Characterization of heart failure patients with preserved ejection fraction: a comparison between ADHERE-US registry and ADHERE-International registry

Aims To characterize geographic differences in clinical characteristics and care of patients hospitalized with heart failure and preserved ejection fraction (HF‐PEF). Methods and results Using data on 61 182 admissions in 307 US hospitals from March 2004 to March 2006 from the Acute Decompensated Heart Failure National Registry (ADHERE)‐United States (US) database and 10 904 admissions in 70 hospitals from 10 countries from March 2005 to January 2009 from the ADHERE‐International (I) database composed of countries in Asia‐Pacific and Latin‐American regions, we compared characteristics, treatments, length of stay, and in‐hospital mortality between patients with PEF (left ventricular EF ≥ 40%). There were 26 258 (49.6%) admissions with HF‐PEF in the ADHERE‐US and 4206 (45.7%) in ADHERE‐I. The USA cohort was older [median 77.2 years (25th, 75th, 66.5, and 84.4) vs. 71.0 (59.0, 79.0), P< 0.001] and more likely to be female (61.8 vs. 54.7%, P< 0.001). The international cohort had a longer length of stay [median 6.0 days (4.0, 10.0)] vs. 4.0 days [3.0, 7.0], P< 0.001) and higher use of inotropes (12.5 vs. 4.8%, P< 0.001). At discharge, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, beta‐blockers, and diuretics were prescribed more in the USA (57.6 vs. 54.4%, P< 0.001; 63.0 vs. 35.5%, P< 0.001; 78.2 vs. 76.2%, P< 0.001); digoxin was prescribed more outside the USA (26.0 vs. 17.7%, P< 0.001). After adjusting for baseline characteristics, 7‐day inpatient mortality was similar between the international and the USA cohorts [hazard ratio 0.80, 95% CI (0.61–1.05); P= 0.11]. Conclusions Clinical characteristics, inpatient interventions, discharge therapies, and length of stay vary significantly for HF‐PEF patients across geographic regions. This has important implications for global clinical trials and outcome studies in HF.