Clinical profile, contemporary management and one‐year mortality in patients with severe acute heart failure syndromes: The EFICA study☆

Abstract

Background: Little is known about the epidemiology of acute decompensated heart failure (ADHF) in patients admitted to intensive and coronary care units (ICU/CCU). Observational data may improve disease management and guide the design of clinical trials. Aims: EFICA is an observational study of the clinical profile, management and survival of ADHF patients admitted to ICU/CCU. Methods: The study included 599 patients admitted to 60 ICU/CCUs across France. Relevant data was recorded during hospitalisation. Survival was assessed at 4 weeks and 1 year. Results: The main cause of ADHF was ischaemic heart disease (61%); 29% of patients had cardiogenic shock. Mortality was 27.4% at 4 weeks and 46.5% at 1 year, increasing to 43.2% and 62.5%, respectively, when including pre-admission deaths. Shock patients had the highest [57.8% vs. 15.2% without shock ( p < 0.001)] and patients with hypertension and pulmonary oedema had the lowest 4-week mortality: (7%). Pre-admission NYHA class III -IV heart failure, not initial clinical presentation, influenced 1-year mortality. Conclusion: ADHF is a heterogeneous syndrome. Based on initial clinical presentation, three entities with distinct features and outcome may be described: cardiogenic shock, pulmonary oedema with hypertension, and Fdecompensated_ chronic heart failure. This should be taken into account in future observational studies, guidelines and clinical trials.

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

“…The length of hospital stay of our patients was comparable to that found in other European registries [29][30][31][32]. Our patients who developed WRF had a longer duration of hospital stay and this may be important both with respect to quality of life and the cost of treatment.…”

Hospital and 4‐Year Mortality Predictors in Patients With Acute Pulmonary Edema With and Without Coronary Artery Disease

“…Also of importance is the fact that identification of CAD patients was based not only on clinical grounds, but also on coronary angiography data available in 69% of them, but also in 43% of those with non‐CAD. This is in contrast to most existing series of APE7, 10, 23 or acute heart failure,1, 2, 3, 4, 5, 13 where angiographic data are not provided. Of interest is the documentation of significant coronary artery stenosis in 32% of non‐CAD patients who underwent cardiac catheterization, pointing to the concomitant presence of CAD in patients with the primary diagnosis of valvular heart disease.…”

“…Most series that have analyzed total mortality in patients with acute heart failure have reported only a 1‐year follow‐up with mortality rates ranging from 17.4% to 34%5, 11, 12, 13, 14 and higher in patients admitted to a critical care area (46.5%) 4. Predictors of 1‐year mortality appeared also to be age,12, 13, 14, 15 admission blood pressure,13, 15 anemia,13 renal failure,12, 13, 15 left ventricular dysfunction, and acute coronary syndromes 14.…”

“…Several recent studies have reported on the 1‐year prognosis of patients with acute heart failure4, 11, 12, 13, 14, 15, 16 and 3 have analyzed longer follow‐up,15, 16, 17 one of them with decompensated heart failure and pulmonary edema 17. In contrast, long‐term follow‐up in patients with well‐defined APE has been limited to 1 year and has been described in only 2 old reports with a reduced number of patients 7, 18.…”

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

“…Recent studies, however, have shown that up to 30%-50% of patients admitted with acute HF may have preserved LVEF [14,15,[18][19][20][21]. Patients with preserved LVEF have a high rate of rehospitalisation and a similar, or only slightly lower, mortality, compared to patients with low LVEF [14,15].…”