Table 1: Definition of a Heart Failure Hospitalisation.

A heart failure hospitalisation is defined as an event that meets ALL of the following criteria
The patient is admitted to the hospital with a primary diagnosis of HF
The patient’s LOS in hospital extends for at least 24 h (or a change in calendar date if the hospital admission and discharge times are unavailable)
The patient exhibits documented new or worsening symptoms due to HF on presentation, including at least ONE of the following: Dyspnoea (dyspnoea with exertion, dyspnoea at rest, orthopnoea, paroxysmal nocturnal dyspnoea) Decreased exercise tolerance Fatigue Other symptoms of worsened end-organ perfusion or volume overload (must be specified and described by the protocol)
The patient has objective evidence of new or worsening HF, consisting of at least TWO physical examination findings OR one physical examination finding and at least ONE laboratory criterion, including: a. Physical examination findings considered to be due to HF, including new or worsened: i. Peripheral oedema ii. Increasing abdominal distension or ascites (in the absence of primary hepatic disease) iii. Pulmonary rales/crackles/crepitations iv. Increased jugular venous pressure and/or hepatojugular reflux v. S3 gallop vi. Clinically significant or rapid weight gain thought to be related to fluid retention b. Laboratory evidence of new or worsening HF, if obtained within 24 h of presentation, including: i. Increased BNP/NT-proBNP concentrations consistent with decompensation of heart failure (e.g. BNP >500 pg/ml or NT-proBNP >2,000 pg/ml). In patients with chronically elevated natriuretic peptides, a significant increase should be noted above baseline ii. Radiological evidence of pulmonary congestion iii. Non-invasive diagnostic evidence of clinically significant elevated left- or right-sided ventricular filling pressure or low cardiac output. For example, echocardiographic criteria could include: septal or lateral E/é >15 or >12, respectively; D-dominant pulmonary venous inflow pattern; plethoric inferior vena cava with minimal collapse on inspiration; or decreased LVOT minute stroke distance (TVI) OR c. Invasive diagnostic evidence with right heart catheterisation showing a pulmonary capillary wedge pressure (pulmonary artery occlusion pressure) ≥18 mmHg, central venous pressure ≥12 mmHg, or a cardiac index <2.2 l/min/m2 Note: All results from diagnostic tests should be reported, if available, even if they do not meet the above criteria because they provide important information for the adjudication of these events.
The patient receives at least ONE of the following treatments specifically for HF: a. Significant augmentation in oral diuretic therapy (e.g. doubling of loop diuretic dose, initiation of maintenance loop diuretic therapy, initiation of combination diuretic therapy) b. Initiation of intravenous diuretic (even a single dose) or vasoactive agent (e.g. inotrope, vasopressor, vasodilator) c. Mechanical or surgical intervention, including: Mechanical circulatory support (e.g. IABP, ventricular assist device, ECMO, total artificial heart) Mechanical fluid removal (e.g. ultrafiltration, haemofiltration, dialysis)

BNP = B-type natriuretic peptide; ECMO = extracorporeal membrane oxygenation; HF = heart failure; IABP = intra-aortic balloon pump; LOS = length of stay; LVOT = left ventricular outflow tract; NT-proBNP = N-terminal pro B-type natriuretic peptide; TVI = time velocity integral.