Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes
Por:
Javaloyes, P, Miro, O, Gil, V, Martin-Sanchez, FJ, Jacob, J, Herrero, P, Takagi, K, Alquezar-Arbe, A, Martin, E, Bibiano, C, Escoda, R, Gil, C, Fuentes, M, Garcia, GL, Perez, JMA, Jerez, A, Tost, J, Llauger, L, Romero, R, Garrido, JM, Rodriguez-Adrada, E, Sanchez, C, Rossello, X, Parissis, J, Mebazaa, A, Chioncel, O, Llorens, P, Alonso, H, Perez-Llantada, E, Cadenas, MS, Xipell, C, Perez-Dura, MJ, Salvo, E, Pavon, J, Noval, A, Torres, JM, Lopez-Grima, ML, Valero, A, Juan, MA, Aguirre, A, Pedragosa, MA, Maso, SM, Alonso, MI, Ruiz, F, Franco, JM, Mecina, AB, Berenguer, M, Donea, R, Ramon, SS, Rodriguez, VC, Pinera, P, Nicolas, JAS, Garate, RT, Rizzi, MA, Herrera, S, Cabello, I, Haro, A, Richard, F, Diez, MPL, Alvarez, JV, Garcia, BP, Garcia, MG, Gonzalez, MS, Marquina, V, Jimenez, I, Hernandez, N, Brouzet, B, Espinosa, B, Andueza, JA, Ruiz, M, Calvache, R, Serralta, MTL, Jave, LEC, Arriaga, BA, Bergua, BS, Mojarro, EM, Jimenez, BSA, Becquer, LT, Burillo, G, Garcia, LL, LaSalle, GC, Urbano, CA, Soto, ABG, Padial, ED, Ferrer, ES, Lucas-Imbernon, FJ, Gaya, R, Mir, M, Rodriguez, B, Carballo, JL, Miranda, BR
Publicada:
1 nov 2019
Resumen:
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.
Filiaciones:
Javaloyes, P:
Hosp Gen Alicante, Short Stay Unit & Home Hospitalizat, Emergency Dept, Alicante, Spain
Hosp Gen Alicante, Alicante, Spain
Miro, O:
Univ Barcelona, Inst Invest Biomed August Pi iSunyer IDIBAPS, Hosp Clin, Emergency Dept, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Gil, V:
Univ Barcelona, Inst Invest Biomed August Pi iSunyer IDIBAPS, Hosp Clin, Emergency Dept, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Martin-Sanchez, FJ:
Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Hosp Clin San Carlos Madrid, Madrid, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Lhospitalet De Llobregat, Catalonia, Spain
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Herrero, P:
Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Spain
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Takagi, K:
Musashi Kosugi Hosp, Nippon Med Sch, Cardiol & Intens Care Unit, Kawasaki, Kanagawa, Japan
AP HP, Dept Anaesthesiol & Crit Care Med, St Louis, France
Lariboisiere Univ Hosp, Paris, France
Alquezar-Arbe, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Martin, E:
Hosp Sant Pau & Santa Tecla, Emergency Dept, Tarragona, Spain
Bibiano, C:
Hosp Infanta Leonor, Emergency Dept, Madrid, Spain
Hosp Infanta Leonor Madrid, Madrid, Spain
Escoda, R:
Univ Barcelona, Inst Invest Biomed August Pi iSunyer IDIBAPS, Hosp Clin, Emergency Dept, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Gil, C:
Hosp Univ Salamanca, Emergency Dept, Salamanca, Spain
Hosp Univ Salamanca, Salamanca, Spain
Fuentes, M:
Hosp Univ Salamanca, Emergency Dept, Salamanca, Spain
Hosp Univ Salamanca, Salamanca, Spain
Garcia, GL:
Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Hosp Clin San Carlos Madrid, Madrid, Spain
Perez, JMA:
Hosp Univ Burgos, Emergency Dept, Burgos, Spain
Hosp Univ Burgos, Burgos, Spain
Jerez, A:
Univ Barcelona, Inst Invest Biomed August Pi iSunyer IDIBAPS, Hosp Clin, Emergency Dept, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Tost, J:
Hosp Terrassa, Emergency Dept, Barcelona, Spain
Consorci Sanitari Terrassa, Barcelona, Spain
Llauger, L:
Hosp Univ Vic, Emergency Dept, Barcelona, Spain
Romero, R:
Univ Europea, Hosp Univ Getafe, Sch Biomed & Hlth Sci, Emergency Dept, Madrid, Spain
Hosp Univ Getafe Madrid, Madrid, Spain
Garrido, JM:
Hosp Virgen delRocio, Emergency Dept, Seville, Spain
Hosp Virgen Macarena Sevilla, Seville, Spain
Rodriguez-Adrada, E:
Univ Rey Juan Carlos, Hosp Mostoles, Emergency Dept, Madrid, Spain
Hosp Rey Juan Carlos Mostoles Madrid, Madrid, Spain
Sanchez, C:
Univ Barcelona, Inst Invest Biomed August Pi iSunyer IDIBAPS, Hosp Clin, Emergency Dept, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Rossello, X:
Inst Salud Carlos III, Ctr Invest Cardiovasc, Madrid, Spain
Parissis, J:
Univ Athens, Med Sch, Dept Cardiol, Athens, Greece
Mebazaa, A:
AP HP, Dept Anaesthesiol & Crit Care Med, St Louis, France
Lariboisiere Univ Hosp, Paris, France
Chioncel, O:
Univ Med & Pharm Carol Davila, Prof CC Iliescu, Emergency Inst Cardiovasc Dis, Bucharest, Romania
Llorens, P:
Hosp Gen Alicante, Short Stay Unit & Home Hospitalizat, Emergency Dept, Alicante, Spain
Hosp Gen Alicante, Alicante, Spain
Alonso, H:
Hosp Marques Valdecilla Santander, Santander, Spain
Perez-Llantada, E:
Hosp Marques Valdecilla Santander, Santander, Spain
Cadenas, MS:
Hosp Clin San Carlos Madrid, Madrid, Spain
Xipell, C:
Hosp Clin Barcelona, Barcelona, Spain
Perez-Dura, MJ:
Hosp Politecn La Fe Valencia, Valencia, Spain
Salvo, E:
Hosp Politecn La Fe Valencia, Valencia, Spain
Pavon, J:
Hosp Dr Negrin Las Palmas Gran Canaria, Las Palmas Gran Canaria, Spain
Noval, A:
Hosp Insular Las Palmas Gran Canaria, Las Palmas Gran Canaria, Spain
Torres, JM:
Hosp Reina Sofia Cordoba, Cordoba, Spain
Lopez-Grima, ML:
Hosp Dr Peset Valencia, Valencia, Spain
Valero, A:
Hosp Dr Peset Valencia, Valencia, Spain
Juan, MA:
Hosp Dr Peset Valencia, Valencia, Spain
Aguirre, A:
Hosp del Mar Barcelona, Barcelona, Spain
Pedragosa, MA:
Hosp del Mar Barcelona, Barcelona, Spain
Maso, SM:
Hosp del Mar Barcelona, Barcelona, Spain
Alonso, MI:
Hosp Valme Sevilla, Seville, Spain
Ruiz, F:
Hosp Valme Sevilla, Seville, Spain
Franco, JM:
Hosp Miguel Servet Zaragoza, Zaragoza, Spain
Mecina, AB:
Hosp Alcorcon Madrid, Madrid, Spain
Berenguer, M:
Consorci Sanitari Terrassa, Barcelona, Spain
Donea, R:
Consorci Sanitari Terrassa, Barcelona, Spain
Ramon, SS:
Hosp Univ Rio Hortega Valladolid, Valladolid, Spain
Rodriguez, VC:
Hosp Univ Rio Hortega Valladolid, Valladolid, Spain
Pinera, P:
Hosp Reina Sofia Murcia, Murcia, Spain
Nicolas, JAS:
Hosp Reina Sofia Murcia, Murcia, Spain
Garate, RT:
Hosp Severo Ochoa Madrid, Madrid, Spain
Rizzi, MA:
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Herrera, S:
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Cabello, I:
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Haro, A:
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Richard, F:
Hosp Univ Burgos, Burgos, Spain
Diez, MPL:
Hosp Univ Burgos, Emergency Dept, Burgos, Spain
Hosp Univ Burgos, Burgos, Spain
Alvarez, JV:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Garcia, BP:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Garcia, MG:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Gonzalez, MS:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Marquina, V:
Hosp Gen Alicante, Alicante, Spain
Jimenez, I:
Hosp Gen Alicante, Alicante, Spain
Hernandez, N:
Hosp Gen Alicante, Alicante, Spain
Brouzet, B:
Hosp Gen Alicante, Alicante, Spain
Espinosa, B:
Hosp Gen Alicante, Alicante, Spain
Andueza, JA:
Hosp Gen Univ Gregorio Maranon Madrid, Madrid, Spain
Ruiz, M:
Hosp Henares Madrid, Madrid, Spain
Calvache, R:
Hosp Henares Madrid, Madrid, Spain
Serralta, MTL:
Hosp Tajo Madrid, Madrid, Spain
Jave, LEC:
Hosp Tajo Madrid, Madrid, Spain
Arriaga, BA:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Bergua, BS:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Mojarro, EM:
Hosp St Pau & Santa Tecla Tarragona, Tarragona, Spain
Jimenez, BSA:
Hosp St Pau & Santa Tecla Tarragona, Tarragona, Spain
Becquer, LT:
Hosp Univ Canarias Tenerife, Tenerife, Spain
Burillo, G:
Hosp Univ Canarias Tenerife, Tenerife, Spain
Garcia, LL:
Hosp Univ Vic Barcelona, Barcelona, Spain
LaSalle, GC:
Hosp Univ Vic Barcelona, Barcelona, Spain
Urbano, CA:
Hosp Costa Sol Marbella Malaga, Malaga, Spain
Soto, ABG:
Hosp Costa Sol Marbella Malaga, Malaga, Spain
Padial, ED:
Hosp Costa Sol Marbella Malaga, Malaga, Spain
Ferrer, ES:
Hosp Josep Trueta Girona, Girona, Spain
Lucas-Imbernon, FJ:
Hosp Gen Univ Albacete, Albacete, Spain
Gaya, R:
Hosp Juan XXIII Tarragona, Tarragona, Spain
Mir, M:
Hosp Infanta Leonor Madrid, Madrid, Spain
Rodriguez, B:
Hosp Infanta Leonor Madrid, Madrid, Spain
Carballo, JL:
Complejo Hosp Univ Ourense, Orense, Spain
Miranda, BR:
Hosp Rey Juan Carlos Mostoles Madrid, Madrid, Spain
Bronze, Green Accepted
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