Evaluation of the acute heart failure patient: Assessment of dyspnea and other physical examination parameters

The Acute Decompensated Heart Failure National Registry (ADHERE^TM)1 is an industrysponsored, large, national, observational, multicenter study of the characteristics, patterns of care, and outcomes of patients hospitalized with ADHF. As of July 2003, 263 representative hospitals from across the United States-including large and small, as well as academic and community, siteshave enrolled patients who were admitted to an acute care hospital and had a discharge diagnosis of heart failure. In the most recent 12-month report, 2 the results from 58 919 discharges are presented, demonstrating that 89% of patients presented with dyspnea, 36% with dyspnea at rest, and 32% presented with fatigue. Information regarding other symptoms is not available in the report, and hopefully more complete details will be described in upcoming publications, but the report clearly establishes the primacy of dyspnea as a presenting symptom in these patients.