@article{3105515,
    title = "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",
    author = "Chioncel, O. and Mebazaa, A. and Maggioni, A.P. and Harjola, V.-P. and Rosano, G. and Laroche, C. and Piepoli, M.F. and Crespo-Leiro, M.G. and Lainscak, M. and Ponikowski, P. and Filippatos, G. and Ruschitzka, F. and Seferovic, P. and Coats, A.J.S. and Lund, L.H. and Auer, J. and Ablasser, K. and Fruhwald, F. and Dolze, T. and Brandner, K. and Gstrein, S. and Poelzl, G. and Moertl, D. and Reiter, S. and Podczeck-Schweighofer, A. and Muslibegovic, A. and Vasilj, M. and Fazlibegovic, E. and Cesko, M. and Zelenika, D. and Palic, B. and Pravdic, D. and Cuk, D. and Vitlianova, K. and Katova, T. and Velikov, T. and Kurteva, T. and Gatzov, P. and Kamenova, D. and Antova, M. and Sirakova, V. and Krejci, J. and Mikolaskova, M. and Spinar, J. and Krupicka, J. and Malek, F. and Hegarova, M. and Lazarova, M. and Monhart, Z. and Hassanein, M. and Sobhy, M. and El Messiry, F. and El Shazly, A.H. and Elrakshy, Y. and Youssef, A. and Moneim, A.A. and Noamany, M. and Reda, A. and Dayem, T.K.A. and Farag, N. and Halawa, S.I. and Hamid, M.A. and Said, K. and Saleh, A. and Ebeid, H. and Hanna, R. and Aziz, R. and Louis, O. and Enen, M.A. and Ibrahim, B.S. and Nasr, G. and Elbahry, A. and Sobhy, H. and Ashmawy, M. and Gouda, M. and Aboleineen, W. and Bernard, Y. and Luporsi, P. and Meneveau, N. and Pillot, M. and Morel, M. and Seronde, M.-F. and Schiele, F. and Briand, F. and Delahaye, F. and Damy, T. and Eicher, J.-C. and de Groote, P. and Fertin, M. and Lamblin, N. and Isnard, R. and Lefol, C. and Thevenin, S. and Hagege, A. and Jondeau, G. and Logeart, D. and Le Marcis, V. and Ly, J.-F. and Coisne, D. and Lequeux, B. and Le Moal, V. and Mascle, S. and Lotton, P. and Behar, N. and Donal, E. and Thebault, C. and Ridard, C. and Reynaud, A. and Basquin, A. and Bauer, F. and Codjia, R. and Galinier, M. and Tourikis, P. and Stavroula, M. and Tousoulis, D. and Stefanadis, C. and Chrysohoou, C. and Kotrogiannis, I. and Matzaraki, V. and Dimitroula, T. and Karavidas, A. and Tsitsinakis, G. and Kapelios, C. and Nanas, J. and Kampouri, H. and Nana, E. and Kaldara, E. and Eugenidou, A. and Vardas, P. and Saloustros, I. and Patrianakos, A. and Tsaknakis, T. and Evangelou, S. and Nikoloulis, N. and Tziourganou, H. and Tsaroucha, A. and Papadopoulou, A. and Douras, A. and Polgar, L. and Merkely, B. and Kosztin, A. and Nyolczas, N. and Nagy, A.C. and Halmosi, R. and Elber, J. and Alony, I. and Shotan, A. and Fuhrmann, A.V. and Amir, O. and Romano, S. and Marcon, S. and Penco, M. and Di Mauro, M. and Lemme, E. and Carubelli, V. and Rovetta, R. and Metra, M. and Bulgari, M. and Quinzani, F. and Lombardi, C. and Bosi, S. and Schiavina, G. and Squeri, A. and Barbieri, A. and Di Tano, G. and Pirelli, S. and Ferrari, R. and Fucili, A. and Passero, T. and Musio, S. and Di Biase, M. and Correale, M. and Salvemini, G. and Brognoli, S. and Zanelli, E. and Giordano, A. and Agostoni, P. and Italiano, G. and Salvioni, E. and Copelli, S. and Modena, M.G. and Reggianini, L. and Valenti, C. and Olaru, A. and Bandino, S. and Deidda, M. and Mercuro, G. and Dessalvi, C.C. and Marino, P.N. and Di Ruocco, M.V. and Sartori, C. and Piccinino, C. and Parrinello, G. and Licata, G. and Torres, D. and Giambanco, S. and Busalacchi, S. and Arrotti, S. and Novo, S. and Inciardi, R.M. and Pieri, P. and Chirco, P.R. and Galifi, M.A. and Teresi, G. and Buccheri, D. and Minacapelli, A. and Veniani, M. and Frisinghelli, A. and Priori, S.G. and Cattaneo, S. and Opasich, C. and Gualco, A. and Pagliaro, M. and Mancone, M. and Fedele, F. and Cinque, A. and Vellini, M. and Scarfo, I. and Romeo, F. and Ferraiuolo, F. and Sergi, D. and Anselmi, M. and Melandri, F. and Leci, E. and Iori, E. and Bovolo, V. and Pidello, S. and Frea, S. and Bergerone, S. and Botta, M. and Canavosio, F.G. and Gaita, F. and Merlo, M. and Cinquetti, M. and Sinagra, G. and Ramani, F. and Fabris, E. and Stolfo, D. and Artico, J. and Miani, D. and Fresco, C. and Daneluzzi, C. and Proclemer, A. and Cicoira, M. and Zanolla, L. and Marchese, G. and Torelli, F. and Vassanelli, C. and Voronina, N. and Erglis, A. and Tamakauskas, V. and Smalinskas, V. and Karaliute, R. and Petraskiene, I. and Kazakauskaite, E. and Rumbinaite, E. and Kavoliuniene, A. and Vysniauskas, V. and Brazyte-Ramanauskiene, R. and Petraskiene, D. and Stankala, S. and Switala, P. and Juszczyk, Z. and Sinkiewicz, W. and Gilewski, W. and Pietrzak, J. and Orzel, T. and Kasztelowicz, P. and Kardaszewicz, P. and Lazorko-Piega, M. and Gabryel, J. and Mosakowska, K. and Bellwon, J. and Rynkiewicz, A. and Raczak, G. and Lewicka, E. and Dabrowska-Kugacka, A. and Bartkowiak, R. and Sosnowska-Pasiarska, B. and Wozakowska-Kaplon, B. and Krzeminski, A. and Zabojszcz, M. and Mirek-Bryniarska, E. and Grzegorzko, A. and Bury, K. and Nessler, J. and Zalewski, J. and Furman, A. and Broncel, M. and Poliwczak, A. and Bala, A. and Zycinski, P. and Rudzinska, M. and Jankowski, L. and Kasprzak, J.D. and Michalak, L. and Soska, K.W. and Drozdz, J. and Huziuk, I. and Retwinski, A. and Flis, P. and Weglarz, J. and Bodys, A. and Grajek, S. and Kaluzna-Oleksy, M. and Straburzynska-Migaj, E. and Dankowski, R. and Szymanowska, K. and Grabia, J. and Szyszka, A. and Nowicka, A. and Samcik, M. and Wolniewicz, L. and Baczynska, K. and Komorowska, K. and Poprawa, I. and Komorowska, E. and Sajnaga, D. and Zolbach, A. and Dudzik-Plocica, A. and Abdulkarim, A.-F. and Lauko-Rachocka, A. and Kaminski, L. and Kostka, A. and Cichy, A. and Ruszkowski, P. and Splawski, M. and Fitas, G. and Szymczyk, A. and Serwicka, A. and Fiega, A. and Zysko, D. and Krysiak, W. and Szabowski, S. and Skorek, E. and Pruszczyk, P. and Bienias, P. and Ciurzynski, M. and Welnicki, M. and Mamcarz, A. and Folga, A. and Zielinski, T. and Rywik, T. and Leszek, P. and Sobieszczanska-Malek, M. and Piotrowska, M. and Kozar-Kaminska, K. and Komuda, K. and Wisniewska, J. and Tarnowska, A. and Balsam, P. and Marchel, M. and Opolski, G. and Kaplon-Cieslicka, A. and Gil, R.J. and Mozenska, O. and Byczkowska, K. and Gil, K. and Pawlak, A. and Michalek, A. and Krzesinski, P. and Piotrowicz, K. and Uzieblo-Zyczkowska, B. and Stanczyk, A. and Skrobowski, A. and Jankowska, E. and Rozentryt, P. and Polonski, L. and Gadula-Gacek, E. and Nowalany-Kozielska, E. and Kuczaj, A. and Kalarus, Z. and Szulik, M. and Przybylska, K. and Klys, J. and Prokop-Lewicka, G. and Kleinrok, A. and Aguiar, C.T. and Ventosa, A. and Pereira, S. and Faria, R. and Chin, J. and De Jesus, I. and Santos, R. and Silva, P. and Moreno, N. and Queirós, C. and Lourenço, C. and Pereira, A. and Castro, A. and Andrade, A. and Guimaraes, T.O. and Martins, S. and Placido, R. and Lima, G. and Brito, D. and Francisco, A.R. and Cardiga, R. and Proenca, M. and Araujo, I. and Marques, F. and Fonseca, C. and Moura, B. and Leite, S. and Campelo, M. and Silva-Cardoso, J. and Rodrigues, J. and Rangel, I. and Martins, E. and Correia, A.S. and Peres, M. and Marta, L. and da Silva, G.F. and Severino, D. and Durao, D. and Leao, S. and Magalhaes, P. and Moreira, I. and Cordeiro, A.F. and Ferreira, C. and Araujo, C. and Ferreira, A. and Baptista, A. and Radoi, M. and Bicescu, G. and Vinereanu, D. and Sinescu, C.-J. and Macarie, C. and Popescu, R. and Daha, I. and Dan, G.-A. and Stanescu, C. and Dan, A. and Craiu, E. and Nechita, E. and Aursulesei, V. and Christodorescu, R. and Otasevic, P. and Seferovic, P.M. and Simeunovic, D. and Ristic, A.D. and Celic, V. and Pavlovic-Kleut, M. and Lazic, J.S. and Stojcevski, B. and Pencic, B. and Stevanovic, A. and Andric, A. and Iric-Cupic, V. and Jovic, M. and Davidovic, G. and Milanov, S. and Mitic, V. and Atanaskovic, V. and Antic, S. and Pavlovic, M. and Stanojevic, D. and Stoickov, V. and Ilic, S. and Ilic, M.D. and Petrovic, D. and Stojsic, S. and Kecojevic, S. and Dodic, S. and Adic, N.C. and Cankovic, M. and Stojiljkovic, J. and Mihajlovic, B. and Radin, A. and Radovanovic, S. and Krotin, M. and Klabnik, A. and Goncalvesova, E. and Pernicky, M. and Murin, J. and Kovar, F. and Kmec, J. and Semjanova, H. and Strasek, M. and Iskra, M.S. and Ravnikar, T. and Suligoj, N.C. and Komel, J. and Fras, Z. and Jug, B. and Glavic, T. and Losic, R. and Bombek, M. and Krajnc, I. and Krunic, B. and Horvat, S. and Kovac, D. and Rajtman, D. and Cencic, V. and Letonja, M. and Winkler, R. and Valentincic, M. and Melihen-Bartolic, C. and Bartolic, A. and Vrckovnik, M.P. and Kladnik, M. and Pusnik, C.S. and Marolt, A. and Klen, J. and Drnovsek, B. and Leskovar, B. and Anguita, M.J.F. and Page, J.C.G. and Martinez, F.M.S. and Andres, J. and Bayes-Genis, A. and Mirabet, S. and Mendez, A. and Garcia-Cosio, L. and Roig, E. and Leon, V. and Gonzalez-Costello, J. and Muntane, G. and Garay, A. and Alcade-Martinez, V. and Fernandez, S.L. and Rivera-Lopez, R. and Puga-Martinez, M. and Fernandez-Alvarez, M. and Serrano-Martinez, J.L. and Crespo-Leiro, M. and Grille-Cancela, Z. and Marzoa-Rivas, R. and Blanco-Canosa, P. and Paniagua-Martin, M.J. and Barge-Caballero, E. and Cerdena, I.L. and Baldomero, I.F.H. and Padron, A.L. and Rosillo, S.O. and Gonzalez-Gallarza, R.D. and Montanes, O.S. and Manjavacas, A.M.I. and Conde, A.C. and Araujo, A. and Soria, T. and Garcia-Pavia, P. and Gomez-Bueno, M. and Cobo-Marcos, M. and Alonso-Pulpon, L. and Cubero, J.S. and Sayago, I. and Gonzalez-Segovia, A. and Briceno, A. and Subias, P.E. and Hernandez, M.V. and Cano, M.J.R. and Sanchez, M.A.G. and Jimenez, J.F.D. and Garrido-Lestache, E.B. and Pinilla, J.M.G. and de la Villa, B.G. and Sahuquillo, A. and Marques, R.B. and Calvo, F.T. and Perez-Martinez, M.T. and Gracia-Rodenas, M.R. and Garrido-Bravo, I.P. and Pastor-Perez, F. and Pascual-Figal, D.A. and Molina, B.D. and Orus, J. and Gonzalo, F.E. and Bertomeu, V. and Valero, R. and Martinez-Abellan, R. and Quiles, J. and Rodrigez-Ortega, J.A. and Mateo, I. and ElAmrani, A. and Fernandez-Vivancos, C. and Valero, D.B. and Almenar-Bonet, L. and Sanchez-Lazaro, I.J. and Marques-Sule, E. and Facila-Rubio, L. and Perez-Silvestre, J. and Garcia-Gonzalez, P. and Ridocci-Soriano, F. and Garcia-Escriva, D. and Pellicer-Cabo, A. and de la Fuente Galan, L. and Diaz, J.L. and Platero, A.R. and Arias, J.C. and Blasco-Peiro, T. and Julve, M.S. and Sanchez-Insa, E. and Aured-Guallar, C. and Portoles-Ocampo, A. and Melin, M. and Hägglund, E. and Stenberg, A. and Lindahl, I.-M. and Asserlund, B. and Olsson, L. and Dahlström, U. and Afzelius, M. and Karlström, P. and Tengvall, L. and Wiklund, P.-A. and Olsson, B. and Kalayci, S. and Temizhan, A. and Cavusoglu, Y. and Gencer, E. and Yilmaz, M.B. and Gunes, H. and on behalf of the ESC-EORP-HFA Heart Failure Long-Term Registry Investigators",
    journal = "European Journal of Heart Failure",
    year = "2019",
    volume = "21",
    number = "11",
    pages = "1338-1352",
    publisher = "John Wiley and Sons Ltd",
    doi = "10.1002/ejhf.1492",
    keywords = "beta adrenergic receptor blocking agent, acute heart failure;  aged;  anemia;  Article;  cardiology;  cardiovascular disease assessment;  cardiovascular procedure;  clinical feature;  clinical outcome;  confidence interval;  congestion classification;  controlled study;  diabetes mellitus;  disease course;  disease registry;  dry cold;  dry warm;  Europe;  female;  hazard ratio;  high risk patient;  hospital admission;  hospital discharge;  hospital management;  hospital mortality;  hospital patient;  hospitalization;  human;  long term care;  major clinical study;  male;  medical society;  New York Heart Association class;  patient coding;  perfusion;  perfusion classification;  practice guideline;  priority journal;  tricuspid valve regurgitation;  wet cold;  wet warm;  acute disease;  adult;  blood pressure;  classification;  coronary artery blood flow;  follow up;  heart failure;  hospitalization;  middle aged;  mortality;  physiology;  register;  risk factor;  treatment outcome, 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",
    abstract = "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. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology"
}