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

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Μονάδα:
Ερευνητικό υλικό ΕΚΠΑ
Τίτλος:
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
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Αγγλικά
Περίληψη:
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
Έτος δημοσίευσης:
2019
Συγγραφείς:
Chioncel, O.
Mebazaa, A.
Maggioni, A.P.
Harjola, V.-P.
Rosano, G.
Laroche, C.
Piepoli, M.F.
Crespo-Leiro, M.G.
Lainscak, M.
Ponikowski, P.
Filippatos, G.
Ruschitzka, F.
Seferovic, P.
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Fruhwald, F.
Dolze, T.
Brandner, K.
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Podczeck-Schweighofer, A.
Muslibegovic, A.
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Fazlibegovic, E.
Cesko, M.
Zelenika, D.
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Gatzov, P.
Kamenova, D.
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Monhart, Z.
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Paniagua-Martin, M.J.
Barge-Caballero, E.
Cerdena, I.L.
Baldomero, I.F.H.
Padron, A.L.
Rosillo, S.O.
Gonzalez-Gallarza, R.D.
Montanes, O.S.
Manjavacas, A.M.I.
Conde, A.C.
Araujo, A.
Soria, T.
Garcia-Pavia, P.
Gomez-Bueno, M.
Cobo-Marcos, M.
Alonso-Pulpon, L.
Cubero, J.S.
Sayago, I.
Gonzalez-Segovia, A.
Briceno, A.
Subias, P.E.
Hernandez, M.V.
Cano, M.J.R.
Sanchez, M.A.G.
Jimenez, J.F.D.
Garrido-Lestache, E.B.
Pinilla, J.M.G.
de la Villa, B.G.
Sahuquillo, A.
Marques, R.B.
Calvo, F.T.
Perez-Martinez, M.T.
Gracia-Rodenas, M.R.
Garrido-Bravo, I.P.
Pastor-Perez, F.
Pascual-Figal, D.A.
Molina, B.D.
Orus, J.
Gonzalo, F.E.
Bertomeu, V.
Valero, R.
Martinez-Abellan, R.
Quiles, J.
Rodrigez-Ortega, J.A.
Mateo, I.
ElAmrani, A.
Fernandez-Vivancos, C.
Valero, D.B.
Almenar-Bonet, L.
Sanchez-Lazaro, I.J.
Marques-Sule, E.
Facila-Rubio, L.
Perez-Silvestre, J.
Garcia-Gonzalez, P.
Ridocci-Soriano, F.
Garcia-Escriva, D.
Pellicer-Cabo, A.
de la Fuente Galan, L.
Diaz, J.L.
Platero, A.R.
Arias, J.C.
Blasco-Peiro, T.
Julve, M.S.
Sanchez-Insa, E.
Aured-Guallar, C.
Portoles-Ocampo, A.
Melin, M.
Hägglund, E.
Stenberg, A.
Lindahl, I.-M.
Asserlund, B.
Olsson, L.
Dahlström, U.
Afzelius, M.
Karlström, P.
Tengvall, L.
Wiklund, P.-A.
Olsson, B.
Kalayci, S.
Temizhan, A.
Cavusoglu, Y.
Gencer, E.
Yilmaz, M.B.
Gunes, H.
on behalf of the ESC-EORP-HFA Heart Failure Long-Term Registry Investigators
Περιοδικό:
European Journal of Heart Failure
Εκδότης:
John Wiley and Sons Ltd
Τόμος:
21
Αριθμός / τεύχος:
11
Σελίδες:
1338-1352
Λέξεις-κλειδιά:
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
Επίσημο URL (Εκδότης):
DOI:
10.1002/ejhf.1492
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