Data From Registry Also Identify a Key Mortality Risk Factor in Acute Heart
Failure
ORLANDO, Fla. and FREMONT, Calif., Nov. 12 /PRNewswire/ -- Data from the
world's largest heart failure registry known as ADHERE(TM) (Acute
Decompensated Heart Failure National Registry) identified that a blood test
indicative of kidney failure is the best predictor of in-hospital mortality.
The study also showed that early use of intravenous (IV) vasoactive agents in
acute heart failure patients can significantly lower mortality when compared
with early use of inotropic agents. These data were presented at the American
Heart Association's Scientific Sessions 2003 in Orlando.
More than one million hospitalizations of patients with acute congestive
heart failure as a primary diagnosis occur in the United States each year.
This translates into a health-care system cost of $15 billion. Congestive
heart failure accounts for the greatest number of hospitalizations of patients
over the age of 65.
"The ADHERE National Registry is filling gaps in knowledge about acute
heart failure patient treatment and identifying strategies for better patient
outcomes," said Gregg C. Fonarow, M.D. "For the first time, clinicians have a
practical bedside tool to help identify acute heart failure patients who are
at risk for mortality."
ADHERE is a first-of-its-kind national registry that prospectively
collects observational data from across the United States in order to track
and study the medical management of patients hospitalized with acute heart
failure. The ADHERE National Registry is sponsored by Scios and overseen by an
independent scientific advisory committee of nationally recognized heart
failure experts. To date, more than 275 hospitals and more than
100,000 patient cases have been entered into The ADHERE Registry, making it
the largest, most extensive registry of its kind.
Maria Rosa Costanzo, M.D. of Midwest Heart Specialists in Naperville, IL,
presented a study showing that early use of intravenous (IV) vasoactive agents
in acute heart failure patients can significantly lower mortality when
compared with early use of inotropic agents. Dr. Costanzo's presentation,
titled Evaluation of In-Hospital Mortality in Patients Treated for Acute Heart
Failure Within the First 24 Hours with Nesiritide vs. Other Vasoactive or
Inotropic Agents (AHA #3160), evaluated ADHERE Registry data to compare the
effects of IV vasoactive agents, nesiritide and nitroglycerin, against effects
of inotropic agents, milrinone and dobutamine, on in-hospital acute heart
failure patient mortality.
Predictors of patient mortality were identified using classification and
regression tree modeling (CART) on 46,599 acute heart failure patients from
the ADHERE Registry. Mortality odds were then calculated for patients who
received IV vasoactive agents (nesiritide and nitroglycerin) and positive
inotropic agents (dobutamine and milrinone) within the first 24-hours of
hospital admission. When these mortality odds were adjusted for demographic
variables (age, gender and race) and statistically analyzed, the results
showed that the IV vasoactive agents, nesiritide and nitroglycerin, were more
effective in treating acute heart failure patients than the positive inotropic
agents dobutamine and milrinone.
"Standard therapy with parenteral inotropic agents for acute decompensated
heart failure has been shown in previous studies to be harmful," said Dr.
Costanzo. "This analysis of ADHERE data confirms previous studies in that
regard, but also shows that early use of IV vasodilators is effective
treatment that should be used at hospital admission to treat patients with
acute heart failure."
Noting that no clinically practical method existed to identify acute heart
failure patients at risk for mortality, Gregg C. Fonarow, M.D., the Eliot
Corday Chair in Cardiovascular Medicine and Science, Director of the
Ahmanson-UCLA Cardiomyopathy Center and Professor of Medicine at UCLA,
presented a study showing how ADHERE Registry data can be used to develop a
mortality risk assessment tree. The study, titled Risk Stratification for
In-Hospital Mortality in Heart Failure Using Classification and Regression
Tree (CART) Methodology: Analysis of 33,046 Patients in ADHERE (AHA #3151),
used classification and regression tree (CART) methodology to analyze ADHERE
Registry data from 33,046 patients from 250 hospitals and develop a mortality
decision tree. The analysis indicated that the best single predictor of
mortality was a high concentration (>43 mg/dL) of BUN (blood urea nitrogen) in
patients' blood. The next most useful predictor appeared to be low admission
SBP (systolic blood pressure <115mmHg) followed by high creatinine (>2.75
mg/dl). The study concluded that acute heart failure patients at low, medium
and high risk for in-hospital mortality may be identified using vital sign and
lab data obtained on hospital admission.
"CART statistical analysis allowed us to identify and construct an ADHERE
risk decision tree that may provide clinicians with a practical beside tool to
help identify acute heart failure patients at risk for mortality and target
them with more appropriate therapy," said Dr. Fonarow.
About ADHERE
The ADHERE Registry Core Module was launched in October 2001. It is a
multicenter, observational, open-label registry of the management of patients
treated in the hospital for acutely decompensated congestive heart failure
(CHF). The Registry is a large clinical database that utilizes information
collected from acute care hospitals across the United States. This first-of-
its-kind registry is designed to help the medical community better understand
acute CHF, improve its management and enhance quality of care. Data regarding
current management and treatment trends is collected from The Registry and
analyzed on a quarterly basis. These data and insights can be used by
individual hospitals to develop guidelines and protocols and increase the use
of evidence-based therapies to improve the standard of care among heart
failure patients, and potentially reduce costs.
To learn more about The ADHERE Registry, call 866-616-2993, or e-mail
adhereinfo@sciosinc.com, or visit http://www.adhereregistry.com.
About Acute Heart Failure
During an episode of acute heart failure, the heart's ability to circulate
blood adequately throughout the body worsens to the point where
hospitalization is necessary to stabilize the patient's condition. A sudden
increase in salt in a person's diet, a patient's failure to take prescribed
oral medications or the development of a new heart problem can cause these
acute episodes. Virtually all congestive heart failure patients will
experience at least one acute episode severe enough that only intravenous
medications administered in the hospital can improve a patient's condition.
More than one million hospitalizations of patients with acute congestive
heart failure as the primary diagnosis occur in the United States each year.
This translates into a health-care system cost of $15 billion. Another two
million Americans are hospitalized annually with acute congestive heart
failure as a secondary diagnosis. Congestive heart failure accounts for the
greatest number of hospitalizations of patients over the age of 65.
Scios Inc.
Scios, a Johnson & Johnson company, is a biopharmaceutical company
headquartered in Fremont, California. Scios is developing novel treatments for
cardiovascular and inflammatory disease. The Company's disease-based
technology platform integrates expertise in protein biology with computational
and medicinal chemistry to identify novel targets and rationally design small
molecule compounds for markets with unmet medical needs.
SOURCE Scios Inc.
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Related links:
http://www.sciosinc.com
CONTACT:
Chris L. Bing of Scios Inc., +1-415-710-9445;
or Karin Bauer Aranaz of WeissCom Partners, Inc.,
+1-415-859-3414, for Scios Inc.
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