Prognosis of acute heart failure based on clinical data of congestion
Por:
Espinosa B., Llorens P., Gil V., Rossello X., Jacob J., Herrero P., Martín-Sánchez F.J., Alquézar-Arbé A., Masip J., Miró Ò.
Publicada:
1 jun 2022
Ahead of Print:
1 ene 2021
Resumen:
Background and objectives: This work aims to assess whether symptoms/signs of congestion in patients with acute heart failure (AHF) evaluated in hospital emergency departments (HED) allows for predicting short-term progress.
Patients and methods: The study group comprised consecutive patients diagnosed with AHF in 45 HED from EAHFE Registry. We collected clinical variables of systemic congestion (edema in the lower extremities, jugular vein distention, hepatomegaly) and pulmonary congestion (dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and pulmonary crackles) and analyzed their individual and group association with all-cause 30-day of mortality crudely and adjusted for differences between groups.
Results: We analyzed 18,120 patients (median=83 years, interquartile range [IQR]=76-88; women=55.7%). Of them, 44.6% had >3 congestive symptoms/signs. Individually, the 30-day adjusted risk of death increased 14% for jugular vein distention (hazard ratio [HR]=1.14, 95% confidence interval [95% CI]=1.01-1.28) and 96% for dyspnea on exertion (HR=1.96, 95% CI=1.55-2.49). Assessed jointly, the risk progressively increased with the number of symptoms/signs present; compared to patients without symptoms/signs of congestion, the risk increased by 109%, 123%, and 156% in patients with 1-2, 3-5, and 6-7 symptoms/signs, respectively. These associations did not show interaction with the final disposition of the patient after their emergency care (discharge/hospitalization) with the exception of edema in the lower extremities, which had a better prognosis in discharged patients (HR=0.66, 95% CI=0.49 -0.89) than hospitalized patients (HR=1.01, 95% CI=0.65-1.57; interaction p<0.001).
Conclusion: The presence of a greater number of congestive symptoms/signs was associated with greater all-cause 30-day mortality. Individually, jugular vein distention and dyspnea on exertion were associated with higher short-term mortality. (C) 2021 The Authors. Published by Elsevier Espana, S.L.U.
Filiaciones:
Espinosa B.:
Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
Llorens P.:
Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
Gil V.:
Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
Rossello X.:
Servicio de Cardiología, Hospital Son Espases, Palma de Mallorca, Spain
Jacob J.:
Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
Herrero P.:
Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
Martín-Sánchez F.J.:
Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
Alquézar-Arbé A.:
Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Masip J.:
Servicio de Cardiología, Consorci Sanitari Integral, Barcelona, Spain
Miró Ò.:
Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
Green Published, hybrid, All Open Access, Hybrid Gold, Green
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