@article{3187376,
    title = "Clinical phenotypes of acute heart failure based on signs and symptoms
of perfusion and congestion at emergency department presentation and
their relationship with patient management and outcomes",
    author = "Javaloyes, Patricia and Miro, Oscar and Gil, Victor and Javier and Martin-Sanchez, Francisco and Jacob, Javier and Herrero, Pablo and and Takagi, Koji and Alquezar-Arbe, Aitor and Lopez Diez, Maria Pilar and and Martin, Enrique and Bibiano, Carlos and Escoda, Rosa and Gil, Cristina and and Fuentes, Marta and Llopis Garcia, Guillermo and Alvarez Perez, Jose and Maria and Jerez, Alba and Tost, Josep and Llauger, Lluis and Romero, and Rodolfo and Manuel Garrido, Jose and Rodriguez-Adrada, Esther and and Sanchez, Carolina and Rossello, Xavier and Parissis, John and Mebazaa, and Alexandre and Chioncel, Ovidiu and Llorens, Pere and Alonso, Hector and and Perez-Llantada, Enrique and Suarez Cadenas, Mar and Xipell, Carolina and and Jose Perez-Dura, Maria and Salvo, Eva and Pavon, Jose and Noval, Antonio and and Manuel Torres, Jose and Luisa Lopez-Grima, Maria and Valero, Amparo and and Angeles Juan, Maria and Aguirre, Alfons and Angels Pedragosa, Maria and and Minguez Maso, Silvia and Isabel Alonso, Maria and Ruiz, Francisco and and Miguel Franco, Jose and Belen Mecina, Ana and Berenguer, Marta and and Donea, Ruxandra and Sanchez Ramon, Susana and Carbajosa Rodriguez, and Virginia and Pinera, Pascual and Sanchez Nicolas, Jose Andres and Torres and Garate, Raquel and Alberto Rizzi, Miguel and Roset, Alex and Cabello, and Irene and Haro, Antonio and Richard, Fernando and Lopez Diez, Maria and Pilar and Vazquez Alvarez, Joaquin and Prieto Garcia, Belen and Garcia and Garcia, Maria and Sanchez Gonzalez, Marta and Marquina, Victor and and Jimenez, Inmaculada and Hernandez, Nestor and Brouzet, Benjamin and and Espinosa, Begona and Antonio Andueza, Juan and Ruiz, Martin and and Calvache, Roberto and Lorca Serralta, Maria Teresa and Calderon Jave, and Luis Ernesto and Amores Arriaga, Beatriz and Sierra Bergua, Beatriz and and Martin Mojarro, Enrique and Alarcon Jimenez, Brigitte Silvana and and Traveria Becquer, Lisette and Burillo, Guillermo and Llauger Garcia, and Lluis and Corominas LaSalle, Gerard and Aguera Urbano, Carmen and Garcia and Soto, Ana Belen and Delgado Padial, Elisa and Soy Ferrer, Ester and and Javier Lucas-Imbernon, Francisco and Gaya, Rut and Mir, Maria and and Rodriguez, Beatriz and Luis Carballo, Jose and Rodriguez Miranda, Belen and and ICA-SEMES Res Grp",
    journal = "European Journal of Heart Failure",
    year = "2019",
    volume = "21",
    number = "11",
    pages = "1353-1365",
    publisher = "Wiley",
    doi = "10.1002/ejhf.1502",
    keywords = "Congestion; Perfusion; Clinical profiles; Acute heart failure; Emergency
department",
    abstract = "Objective To compare the clinical characteristics and outcomes of
patients with acute heart failure (AHF) according to clinical profiles
based on congestion and perfusion determined in the emergency department
(ED).
Methods and results Overall, 11 261 unselected AHF patients from 41
Spanish EDs were classified according to perfusion (normoperfusion =
warm; hypoperfusion = cold) and congestion (not = dry; yes = wet).
Baseline and decompensation characteristics were recorded as were the
main wards to which patients were admitted. The primary outcome was
1-year all-cause mortality; secondary outcomes were need for
hospitalisation during the index AHF event, in-hospital all-cause
mortality, prolonged hospitalisation, 7-day post-discharge ED revisit
for AHF and 30-day post-discharge rehospitalisation for AHF. A total of
8558 patients (76.0%) were warm+ wet, 1929 (17.1%) cold+ wet, 675
(6.0%) warm+ dry, and 99 (0.9%) cold+ dry; hypoperfused (cold)
patients were more frequently admitted to intensive care units and
geriatrics departments, and warm+ wet patients were discharged home
without admission. The four phenotypes differed in most of the baseline
and decompensation characteristics. The 1-year mortality was 30.8%, and
compared to warm+ dry, the adjusted hazard ratios were significantly
increased for cold+ wet (1.660; 95% confidence interval 1.400-1.968)
and cold+ dry (1.672; 95% confidence interval 1.189-2.351).
Hypoperfused (cold) phenotypes also showed higher rates of index episode
hospitalisation and in-hospital mortality, while congestive (wet)
phenotypes had a higher risk of prolonged hospitalisation but decreased
risk of rehospitalisation. No differences were observed among phenotypes
in ED revisit risk.
Conclusions Bedside clinical evaluation of congestion and perfusion of
AHF patients upon ED arrival and classification according to phenotypic
profiles proposed by the latest European Society of Cardiology
guidelines provide useful complementary information and help to rapidly
predict patient outcomes shortly after ED patient arrival."
}