Prognosis of acute heart failure based on clinical data of congestion Pronóstico de la insuficiencia cardíaca aguda basado en datos clínicos de congestión
Espinosa, Bego (Instituto de Investigación Sanitaria y Biomédica de Alicante)
Llorens, P. (Hospital General de Alicante. Servicio de Urgencias. Corta Estancia y Hospitalización a Domicilio. Instituto de Investigación Sanitaria y Biómedica de Alicante. Universidad Miguel Hernández)
Gil, V. (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Rossello, X. (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Jacob, Javier (Hospital Universitari de Bellvitge)
Herrero, P. (Hospital Universitario Central de Asturias. Servicio de Urgencias)
Martín-Sánchez, F.J. (Hospital Clínico San Carlos (Madrid))
Alquézar-Arbé, A (Institut d'Investigació Biomèdica Sant Pau)
Masip, J. (Consorci Sanitari Integral. Servei de Cardiologia)
Miró, None (Institut d'Investigacions Biomèdiques August Pi i Sunyer)

Date:	2022
Abstract:	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.
Grants:	Instituto de Salud Carlos III PI15/01019 Instituto de Salud Carlos III PI18/00393 Agència de Gestió d'Ajuts Universitaris i de Recerca GRC 2009/1385 Agència de Gestió d'Ajuts Universitaris i de Recerca 2014/0313 Agència de Gestió d'Ajuts Universitaris i de Recerca 2017/1424
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Castellà
Document:	Article ; recerca ; Versió publicada
Subject:	Acute heart failure ; Congestion ; Signs ; Mortality ; Emergency departments
Published in:	Revista Clinica Espanola, Vol. 222 Núm. 6 (enero 2022) , p. 321-331, ISSN 1578-1860

DOI: 10.1016/j.rce.2021.07.003

11 p, 2.3 MB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles