Inclusion Criteria:  Hospitalized heart failure patients with objective heart failure evidence during or before hospitalization.  New York Heart Association (NYHA) class II, III, or IV.  Patients with NT-proBNP level of at least 600pg/meal (or ≥400 pg/meal if they had been hospitalized for heart failure within the previous 12 months). Atrial fibrillation or atrial flutter patients with NT-proBNP level of at least 900 pg/ml, regardless of their history of HF hospitalization.  Exclusion Criteria:  Exclusion criteria included patients with life expectancy less than 1 year due to malignancy. Patients with ARDS and pneumonia.