Predictors of in-hospital mortality in acute decompensated heart failure (Thai ADHERE).

BACKGROUND: Heart failure had emerged as a major public health problem and became the leading cause of hospitalization. The Acute Decompensated Heart Failure National Registry (ADHERE) of US patients hospitalized with a primary diagnosis of acute decompensated heart Failure (ADHF) had been reported worldwide for the risk stratification and predicting In-hospital mortality. OBJECTIVE: Identify clinical risk factors or treatment procedures that could predict In-hospital mortality in Thai patients with ADHF. MATERIAL AND METHOD: Thai ADHERE is a multicenter, observational, prospective study. The data were collected via web-based electronic data capture and analyzed. Two thousand forty one hospitalization episodes involving 1,671 patients in the 18 participating hospitals between March 2006 and September 2007 were analyzed. All clinical factors associated with In-hospital mortality identified by univariated analysis were further analyzed by Logistic regression model. RESULTS: One hundred thirteen patients died during the hospitalization period with overall mortality rate of 5.5%. Systolic blood pressure < 90 mmHg, creatinine > 2.0 mg/dL, history of stroke/TIA, and NYHA class IV were independent risk factors for In-hospital mortality with adjusted OR (95% CI) = 3.45 (1.77-6.79), 1.99 (1.30-3.05), 1.85 (1.11-3.08) and 1.69 (1.08-2.64) respectively. Hypertensive cause of CHF, prior use of lipid lowering drug, and hemoglobin level were associated with lower risk, adjusted OR (95% CI) = 0.35 (0.15-0.81), 0.51 (0.34-0.78) and 0.90 (0.82-0.98) respectively. CONCLUSION: The clinical predictors for In-hospital mortality of Thai ADHERE that associated with worse outcome were systolic blood pressure < 90 mmHg, creatinine > 2.0 mg/dL, history of stroke/TIA, and NYHA class IV. Hypertensive cause of CHF, prior use of lipid lowering drug, and hemoglobin were associated favorable outcome.

Ten-year survival and factors associated with increased mortality in patients admitted for acute decompensated heart failure in Thailand.

INTRODUCTION: Data on the long-term outcomes of Asian patients admitted for acute decompensated heart failure is scarce. The objectives of this study were to determine short-term, intermediate-term and long-term survival among patients admitted for acute decompensated heart failure in Thailand, and to identify factors independently associated with increased mortality. METHODS: Patients who were admitted with a primary diagnosis of heart failure were enrolled in the Thai Acute Decompensated Heart Failure Registry (ADHERE) from 18 hospitals located across Thailand during 2006. Medical record data was collected according to ADHERE protocol. Mortality data was collected from death certificates on file at the Thailand Bureau of Registration Administration. RESULTS: A total of 1,451 patients were included. The mean age of the patients was 63.7 ± 14.4 years, and 49.7% were male. One-year, five-year and ten-year mortality rates in Thai patients admitted for acute decompensated heart failure were 28.0%, 58.2% and 73.3%, respectively. Independent predictors of increased mortality were identified. There were more cardiovascular-related deaths than non-cardiovascular-related deaths (54.6% vs. 45.4%, respectively). CONCLUSIONS: The ten-year mortality rate in Thai patients admitted for acute decompensated heart failure was 73.3%. Many factors were found to be independently associated with increased mortality, including left ventricular ejection fraction.

Efficacy and safety of atorvastatin 10 mg every other day in hypercholesterolemia.

OBJECTIVES: The authors sought to evaluate the safety and efficacy of atorvastatin administered every other day in patients with hypercholesterolemia. BACKGROUND: Statins have efficacy in lowering cholesterol and reducing cardiovascular events but their cost is a major disadvantage. Atorvastatin is the most potent statin and has a long half-life. Therefore, atorvastatin given on alternate days may be reasonable and cost effective, particularly in hypercholesterolemia patients. METHOD AND RESULT: Sixty patients with hypercholesterolemia despite diet therapy were enrolled into the study. They received atorvastatin 10 mg every other day before bedtime. Duration of treatment was 8 weeks. A lipid profile was determined as baseline, at 4 weeks and again at 8 weeks. Atorvastatin every other day significantly reduced total cholesterol (TC), triglyceride (TG), and LDL-c versus baseline. The TC, TG, and LDL-c levels were lower by 23 per cent, 8 per cent, and 30 per cent. Increase in HDL-c level was not statistically significant. Three patients had drug side effects. One patient had increased serum transaminase and one patient had increased serum muscle enzyme. The other one had somnolence. CONCLUSIONS: In hypercholesterolemia patients, atorvastatin 10 mg every other day is safe and effective in lowering TC, TG, with LDL-c and a slight increase in HDL-c.