TY - JOUR
TI - 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
AU - Javaloyes, Patricia
AU - Miro, Oscar
AU - Gil, Victor
AU - Javier
AU - Martin-Sanchez, Francisco
AU - Jacob, Javier
AU - Herrero, Pablo and
AU - Takagi, Koji
AU - Alquezar-Arbe, Aitor
AU - Lopez Diez, Maria Pilar and
AU - Martin, Enrique
AU - Bibiano, Carlos
AU - Escoda, Rosa
AU - Gil, Cristina
AU - and Fuentes, Marta
AU - Llopis Garcia, Guillermo
AU - Alvarez Perez, Jose
AU - Maria
AU - Jerez, Alba
AU - Tost, Josep
AU - Llauger, Lluis
AU - Romero,
AU - Rodolfo
AU - Manuel Garrido, Jose
AU - Rodriguez-Adrada, Esther and
AU - Sanchez, Carolina
AU - Rossello, Xavier
AU - Parissis, John
AU - Mebazaa,
AU - Alexandre
AU - Chioncel, Ovidiu
AU - Llorens, Pere
AU - Alonso, Hector and
AU - Perez-Llantada, Enrique
AU - Suarez Cadenas, Mar
AU - Xipell, Carolina and
AU - Jose Perez-Dura, Maria
AU - Salvo, Eva
AU - Pavon, Jose
AU - Noval, Antonio
AU - and Manuel Torres, Jose
AU - Luisa Lopez-Grima, Maria
AU - Valero, Amparo
AU - and Angeles Juan, Maria
AU - Aguirre, Alfons
AU - Angels Pedragosa, Maria
AU - and Minguez Maso, Silvia
AU - Isabel Alonso, Maria
AU - Ruiz, Francisco
AU - and Miguel Franco, Jose
AU - Belen Mecina, Ana
AU - Berenguer, Marta and
AU - Donea, Ruxandra
AU - Sanchez Ramon, Susana
AU - Carbajosa Rodriguez,
AU - Virginia
AU - Pinera, Pascual
AU - Sanchez Nicolas, Jose Andres
AU - Torres
AU - Garate, Raquel
AU - Alberto Rizzi, Miguel
AU - Roset, Alex
AU - Cabello,
AU - Irene
AU - Haro, Antonio
AU - Richard, Fernando
AU - Lopez Diez, Maria
AU - Pilar
AU - Vazquez Alvarez, Joaquin
AU - Prieto Garcia, Belen
AU - Garcia
AU - Garcia, Maria
AU - Sanchez Gonzalez, Marta
AU - Marquina, Victor and
AU - Jimenez, Inmaculada
AU - Hernandez, Nestor
AU - Brouzet, Benjamin and
AU - Espinosa, Begona
AU - Antonio Andueza, Juan
AU - Ruiz, Martin and
AU - Calvache, Roberto
AU - Lorca Serralta, Maria Teresa
AU - Calderon Jave,
AU - Luis Ernesto
AU - Amores Arriaga, Beatriz
AU - Sierra Bergua, Beatriz and
AU - Martin Mojarro, Enrique
AU - Alarcon Jimenez, Brigitte Silvana and
AU - Traveria Becquer, Lisette
AU - Burillo, Guillermo
AU - Llauger Garcia,
AU - Lluis
AU - Corominas LaSalle, Gerard
AU - Aguera Urbano, Carmen
AU - Garcia
AU - Soto, Ana Belen
AU - Delgado Padial, Elisa
AU - Soy Ferrer, Ester and
AU - Javier Lucas-Imbernon, Francisco
AU - Gaya, Rut
AU - Mir, Maria and
AU - Rodriguez, Beatriz
AU - Luis Carballo, Jose
AU - Rodriguez Miranda, Belen
AU - and ICA-SEMES Res Grp
JO - European Journal of Heart Failure
PY - 2019
VL - 21
TODO - 11
SP - 1353-1365
PB - Wiley
SN - null
TODO - 10.1002/ejhf.1502
TODO - Congestion; Perfusion; Clinical profiles; Acute heart failure; Emergency
department
TODO - 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.
ER -