Current epidemiology and management of acute heart failure: the multicenter prospective OFICA2 cohort

Acute heart failure (AHF) represents a major cause of morbi-mortality. In the last decade, the management of HF has changed, but up-to-date real-life data are scarce. The aim of our study was to describe contemporary data about AHF patients' medical pathway, management and to identify predictors of in-hospital outcomes.

OFICA2 is a French prospective multicenter cohort led from March to April 2021 in 80 participating centres. In-hospital outcomes were defined as a composite of all-cause death, cardiogenic shock or transfer to intensive care unit. A total of 1513 consecutive patients (mean age 76 years, 61% male) hospitalized for AHF were included. One in five patients was not admitted in cardiology wards. A triggering factor was identified in 70% of cases, mostly supraventricular arrhythmia (21%). Median hospital stay was 11 days, and in-hospital mortality was 4.6%. Predictive factors of worse outcomes were a younger age, an initial acute coronary syndrome, a ventricular arrhythmia, a left ventricular ejection fraction (LVEF) ≤ 40%, a lower systolic blood pressure, a worse kidney function, and a higher C-reactive protein level on admission. At discharge, 61% of patients had an appointment scheduled with a cardiologist, 1 out of 4 patients with LVEF ≤ 40% had a combination of beta-blocker, renin-angiotensin system blocker and mineralocorticoid receptor antagonist, while 12% had no HF medication.

This comprehensive survey about patients hospitalized with AHF emphasizes HF care pathway, medical therapies and follow-up as weak spots. Filling these gaps might improve patients' management and prognosis.