Acute heart failure congestion and perfusion status - impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry
Acute heart failure congestion and perfusion status - impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry
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DOI：
10.1002/ejhf.1492
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发表时间：
2019-11-01
影响因子：
18.2
通讯作者：
Lund, Lars H.
中科院分区：
文献类型：
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作者：
Chioncel, Ovidiu;Mebazaa, Alexandre;Lund, Lars H.
2016年欧洲心脏病学会（ESC）指南提倡将急性心力衰竭（AHF）患者根据充血和灌注证据分为四种临床特征。基于ESC-EORP-HFA心力衰竭长期登记，我们比较了使用该分类的充血/灌注概况的基线特征、住院管理和结果的差异。方法和结果纳入7865例AHF患者，入院时分为“干热”（9.9%）、“湿温”（69.9%）、“湿冷”（19.8%）和“干冷”（0.4%）。这些组在基线特征、院内管理和结局方面存在显著差异。“干热型”患者的住院死亡率为2.0%，“湿热型”患者为3.8%，“干冷型”患者为9.1%，“湿冷型”患者为12.1%。根据入院时的临床分类，1年死亡率的调整风险比（95%置信区间）为：“湿-暖”vs“湿-暖”。“干热”为1.78(1.43-2.21)，“湿冷”为1.78（1.43-2.21）。‘wet-warm’ 1.33（1.19-1.48）。对于由出院分类得出的概况，1年死亡率的调整风险比（95%置信区间）为：“湿-暖”vs。“干热”为1.46(1.31-1.63)，“湿冷”为1.46（1.31-1.63）。‘wet-warm’ 2.20（1.89-2.56）。在存活出院的患者中，30.9%存在残余充血，这些患者的1年死亡率高于无充血出院的患者（28.0% vs. 18.5%）。三尖瓣反流、糖尿病、贫血和纽约心脏协会高分级与出院时淤血风险较高独立相关，而入院时的β受体阻滞剂、新发心力衰竭或住院期间的任何心血管手术与残留淤血风险较低相关。结论基于充血/灌注状态的分级可提供住院和出院时的临床相关信息。更好地了解这两个实体的临床过程可以对实施可能改善结果的有针对性的战略发挥重要作用。
Aims 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.