Precipitating factors and 90‐day outcome of acute heart failure: a report from the intercontinental <scp>GREAT</scp> registry

Arrigo, Mattia; Gayat, Étienne; Pařenica, Jiří; Ishihara, Shiro; Zhang, Jiän; Choi, Dong Ju; Park, Jin Joo; AlHabib, Khalid F.; Sato, Naoki; Miró, Òscar; Maggioni, Aldo P.; Zhang, Yuhui; Špinar, Jindřich; Cohen‐Solal, Alain; Iwashyna, Theodore J.; Mebazaa, Alexandre

doi:10.1002/ejhf.682

Cited by 134 publications

(136 citation statements)

References 33 publications

(32 reference statements)

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“…25 In our study, ACS was an exclusion criteria; there was no difference in the presence of atrial fibrillation/flutter and hypertension, and also, there were similar levels of inflammatory parameters (C-reactive protein and white blood cells) in studied groups; therefore, possible precipitants of worse or better outcomes in acute HF could not influence the results of our study. 25 In our study, ACS was an exclusion criteria; there was no difference in the presence of atrial fibrillation/flutter and hypertension, and also, there were similar levels of inflammatory parameters (C-reactive protein and white blood cells) in studied groups; therefore, possible precipitants of worse or better outcomes in acute HF could not influence the results of our study.…”

Section: Discussionmentioning

confidence: 57%

Patterns of dyspnoea onset in patients with acute heart failure: clinical and prognostic implications

et al. 2018

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AimsDespite attempts to improve the management of patients with acute heart failure (HF), virtually all therapeutic agents investigated in large clinical trials failed to show any consistent reduction in mortality and morbidity. Complexity of the clinical syndrome of acute HF seems to be likely an underlying explanation. Traditionally, clinical trials studied mixed patient populations with acute HF, and only recently, better clinical characterization of patients has been proposed. Dyspnoea is the most common presenting symptom related to hospital admission for acute HF. Whether in patients with acute HF, the pattern of symptoms onset preceding hospital admission is associated with clinical characteristics, and the outcomes have not yet been established.Methods and resultsWe investigated 137 patients (mean age: 65 ± 13 years; 80% men) hospitalized due to acute HF with dyspnoea as major reported symptom, who were divided according to the time of its onset into those with acute (n = 98) vs. subacute (n = 39) onset (i.e. within 7 days vs. >7 days preceding hospital admission, respectively). On admission, the former group presented higher blood pressure (138 ± 33 vs. 121 ± 32 mmHg), more often moderate–severe pulmonary congestion (33 vs. 8%), and lower bilirubin level [1.07 (0.72–1.60) vs. 1.27 (0.87–2.06); P < 0.05 in all comparisons]. There were no other differences in baseline clinical characteristics and laboratory indices. Higher percentage of patients with an acute dyspnoea onset reported marked/moderate dyspnoea relief after 6 (18% vs. 7%), 24 (59% vs. 24%), and 48 h (80% vs. 46% assessed as an improvement of at least 5 points in self‐reported 10‐point Likert scale; P < 0.05 in all time points). In patients with an acute onset of dyspnoea after 48 h, a decrease of N‐terminal pro BNP was more frequently observed (83% vs. 65%), and the levels of endothelin‐1 were more reduced [−1.1 (−2.9–0.03) vs 0.4 (−2.2–1.4); all P < 0.05]. Patients with acute onset experienced less in‐hospital HF worsening (13% vs. 40%, P = 0.001), and 1 year cardiovascular mortality was significantly lower (20% vs. 41%, P = 0.01). On the multivariable analysis, subacute pattern of dyspnoea was independent predictor of 12 month cardiovascular mortality in patients with acute HF after adjusting for other prognostic factors: systolic blood pressure, urea, and HF de novo [hazard ratio (95% confidence interval): 2.32 (1.13–4.75), P = 0.02].ConclusionsIn patients with acute HF, the pattern of symptoms onset is associated with baseline differences in clinical characteristics, biomarker profile, response to standard treatment, and the long‐term outcomes. This is relevant information for planning future clinical trials.

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Section: Discussionmentioning

confidence: 57%

Patterns of dyspnoea onset in patients with acute heart failure: clinical and prognostic implications

et al. 2018

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“…The lack of effect on HF rehospitalization in unselected HF cohorts could be due to inclusion of a substantial proportion (≈50%) of patients with HFpEF . The precipitating factors for HF hospitalization are also diverse and include noncardiovascular causes (eg respiratory infection, renal failure), and noncompliance/inappropriate decrease in HF therapy may represent only a minority among cardiovascular causes . We observed a favorable association of β‐blocker use with HF rehospitalization in ischemic HF patients and this is probably because myocardial ischemia is a common precipitant of HF .…”

Section: Discussionmentioning

confidence: 67%

Evidence‐based pharmacotherapies used in the postdischarge phase are associated with improved one‐year survival in senior patients hospitalized with heart failure

Qin

Hung

Knuiman

et al. 2018

Cardiovascular Therapeutics

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“…Cardiac troponin obtained at admission in patients with AHF (class I, level of evidence C) is useful to evaluate the possibility of acute coronary syndrome as a precipitating factor, but a dynamic change pattern should be observed to confirm the acute myocardial infarction diagnosis according to current acute coronary syndrome guidelines . The majority of patients presenting with AHF will have elevated cardiac troponin levels, and although elevated cardiac troponin is associated with adverse prognosis, it does not necessarily indicate an acute coronary event if other criteria for acute myocardial infarction are absent.…”

Section: Biomarker Monitoringmentioning

confidence: 99%

Comprehensive in‐hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Harjola

Parissis

Rocca

et al. 2018

European J of Heart Fail

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This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non-invasive approaches. Comprehensive inpatient monitoring is crucial to the optimal management of acute heart failure patients. The European Society of Cardiology heart failure guidelines provide recommendations for the inpatient monitoring of acute heart failure, but the level of evidence underpinning most recommendations is limited. Many tools are available for the in-hospital monitoring of patients with acute heart failure, and each plays a role at various points throughout the patient's treatment course, including the emergency department, intensive care or coronary care unit, and the general ward. Clinical judgment is the preeminent factor guiding application of inpatient monitoring tools, as the various techniques have different patient population targets. When applied appropriately, these techniques enable decision making. However, there is limited evidence demonstrating that implementation of these tools improves patient outcome. Research priorities are identified to address these gaps in evidence. Future research initiatives should aim to identify the optimal in-hospital monitoring strategies that decrease morbidity and prolong survival in patients with acute heart failure.

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Precipitating factors and 90‐day outcome of acute heart failure: a report from the intercontinental GREAT registry

Abstract: Precipitating factors are independently associated with 90-day mortality in AHF. AHF precipitated by ACS or infection is independently associated with higher, while AHF precipitated by AF is associated with lower 90-day risk of death.

Cited by 134 publications

References 33 publications

Patterns of dyspnoea onset in patients with acute heart failure: clinical and prognostic implications

Patterns of dyspnoea onset in patients with acute heart failure: clinical and prognostic implications

Evidence‐based pharmacotherapies used in the postdischarge phase are associated with improved one‐year survival in senior patients hospitalized with heart failure

Comprehensive in‐hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

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