RT Journal Article
T1 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.
A1 Javaloyes, Patricia
A1 Miró, Òscar
A1 Gil, Víctor
A1 Martín-Sánchez, Francisco Javier
A1 Jacob, Javier
A1 Herrero, Pablo
A1 Takagi, Koji
A1 Alquézar-Arbé, Aitor
A1 López Díez, María Pilar
A1 Martín, Enrique
A1 Bibiano, Carlos
A1 Escoda, Rosa
A1 Gil, Cristina
A1 Fuentes, Marta
A1 Llopis García, Guillermo
A1 Álvarez Pérez, José María
A1 Jerez, Alba
A1 Tost, Josep
A1 Llauger, Lluís
A1 Romero, Rodolfo
A1 Garrido, José Manuel
A1 Rodríguez-Adrada, Esther
A1 Sánchez, Carolina
A1 Rossello, Xavier
A1 Parissis, John
A1 Mebazaa, Alexandre
A1 Chioncel, Ovidiu
A1 Llorens, Pere
A1 ICA-SEMES Research Group, 
K1 Acute heart failure
K1 Clinical profiles
K1 Congestion
K1 Emergency department
K1 Perfusion
AB 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). 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. 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.
YR 2019
FD 2019-06-18
LK http://hdl.handle.net/10668/14016
UL http://hdl.handle.net/10668/14016
LA en
DS RISalud
RD Apr 7, 2025