Gregg C. Fonarow, MD, director, Ahmanson - University of California Cardiomyopathy Center, Los Angeles, California, United States, and associates compared patients who were hospitalized with new-onset heart failure to patients with acute decompensation of pre-existing heart failure.

"Among patients hospitalized with heart failure, a significant proportion are hospitalized with new-onset heart failure," Dr. Fonarow said.

"Little is known as to whether patients hospitalized with a new onset of heart failure differ in characteristics, treatments, and outcomes from patients with acute decompensation of pre-existing heart failure," he added. "Any significant differences between these two groups could have important implications on recommendations for their evaluation and management."

For their trial, Dr. Fonarow and colleagues used data from the Acute Decompensated Heart Failure National Registry, an ongoing observational registry begun in 2001 that tracks hospital data from patients admitted with heart failure.

Overall, 25% of 105,386 patients had new-onset heart failure. Also, 39.3% of these patients and 62.8% of patients with preexisting heart failure had coronary artery disease (P <.001). Atrial fibrillation was present in 19.6% and 34.4% of the two groups, respectively (P <.001).

New onset patients had higher systolic blood pressure levels, lower blood urea nitrogen levels (BUN), similar hemoglobin levels, and higher left ventricular ejection fractions at presentation.

Patients with new-onset heart failure also more often received angiotensin converting enzyme inhibitors as in-patients, while beta -blocker use was similar in the two groups.

There was no meaningful difference in administration of most procedures performed in hospital for the two groups. The exception was cardiac catheterization, with twice as many performed in the new-onset group.

Total in-hospital length of stay and mean intensive care unit length of stay were similar in the two groups (3.8 versus 4.0 days, P =.012).

Fewer new-onset patients died in hospital (3.0% versus 4.3%, OR=0.67, P <.001). When the mortality comparison was risk-adjusted for gender, age, BUN, systolic blood pressure, and creatinine levels, however, mortality was similar for the two groups (OR=1.00, P =.95).

"The data suggest that new-onset heart failure may not represent a unique clinical syndrome," Dr. Fonarow said. "Significant opportunities exist to improve care and outcomes for patients hospitalized with both new onset and exacerbations of pre-existing heart failure."


[Presentation title: Comparison Between Cases of New Onset Heart Failure and Acutely Decompensated Heart Failure: An ADHERE Analysis. Abstract 1133-169]

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