Argentine Registry of Acute Heart Failure (ARGEN-IC). Evaluation of a Partial Cohort at 30 Days

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Abstract

Background: Acute heart failure is a current epidemiological problem, closely correlating with increased population age and greater survival of patients with cardiovascular diseases.

Objectives: The aim of this study was to evaluate the clinical profile, diagnostic and therapeutic strategies and complications during hospitalization and 30-day follow up of the ARGEN-IC Registry.

Methods: A national prospective, multicenter registry was performed including patients with confirmed diagnosis of acute heart failure followed-up for 12 months in 50 health centers from August 2018 to March 2019.

Results: Data from 909 patients were provided by 74 investigators from 18 provinces of Argentina. Mean age was 72.2±14 years, and 60.5% of patients were men. Baseline characteristics showed prevalence of diabetes (33%), prior acute myocardial infarction (17%), atrial fibrillation (31%), and private health insurance (38%). Among precipitating factors of decompensation, there was greater incidence of unknown causes (28.5%) followed by infective diseases (15.7%) and food transgression (13.5%). Predominant presentations were ischemic-necrotic etiology (26%), mixed congestion (48%) and the group with reduced ejection fraction (EF (<o = 40%)). Use of natriuretic peptides was almost 50% and 25% (admission and discharge, respectively), and echocardiographic evaluation of diastolic function was performed in 77% of patients, with significant abnormality in 46%. In 77.6% of cases, patients were admitted to the critical care unit, with median hospital stay of 8 days and overall mortality of 7.9%. Pharmacological treatment at discharge was underutilized, even in the group with reduced EF: 78.7% received betablockers, 70.9% angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers or angiotensin receptor–neprilysin inhibitor and 56.3% anti-aldosterone agents, while referral to cardiovascular rehabilitation involved 17% of cases. The 30-day follow-up period showed 16.7% rehospitalizations, 5.5% mortality and 18% combined events. Only 47% of patients had accessed the medical consultation.

Conclusions: The ARGEN-IC registry represents a heterogeneous population, with advanced mean age and high number of comorbidities. The diagnostic and therapeutic strategies are underutilized during hospitalization and in the first 30 days, with poor access to the health system. The overall combined rate of in-hospital events and at 30 days remains high.