Key result
Increased signs of congestion and hypoperfusion at emergency department arrival in acute heart failure patients were associated with higher risks of hospitalization (P<0.001) and mortality (P<0.001).
Why the study?
It was unclear whether symptoms and signs of congestion and perfusion evaluated at ED arrival can predict decompensation severity and short-term outcomes in AHF.
Does the presence and severity of congestion and hypoperfusion signs at ED arrival predict hospitalization and short-term outcomes in patients with acute heart failure?
Observational (n=18,120)
Does the presence and severity of congestion and hypoperfusion signs at ED arrival predict hospitalization and short-term outcomes in patients with acute heart failure?
p-value: p=<0.001
Simple clinical assessment of congestion and hypoperfusion at ED arrival provides additive prognostic value for predicting hospitalization, prolonged stay, and in-hospital mortality in acute heart failure.
May aid ED risk stratification in acute HF; leaves open whether it alters management or outcomes.
AIMS: To assess whether symptoms/signs of congestion and perfusion in acute heart failure (AHF) evaluated at patient arrival to the emergency department (ED) can predict the severity of decompensation and short-term outcomes. METHODS AND RESULTS: We included patients from the Epidemiology of AHF Emergency Registry (EAHFE Registry). We registered seven clinical surrogates of congestion and five of hypoperfusion. Patients were grouped according to severity of congestion/hypoperfusion. We assessed the need for hospitalization, in-hospital all-cause mortality for patients needing hospitalization, and prolonged hospitalization for patients surviving the decompensation episode. Outcomes were adjusted for patient characteristics and the coexistence of congestion and hypoperfusion. We analysed 18 120 patients (median = 83 years, interquartile range = 76-88; women = 55.7%). Seventy-two per cent presented >2 signs/symptoms of congestion and 18% had at least 1 sign/symptom of hypoperfusion. Seventy-five per cent were hospitalized with in-hospital death in 9% and prolonged hospitalization in 47% discharged alive. The presence of congestion/hypoperfusion was independently associated with poorer outcomes. An increase in the number of signs/symptoms of congestion was associated with increased risk of hospitalization (P < 0.001) and prolonged stay (P = 0.011), but not mortality (P = 0.06). Increased signs/symptoms of hypoperfusion were associated with hospitalization (P < 0.001) and mortality (P < 0.001), but not prolonged stay (P = 0.227). In the combined model, including congestion and hypoperfusion, both had additive effects on hospitalization, in-hospital mortality was driven by hypoperfusion and no differences were observed for prolonged hospitalization. CONCLUSION: The presence of congestion/hypoperfusion at ED arrival is a simple clinical marker associated with a higher risk of severity/adverse short-term outcomes.
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Espinosa et al. (2022) conducted an observational in Acute heart failure (n=18,120). Symptoms and signs of congestion and hypoperfusion vs. Fewer or no signs/symptoms of congestion and hypoperfusion was evaluated on Need for hospitalization, in-hospital all-cause mortality, and prolonged hospitalization (p=<0.001). Increased signs of congestion and hypoperfusion at emergency department arrival in acute heart failure patients were associated with higher risks of hospitalization (P<0.001) and mortality (P<0.001).
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