Premium
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
Author(s) -
Chioncel Ovidiu,
Mebazaa Alexandre,
Maggioni Aldo P.,
Harjola VeliPekka,
Rosano Giuseppe,
Laroche Cecile,
Piepoli Massimo F.,
CrespoLeiro Maria G.,
Lainscak Mitja,
Ponikowski Piotr,
Filippatos Gerasimos,
Ruschitzka Frank,
Seferovic Petar,
Coats Andrew J.S.,
Lund Lars H.
Publication year - 2019
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1492
Subject(s) - medicine , hazard ratio , heart failure , confidence interval , cardiology , acute decompensated heart failure
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.