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  3. 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

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

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • 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
  • 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
  • ICA-SEMES Res Grp

Grupos

Abstract

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.

Datos de la publicación

ISSN/ISSNe:
1388-9842, 1879-0844

EUROPEAN JOURNAL OF HEART FAILURE  WILEY-BLACKWELL

Tipo:
Article
Páginas:
1353-1365
PubMed:
31127677
Factor de Impacto:
5,556 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 42

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Keywords

  • Congestion; Perfusion; Clinical profiles; Acute heart failure; Emergency department

Campos de Estudio

Proyectos y Estudios Clínicos

PRAGMATIC, CONTROLLED, INTERNATIONAL STUDY CONDUCTED IN SEVERAL CENTRES ON THE SAFETY AND THERAPEUTIC EFFECT OF A HYDROXYLETHYL-STARCH (HES) SOLUTION VERSUS AN ELECTROLYTE SOLUTION IN TRAUMA PATIENTS.

Investigador Principal: ÓSCAR DÍAZ CAMBRONERO

HC-G-H-1505 . 2018

EFECTO DE V0251 EN EL VÉRTIGO AGUDO. ESTUDIO ALEATORIZADO, DOBLE CIEGO Y CONTROLADO CON PLACEBO.

Investigador Principal: HERMINIO PÉREZ GARRIGUES

V00251IV2024A

PERFIL DE RIESGO DE LOS PACIENTES CON ETV EN HOSPITALES ESPAÑOLES ATENDIDOS EN LOS SERVICIOS DE URGENCIAS E IMPACTO ASISTENCIAL: REGISTRO ESPHERIA.

Investigador Principal: MARÍA JOSÉ PÉREZ DURÁ

ESPHERIA

PLANIFICACIÓN DEL ALTA DESDE URGENCIAS PARA REDUCIR REINGRESOS A 30 DÍAS EN MAYORES FRÁGILES CON INSUFICIENCIA CARDÍACA AGUDA: ENSAYO CLÍNICO ALEATORIZADO POR CONGLOMERADOS PAREADO.

Investigador Principal: CARMEN GARGALLO MAICAS

DEED FRAIL-AHF . 2019

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