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Impact of congestion and perfusion status in the emergency department on severity of decompensation and short-term prognosis in patients with acute heart failure

2022; Oxford University Press; Volume: 12; Issue: 3 Linguagem: Inglês

10.1093/ehjacc/zuac115

2048-8734

Begoña Espinosa, Pere Llorens, Víctor Gil, Javier Jacob, Aitor Alquézar‐Arbé, Josep Masip, Lluís Llauger, Josep Tost, Juan Antonio Andueza, José Manuel Garrido, Ester Soy-Ferrer, Carmen Agüera-Urbano, Pablo Herrero, Adriana Gil‐Rodrigo, Javier Millán, Ana Belén Mecina, Raquel Torres Gárate, Nayra Cabrera-González, Julio Núñez, Òscar Miró, Marta Fuentes, Cristina Gil, Héctor Alonso, Enrique Pérez‐Llantada, Francisco Javier Martín‐Sánchez, Guillermo García, Mar Suárez Cadenas, Òscar Miró, Víctor Gil, Rosa Escoda, Sira Aguiló, Carolina Sánchez, Javier Millán, José Pavón, Nayra Cabrera González, Antonio Noval, Rafael Calvo Rodríguez, Juan Antonio Vega Reyes, María Luisa López‐Grima, Amparo Valero, María Ángeles Juan, Alfons Aguirre, Silvia Mínguez Masó, L.E. Castillero-Díaz, María Isabel Alonso, Francisco Ruiz, José Miguel Franco, Ana Belén Mecina, Josep Tost, Marta Berenguer, Ruxandra Donea, Susana Sánchez Ramón, Virginia Carbajosa Rodríguez, Pascual Piñera, José Andrés Sánchez Nicolás, Paula Lázaro Aragüés, Raquel Torres Gárate, Aitor Alquézar‐Arbé, Miguel Alberto Rizzi, Sergio Herrera, Javier Jacob, Àlex Roset, Irene Cabello, Antonio Haro, Fernando Richard, José María Álvarez Pérez, María Pilar López Díez, Pablo Herrero, Joaquín Vázquez Álvarez, Belén Prieto García, María García García, Marta Sánchez González, Pere Llorens, Inmaculada Mora-Jiménez, Néstor Hernández, Benjamín Brouzet, Begoña Espinosa, Adriana Gil, Tamara García, María Dolores Jodar, Juan Antonio Andueza, Rodolfo Romero, Martín Ruíz, María Teresa Lorca Serralta, Luis Ernesto Calderón Jave, Beatriz Amores Arriaga, Beatriz Sierra Bergua, Enrique Martín Mojarro, Brigitte Silvana Alarcón Jiménez, Lisette Travería Bécquer, Guillermo Burillo, Lluís Llauger García, Gerard Corominas LaSalle, Carmen Agüera Urbano, Ana Belén García Soto, Elisa Delgado Padial, Ester Soy Ferrer, María Adroher Múñoz, José Manuel Garrido, Francisco Javier Lucas-Imbernón, Rut Gaya, Carlos Bibiano, María Mir, Beatriz Rodríguez, José Luís Carballo, Esther Rodríguez‐Adrada, Belén Rodríguez Miranda, Monika Vicente Martín, Pere Coma Casanova, Joan Espinach Alvarós,

Stuttering Research and Treatment

Abstract 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.