22EHS HF II: data collection Patients screened at the emergency area, including cardiac care unit (CCU) or intensive care unit (ICU), as well as on ward facilities (internal medicine or cardiology)133 participating hospitals:university hospitals (47%)community or district hospitals (49%)private clinics (4%)30 European countriesRecruitment from 21 October 2004 until 31 August 2005
26EHFS II: All-cause in-hospital mortality by strata of risk scoreRisk scoreN. of pts772743726574305321
27Per cominciare a ragionare più seriamente E’ possibile fare una stratificazione dei rischi affidabile ?Quali end-point e a quali tempi dobbiamo misurarli ?
28The lessons learned from trials and registries... All-cause mortality:The lessons learned from trials and registries...Chronic HFACSAcute HFOpasich C et al. for the IN-CHF Investigators. Am J Cardiol 2000; 86:GISSI-3: Six-month data. J Am Coll Cardiol 1996; 27: Tavazzi L et al. The Italian survey on Acute Heart Failure. Eur Heart J 2006; 27:
29Research in acute HF: Conclusions Morbidity and mortality of patients with acute HF remain unacceptably highTreatment of acute HF continues to remain largely anecdotal without much progress in the last decadesRisk stratification with the identification of simple clinical variables seems to be feasible in any clinical settingIn any case, the application of risk scores in the real world of acute HF could be limited by:The heterogeneity of this clinical conditionThe different patho-physiological backgroundThe various clinical settings (and doctor profiles) in which patients with AHF are managedFurther efforts should be focused on planning research in the field of AHF
30What do we need ? Or in other words … everything… Data on the clinical characteristics.Definition, sub-clasification (ST/non-ST )Data on the exact pathophysiology of each subtype.Better ways to risk-stratify the patients.Treatments to:Reduce MortalityReduce Morbidity (worsening heart failure?)Rapid and safe symptoms reliefOr in other words … everything…
31Comparison of decompensated heart failure with acute myocardial infarction Decompensated Acute myocardialHeart failure infarctionHospitalization per year(in US) 1,000,000 1,000,000In-Hospital Mortality % 3-7%Readmission rate (60 days) 35% 10%Guidelines for risk stratification No YesGuidelines for therapy Yes (ESC) YesNo (AHA/ACC)Largest randomized trial 4, ,021MEDLINE citations ( ) ,908Modified from Am Heart J 2003; 145: S18-25