Does the presentation of fewer acute symptoms in patients hospitalized with decompensated heart failure affect treatment practices and short-term mortality?
Patients hospitalized with acute heart failure who present with fewer symptoms are paradoxically at higher risk for short-term mortality and are less likely to receive guideline-directed medical therapies.
OBJECTIVES: The objectives of this study were to examine the type and frequency of symptoms in patients hospitalized with acute heart failure (HF) as well as the relationship between symptom patterns and patient characteristics, treatment practices, and hospital outcomes in patients hospitalized with decompensated HF. METHODS: The study sample consisted of 4537 residents of the Worcester, MA metropolitan area hospitalized for decompensated HF at 11 greater Worcester medical centers in 1995 and 2000. RESULTS: The average age of the study sample was 76 years; the majority (57%) were women, and three-quarters of our patient population had been previously diagnosed with HF. Dyspnea (93%) was the most frequent complaint reported by patients followed by the presence of peripheral edema (70%), cough (51%), orthopnea (37%), and chest pain/discomfort (30%). Patients reporting few cardiac symptoms were less likely to be treated with effective cardiac therapies during hospitalization than patients with multiple cardiac signs and symptoms and experienced higher hospital (9.7% vs. 7.7%) as well as 30-day (17.1% vs. 10.2%) death rates (P < 0.05). CONCLUSIONS: The results of this study in residents of a large New England community suggest that patients with fewer reported symptoms of decompensated HF were less likely to receive effective cardiac treatments and had worse short-term outcomes. Reasons for these differences in treatment practices and short-term outcomes need to be elucidated and attention directed to these high-risk patients.
Goldberg et al. (Sat,) studied this question.