitalized for heart failure are younger and sicker than European and American patients. There is a high prevalence of HF with preserved ejection fraction. CAD was the most common cause of HF while HT was the most common underlying disease. There was a 5.4% mortality rate, which was higher in those with poor LV systolic function. There was underutilization of NHB (ACEI, ARB, BB and AA).