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Indonesia is an archipelago consisting of 17,000 islands (6000 inhabited) to spanning by the equator in South East Asia. The total area is 741,096 sq mil (1,919,440 km sq). The population in 2005 was 241,973,879, with a population growth rate of 1.5%, a birth rate of 20.7/1000 population and a life expectancy of 69.6 years. There are 1246 hospitals in Indonesia, of which 49.8% are in private hospitals and 50.5% are located in Java. There is a total of 132,231 beds or one hospital bed per 1628 population.

In 2005 we did a pilot cohort study of 100 consecutive new cases of Acute Decompensated Heart Failure (ADHF) at NCVC Jakarta to search for predictors of mortality and re-hospitalization. We found the independent predictors for mortality and re-hospitalization are high NT proBNP at entry, NT proBNP at discharge, not decreased> 35% during hospitalization, NYHA functional class 4, edema with a BMI> 30 kg/m2, ejection fraction< 20%, acute pulmonary edema, not on a beta-blocker, hemoglobin< 12 g/dl and Hyponatremia< 130 mmol/L. More than 78% using ACEI/ARB, diuretic and aldosterone antagonist, but only 32% using beta-blocker. In 2006, we conducted an Acute Decompensated Heart Failure Registry (ADHERE) with the participation of five hospitals including National Cardiovascular Center (NCVC) Jakarta, the top cardiovascular referral hospital. In total, there were 1687 patients admitted with ADHF. The mean age was 60 years and male patients were 64.5%. Compared to other countries, our heart failure patients were younger, had more severe symptoms and there were more new patients