Heart failure in patients hospitalized with acute coronary syndromes: observations from the Gulf Registry of Acute Coronary Events (Gulf RACE)

We describe the prevalence and prognostic significance of heart failure (HF) complicating acute coronary syndromes (ACS) in patients enrolled in the Gulf Registry of Acute Coronary Events (Gulf RACE). Gulf RACE is a prospective, multi-national study of all patients hospitalized with ACS in 65 centres in six Arab countries. Data were analysed based on HF on presentation (Killip class II/III) or during hospital stay. The study endpoint was all-cause in-hospital mortality. Of 8000 patients with ACS, 2009 (25%) had HF on presentation or during the hospital stay. Patients with HF were older, more often with co-morbid conditions, and less often treated with evidence-based therapies. Heart failure was associated with higher in-hospital mortality (7.9 vs. 0.9%, P < 0.001), which persisted after adjusting for age, gender, and presentation and treatment characteristics [adjusted odds ratio 4.1 (1.8-9.4)]. There was a significant interaction between age and the prognostic effect of HF on in-hospitality mortality, such that younger patients had a significantly higher increase in mortality related to HF (P for interaction = 0.002). Heart failure complicates a substantial proportion of ACS admissions in the Arab Middle East and is associated with higher in-hospital death. Younger patients with ACS have a higher relative increase in mortality related to HF.