In-Hospital Management and Long-term Clinical Outcomes and Adherence in Patients With Acute Decompensated Heart Failure: Primary Results of the First Brazilian Registry of Heart Failure (BREATHE).

• BREATHE was the first nationwide registry in Brazil that included patients hospitalized due to acute HF. • Almost 28% of patients were hospitalized due to poor adherence to HF medications. • Less than half of the patients with LVEF < 40% used beta-blockers, renin-angiotensin-aldosterone inhibitors and spironolactone concomitantly at hospital discharge. • The mortality rate at 12 months was 28.9/100 patient-years, with 26.2% readmission at 90 days and 46.4% at 12 months. • Our findings should guide the implementation of quality-improvement interventions to help close the gap between scientific evidence and clinical practice in HF. Heart failure (HF), a common cause of hospitalization, is associated with poor short-term clinical outcomes. Little is known about the long-term prognoses of patients with HF in Latin America. BREATHE was the first nationwide prospective observational study in Brazil that included patients hospitalized due to acute heart failure (HF). Patients were included during 2 time periods: February 2011–December 2012 and June 2016–July 2018 In-hospital management, 12-month clinical outcomes and adherence to evidence-based therapies were evaluated. A total of 3013 patients were enrolled at 71 centers in Brazil. At hospital admission, 83.8% had clear signs of pulmonary congestion. The main cause of decompensation was poor adherence to HF medications (27.8%). Among patients with reduced ejection fraction, concomitant use of beta-blockers, renin-angiotensin-aldosterone inhibitors and spironolactone decreased from 44.5% at hospital discharge to 35.2% at 3 months. The cumulative incidence of mortality at 12 months was 27.7%, with 24.3% readmission at 90 days and 44.4% at 12 months. In this large national prospective registry of patients hospitalized with acute HF, rates of mortality and readmission were higher than those reported globally. Poor adherence to evidence-based therapies was common at hospital discharge and at 12 months of follow-up. [Display omitted] [ABSTRACT FROM AUTHOR]