National Registry of Hospitalization due to Heart Failure in Argentina

pp 260-273

Abstract

Introduction 

Heart failure (HF) is one of the most frequent causes of hospitalization, mainly in patients older than 65 years. Two great registries of HF hospitalizations were performed in Argentina during the last 10 years: the SAC Registry (1993) and the CONAREC VI Registry (1999). Both were focused in data relative to the hos­pitalization. The present registry gathers in­formation about the factors associated with the hospitalization, includes a more detailed analy­sis of the care during in-hospital period and updates issues already explored. 

Objectives 

The main objective of our registry was to define the profile of the patients admitted be­cause of HF in intensive care units of general medicine and cardiology departments. We also considered patients hospitalized in intermedi­a te care or general room, in our whole coun­try, and review the most usual diagnostic and therapeutic modalities. Identification of prog­nostic markers of mortality and length of in­hospital period were also investigated.

Material and methods  Inclusion criteria were: age older than 18 years and uncompensated HF for patients in any of the 74 participant centers. Patients were recruited prospectively along 2 months in each of the health centers during 1999. Familiar data , socioeconomic data , non cardiac and cardiac medical history, and data relative to the hospitalization were obtained. 

Results 

Four hundred patients were included with male patients prevalence. Average age was 68,3±14,8 years. Relevant comorbidities were observed in 50% of patients. We found previous HF in 78,3% of the patients. There was not a clear leading factor in 30,5% of the cases. Seventy five percent of the cases were non severe forms of presentation but 65% of admissions were in critical care areas. Mortality rate was 10,5 %. Mortality risk increased nearly three times when dyastolic blood pressure was be­low 70 mm Hg, blood nitrogen above 60 mg% and leukocyte count was 8500/mm3 or greater . Low cardiac output was associated to 3-4 times higher mortality risk, whereas the previous use of AAS and blood sodium below 133 mEq/l were associated with a duplication of the mortality risk. The mean length of stay was 7 days (4-12). The admission to a public hospital, the previ­ous Functional Class III-IV and low blood so­dium were independent predictors of longer length of stay. Hospitalization in intensive care units was associated to the severity of presen­tation, previous coronary artery disease and the kind of medical insurance. 

Conclusions. 

The hospitalization due to HF, in Argentina, occurs in a aged population, with previous heart failure events and elevated rate of comorbidities. Almost two third of the cases were readmissions. Most cases were due to po­tentially avoidable factors. Mortality during hospitalization was near 10%. The length of stay was similar to the one in many American and European registries. We observed an over­use of intensive care facilities at admission. Predictors of bad prognosis could help to a more rational decision making process.