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 two prior 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 7,351 AHF patients from 47 tertiary hospitals between March 2018 and December 2022, with a 2-year follow-up. HF with reduced ejection fraction (HFrEF) accounted for 57.3% of 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 (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNIs); 68.5% received beta-blockers; and 57.4% received mineralocorticoid receptor antagonists (MRAs). Sodium-glucose cotransporter 2 inhibitor prescription was 15.8%. In-hospital mortality was 2.2%, and 2-year mortality was 20.9%, highest among patients with HF with preserved ejection fraction (HFpEF, 24.6%). Hyponatremia was independently associated with in-hospital (hazard ratio [HR] 2.50, p<0.001) and post-discharge mortality (HR 1.72, p<0.001).

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

Lay Summary: This study looked at how patients with acute heart failure (AHF) are being treated in Korea today. Over 7,000 people who were admitted to 47 hospitals between 2018 and 2022 were included. The goal was to better understand their health conditions, treatments, and survival after leaving the hospital. The study found that care inside hospitals has improved. Death rates during hospital stays were low (2.2%), and many patients received recommended medications for heart failure. However, the study also showed that many patients still faced serious risks after they left the hospital. Within two years, about 1 in 5 patients had died, especially those with more complex conditions like kidney problems or low sodium levels. These results show that Korea has made progress in treating heart failure in hospitals, but more attention is needed to support patients after they go home. Better follow-up care and long-term treatment plans may help improve survival and quality of life.