Temporal trends in clinical characteristics, treatments, and outcomes for heart failure hospitalizations, 2002 to 2004: findings from Acute Decompensated Heart Failure National Registry (ADHERE)

doi:10.1016/j.ahj.2007.03.012

American Heart Journal

Volume 153, Issue 6, June 2007, Pages 1021-1028

https://doi.org/10.1016/j.ahj.2007.03.012 Get rights and content

Background

The purpose of this study was to assess temporal trends in clinical characteristics, treatments, quality indicators, and outcomes for heart failure (HF) hospitalizations.

Methods

Characteristics, treatments, quality measures, and inhospital outcomes were measured over 12 consecutive quarters (January 2002 to December 2004) using data from 159 168 enrollments from 285 ADHERE hospitals.

Results

Baseline characteristics were similar or showed only modest changes, and severity of illness by logistic regression was unchanged over all 12 quarters. Inhospital treatment changed significantly over time with inotrope use decreasing from 14.7% to 7.9% (P < .0001). Discharge instructions increased 133%; smoking counseling, 132%; left ventricular function measurement, 8%; and β-blocker use, 29% (all P < .0001). Clinical outcomes improved over time, including need for mechanical ventilation, which decreased 5.3% to 3.4% (relative risk 0.64, P < .0001); length of stay (mean), 6.3 to 5.5 days; and mortality, 4.5% to 3.2% (relative risk 0.71, P < .0001).

Conclusions

Over a 3-year period, demographics and clinical characteristics were relatively similar, but significant changes in intravenous therapy, enhancements in conformity to quality-of-care measures, increased administration of evidence-based HF medications, and substantial improvements in inhospital morbidity and mortality were observed during hospitalization for HF.

Section snippets

Methods

This analysis is based on all hospitalization episodes in the ADHERE registry that were discharged from January 1, 2002, through December 31, 2004: a total of 159 168 from 285 hospitals. Details of the objectives, design, and methods in ADHERE have been previously described.⁹ ADHERE hospitals, community, tertiary, and academic centers, are located throughout the United States and are demographically representative of the nation as a whole.9, 10 The registry collects information on demographic

Results

There were 159 168 hospitalization episodes that were entered during the 12 quarters, with a mean ± SD of 13 264 ± 3025 hospitalizations entered per quarter (range 8220 to 17 878).

Discussion

Results from this analysis indicated that in 159 168 HF discharges, there were only minor appreciable differences in the demographic characteristics or clinical status over the 3-year study period. During this period, there were significant changes in treatment patterns and quality-of-care indicators. Use of IV inotropes declined, whereas the use of vasodilator agents increased. The use of β-blockers increased substantially. The rate of hospital compliance with 2 JCAHO core performance measures

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Clinical InvestigationCongestive Heart DiseaseTemporal trends in clinical characteristics, treatments, and outcomes for heart failure hospitalizations, 2002 to 2004: findings from Acute Decompensated Heart Failure National Registry (ADHERE)

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Am Heart J

Am Heart J

Am Heart J

Am Heart J

J Am Coll Cardiology

Am Heart J

Am Heart J

Am Heart J

J Am Coll Cardiol

J Card Fail

Am J Med

Heart Disease and Stroke Statistics—2007 Update

ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult

Circulation

Prognosis and determinants of survival in patients newly hospitalized for heart failure: a population-based study

Arch Intern Med

Clinical Investigation
Congestive Heart Disease
Temporal trends in clinical characteristics, treatments, and outcomes for heart failure hospitalizations, 2002 to 2004: findings from Acute Decompensated Heart Failure National Registry (ADHERE)