Key result
Severe AHF congestion clusters are linked to greater comorbidity burden and HFpEF than mild congestion.
Why the study?
Patients with acute heart failure present with diverse signs and symptoms, and evaluating symptoms in clusters may be more clinically meaningful than evaluating them individually.
Observational (n=218)
Patients presenting to the emergency department with acute heart failure can be grouped into severe and mild congestion symptom clusters, which correlate with comorbidity burden and ejection fraction.
Symptom clustering may aid ED risk stratification in acute HF; hypothesis-generating for HFpEF and comorbidity-targeted trials.
BACKGROUND: Patients with acute heart failure present to the emergency department with a myriad of signs and symptoms. Symptoms evaluated in clusters may be more meaningful than those evaluated individually by clinicians. OBJECTIVE: Among emergency department patients, we aimed to identify signs and symptoms correlations, clusters, and differences in clinical variables between clusters. METHODS: Medical record data included adults older than 18 years, International Classification of Diseases, Tenth Revisions codes , and positive Framingham Heart Failure Diagnostic Criteria. Exclusion criteria included medical records with a ventricular assist device and dialysis. For analysis, correlation, and the Gower distance, the independent t test, Mann-Whitney U test, χ 2 test, and regression were performed. RESULTS: A secondary analysis was conducted from the data set to evaluate door-to-diuretic time among patients with acute heart failure in the emergency department. A total of 218 patients were included, with an average age of 69 ± 15 years and predominantly White (74%, n = 161). Two distinct symptom clusters were identified: severe and mild congestion. The severe congestion cluster had a more comorbidity burden compared with the mild congestion cluster, as measured by the Charlson Comorbidity index (cluster 1 vs cluster 2, 6 [5-7] vs 5 [4-6]; P = .0019). Heart failure with preserved ejection fraction was associated with the severe congestion symptom cluster ( P = .009), and heart failure with mildly reduced ejection fraction was associated with the mild congestion cluster ( P = .019). CONCLUSIONS: In conclusion, 2 distinct symptom clusters were identified among patients with acute heart failure. Symptom clusters may be related to ejection fraction or overall cardiac output and comorbidity burden.
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Bhattarai et al. (2023) conducted an observational in Acute heart failure (n=218). Severe congestion symptom cluster vs. Mild congestion symptom cluster was evaluated on Charlson Comorbidity index (p=.0019). Severe congestion symptom clusters in acute heart failure were associated with a higher comorbidity burden (Charlson Comorbidity index 6 vs 5; P=0.0019) and HFpEF (P=0.009) than mild congestion.
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