University of Cyprus School of Medicine, Cyprus, Greece.
Attikon University Hospital, Department of Cardiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
JAMA Cardiol. 2020 Apr 1;5(4):401-410. doi: 10.1001/jamacardio.2019.5108.
Acute heart failure (AHF) precipitates millions of hospital admissions worldwide, but previous registries have been country or region specific.
To conduct a prospective contemporaneous comparison of AHF presentations, etiologic factors and precipitants, treatments, and in-hospital outcomes among global regions through the International Registry to Assess Medical Practice with Longitudinal Observation for Treatment of Heart Failure (REPORT-HF).
DESIGN, SETTING, AND PARTICIPANTS: A total of 18 553 adults were enrolled during a hospitalization for AHF. Patients were recruited from the acute setting in Western Europe (WE), Eastern Europe (EE), Eastern Mediterranean and Africa (EMA), Southeast Asia (SEA), Western Pacific (WP), North America (NA), and Central and South America (CSA). Patients with AHF were approached for consent and excluded only if there was recent participation in a clinical trial. Patients were enrolled from July 23, 2014, to March 24, 2017. Statistical analysis was conducted from April 18 to June 29, 2018; revised analyses occurred between August 6 and 29, 2019.
Heart failure etiologic factors and precipitants, treatments, and in-hospital outcomes among global regions.
A total of 18 553 patients were enrolled at 358 sites in 44 countries. The median age was 67.0 years (interquartile range [IQR], 57-77), 11 372 were men (61.3%), 9656 were white (52.0%), 5738 were Asian (30.9%), and 867 were black (4.7%). A history of HF was present in more than 50% of the patients and 40% were known to have a prior left-ventricular ejection fraction lower than 40%. Ischemia was a common AHF precipitant in SEA (596 of 2329 [25.6%]), WP (572 of 3354 [17.1%]), and EMA (364 of 2241 [16.2%]), whereas nonadherence to diet and medications was most common in NA (306 of 1592 [19.2%]). Median time to the first intravenous therapy was 3.0 (IQR, 1.4-5.6) hours in NA; no other region had a median time above 1.2 hours (P < .001). This treatment delay remained after adjusting for severity of illness (P < .001). Intravenous loop diuretics were the most common medication administered in the first 6 hours of AHF management across all regions (65.4%-89.9%). Despite similar initial blood pressure across all regions, inotropic agents were used approximately 3 times more often in SEA, WP, and EE (11.3%-13.5%) compared with NA and WE (3.1%-4.3%) (P < .001). Older age (odds ratio [OR], 1.0; 95% CI, 1.00-1.02), HF etiology (ischemia: OR, 1.65; 95% CI, 1.11-2.44; valvular: OR, 2.10; 95% CI, 1.36-3.25), creatinine level greater than 2.75 mg/dL (OR, 1.85; 95% CI, 0.71-2.40), and chest radiograph signs of congestion (OR, 2.03; 95% CI, 1.39-2.97) were all associated with increased in-hospital mortality. Similarly, younger age (OR, -0.04; 95% CI, -0.05 to -0.02), HF etiology (ischemia: OR, 0.77; 95% CI, 0.26-1.29; valvular: OR, 2.01; 95% CI, 1.38-2.65), creatinine level greater than 2.75 mg/dL (OR, 1.16; 95% CI, 0.31-2.00), and chest radiograph signs of congestion (OR, 1.02; 95% CI, 0.57-1.47) were all associated with increased in-hospital LOS.
Data from REPORT-HF suggest that patients are similar across regions in many respects, but important differences in timing and type of treatment exist, identifying region-specific gaps in medical management that may be associated with patient outcomes.
急性心力衰竭（AHF）导致全球数百万人住院，但以前的注册研究都是针对特定国家或地区的。
通过国际心力衰竭治疗纵向观察评估医学实践注册研究（REPORT-HF），对全球不同地区 AHF 的表现、病因和诱因、治疗和住院结局进行前瞻性同期比较。
设计、地点和参与者：共纳入 18553 名因 AHF 住院的成年人。在西欧（WE）、东欧（EE）、东地中海和非洲（EMA）、东南亚（SEA）、西太平洋（WP）、北美（NA）和中美洲和南美洲（CSA）的急性环境中招募了患者。征得急性心力衰竭患者同意，最近参加临床试验的患者除外。患者于 2014 年 7 月 23 日至 2017 年 3 月 24 日登记。2018 年 4 月 18 日至 6 月 29 日进行了统计分析；2019 年 8 月 6 日至 29 日进行了修订分析。
全球不同地区心力衰竭病因和诱因、治疗和住院结局。
在 44 个国家的 358 个地点共登记了 18553 名患者。中位年龄为 67.0 岁（四分位距[IQR]，57-77），11372 名男性（61.3%），9656 名白人（52.0%），5738 名亚洲人（30.9%），867 名黑人（4.7%）。超过 50%的患者有心力衰竭病史，40%的患者已知左心室射血分数低于 40%。SEA（25.6%，2329 例中的 596 例）、WP（17.1%，3354 例中的 572 例）和 EMA（16.2%，2241 例中的 364 例）中常见的 AHF 诱因是缺血，而 NA（1592 例中的 306 例，19.2%）最常见的是不遵守饮食和药物规定。NA 中首次静脉治疗的中位时间为 3.0（IQR，1.4-5.6）小时；没有其他地区的中位时间超过 1.2 小时（P < .001）。在调整疾病严重程度后，这种治疗延迟仍然存在（P < .001）。在 AHF 管理的最初 6 小时内，静脉滴注袢利尿剂是所有地区最常用的药物（65.4%-89.9%）。尽管所有地区的初始血压相似，但 SEA、WP 和 EE（11.3%-13.5%）中使用的正性肌力药物大约是 NA 和 WE（3.1%-4.3%）的 3 倍（P < .001）。年龄较大（比值比[OR]，1.0；95%置信区间[CI]，1.00-1.02）、心力衰竭病因（缺血：OR，1.65；95%CI，1.11-2.44；瓣膜：OR，2.10；95%CI，1.36-3.25）、肌酐水平大于 2.75mg/dL（OR，1.85；95%CI，0.71-2.40）和胸部 X 线征象充血（OR，2.03；95%CI，1.39-2.97）均与住院死亡率增加相关。同样，年龄较小（OR，-0.04；95%CI，-0.05 至-0.02）、心力衰竭病因（缺血：OR，0.77；95%CI，0.26-1.29；瓣膜：OR，2.01；95%CI，1.38-2.65）、肌酐水平大于 2.75mg/dL（OR，1.16；95%CI，0.31-2.00）和胸部 X 线征象充血（OR，1.02；95%CI，0.57-1.47）均与住院 LOS 增加相关。
REPORT-HF 数据表明，在许多方面，患者在不同地区之间是相似的，但在治疗的时机和类型方面存在重要差异，这可能与患者的预后有关，提示存在特定地区的医疗管理差距。
