Advancements and Challenges in Acute Heart Failure Management in Korea: Initial Report and Insights from the Korean Heart Failure III Registry.

BACKGROUND

Heart failure (HF) is a major global health burden. Building on 2 previous national registries, the Korean Heart Failure III (KorHF III) registry provides a contemporary evaluation of clinical characteristics, treatment patterns, and outcomes in patients hospitalized with acute HF (AHF) in Korea.

METHODS AND

RESULTS

KorHF III prospectively enrolled 7351 patients with AHF from 47 tertiary hospitals between March 2018 and December 2022, with a 2-year follow-up. HF with reduced ejection fraction accounted for 57.3% of all cases. Common comorbidities included hypertension (59.5%) and diabetes (40.0%). The most frequent etiologies were ischemic heart disease (27.7%) and dilated cardiomyopathy (24.9%). At discharge, 74.3% of patients received angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors; 68.5% received beta-blockers; and 57.4% received mineralocorticoid receptor antagonists. Prescriptions of sodium-glucose cotransporter 2 inhibitor were 15.8%. In-hospital mortality was 2.2%, and 2-year mortality was 20.9%, greatest among patients with HF with preserved ejection fraction (24.6%). Hyponatremia was independently associated with in-hospital (hazard ratio 2.50, P < .001) and postdischarge mortality (HR 1.72, P < .001).

CONCLUSIONS

KorHF III provides the most comprehensive and current assessment of AHF in Korea. Despite high prescription rates of guideline-directed medical therapy and low in-hospital mortality, long-term mortality is substantial. These findings emphasize the need for improved postdischarge care and highlight hyponatremia as a key prognostic factor in AHF management.