Does clinician assessment of hemodynamics from history and physical examination accurately reflect invasive measurements and predict outcomes in advanced heart failure?
Clinical assessment of hemodynamics via history and physical exam reliably detects elevated filling pressures and reduced perfusion, and identifies advanced heart failure patients at increased risk of early adverse events.
BACKGROUND: We determined whether estimated hemodynamics from history and physical examination (H P or =2 pillows (OR 3.6; P or =30 mm Hg. Estimated cardiac index did not reliably reflect measured cardiac index (P=0.09), but "cold" versus "warm" profile was associated with lower median measured cardiac index (1.75 vs. 2.0 L/min/m(2); P=0.004). In Cox regression analysis, discharge "cold" or "wet" profile conveyed a 50% increased risk of death or rehospitalization. CONCLUSIONS: In advanced HF, the presence of orthopnea and elevated jugular venous pressure are useful to detect elevated PCWP, and a global assessment of inadequate perfusion ("cold" profile) is useful to detect reduced cardiac index. Hemodynamic profiles estimated from the discharge H&P identify patients at increased risk of early events.
Drazner et al. (Mon,) studied this question.