Ovidiu Chioncel1, Alexandre Mebazaa2, Aldo P Maggioni3,4, Veli-Pekka Harjola5, Giuseppe Rosano6,7, Cecile Laroche4, Massimo F Piepoli8, Maria G Crespo-Leiro9, Mitja Lainscak10, Piotr Ponikowski11,12, Gerasimos Filippatos13,14, Frank Ruschitzka15, Petar Seferovic16, Andrew J S Coats17, Lars H Lund18,19. 1. Emergency Institute for Cardiovascular Diseases 'Prof. C.C.Iliescu', University of Medicine Carol Davila, Bucharest, Romania. 2. University of Paris Diderot, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, Paris, France. 3. ANMCO Research Center, Florence, Italy. 4. EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France. 5. Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland. 6. Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK. 7. IRCCS San Raffaele Roma, Rome, Italy. 8. Cardiology Department, Polichirurgico Hospital G. da Saliceto, Cantone del Cristo, Piacenza, Italy. 9. Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna (CHUAC), INIBIC, UDC, CIBERCV, La Coruna, Spain. 10. Department of Internal Medicine, and Department of Research and Education, General Hospital Murska Sobota, Murska Sobota, Slovenia. 11. Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland. 12. Cardiology Department Centre for Heart Diseases, Military Hospital, Wroclaw, Poland. 13. National and Kapodistrian University of Athens, Athens, Greece. 14. University of Cyprus, Nicosia, Cyprus. 15. Universitäts Spital Zürich, Zürich, Switzerland. 16. University of Belgrade, Faculty of Medicine, Belgrade, Serbia. 17. IRCCS San Raffaele Pisana, Rome, Italy. 18. Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden. 19. Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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.
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.
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Authors: Alexander Jobs; Reinhard Vonthein; Inke R König; Jane Schäfer; Matthias Nauck; Svenja Haag; Carlo Federico Fichera; Thomas Stiermaier; Jakob Ledwoch; Alisa Schneider; Miroslava Valentova; Stephan von Haehling; Stefan Störk; Dirk Westermann; Tobias Lenz; Natalie Arnold; Frank Edelmann; Philipp Seppelt; Stephan Felix; Matthias Lutz; Felix Hedwig; Martin Borggrefe; Clemens Scherer; Steffen Desch; Holger Thiele Journal: ESC Heart Fail Date: 2020-01-28