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

Abstract

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.

Time to update our profiles

“…To better address WASH rates, it will be necessary to dissect the profiles of congestion to distinguish between right‐ and left‐sided congestion, as recently reviewed by Thibodeau and Drazner . The European study identified tricuspid regurgitation as a prominent factor in persistent congestion . Patients with right ventricular failure and disproportionate right‐sided congestion are now well‐recognized to be at greater disadvantage from cardio‐renal limitations.…”

“…3 The European study identified tricuspid regurgitation as a prominent factor in persistent congestion. 6 Patients with right ventricular failure and disproportionate right-sided congestion are now well-recognized to be at greater disadvantage from cardio-renal limitations. We are only beginning to recognize the relationships between congestive hepatopathy, inflammation, malnutrition, and HF outcomes.…”

“…Published in the current issue of the Journal, the ESC‐EORP‐HFA Heart Failure Long‐Term Registry of 7865 patients from 211 cardiology centres in 21 countries and the EAHFE Registry of 11 261 patients from 41 Spanish emergency departments deserve high commendation for their large‐scale collaborations to better understand and treat HF. This prospective data collection is remarkable for its thoughtful design and rigour.…”

“…Published in the current issue of the Journal, the ESC-EORP-HFA Heart Failure Long-Term Registry of 7865 patients from 211 cardiology centres in 21 countries 6…”

November 2019 at a glance. Chronic and acute heart failure: from epidemiology to treatment

“…Clinical profile of acute HF patients affects outcomes. 12 Chioncel et al 13 and Javaloyes et al 14 reported prevalence and prognostic impact of clinical phenotypes based on perfusion and congestion status. The phenotype 'wet-warm' was the most commonly observed.…”