IN-HF on line: atient settings (Enrollement eriod= 1995-2018) N of centers (total) 187 N of centers (ts. AHF only) 13 N of centers (ts. CHF only) 71 N of centers (both ts. AHF and CHF) 103 N of atients (total) 32599 N of atients (AHF) 3308 (/32599, 10.2%) N of atients (AHF worsening) 1708 (/3308, 51.6%) N of atients (AHF De-novo) 1600 (/3308, 48.4%) N of atients (CHF) 29291 (/32599, 89.8%) N of atients (CHF NYHA I class) 4953 (/29291, 16.9%) N of atients (CHF NYHA II class) 17696 (/29291, 60.4%) N of atients (CHF NYHA III class) 6279 (/29291, 21.4%) N of atients (CHF NYHA IV class) 363 (/29291, 1.3%) N
IN-HF on line: atient settings (Enrollement eriod= 1995-2018) CHF N 29291 (89.8%) AHF N 3308 (10.2%) N of atients enrolled in 1995-2000 N of atients enrolled in 2001-2005 5541 (18.9%) 7677 (26.2%) // 5541 // 7677 N of atients enrolled in 2006-2010 7440 (25.4%) 1923 (58.1%) 9363 N of atients enrolled in 2011-2015 3219 (11.0%) 157 (4.8%) 3376 N of atients enrolled in 2016-2018 5414 (18.5%) 1228 (37.1%) 6642
AHF and CHF: descrition of the baseline characteristics CHF ts (n. 29291) AHF ts (n. 3308) Age (years), mean±sd 67±13 72±12 Females, % 27.2 38.3 SBP (mmhg), mean±sd 128±21 133±31 HR (bm), mean±sd 74±15 92±26 Hyertension, % 49.6 67.5 Diabetes mellitus, % 26.2 38.4 History of Atrial Fibrillation, % 25.6 38.4 Renal dysfunction, % 29.7 (on 14979 ts) 35.1 ICD, % 13.9 10.8 CRT, % 1.1 1.4 CRT-D, % 4.9 4.2
Acute HF: baseline characteristics (1) (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) Age 70 years, % 65.7 68.4 62.7 0.0005 Age (years), mean±sd 72±12 73±11 72±12 0.008 Females, % 38.3 37.5 39.2 0.31 Ischemic etiology, % available for 3269 ts 42.7 45.2 40.0 0.003 BMI 30 (kg/m 2 ), % available for 2330 ts 27.9 27.7 28.1 0.86 BMI (kg/m 2 ), mean±sd available for 2330 ts 28±5 27±5 28±5 0.04
Acute HF: baseline characteristics (2) (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) SBP <110 mmhg, % available for 3288 ts 18.8 23.9 13.3 <.0001 SBP (mmhg), mean±sd available for 3288 ts 133±31 129±30 139±31 <.0001 HR (bm), mean±sd available for 3263 ts 92±26 88±24 97±27 <.0001 EF (%) in the revious 6 months, available for 1164 ts 35.2 47.8 21.8 <.0001 EF (%) in the revious 6 months, mean±sd available for 1164 ts 38±13 36±13 44±12 <.0001
Acute HF: clinical history (n. 3308) Worsening HF (n. 1708) HF diagnosis > 48 months% available for 1697 ts 49.7 Hositalization for HF last year% 43.7 De Novo (n. 1600) Hyertension, % 67.5 65.8 69.3 0.03 Diabetes, % 38.4 41.3 35.3 0.0004 History of Atrial Fibrillation, % 38.4 46.6 29.8 <.0001 Previous stroke, % 5.2 5.6 4.7 0.23 PAD, % 18.6 21.3 15.6 <.0001 Renal dysfunction, % 35.1 43.4 26.1 <.0001 COPD, % 28.3 31.9 24.6 <.0001 ICD, % 10.8 17.6 3.5 <.0001 CRT, % 1.4 1.9 0.8 0.009 CRT-D, % 4.2 7.7 0.6 <.0001
Acute HF: clinical signs at entry (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) Pulmonary congestion, % 81.3 79.5 83.2 0.006 Periheral congestion, % 60.1 66.0 53.8 <.0001 Pulmonary or eriheral congestion, % 91.0 91.2 90.7 0.60 Periheral hyoerfusion, % 12.1 13.9 10.3 0.001 Cold, % 10.3 11.1 9.4 0.12 Somnolent, confused, sedated, % 11.1 10.4 11.9 0.17
Acute HF: IV treatment during hositalization (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) Furosemide (IV or oral), % 99.3 99.3 99.3 0.88 IV Furosemide, % 96.3 95.3 97.4 0.001 IV Furosemide, median [IQR] daily max dosage available for 3075 ts 80 [40-240] 100 [50-250] 80 [40-125] <.0001 Oral Furosemide, % 79.4 81.5 77.1 0.002 Oral Furosemide, median [IQR] daily max dosage available for 2505 ts 75 [50-125] 100 [50-125] 50 [50-100] <.0001 IV diuretics, % 99.5 99.5 99.4 0.89 Other IV diuretics, % 14.7 16.2 13.1 0.01 IV nitrates, % 24.0 21.6 26.7 0.0005 Inotroes, % Doamine, % Dobutamine, % Levosimendan, % 16.9 11.1 6.7 4.4 21.4 13.2 9.0 5.7 12.2 8.9 4.3 3.1 <.0001 <.0001 <.0001 0.0002
Acute HF: laboratory examinations at entry (1) Hemoglobin <12g/dL, % available for 3198 ts Creatinine >1.5mg/dL, % available for 3159 ts egfr <60 ml/min/1.73m 2, % available for 3092 ts egfr <30 ml/min/1.73m 2, % available for 3092 ts Glycemia >126mg/dL, % available for 2752 ts (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) 36.9 42.1 31.2 <.0001 27.7 34.5 20.3 <.0001 54.7 62.6 46.0 <.0001 13.0 16.3 9.4 <.0001 53.1 52.1 54.2 0.26
Acute HF: laboratory examinations at entry (2) Sodium <136mEq/L, % available for 2968 ts (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) 18.8 23.4 13.9 <.0001 BUN>50mg/dL,% available for 2100 ts 55.6 63.8 47.0 <.0001 NT-ro BNP, g/ml, median [IQR] (available for 779 ts) BNP, g/ml, median [IQR] (available for 546 ts) hs-crp, mg/l, median [IQR] (available for 589 ts) 5176 [2500-10407] 1021 [503-2700] 5.7 [1.9-14.9] 5809 [2869-11415] 1092 [510-2194] 5.6 [2.0-14.0] 4548 [1922-9081] 912 [497-1713] 5.9 [1.9-15.0] 0.0007 0.10 0.80
Acute HF: drug treatment rior hositalization (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) ACE-i/ARBs, % 52.8 59.3 45.9 <.0001 Betablockers, % 42.4 53.5 30.5 <.0001 Digitalis, % 11.6 15.8 7.1 <.0001 Diuretics, % 57.4 75.2 38.5 <.0001 Aldosterone blockers, % 16.9 26.9 6.3 <.0001 Ivabradine*, % 4.1 6.1 2.5 0.002 * 1225 ts enrolled from march 1st, 2017 (worsening HF: 542; de novo HF: 683)
Acute HF: drug treatment (os) during hositalization (n. 3308) Worsening HF (n. 1708) De Novo (n. 1600) ACE-i/ARBs, % 65.0 63.2 67.0 0.02 Betablockers, % 17.4 17.6 17.1 0.71 Digitalis, % 19.6 22.8 16.9 <.0001 Diuretics, % 67.4 67.6 67.3 0.82 Aldosterone blockers, % 37.1 38.6 35.4 0.06 Ivabradine*, % 6.1 4.1 7.8 0.007 * 1225 ts enrolled from march 1st, 2017 (worsening HF: 542; de novo HF: 683)
Acute HF: drug treatment at discharge (only survivors) (n. 3138) Worsening HF (n. 1613) De Novo (n. 1525) ACE-i/ARBs, % 70.0 66.3 73.8 <.0001 Betablockers, % 65.4 63.7 67.2 0.04 Digitalis, % 18.5 22.3 14.5 <.0001 Diuretics, % 90.8 92.5 88.9 0.0005 Aldosterone blockers, % 56.1 57.3 54.8 0.16 Ivabradine*, % 8.6 8.7 8.6 0.93 * 1185 ts enrolled from march 1st, 2017 (worsening HF: 518; de novo HF: 667)
Acute HF: discharge status Death % Alive % Lenght of Stay (days) Median [IQR] (n. 3308) 5.1 94.9 10 [7-15] Worsening HF (n. 1708) 5.6 94.4 10 [7-16] De Novo (n. 1600) 4.7 95.3 9 [7-14] 0.25 0.03 ICU admission, % 50.6 45.8 55.7 <.0001 ICU Lenght of Stay (days) Median [IQR] available for 1631 ts 4 [2-6] 4 [2-7] 4 [2-6] 0.15
Chronic HF: baseline characteristic (1) (n. 29291) NYHA I-II (n. 22649, 77.3%) NYHA III-IV (n. 6642, 22.7%) Age 70 years, % available for 29255 ts 48.8 46.4 57.1 <.0001 Age (years), mean±sd available for 29255 ts 67±13 67±13 70±12 <.0001 Females, % 27.2 25.9 31.4 <.0001 Ischemic etiology, % available for 28907 ts 41.0 40.2 43.9 <.0001 BMI 30 (kg/m 2 ), % available for 29132 ts 20.6 20.2 22.0 0.0009 BMI (kg/m 2 ), mean±sd available for 29132 ts 27±5 27±5 27±5 0.046
Chronic HF: baseline characteristic (2) (n. 29291) NYHA I-II (n. 22649, 77.3%) NYHA III-IV (n. 6642, 22.7%) SBP >140 mmhg, % available for 29287 ts 19.2 20.0 16.5 <.0001 SBP (mmhg), mean±sd available for 29287 ts 128±21 129±20 124±22 <.0001 HR (bm), mean±sd available for 28316 ts 74±15 72±14 78±16 <.0001 Third heart sound, % 9.4 7.2 17.0 <.0001 Periheral congestion, % 15.0 10.1 31.7 <.0001 Rales, % 10.1 5.6 25.3 <.0001
Chronic HF: clinical history (n. 29291) NYHA I-II (n. 22649) NYHA III-IV (n. 6642) HF duration >48 months, % available for 26174 ts 38.3 36.4 44.0 <.0001 Hosital admission for HF in revious year, % 46.1 42.7 57.7 <.0001 Hyertension, % 49.6 50.4 47.0 <.0001 Diabetes mellitus, % 26.2 25.0 30.3 <.0001 History of Atrial Fibrillation, % 25.6 24.2 30.1 <.0001 Previous stroke, % 4.5 4.2 5.6 <.0001 PAD, % available for 15034 ts 15.4 14.0 21.1 <.0001 Renal dysfunction, % available for 14979 ts 29.7 26.5 42.5 <.0001 COPD, % available for 15051 ts 23.2 20.8 33.1 <.0001 ICD, % 13.9 13.4 15.7 <.0001 CRT, % 1.1 1.1 1.3 0.07 CRT-D, % 4.9 4.8 5.3 0.07
Chronic HF: harmacological treatment (n. 29291) NYHA I-II (n. 22649) NYHA III-IV (n. 6642) ACE-i, % 67.3 68.7 62.5 <.0001 ARBs, % 17.6 17.2 18.9 0.002 ACE-i/ARBs, % 83.4 84.4 80.0 <.0001 Betablockers, % 61.4 64.1 52.0 <.0001 Digitalis, % 29.0 25.5 40.9 <.0001 Diuretics, % 85.4 82.7 94.6 <.0001 Aldosterone blockers, % 43.7 40.9 53.4 <.0001 Nitrates, % 24.9 22.5 33.2 <.0001 Asirin, % 41.4 42.9 36.1 <.0001 Oral anticoagulants, % 31.8 29.4 39.8 <.0001 Statins, % 31.9 33.1 27.8 <.0001
Chronic HF: harmacological treatment Ivabradine Patients enrolled from 01January 2011 (n. 8633) NYHA I-II (n. 6903) NYHA III-IV (n. 1730) Ivabradine 12.4 12.0 14.4 0.006
Chronic HF: Combinations of recommended treatments Betablockers + ACE-i/ARBs + Aldosterone blockers, % Betablockers + ACE-i + ARBs, % At least 2 neurohormonal blockers, % (n. 29291) NYHA I-II (n. 22649) NYHA III-IV (n. 6642) 24.5 24.7 24.1 0.34 0.8 0.9 0.7 0.15 68.8 69.5 66.5 <.0001
Chronic HF: ECG (*) Findings (available for 28119 ts, 96.0%) (n. 28119) NYHA I-II (n. 21787) NYHA III-IV (n. 6332) Atrial Fibrillation/Flutter, % available for 28118 ts 20.5 18.0 29.0 <.0001 LBBB, % 17.9 17.6 18.9 0.03 QRS 120 msec, % available for 12359 ts 42.0 40.2 49.4 <.0001 QRS duration, median [IQR] available for 12359 ts 110 [90-130] (*) within 60 days from enrollement visit 107 [90-130] 118 [90-140] <.0001
Chronic HF: ECHO (*) Findings (available for 20500 ts, 70.0%) (n. 20500) NYHA I-II (n. 15645) NYHA III-IV (n. 4855) EF (%) <30, % 30-40, % >40, % available for 20015 ts EF (%), median [IQR] available for 20015 ts 25.6 42.1 32.3 35 [29-45] 21.7 44.0 34.3 37 [30-45] 38.1 36.3 25.6 32 [25-41] <.0001 <.0001 Severe mitral regurgitation, % available for 18770 ts 14.8 12.0 23.6 <.0001 (*) within 60 days from enrollement visit
Chronic HF: Chest X-ray (*) Findings (available for 2319 ts, 7.9%) (n. 2319) NYHA I-II (n. 1506) NYHA III-IV (n. 813) Cardiomegaly, % available for 598 ts 71.2 64.4 80.8 <.0001 Pulmonary venous congestion, % 49.1 41.2 63.7 <.0001 Interstitial edema, % 38.5 33.2 48.2 <.0001 Alveolar edema, % 1.8 1.1 3.2 0.0002 Pleural effusion, % 18.2 13.3 27.3 <.0001 (*) within 60 days from enrollement visit
Chronic HF: laboratory examinations (*) (n. 29291) NYHA I-II (n. 22649) NYHA III-IV (n. 6642) Hemoglobin <12g/dL, % available for 12060 ts 24.5 21.2 35.4 <.0001 Creatinine >1.5mg/dL, % available for 13249 ts egfr <60 ml/min/1.73m 2, % available for 12963 ts egfr <30 ml/min/1.73m 2, % available for 12963 ts 22.9 19.9 32.7 <.0001 48.2 44.2 60.9 <.0001 8.3 7.2 12.1 <.0001 Glycemia >126mg/dL, % available for 7650 ts 25.5 24.9 27.6 0.02 Sodium <136mEq/L, % available for 11678 ts 10.7 8.7 16.9 <.0001 BUN >50mg/dL, % available for 8649 ts 50.8 47.1 61.2 <.0001 Uricemia >6.9 mg/dl, % available for 5336 ts 39.3 36.6 47.7 <.0001 (*) within 60 days from enrollement visit