Prognostic Value of Clinical Presentation in Acute Heart Failure Syndromes

César Belziti, Fernando Garagoli, Agustín Favini, Juan Chiabrando, Emiliano Rossi, Leandro Barbagelata, Julieta Denes, Emiliano Rossi, Rodolfo Pizarro

Abstract


Background: Heart failure is a highly prevalent disease with elevated morbidity and mortality. It is a very heterogeneous condition and there is no consensus in its classification.

Objective: The aim of this study was to compare the incidence of in-hospital and annual mortality as well as rehospitalizations dueto heart failure, during the first follow-up year, according to the clinical presentation.Methods: A retrospective descriptive and survival analysis was carried out in a cohort of 758 consecutive patients from the healthplan of our hospital who were admitted to the cardiology intensive care unit for acute heart failure, evaluating the association between clinical presentation and annual mortality.

Results: Treatment and use of resources were different in the diverse presentations. Overall in-hospital mortality was 6.3%; 5.4% corresponded to acute pulmonary edema, 4.9% to volume overload and 40.7% to cardiogenic shock (p <0.001). The incidence ofmortality per 100 patient-years was 40 (95% CI: 31-51), 45 (95% CI: 39-52) and 100 (95% CI: 60-100), respectively, with an incidence of 34.3% overall annual mortality. In the multivariate analysis, the annual mortality associated with cardiogenic shock had a HR of3.39 (95% CI: 1.79-6.44) compared with that associated with acute pulmonary edema. There were no statistically significant differencesin the rate of readmissions.

Conclusions: In patients with acute heart failure, clinical presentation was associated with mortality at one-year follow-up. Patientswith cardiogenic shock on admission had a worse prognosis compared with the rest of the groups.


References


Felker GM, Adams KF, Konstam MA, O’Connor CM, Gheorghiade M. The problem of decompensated heart failure: nomenclature, classification, and risk stratification. Am Heart J 2003;145:S18-25. http://doi.org/dntrjw

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cush¬man M, et al. American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Executive Summary: Heart Disease and Stroke Statistics--2016 Update: A Report From the American Heart Association. Circulation 2016;133:447-54. http://doi.org/cwhc

Nieminen MS, Harjola VP. Definition and epidemiology of acute heart failure syndromes. Am J Cardiol 2005;96:5G-10G. http://doi. org/cs2fnk

Cook C, Cole G, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure. Int J Cardiol 2014;171:368-76. http://doi.org/f5qn7d

Gheorghiade M,Pang PS, Acute heart failure syndromes. J Am Coll Cardiol 2009; 53:557-73. http://doi.org/c9p744

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJ, et al, 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.,Eur Heart J 2016;37:2129-200. http://doi.org/gbv2k3

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM et al, 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America., Circulation 2017;136:e137-e161. http://doi.org/cwhd

Ponikowski P. and Jankowska EA. Pathogenesis and clinical presen¬tation of acute heart failure. Rev Esp Cardiol (Engl Ed) 2015;68:331-7. http://doi.org/f26btz

Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Marvin A, et al., Acute heart failure syndromes: current state and frame¬work for future research. Circulation 2005; 112:3958-68. http:// doi.org/fg4v42

Nieminen MS, Böhm M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, cols. Grupo de Trabajo sobre la Insuficiencia Cardíaca Aguda de la Sociedad Europea de Cardiología and Aprobado por la Sociedad Europea de Medicina Intensiva (ESICM), Guías de Práctica Clínica sobre el diagnóstico y tratamiento de la insuficiencia cardíaca aguda. Versión resumida. Rev Esp Cardiol 2005;58:389-429. http:// doi.org/frs364

Nohria A, Tsang SW, Fang JC, Lewis EF, Jarcho JA, Mudge GH, et al., Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol 2003;41:1797-804. http://doi.org/dmqss2

Belziti CA. Síndromes de Insuficiencia Cardiaca I, Insuficiencia cardiaca. Respuestas sobre casos clínicos. César A. Belziti y Norberto Vulcano. Primera Edición. Buenos Aires. Inter-Médica, 2010. Pág. 1-8.

McMurray JJ, “Improving outcomes in heart failure: a personal perspective.,” Eur Heart J. 2015; 36:3467-70. http://doi.org/cwhh

Hamo CE, Butler J, Gheorghiade M, Chioncel O. The bumpy road to drug development for acute heart failure. Eur Heart J 2016;18:G19– G32. http://doi.org/f92z9f

Solomon SD and Desai AS, Acute Heart Failure: One Syndrome or Many?, J Am Coll Cardiol 2017;69:3040-1. http://doi.org/cwhj

Arrigo M, Parissis JT, Akiyama E, Mebazaa A. Understanding acute heart failure: pathophysiology and diagnosis. Eur Heart J 2016;18:G11–G18. http://doi.org/f926dj

Follath F, Yilmaz MB, Delgado JF, Parissis JT, Porcher R, Gayat E, et al., Clinical presentation, management and outcomes in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). Intensive Care Med. 2011;37:619-26. http://doi.org/d9k3k3

Adams KF Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 2005; 149:209-16. http://doi.org/bd56dt

Abraham WT, Fonarow GC, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, et al., Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol 2008;52:347-56. http:// doi.org/cqn86f

Komajda M, Follath F, Swedberg K. The Euroheart Failure Survey Programme-a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. The study group of diagnosis on the working group on heart failure of the European Society of Cardiology, Eur Heart J 2003;24:442-63. http://doi.org/d4cf92

Nieminen M, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J 2006;27:2725-36. http://doi.org/cr5zpm

Zannad F, Mebazaa A, Juillière Y, Cohen-Solal A, Guize L, Alla F, et al., Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study. Eur J Heart Fail 2006;8:697-705. http://doi.org/dbmwq7

Tavazzi L, Maggioni AP, Lucci D, Cacciatore G, Ansalone G, Oliva F, et al., Nationwide survey on acute heart failure in cardiology ward services in Italy. Eur Heart J 2006; 27:1207-15. http://doi.org/bqsnbz

Perna ER, Barbagelata A, Grinfeld L, García Ben M, Címbaro Canella JP, Bayol PA, et al., Overview of acute decompensated heart failure in Argentina: lessons learned from 5 registries during the last decade. Am Heart J 2006;151:84-91. http://doi.org/bqsnbz

Maggioni AP, Orso F, Calabria S, Rossi E, Cinconze E, Baldasseroni S, et al; ARNO Observatory. The real-world evidence of heart failure: findings from 41 413 patients of the ARNO database.Eur J Heart Fail 2016;18:402-1. http://doi.org/cs79

Young JB, Abraham WT, Warner-Stevenson L, Horton DP, Elkayam U, Bourge RC, et al. Publication Committee for the VMAC Investigators (Vasodilatation in the Management of Acute CHF), Intravenous nesiritide vs nitroglycerin for treatment of decompen¬sated congestive heart failure: a randomized controlled trial. JAMA 2002;287:1531-40.

Cuffe MS, Califf RM, Adams KF Jr, Benza R, Bourge R, Colucci WS, et al, Short-term Intravenous Milrinone for Acute Exacerbation of Chronic Heart Failure. A Randomized Controlled Trial, JAMA 2002;287:1541-7. http://doi.org/cbxc3

Kurmani S, Squire L, Acute Heart Failure: Definition, Classifica¬tion and Epidemiology., Curr Heart Fail Rep 2017;14:385-92. http:// doi.org/cwhm

Maggioni AP, Dahlström U, Filippatos G, Chioncel O, Crespo Leiro M, Drozdz J, et al EURObservational Research Programme:regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 2013;15:808-17. http://doi.org/f23zc4

Setoguchi S, Stevenson LW, Hospitalizations in patients with heart failure: who and why. J Am Coll Cardiol 2009;54:1703–5. http:// doi.org/d6g3pp


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