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compared those registries data with ADHERE, Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) and Euro Heart Failure Survey (EHFS) II database. Method: We analyzed characteristics and managements in 217 consecutive patients from hospital based ADHF registry database in a single National Cardiovascular Center in Japan. Results: In characteristics, age, serum BNP level and creatinine level were similar between four databases, but we had more patients with systolic dysfunction, hypotension and cardiomyopathy, and less frequently had COPD or asthma in Japan. There is considerable difference was seen in the use of inotrope and vasodilator. In the US, fewer patients were treated with inotropic agent or nitroglycerin as vasodilator than those in Japan or Europe. Especially in Japan, more than one third of patients were treated with human natriuretic peptide which has similar pharmacological effect as Nesiritide.