SMILE-HF registry: contemporary management, frailty profile, and 12-month outcomes of acute heart failure in Korea

초록

Background: Contemporary data on acute heart failure (AHF) care in Korea, particularly regarding frailty burden and phenotype-specific management, remain limited. The SMILE-HF registry is a prospective, multicenter cohort established to evaluate clinical characteristics, discharge pharmacotherapy patterns, and outcomes in hospitalized AHF patients. Methods: SMILE-HF prospectively enrolled consecutive patients hospitalized for AHF across 10 Korean centers between September 2019 and December 2023. Collected data included baseline characteristics, AHF etiology, echocardiographic parameters, and discharge guideline-directed medical therapy (GDMT). Patients were stratified by left ventricular ejection fraction (LVEF) as HFrEF (≤40%), HFmrEF (40– 49%), or HFpEF (≥50%). When available, frailty and functional status were assessed using the 6-minute walk test (6MWT), Korean MMSE (K-MMSE), PHQ-9, and cardiopulmonary exercise testing (CPET). The primary 12-month outcomes were all-cause mortality and heart failure rehospitalization. Results: Among 1,976 patients (mean age 68.8±15.4 years; 58.6% male), LVEF was available in 1,974 cases: HFrEF 50.1%, HFmrEF 18.2%, and HFpEF 31.8%. At discharge, ACEI/ARB/ARNI use was 77.0%, β-blockers 67.8%, MRAs 52.5%, and SGLT2 inhibitors 28.1%. Marked differences in the uptake of newer therapies were observed by phenotype (ARNI: 45.5% in HFrEF vs. 12.8% in HFmrEF vs. 3.0% in HFpEF; SGLT2i: 36.2%, 23.4%, and 17.9%, respectively). Objective frailty assessments were underutilized (6MWT: 14.7%, CPET: 9.9%); among those assessed, functional impairment was common (reduced 6MWT: 46%, low K-MMSE: 76%, elevated PHQ-9: 26%, impaired CPET: 33%). At 12 months, all-cause mortality and HF rehospitalization rates were 8.7% and 10.9%, respectively. Conclusions: In this contemporary Korean AHF cohort, 12-month outcomes were relatively favorable. However, frailty assessments were infrequently conducted, and uptake of newer GDMT remained limited, particularly in HFmrEF and HFpEF. Systematic integration of frailty evaluation and phenotype-specific optimization of therapy at discharge may enhance long-term outcomes in AHF care.