Rationale, design, methodology and hospital characteristics of the first gulf acute heart failure registry [gulf care]

There is paucity of data on heart failure [HF] in the Gulf Middle East. The present paper describes the rationale, design, methodology and hospital characteristics of the first Gulf acute heart failure registry [Gulf CARE]. Gulf CARE is a prospective, multicenter, multinational registry of patients >18 year of age admitted with diagnosis of acute HF [AHF]. The data collected included demographics, clinical characteristics, etiology, precipitating factors, management and outcomes of patients admitted with AHF. In addition, data about hospital readmission rates, procedures and mortality at 3 months and 1-year follow-up were recorded. Hospital characteristics and care provider details were collected. Data were entered in a dedicated website using an electronic case record form. A total of 5005 consecutive patients were enrolled from February 14, 2012 to November 13, 2012. Forty-seven hospitals in 7 Gulf States [Oman, Saudi Arabia, Yemen, Kuwait, United Gulf Emirates, Qatar and Bahrain] participated in the project. The majority of hospitals were community hospitals [46%; 22/47] followed by non-University teaching [32%; 15/47 and University hospitals [17%]. Most of the hospitals had intensive or coronary care unit facilities [93%; 44/47] with 59% [28/47] having catheterization laboratory facilities. However, only 29% [14/47] had a dedicated HF clinic facility. Most patients [71%] were cared for by a cardiologist. Gulf CARE is the first prospective registry of AHF in the Middle East, intending to provide a unique insight into the demographics, etiology, management and outcomes of AHF in the Middle East. HF management in the Middle East is predominantly provided by cardiologists. The data obtained from this registry will help the local clinicians to identify the deficiencies in HF management as well as provide a platform to implement evidence based preventive and treatment strategies to reduce the burden of HF in this region

Clinical characteristics and outcome of acute decompensated heart failure [ADHF] patients in Adan hospital, Kuwait

To determine the prevalence of acute decompensated heart failure [ADHF] among the acute medical admissions in Adan Hospital, Kuwait, and describe their clinical characteristics and in-hospital mortality. Prospective study. Medical wards and coronary care unit at Adan Hospital, Kuwait. All adult patients admitted from 18[th] of September to 17[th] of November 2008 with the diagnosis of ADHF. Echocardiography. Determination of the prevalence of ADHF among medical admissions, their clinical features, and their in-hospital mortality. The prevalence of ADHF was 14.5%. The mean age of our patients was 60.3 +/- 13.2 years. There was a male preponderance [71.8 Vs 28.2%]. There was a high percentage of co-morbidities among our patients. The average length of stay was 8.5 days. The in-hospital mortality was 4.9%. Beta-blocker use was relatively less than other studies. 88.5% patients had echocardiography done and 47.3% of them had preserved left ventricular ejection fraction [LVEF > 45%]. The clinical profile of this sample of ADHF reported from Kuwait is different from that observed in other clinical studies. These findings might have implications in the need for a nationwide database for future investigation and comparison

Kuwait acute coronary syndromes registry: baseline characteristics, management practices and in-hospital outcomes of patients hospitalized with acute coronary syndromes in Kuwait

To identify the characteristics of patients with acute coronary syndromes [ACS], their hospital management and in-hospital outcomes, through a prospective registry system in Kuwait. A registry involving all 7 general hospitals in Kuwait was set up. Consecutive patients diagnosed as having ACS over a period of 6 months were enrolled. Of 2,129 patients enrolled, 718 [34%] had ST segment elevation myocardial infarction [STEMI], 576 [27%] non-ST segment elevation myocardial infarction [NSTEMI] and 835 [39%] unstable angina [UA]. Thrombolytic therapy was used in 556 [77%] patients with STEMI. The median time from diagnostic electrocardiogram to administration of thrombolytic therapy was 38 min. Almost all patients with ACS [2,050, 96%] received aspirin during hospitalization. Only a minority received clopidogrel, 18 [3%] STEMI, 36 [6%] NSTEMI and 96 [12%] UA patients. The use of glycoprotein llb/llla antagonists was minimal [38 patients, 2%]. beta-blockers were used in 1,473 [69%] patients, while 982 [46%] received angiotensin-converting enzyme inhibitors. Coronary angiography during hospitalization was performed in 119 [17%], 120 [21%] and 126 [15%] patients with STEMI, NSTEMI and UA, respectively. In-hospital mortality occurred in 31 [4%] myocardial infarction patients and 4 [0.5%] UA patients [p < 0.0001]. This registry has enabled us to determine the incidence and characteristics of ACS patients in Kuwait. It has also enabled us to identify some barriers that we need to overcome for the full implementation of published guidelines for the management of patients with ACS

prevalence of atrial fibrillation among acute medical admissions in Kuwait

To establish the prevalence of atrial fibrillation [AF] among acute medical admissions to the Adan Hospital, Kuwait, and to evaluate the clinical features of the patients. Subjects and Of 2,833 acute medical admissions to the Adan Hospital from January 1 to May 31, 2003, 120 patients with AF were included in the study. The patients were divided into paroxysmal or persistent [PPAF], and chronic atrial fibrillation [CAF]. The prevalence of stroke and clinical features of the CAF patients with and without strokes were studied. All the patients with AF underwent echocardiography to evaluate left ventricular ejection fraction [LVEF] and left atrial dimension [LAD]. The prevalence of AF in the study period was 4.24%, of which 68.3% had CAF and 31.7% had PPAF. The prevalence of heart failure, ischemic heart disease, systemic hypertension, and diabetes mellitus was 27.5, 55.8, 65.8, and 53.3%, respectively. Patients with CAF were older and had a higher prevalence of heart failure compared to PPAF patients. Of the patients with CAF, 26.8% had at least one episode of stroke. The CAF patients had lower LVEF and larger LAD than PPAF patients. Stroke patients with CAF had lower LVEF and larger LAD as compared to those without stroke. Atrial fibrillation is a common admission diagnosis in our hospital. Patients with AF commonly suffer from heart failure, hypertension, diabetes mellitus, and ischemic heart disease. There was a high prevalence of stroke among CAF patients

Pharmacotherapy of systolic heart failure

Systolic heart failure is defined as heart failure due to left ventricular systolic dysfunction. It represents a major admission diagnosis, and carries a high rate of mortality and morbidity. Ischemic heart disease and systemic hypertension are the two most common causes of systolic heart failure. Moreover, lack of compliance with diet and/or drug therapy represents the most common cause of heart failure decompositions and hospital readmissions. The pharmacotherapy of systolic heart failure aims toward reduction of both mortality and morbidity. This includes angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, spironolactone, digitalis, and others. Moreover, a new modality of adjunctive therapy was recently introduced for severe heart failure i.e. cardiac resynchronization therapy

Reperfusion therapy for ST-segment elevation myocardial infarction: a review of the available treatment options in Kuwait

Acute myocardial infarction is currently classified into two broad categories of ST-segment elevation [STEMI] and non-ST-segment elevation [NSTEMI] myocardial infarction, based on electrocardiographic features at the time of presentation. This classification serves as an important factor determining the type of treatment a patient receives. Reperfusion therapy is currently the standard treatment for STEMI. There are two forms of reperfusion therapy, pharmacologic and mechanical. There is strong evidence that, when carried out in a timely fashion and in appropriate circumstances, mechanical reperfusion provides lower mortality and morbidity events compared to pharmacologic reperfusion. In this article we will review the pros and cons of each of the two reperfusion therapies and comment on the treatment options available to physicians in Kuwait