Journal article
Acute heart failure congestion and perfusion status - impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry.
- Chioncel O Emergency Institute for Cardiovascular Diseases 'Prof. C.C.Iliescu', University of Medicine Carol Davila, Bucharest, Romania.
- Mebazaa A University of Paris Diderot, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, Paris, France.
- Maggioni AP ANMCO Research Center, Florence, Italy.
- Harjola VP Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
- Rosano G Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK.
- Laroche C EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France.
- Piepoli MF Cardiology Department, Polichirurgico Hospital G. da Saliceto, Cantone del Cristo, Piacenza, Italy.
- Crespo-Leiro MG Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna (CHUAC), INIBIC, UDC, CIBERCV, La Coruna, Spain.
- Lainscak M Department of Internal Medicine, and Department of Research and Education, General Hospital Murska Sobota, Murska Sobota, Slovenia.
- Ponikowski P Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
- Filippatos G National and Kapodistrian University of Athens, Athens, Greece.
- Ruschitzka F Universitäts Spital Zürich, Zürich, Switzerland.
- Seferovic P University of Belgrade, Faculty of Medicine, Belgrade, Serbia.
- Coats AJS IRCCS San Raffaele Pisana, Rome, Italy.
- Lund LH Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
- 2019-05-26
Published in:
- European journal of heart failure. - 2019
Acute heart failure
Congestion
Forrester classification
Outcomes
Perfusion
Registry
Acute Disease
Adult
Aged
Blood Pressure
Coronary Circulation
Female
Follow-Up Studies
Heart Failure
Hospital Mortality
Hospitalization
Humans
Long-Term Care
Male
Middle Aged
Registries
Risk Factors
Treatment Outcome
English
AIMS
Classification of acute heart failure (AHF) patients into four clinical profiles defined by evidence of congestion and perfusion is advocated by the 2016 European Society of Cardiology (ESC)guidelines. Based on the ESC-EORP-HFA Heart Failure Long-Term Registry, we compared differences in baseline characteristics, in-hospital management and outcomes among congestion/perfusion profiles using this classification.
METHODS AND RESULTS
We included 7865 AHF patients classified at admission as: 'dry-warm' (9.9%), 'wet-warm' (69.9%), 'wet-cold' (19.8%) and 'dry-cold' (0.4%). These groups differed significantly in terms of baseline characteristics, in-hospital management and outcomes. In-hospital mortality was 2.0% in 'dry-warm', 3.8% in 'wet-warm', 9.1% in 'dry-cold' and 12.1% in 'wet-cold' patients. Based on clinical classification at admission, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: 'wet-warm' vs. 'dry-warm' 1.78 (1.43-2.21) and 'wet-cold' vs. 'wet-warm' 1.33 (1.19-1.48). For profiles resulting from discharge classification, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: 'wet-warm' vs. 'dry-warm' 1.46 (1.31-1.63) and 'wet-cold' vs. 'wet-warm' 2.20 (1.89-2.56). Among patients discharged alive, 30.9% had residual congestion, and these patients had higher 1-year mortality compared to patients discharged without congestion (28.0 vs. 18.5%). Tricuspid regurgitation, diabetes, anaemia and high New York Heart Association class were independently associated with higher risk of congestion at discharge, while beta-blockers at admission, de novo heart failure, or any cardiovascular procedure during hospitalization were associated with lower risk of residual congestion.
CONCLUSION
Classification based on congestion/perfusion status provides clinically relevant information at hospital admission and discharge. A better understanding of the clinical course of the two entities could play an important role towards the implementation of targeted strategies that may improve outcomes.
Classification of acute heart failure (AHF) patients into four clinical profiles defined by evidence of congestion and perfusion is advocated by the 2016 European Society of Cardiology (ESC)guidelines. Based on the ESC-EORP-HFA Heart Failure Long-Term Registry, we compared differences in baseline characteristics, in-hospital management and outcomes among congestion/perfusion profiles using this classification.
METHODS AND RESULTS
We included 7865 AHF patients classified at admission as: 'dry-warm' (9.9%), 'wet-warm' (69.9%), 'wet-cold' (19.8%) and 'dry-cold' (0.4%). These groups differed significantly in terms of baseline characteristics, in-hospital management and outcomes. In-hospital mortality was 2.0% in 'dry-warm', 3.8% in 'wet-warm', 9.1% in 'dry-cold' and 12.1% in 'wet-cold' patients. Based on clinical classification at admission, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: 'wet-warm' vs. 'dry-warm' 1.78 (1.43-2.21) and 'wet-cold' vs. 'wet-warm' 1.33 (1.19-1.48). For profiles resulting from discharge classification, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: 'wet-warm' vs. 'dry-warm' 1.46 (1.31-1.63) and 'wet-cold' vs. 'wet-warm' 2.20 (1.89-2.56). Among patients discharged alive, 30.9% had residual congestion, and these patients had higher 1-year mortality compared to patients discharged without congestion (28.0 vs. 18.5%). Tricuspid regurgitation, diabetes, anaemia and high New York Heart Association class were independently associated with higher risk of congestion at discharge, while beta-blockers at admission, de novo heart failure, or any cardiovascular procedure during hospitalization were associated with lower risk of residual congestion.
CONCLUSION
Classification based on congestion/perfusion status provides clinically relevant information at hospital admission and discharge. A better understanding of the clinical course of the two entities could play an important role towards the implementation of targeted strategies that may improve outcomes.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1002/ejhf.1492
- PMID 31127678
- Persistent URL
- https://folia.unifr.ch/global/documents/152865
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