Prognostic significance and clinical determinants of residual dyspnoea at discharge in acute heart failure: a single-centre, prospective observational study

Abstract

Objective: This study aimed to assess the prognostic significance of residual (discharge) dyspnoea in acute heart failure (AHF) patients.

Design: Single-centre, prospective observational study.

Setting: Patients hospitalised for decompensated AHF in a single cardiology centre, in Poland.

Participants: All patients (n=202) who survived the hospitalisation with the primary diagnosis of AHF and were discharged from the hospital.

Primary and secondary outcome measures: 1-year all-cause mortality; and the composite endpoint of 1-year all-cause mortality and rehospitalisation for the HF (whichever occurred first).

Results: On admission, 159 (78.7%) AHF patients presented dyspnoea at rest, while residual resting dyspnoea at discharge was present in 16 patients (7.9%). There were 48 (24%) patients with moderate/severe exertional dyspnoea at discharge. In the multivariable model, the resting dyspnoea at discharge was related to a higher risk of both 1-year mortality and composite outcome, with HR (95% CI) 8.0 (3.7 to 17.3) and 5.1 (2.6 to 10.2), respectively, both p<0.0001. Analogically, moderate or severe residual dyspnoea at discharge was related to the heightened risk of study both outcomes, with HR (95% CI) 3.1 (1.8 to 5.4) and 1.8 (1.1 to 2.9), respectively, p<0.01.

Conclusions: Among AHF patients the residual dyspnoea at discharge was unexpectedly common and was associated with an unfavourable outcome during 1-year follow-up.

Keywords: Acute Heart Failure; dyspnea; outcome.

Figure 1

The number of patients reporting dyspnoea at rest in subsequent days of hospitalisation.

Figure 2

The Kaplan-Meier curves for 1-year mortality by residual dyspnoea at discharge. Log rankp=0.0001. Red line—patients without dyspnoea at discharge. Blue line—patients with dyspnoea at discharge.