AMERICCAASS Registry: A Contemporary View of Heart Failure in the Americas

BACKGROUND: Heart failure (HF) is a growing global health concern, particularly in low- and middle-income countries. Contemporary, region-specific data from the Americas remain scarce. The AMERICCAASS (Registro Americano de Insuficiencia Cardiaca Ambulatoria o Agudamente Descompensada [American Registry of Ambulatory or Acutely Decompensated Heart Failure]) registry was designed to provide broad, robust regional evidence on HF. METHODS: The AMERICCAASS registry is a prospective, multicenter, observational study including adults with HF enrolled as inpatients or outpatients at 119 institutions in 21 countries across the Americas. Sociodemographic and clinical variables were summarized descriptively. RESULTS: A total of 6732 patients were included; 30.1% were inpatients and 69.9% outpatients. The median age was 68.6 years, and 58.2% were men. Hypertension (69.6%), dyslipidemia (41.6%), and coronary artery disease (39.2%) were the most common comorbidities. Ischemic (39.9%) and hypertensive (17.9%) etiologies predominated, while Chagas disease was present in 3.4%. Unhealthy habits were common, with 39.8% reporting smoking, 24.4% alcohol use, and only 23.9% regular physical activity. New York Heart Association class III predominated in inpatients (45.2%), whereas New York Heart Association class II predominated in outpatients (52.6%). HF with reduced left ventricular ejection fraction was the most common phenotype in both settings: inpatients (56.8%) and outpatients (55.0%). β Blockers and mineralocorticoid receptor antagonists were the most frequently prescribed therapies, followed by sodium-glucose cotransporter-2 inhibitors. Among inpatients, intensive care unit admission occurred in 55.9%, and the in-hospital mortality rate was 7%. CONCLUSIONS: The AMERICCAASS registry offers a comprehensive overview of HF in the Americas. Although patient profiles were broadly consistent with global trends, important regional features were observed, including frequent unhealthy lifestyle habits and underuse of key therapies. The high prevalence of HF with reduced left ventricular ejection fraction, together with elevated intensive care unit admission rates and in-hospital death, suggests potential gaps in care and underscores the need to further evaluate HF care delivery across the region. REGISTRATION: URL: clinicaltrials.gov; Unique Identifier: NCT05295641.