Avtor/Urednik		Chioncel, Ovidiu; Mebazaa, Alexandre; Maggioni, Aldo P.; Harjola, Veli-Pekka; Rosano, Giuseppe M.; Laroche, Cécile; Piepoli, Massimo Francesco; Crespo-Leiro, Maria G.; Lainščak, Mitja; Ponikowski, Piotr; Strašek, Milena; Savnik-Iskra, Mojca; Ravnikar, Tinkara; Černič Šuligoj, Nataša; Komel, Jana; Fras, Zlatko; Jug, Borut; Glavič, Tanja; Lošić, Renata; Bombek, Mirko; Krajnc, Igor; Krunič, Barbara; Horvat, S.; Kovac, Dusan; Rajtman, Darko; Cenčič, Vid; Letonja, Mitja; Winkler, Robert; Valentinčič, Matej; Melihen Bartolič, Cvetka; Bartolić, Andrej; Pušnik, Maja; Kladnik, Majda; Slemenik-Pušnik, Cirila; Marolt, Apolon; Klen, Jasna; Drnovšek, Borut; Leskovar, Boštjan
Naslov		Acute heart failure congestion and perfusion status
Tip		članek
Vol. in št.		Letnik 21, št. 11
Leto izdaje		2019
Obseg		str. 1338-1352
ISSN		1879-0844 - European journal of heart failure
Jezik		eng
Abstrakt		Classification of acute heart failure (AHF) patients into four clinical profiles defined by evidence of congestion and perfusion is advocated by the 2016 European Society of Cardiology (ESC)guidelines. Based on the ESC-EORP-HFA Heart Failure Long-Term Registry, we compared differences in baseline characteristics, in-hospital management and outcomes among congestion/perfusion profiles using this classification. METHODS AND RESULTS: We included 7865 AHF patients classified at admission as: 'dry-warm' (9.9%), 'wet-warm' (69.9%), 'wet-cold' (19.8%) and 'dry-cold' (0.4%). These groups differed significantly in terms of baseline characteristics, in-hospital management and outcomes. In-hospital mortality was 2.0% in 'dry-warm', 3.8% in 'wet-warm', 9.1% in 'dry-cold' and 12.1% in 'wet-cold' patients. Based on clinical classification at admission, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: 'wet-warm' vs. 'dry-warm' 1.78 (1.43-2.21) and 'wet-cold' vs. 'wet-warm' 1.33 (1.19-1.48). For profiles resulting from discharge classification, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: 'wet-warm' vs. 'dry-warm' 1.46 (1.31-1.63) and 'wet-cold' vs. 'wet-warm' 2.20 (1.89-2.56). Among patients discharged alive, 30.9% had residual congestion, and these patients had higher 1-year mortality compared to patients discharged without congestion (28.0 vs. 18.5%). Tricuspid regurgitation, diabetes, anaemia and high New York Heart Association class were independently associated with higher risk of congestion at discharge, while beta-blockers at admission, de novo heart failure, or any cardiovascular procedure during hospitalization were associated with lower risk of residual congestion. CONCLUSION: Classification based on congestion/perfusion status provides clinically relevant information at hospital admission and discharge. A better understanding of the clinical course of the two entities could play an important role towards the implementation of targeted strategies that may improve outcomes.
Proste vsebinske oznake		acute heart failure congestion forrester classification outcomes perfusion registry