Elsevier

American Heart Journal

Volume 149, Issue 2, February 2005, Pages 209-216
American Heart Journal

Trial Design
Characteristics and outcomes of patients hospitalized for heart failure in the United States: Rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE)

https://doi.org/10.1016/j.ahj.2004.08.005Get rights and content

Background

The ADHERE is designed to study characteristics, management, and outcomes in a broad sample of patients hospitalized with acute decompensated heart failure. Heart failure is a leading cause of hospitalization for adults older than 65 years in the United States. Most available data on these patients are limited by patient selection criteria and study design of clinical trials and single-center studies.

Methods

Participating hospitals identify patients with a primary or secondary discharge diagnosis of heart failure. Medical history, management, treatments, and health outcomes data are collected through review of medical records and entered into a database via secure web browser technology.

Results

As of January 2004, data on 107 362 patients have been received from 282 participating hospitals. Of enrollees with available analyzable data (N = 105 388 from 274 hospitals), the mean age was 72.4 (±14.0), and 52% were women. The most common comorbid conditions were hypertension (73%), coronary artery disease (57%), and diabetes (44%). Evidence of mild or no impairment of systolic function was found in 46% of patients. Inhospital mortality was 4.0% and the median hospital length of stay was 4.3 days.

Conclusions

The ADHERE demonstrates both the feasibility and significant implications of gathering representative data on large numbers of patients hospitalized with heart failure. Initial data provided important insights into the clinical characteristics and patterns of care of these patients. Ongoing registry work will provide the framework for improved treatment strategies for patients hospitalized with decompensated heart failure.

Section snippets

Methods

ADHERE is a large, multicenter registry designed to compile a large clinical database on the clinical characteristics, management, and outcomes of patients hospitalized for heart failure across the United States. Data are collected on the episode of hospitalization beginning with the point of initial care and ending with the patient's discharge, transfer out of the hospital, or inhospital death. The ADHERE is sponsored by the biopharmaceutical company Scios, Inc (Fremont, Calif).

Results

The ADHERE was open for enrollment in late September 2001. Several participating sites received IRB approval to include discharges as far back as January 2001. As of January 4, 2004, 107 362 patients have been enrolled at 282 sites (Figure 3). This report is based on analysis of 105 388 patients from 274 hospitals with finalized data.

The mean age of patients was 72.4 (±14.0) years and 52% were women. Most patients were white (72%) or black (20%) and were covered by Medicare or Medicaid (78%).

Discussion

The characteristics and outcomes of patients with acutely decompensated heart failure are poorly defined currently despite the public health importance of this syndrome. The ADHERE, developed to better characterize this population, is the first diverse, large-scale, prospective multicenter database of patients hospitalized for heart failure. Progress in ADHERE to date demonstrates the feasibility of a registry program to describe patients admitted to the hospital with heart failure. Enrollment

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1

The ADHERE Scientific Advisory Committee members are listed in Appendix A.

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