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Background: Outcomes of hospitalized patients with heart failure (HF) and characteristics of advanced HF stage may vary across left ventricular ejection fraction (LVEF) and world regions., Objectives: This study sought to analyze characteristics of hospitalized advanced HF patients across LVEF spectrum, world regions, and country income., Methods: Among 18,553 hospitalized patients with acute HF (7,902 new-onset HF and 10,651 decompensated chronic HF) enrolled in the global registry REPORT-HF (International Registry to Assess Medical Practice With Longitudinal Observation for Treatment of Heart Failure), the authors analyzed characteristics and outcomes of patients with advanced HF, defined as previously diagnosed HF; severe symptoms before current admission (NYHA functional class III/IV); and ≥1 HF-related hospitalization in the preceding 12 months, excluding the current. Differences among hospitalized advanced HF subgroups stratified by LVEF, world region, and country income were examined., Results: Among 6,999 patients with decompensated chronic HF and available previous NYHA functional class and HF hospitalization status, 3,397 (48.5%; 18.3% of the total population) had advanced HF. Of these, 44.5% had severely reduced (≤30%), 34.9% mildly/moderately reduced (31%-49%), and 20.7% preserved (≥50%) LVEF. Patients from Eastern Europe had the lowest 1-year mortality (23%), whereas those from Southeast Asia had the highest (37%). Patients from lower-middle-income countries were younger, with shorter HF duration and lower comorbidity prevalence, received fewer beta-blockers and HF-devices, and had higher 1-year mortality (34%) than upper-middle-income (26%) or high-income countries (27%; P = 0.018). Adjusted 1-year mortality risk did not differ among LVEF subgroups (all P > 0.05), nor did 1-year HF hospitalization rate (P = 0.56)., Conclusions: Hospitalized patients with advanced HF and preserved LVEF had similarly adverse outcomes as those with reduced LVEF. Patients from lower-middle-income countries had less implementation of HF therapies and higher 1-year mortality., Competing Interests: Funding Support and Author Disclosures Novartis Pharma AG sponsored REPORT-HF. The Steering Committee was responsible for the trial design and supervised patient recruitment and clinical management of the trial. Novartis Pharma AG oversaw data collection and management. The Steering Committee oversaw the analysis and interpretation of the data; preparation, review, and approval of the manuscript; and the decision to submit the manuscript for publication. Dr Bistola has received honoraria for lectures or Advisory Boards from AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, Pfizer, and Roche Diagnostics. Dr Farmakis has received lecture honoraria, consulting or Advisory Board fees and/or grants from AstraZeneca, Bayer, Boehringer Ingelheim, Leo, Myocardial Solutions, Novartis, Remedica, Roche Diagnostics, and Viatris, all outside the present work. Dr Tromp is supported by the National University of Singapore Start-up grant, the tier 1 grant from the Ministry of Education, and the Clinician Scientist–Individual Research Grant New Investigator Grant from the National Medical Research Council; has received research support from AstraZeneca and consulting or speaker fees from Daiichi-Sankyo, Boehringer Ingelheim, Roche Diagnostics and Us2.ai; and owns patent US-10702247-B2 unrelated to the present work. Dr Angermann has been a member of the Executive Committee of International Registry to Assess Medical Practice With Longitudinal Observation for Treatment of Heart Failure (REPORT-HF) and has received speaker honoraria, personal fees, and publication support from Novartis in the context of REPORT-HF; has received grant support from the German Ministry for Education and Research (grants 01GI0205 and 01GI1202A); and grant support, personal fees, and/or nonfinancial support from Abbott, AstraZeneca, Boehringer Ingelheim, Eli Lilly Company, Medtronic, Novo Nordisk, ResMed, Thermo Fisher, and Vifor, all outside of the submitted work. Dr Dahlström has received research grants from Pfizer, AstraZeneca, Vifor Pharma, Boehringer Ingelheim, Boston Scientific, and Roche Diagnostics and honoraria/consultancies from AstraZeneca, Pfizer, and Amgen, all outside the submitted work. Dr Ghadanfar is a former employee of Novartis Pharma AG and owns Novartis shares. Dr Schweizer is an employee of Novartis Pharma AG and owns Novartis shares. Dr Collins has received research support from the National Institutes of Health, Patient-Centered Outcomes Research Institute, U.S. Department of Defense, and Beckman Coulter and consulting fees from Abbott, Redesign Health, and Reprieve Cardiovascular, Inc. Dr Lam has been supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from Novo Nordisk and Roche Diagnostics; has served as consultant or on the Advisory Board/Steering Committee/Executive Committee for Alleviant Medical, Allysta Pharma, AnaCardio AB, Applied Therapeutics, AstraZeneca, Bayer, Biopeutics, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, CardioRenal, Cytokinetics, Darma Inc, EchoNous Inc, Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Ionis Pharmaceutical, Janssen Research & Development LLC, Medscape/WebMD Global LLC, Merck, Novartis, Novo Nordisk, Prosciento Inc, Quidel Corporation, Radcliffe Group Ltd, Recardio Inc, ReCor Medical, Roche Diagnostics, Sanofi, Siemens Healthcare Diagnostics, and Us2.ai; and serves as cofounder and nonexecutive director of Us2.ai. Dr Filippatos has received lecture fees and/or Advisory and/or Trial Committee membership from Bayer, Boehringer Ingelheim, Servier, Novartis, Impulse Dynamics, Vifor, Medtronic, Cardior, and Novo Nordisk and research grants from the European Union. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Atrial fibrillation (AF) and heart failure (HF) each contributes to global disease burden and can coexist. The interplay of prior HF, prior AF, and presenting rhythm have not previously been jointly considered in prognostic implication., Objective: The authors sought to assess 1-year all-cause mortality according to permutations of prior HF, prior AF, and AF as presenting rhythm, in a global cohort of patients hospitalized for HF., Methods: The REPORT-HF registry enrolled patients during hospitalization for acute HF from 44 countries over 6 continents. Cox proportional hazard models were used to compute HRs for the primary outcome of 1-year all-cause mortality., Results: Of 13,401 participants (median age 67 years, 61% men), 58% had prior HF. AF prevalence (prior or newly detected) at HF admission was 39%, varying by LVEF and race subgroups. Compared with patients with no prior HF, no prior AF, and presenting in sinus rhythm, 1-year all-cause mortality was elevated in patients with prior HF, prior AF, and presenting in AF (adjusted HR: 1.54; 95% CI: 1.34-1.78; P < 0.001) and in patients with prior HF, no prior AF, and presenting in AF (adjusted HR: 1.51, CI: 1.20-1.90, P < 0.001), but not in patients with no prior HF and with prior AF or presenting in AF. These results were conserved across LVEF and race subgroups., Conclusions: In a global cohort of patients hospitalized for HF, permutations of prior HF, prior AF, and AF as presenting rhythm differentiate outcome. History of prior HF influences the prognostic implications of AF in patients hospitalized for HF. (Global Noninterventional Heart Failure Disease Registry [REPORT-HF]; NCT02595814)., Competing Interests: Funding Support and Author Disclosures REPORT-HF is sponsored by Novartis Pharma. Dr Chyou is supported by a research grant from the American Heart Association; and has received consulting fees from Medtronic. Dr Tromp is supported by a National University of Singapore Start-up grant, a Tier 1 Grant from the Ministry of Education, and a CS-IRG New Investigator Grant from the National Medical Research Council; has received consulting and speaker fees from Daiichi-Sankyo, Boehringer Ingelheim, Roche Diagnostics, and Us2.ai; and owns patent US-10702247-B2 unrelated to the present work. Dr Ouwerkerk has an advisory role at Us2.ai. Dr Yiu has received research grants from Novartis. Dr Cleland has received grants from the British Heart Foundation and the National Institute of Health Research; personal fees from Abbott; support for manuscript submission from Bristol Myers Squibb; personal fees from Novartis, Medtronic, and Idorsia, Pharmacosmos, CSL-Vifor, Servier, Boehringer Ingelheim, Astra-Zeneca, Biopeutics, Innolife, Moderna, and Viscardia; personal fees and nonfinancial support from NI Medical; stock options from Heartfelt Technologies; and grants from Pharmacosmos, CSL-Vifor, Viscardia, and Innolife. Dr Collins has received consulting fees from from Reprieve Cardiovascular, Abbott, and Siemens; and has received research support from the National Institutes of Health, the Patient-Centered Outcomes Research Institute, the Department of Defense, and from Beckman Coulter. Dr Angermann has received grant support, personal fees, and nonfinancial support from Abbott, AstraZeneca, Boehringer Ingelheim, Medtronik, Novartis, Novo Nordisk, Radcliffe Group Ltd, and Vifor Pharma, all outside the submitted work; and has received nonfinancial support from the University Hospital Würzburg and the Comprehensive Heart Failure Center Würzburg; and grant support from German Ministry for Education and Research. Dr Ertl has received consulting fees from AstraZeneca, Novartis, Vivor, and Abbott. Dr Dahlström has received grants from Pfizer, Boehringer Ingelheim, Vifor, AstraZeneca, Boston Scientific, and Roche Diagnostics; and honoraria and consultancies from Pfizer, Amgen, and AstraZeneca, all outside the submitted work. Dr Ghadanfar is a former Novartis employee. Drs Schweizer and Obergfell are employees of Novartis and own Novartis shares. Dr Filippatos has received support from the European Commission and payments and honoraria from Bayer and Boehringer Ingelheim; and has served as committee member and on data safety and monitoring boards for Medtronic, Bayer, Boehringer Ingelheim, Vifor, Amgen, Servier, Impule Dynamics, and Novartis. Dr Lam is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from Novo Nordisk and Roche Diagnostics; has served as consultant or on advisory boards, steering committees, or executive committees for Alleviant Medical, Allysta Pharma, Amgen, AnaCardio AB, Applied Therapeutics, Astra-Zeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, CardioRenal, Cytokinetics, Darma, EchoNous, Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Ionis Pharmaceutical, Janssen Research & Development, Medscape/WebMD Global, Merck, Novartis, Novo Nordisk, Prosciento, Quidel Corporation, Radcliffe Group, Recardio, ReCor Medical, Roche Diagnostics, Sanofi, Siemens Healthcare Diagnostics, and Us2.ai; and serves as co-founder and nonexecutive director of Us2.ai. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Heart Failure (HF) quality of care (QoC) is associated with clinical outcomes. Therefore, we investigated differences in HF QoC across worldwide regions (with differing national income) and the association of quality indicators with outcomes., Methods: We examined the quality of care (QoC) in acute heart failure (HF) patients across different regions using quality indicators (QIs) from the European Society of Cardiology (ESC) and the American Heart Association (AHA) to evaluate QoC. The analysis included 17,632 patients enrolled from 358 medical centres in 44 countries between 23 July 2014 and 24 March 2017, all part of the prospective REPORT-HF cohort study. We investigated how QoC varied by region and its relationship with mortality rates at 30 days and 1 year after hospital discharge. For each QI, percentage attainment of QI among eligible patients was calculated and compared across regions., Findings: Among 17,632 patients (median age: 67 years; 61% women) followed up for a median of two years, we assessed 16 QIs. QIs that were least often achieved included measurement of natriuretic peptides, performance of echocardiography, treatment with guideline medical therapy, and a scheduled follow-up consultation after discharge. QI achievement was significantly lower in lower-than higher-income countries. Higher (≥50% vs. <50%) achievement of cumulative QIs was associated with lower 30-day (hazard ratio [HR] 0.58, 95% Confidence Interval [CI] 0.40-0.83; p < 0.001), and 1-year mortality (HR 0.58, 95% CI 0.50-0.68; p < 0.001)., Interpretation: QoC is lower in lower-than higher-income countries and lower QoC is associated with worse outcomes. Improving QoC by addressing structural barriers and quality improvement programs may improve the outcomes of patients with HF., Funding: Novartis., Competing Interests: CSPL is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has Received research support from NovoNordisk and Roche Diagnostics; has Served as consultant or on the Advisory Board/Steering Committee/Executive Committee for Alleviant Medical, Allysta Pharma, AnaCardio AB, Applied Therapeutics, AstraZeneca, Bayer, Biopeutics, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, CardioRenal, Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Ionis Pharmaceutical, Janssen Research & Development LLC, Medscape/WebMD Global LLC, Merck, Novartis, Novo Nordisk, Prosciento Inc, Quidel Corporation, Radcliffe Group Ltd., Recardio Inc, ReCor Medical, Roche Diagnostics, Sanofi, Siemens Healthcare Diagnostics and Us2.ai; and serves as co-founder & non-executive director of Us2.ai. Patents issued or pending: Patent pending: PCT/SG2016/050217 (Method for diagnosis and prognosis of chronic heart failure); US Patent No. 10,702, 247 (Automated clinical workflow that recognizes and analyses 2-dimensional and Doppler echo images for cardiac measurements and the diagnosis, prediction and prognosis of heart disease). JT is supported by the National University of Singapore Start-up grant, the tier 1 grant from the Ministry of Education and the CS-IRG New Investigator Grant from the National Medical Research Council; has received research support from AstraZeneca and consulting or speaker fees from Daiichi-Sankyo, Boehringer Ingelheim, Roche diagnostics and Us2.ai. Patent holder of US-10702247-B2. Stock options in Us2.ai. JGFC reports personal fees from Amgen, grants and personal fees from Bayer, grants and personal fees from Bristol Myers Squibb, personal fees from Novartis, personal fees from Medtronic, personal fees from Idorsia, grants and personal fees from Vifor, grants and personal fees from Pharmacosmos, grants and personal fees from Cytokinetics, personal fees from Servier, personal fees and nonfinancial support from Boehringer Ingelheim, personal fees from AstraZeneca, personal fees from Innolife, personal fees from Torrent, grants and personal fees from Johnson & Johnson, grants and personal fees from Myokardia, personal fees from Respicardia, grants and personal fees from Stealth Biopharmaceuticals, grants and personal fees from Viscardia, personal fees from Abbott, outside the submitted work. UD reports research support from AstraZeneca, Pfizer, Boehringer Ingelheim, Vifor pharma, Roche Diagnostics, Boston Scientific and speaker's honoraria, and consultancies from AstraZeneca. SPC reports research grants from NIH, PCORI, and consulting fees from Reprieve Cardiovascular, Tosoh, Prenosis, Abbott, Boehringer Ingelheim, Corteria and holds stocks for Reprieve Cardiovascular, Inc and Prenosis. AO is a former employee of Novartis and holds Novartis stocks. GF reports grants from the European Commission; payments or honoraria from Boehringer Ingelheim and Bayer; committee membership involving Medtronic, BAYER, Boehringer Ingelheim, Vifor, Amgen and Novonordisc. AS is employed by Novartis and own shares in the company. WO has consulted for Us2.ai. Patent holder of US-10702247-B2. Stock options in Us2.ai. CA holds a grant from the German Ministry of Education & Research, and received consultancy fees from Abbott, AstraZeneca, Boehringer Ingelheim & Lilly Company, Medtronic, NovoNordisk, Novartis, ResMed, ThermoFisher. Vifor, Boehringer Ingelheim and Vifor. GE received fees from AstraZeneca and stock in Bayer, Sanofi AG and Siemens. The remaining authors have nothing to disclose., (© 2024 The Author(s).)