Reassessing treatment of acute heart failure syndromes: The ADHERE Registry

Acute heart failure syndromes (AHFS) are the leading cause of hospitalisation in persons aged over 65 years, costing an estimated $12.7 billion per year in the United States alone. Acute Decompensated Heart Failure National Registry (ADHERE) was established in the United States in 2001, and now represents the largest database on acute heart failure in the world, with over 100000 patients enrolled to date. The first analyses of data from the registry are now in the public domain, and offer useful insights into the characteristics, management, and outcomes of AHFS patients. The 'real-life' patient population represented in ADHERE is older, contains more women, and has a higher incidence and complexity of co-morbidities than individuals studied in clinical trials. Patient management varies substantially, and often does not utilize the full range of technical resources and clinical knowledge available. It is also notable that among patients admitted with worsening chronic heart failure, at least one-third are not receiving well-established life-saving medications. The information gathered so far by ADHERE has highlighted key areas for improvement in the management of both acute and chronic heart failure.