Management of heart failure complicating acute coronary syndromes in Montenegro and Serbia

It is essential that context-appropriate health research and health interventions take place in countries with economy in transition. The aims of this study were to describe the clinical characteristics, management, and in-hospital outcomes of acute coronary syndrome (ACS) patients with heart failure (HF) in Montenegro and Serbia. The data of this study are a framework of the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC; NCT01218776), a multi-national and multicentre registry of patients hospitalized with ACS in the European countries that emerged from the Socialist era. The present analysis focused on participants admitted to 15 hospitals in Montenegro and Serbia with a diagnosis of ACS during the period between October 2012 and August 2013. Among 1115 patients, 94 (8.4%) had an admission diagnosis of HF (Killip Class II or III). Heart failure patients were significantly older (P < 0.001). Heart failure was more frequently associated with hypertension. When compared with patients presenting without HF (Killip Class I), those with HF had lower rates of reperfusion therapy either by percutaneous coronary intervention (47.9 vs. 60.7%, P = 0.015) or by fibrinolysis (2.1 vs. 11.8%, P = 0.004). In multivariate logistic regression analysis, older age, prior coronary artery bypass graft, and ST-segment elevation myocardial infarction were the relevant predictor of HF at admission. Heart failure on admission was associated with a marked increase in mortality rates during hospitalization (13.8 vs. 3.7%, P < 0.001). After adjustment for differences in clinical characteristics, HF was still associated with higher mortality (odds ratio 2.88, 95% confidence interval 1.22–6.79, P = 0.016). Heart failure is observed in nearly 9% of patients with ACS in Serbia and Montenegro and is also associated with a significant increase in in-hospital mortality. More aggressive treatment of these patients is warranted to improve prognosis.