Advancements and Challenges in Acute Heart Failure Management in Korea: Initial Report and Insights from the Korean Heart Failure III Registry

Background: Heart failure (HF) is a major global health burden. Building on 2 previous national registries, the Korean Heart Failure III (KorHF III) registry provides a contemporary evaluation of clinical characteristics, treatment patterns, and outcomes in patients hospitalized with acute HF (AHF) in Korea. Methods and Results: KorHF III prospectively enrolled 7351 patients with AHF from 47 tertiary hospitals between March 2018 and December 2022, with a 2-year follow-up. HF with reduced ejection fraction accounted for 57.3% of all cases. Common comorbidities included hypertension (59.5%) and diabetes (40.0%). The most frequent etiologies were ischemic heart disease (27.7%) and dilated cardiomyopathy (24.9%). At discharge, 74.3% of patients received angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor–neprilysin inhibitors; 68.5% received beta-blockers; and 57.4% received mineralocorticoid receptor antagonists. Prescriptions of sodium-glucose cotransporter 2 inhibitor were 15.8%. In-hospital mortality was 2.2%, and 2-year mortality was 20.9%, greatest among patients with HF with preserved ejection fraction (24.6%). Hyponatremia was independently associated with in-hospital (hazard ratio 2.50, P < .001) and postdischarge mortality (HR 1.72, P < .001). Conclusions: KorHF III provides the most comprehensive and current assessment of AHF in Korea. Despite high prescription rates of guideline-directed medical therapy and low in-hospital mortality, long-term mortality is substantial. These findings emphasize the need for improved postdischarge care and highlight hyponatremia as a key prognostic factor in AHF management.