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