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. 2019 Nov;21(11):1353-1365.
doi: 10.1002/ejhf.1502. Epub 2019 Jun 18.

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

Patricia Javaloyes  1 , Òscar Miró  2 , Víctor Gil  2 , Francisco Javier Martín-Sánchez  3 , Javier Jacob  4 , Pablo Herrero  5 , Koji Takagi  6   7 , Aitor Alquézar-Arbé  8 , María Pilar López Díez  9 , Enrique Martín  10 , Carlos Bibiano  11 , Rosa Escoda  2 , Cristina Gil  12 , Marta Fuentes  12 , Guillermo Llopis García  3 , José María Álvarez Pérez  9 , Alba Jerez  2 , Josep Tost  13 , Lluís Llauger  14 , Rodolfo Romero  15 , José Manuel Garrido  16 , Esther Rodríguez-Adrada  17 , Carolina Sánchez  2 , Xavier Rossello  18 , John Parissis  19 , Alexandre Mebazaa  7 , Ovidiu Chioncel  20 , Pere Llorens  1 ; ICA-SEMES Research Group
Collaborators, Affiliations
Free article

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

Patricia Javaloyes et al. Eur J Heart Fail. 2019 Nov.
Free article

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.

Keywords: Acute heart failure; Clinical profiles; Congestion; Emergency department; Perfusion.

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Comment in

  • Time to update our profiles.
    Punnoose LR, Gopal DM, Stevenson LW. Punnoose LR, et al. Eur J Heart Fail. 2019 Nov;21(11):1366-1369. doi: 10.1002/ejhf.1549. Epub 2019 Jul 18. Eur J Heart Fail. 2019. PMID: 31321859 No abstract available.

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