Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the First Euro Heart Failure Survey

Abstract

Background Heart failure is heterogeneous in aetiology, pathophysiology, and presentation. Despite this diversity, clinical trials of patients hospitalized for HF deal with this problem as a single entity, which may be one reason for repeated failures. Methods The first EuroHeart Failure Survey screened consecutive deaths and discharges of patients with suspected heart failure during 2000–2001. Patients were sorted into seven mutually exclusive hierarchical presentations: (1) with cardiac arrest/ventricular arrhythmia; (2) with acute coronary syndrome; (3) with rapid atrial fibrillation; (4) with acute breathlessness; (5) with other symptoms/signs such as peripheral oedema; (6) with stable symptoms; and (7) others in whom the contribution of HF to admission was not clear. Results The 10,701 patients enrolled were classified into the above seven presentations as follows: 260 (2%), 560 (5%), 799 (8%), 2479 (24%), 1040 (10%), 703 (7%), and 4691 (45%) for which index-admission mortality was 26%, 20%, 10%, 8%, 6%, 6%, and 4%, respectively. Compared to those in group 7, the hazard ratios for death during the index admission were 4.9 ( p ≤ 0.001), 4.0 ( p < 0.001), 2.2 ( p < 0.001), 2.1 ( p < 0.001), 1.4 ( p < 0.04) and 1.4 ( p = 0.04), respectively. These differences were no longer statistically significant by 12 weeks. Conclusion There is great diversity in the presentation of heart failure that is associated with very different short-term outcomes. Only a minority of hospitalizations associated with suspected heart failure are associated with acute breathlessness. This should be taken into account in the design of future clinical trials.

Heart failure etiologies and clinical factors precipitating for worsening heart failure: Findings from BIOSTAT-CHF

“…ACS was a frequent precipitant in patients with ischemic HF, whereas hypertension was a frequent precipitant in patients with hypertensive HF, both of which were consistent with previous literature [32,33]. In contrast, patients with valvular HF were more likely to be precipitated by AF and renal failure.…”

Chronic heart failure and adherence to medication: methods for assessing adherence to therapy and unresolved issues

“…Отличительной euro heart failure survey Многоцентровое исследование [30] Multicenter study [30] Более 11 тыс. КЛИНИЦИСТ 3-4'2020 ТОМ 14 THE CLINICIAN 3-4'2020 VOL.…”

The year in cardiology 2019: heart failure

“…Congestion lies at the heart of failure. [25][26][27] Imaging has long been used to identify dilation of the atria and venous system, which might be termed haemodynamic congestion, for which natriuretic peptides are a useful biomarker. 25 More recently imaging has been used to identify accumulation of fl uid in tissues (tissue congestion), 25,[28][29][30][31][32] which may be associated with increases in the biomarker, (bio)-adrenomedullin.…”