Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes
Abstract Aims Patients with acute heart failure (AHF) are included into clinical trials regardless of differences in baseline clinical characteristics. The aim of this study was to assess patients with AHF according to the presence of central and/or peripheral congestion at hospital admission and ev...
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doaj-128764074f324544812244639b37557d2021-02-24T06:51:29ZengWileyESC Heart Failure2055-58222020-12-01763830384010.1002/ehf2.12973Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomesJustyna Maria Sokolska0Mateusz Sokolski1Robert Zymliński2Jan Biegus3Paweł Siwołowski4Sylwia Nawrocka‐Millward5Katarzyna Swoboda6Piotr Gajewski7Ewa Anita Jankowska8Waldemar Banasiak9Piotr Ponikowski10Department of Heart Diseases Wroclaw Medical University ul. Borowska 213 Wrocław 50‐556 PolandDepartment of Heart Diseases Wroclaw Medical University ul. Borowska 213 Wrocław 50‐556 PolandDepartment of Heart Diseases Wroclaw Medical University ul. Borowska 213 Wrocław 50‐556 PolandDepartment of Heart Diseases Wroclaw Medical University ul. Borowska 213 Wrocław 50‐556 PolandDepartment of Heart Diseases Wroclaw Medical University ul. Borowska 213 Wrocław 50‐556 PolandCentre for Heart Diseases University Hospital Wrocław PolandCentre for Heart Diseases Clinical Military Hospital Wrocław PolandDepartment of Heart Diseases Wroclaw Medical University ul. Borowska 213 Wrocław 50‐556 PolandDepartment of Heart Diseases Wroclaw Medical University ul. Borowska 213 Wrocław 50‐556 PolandCentre for Heart Diseases Clinical Military Hospital Wrocław PolandDepartment of Heart Diseases Wroclaw Medical University ul. Borowska 213 Wrocław 50‐556 PolandAbstract Aims Patients with acute heart failure (AHF) are included into clinical trials regardless of differences in baseline clinical characteristics. The aim of this study was to assess patients with AHF according to the presence of central and/or peripheral congestion at hospital admission and evaluate treatment response and outcomes in studied phenotypes. Methods and results We investigated retrospectively 352 patients (mean age: 68 ± 13 years, 77% men) hospitalized due to AHF with the signs of congestion on admission. Patients were divided according to the type of signs of congestion into three groups: A, isolated pulmonary congestion (n = 52, 15%); B, isolated peripheral congestion (n = 31, 9%); and C, signs of mixed (peripheral and central) congestion (n = 269, 76%). Patients from Group A had lower concentration of urea, bilirubin, and gamma‐glutamyl transferase whereas higher level of haematocrit, albumin, and leukocytes on admission. The highest baseline N‐terminal pro‐B‐type natriuretic peptide level (median: 4113 vs. 3634 vs. 6093 pg/mL) and percentage of patients with chronic heart failure (56 vs. 58 vs. 74%; A vs. B. vs. C, respectively, all P < 0.01) were observed in Group C. There were no differences in terms of demographics, co‐morbidities, left ventricular ejection fraction, and applied treatment between studied groups. Patients from Group A had the highest systolic blood pressure on admission (145 ± 37 vs. 122 ± 20 vs. 130 ± 29 mmHg) and the biggest decrease in systolic blood pressure [−22 (−45 to −4) vs. −2 (−13 to 2) vs. −10 (−25 to 0) mmHg] and heart rate [−16 (−35 to −1.5) vs. −1 (−10 to 5) vs. −7 (−20 to 0) b.p.m.] with the lowest weight change [−1.0 (−1.0 to 0) vs. −2.9 (−3.8 to −0.9) vs. −2.0 (−3.0 to −1.0) kg; all P < 0.01] after 48 h of hospitalization. There were differences in short‐term and long‐term outcomes with favourable results in Group A. Group A experienced less frequent in‐hospital heart failure worsening during the first 48 h (4 vs. 23 vs. 7%), had shorter length of hospital stay [6 (5–8) vs. 7 (5–11) vs. 7 (6–11) days], and had lower 1 year all‐cause mortality (12 vs. 28 vs. 29%; all P < 0.05). Presence of peripheral congestion on admission was independent predictor for all‐cause mortality within 1 year [hazard ratio (95% confidence interval): 2.68 (1.06–6.79); P = 0.04]. Conclusions Patterns of congestion in AHF are associated with differences in clinical characteristics, treatment response, and outcomes. It needs to be considered once planning clinical trials in AHF.https://doi.org/10.1002/ehf2.12973Heart failureCardiac failureCongestive heart failureClinical trialsSigns and symptoms |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Justyna Maria Sokolska Mateusz Sokolski Robert Zymliński Jan Biegus Paweł Siwołowski Sylwia Nawrocka‐Millward Katarzyna Swoboda Piotr Gajewski Ewa Anita Jankowska Waldemar Banasiak Piotr Ponikowski |
spellingShingle |
Justyna Maria Sokolska Mateusz Sokolski Robert Zymliński Jan Biegus Paweł Siwołowski Sylwia Nawrocka‐Millward Katarzyna Swoboda Piotr Gajewski Ewa Anita Jankowska Waldemar Banasiak Piotr Ponikowski Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes ESC Heart Failure Heart failure Cardiac failure Congestive heart failure Clinical trials Signs and symptoms |
author_facet |
Justyna Maria Sokolska Mateusz Sokolski Robert Zymliński Jan Biegus Paweł Siwołowski Sylwia Nawrocka‐Millward Katarzyna Swoboda Piotr Gajewski Ewa Anita Jankowska Waldemar Banasiak Piotr Ponikowski |
author_sort |
Justyna Maria Sokolska |
title |
Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes |
title_short |
Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes |
title_full |
Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes |
title_fullStr |
Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes |
title_full_unstemmed |
Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes |
title_sort |
distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes |
publisher |
Wiley |
series |
ESC Heart Failure |
issn |
2055-5822 |
publishDate |
2020-12-01 |
description |
Abstract Aims Patients with acute heart failure (AHF) are included into clinical trials regardless of differences in baseline clinical characteristics. The aim of this study was to assess patients with AHF according to the presence of central and/or peripheral congestion at hospital admission and evaluate treatment response and outcomes in studied phenotypes. Methods and results We investigated retrospectively 352 patients (mean age: 68 ± 13 years, 77% men) hospitalized due to AHF with the signs of congestion on admission. Patients were divided according to the type of signs of congestion into three groups: A, isolated pulmonary congestion (n = 52, 15%); B, isolated peripheral congestion (n = 31, 9%); and C, signs of mixed (peripheral and central) congestion (n = 269, 76%). Patients from Group A had lower concentration of urea, bilirubin, and gamma‐glutamyl transferase whereas higher level of haematocrit, albumin, and leukocytes on admission. The highest baseline N‐terminal pro‐B‐type natriuretic peptide level (median: 4113 vs. 3634 vs. 6093 pg/mL) and percentage of patients with chronic heart failure (56 vs. 58 vs. 74%; A vs. B. vs. C, respectively, all P < 0.01) were observed in Group C. There were no differences in terms of demographics, co‐morbidities, left ventricular ejection fraction, and applied treatment between studied groups. Patients from Group A had the highest systolic blood pressure on admission (145 ± 37 vs. 122 ± 20 vs. 130 ± 29 mmHg) and the biggest decrease in systolic blood pressure [−22 (−45 to −4) vs. −2 (−13 to 2) vs. −10 (−25 to 0) mmHg] and heart rate [−16 (−35 to −1.5) vs. −1 (−10 to 5) vs. −7 (−20 to 0) b.p.m.] with the lowest weight change [−1.0 (−1.0 to 0) vs. −2.9 (−3.8 to −0.9) vs. −2.0 (−3.0 to −1.0) kg; all P < 0.01] after 48 h of hospitalization. There were differences in short‐term and long‐term outcomes with favourable results in Group A. Group A experienced less frequent in‐hospital heart failure worsening during the first 48 h (4 vs. 23 vs. 7%), had shorter length of hospital stay [6 (5–8) vs. 7 (5–11) vs. 7 (6–11) days], and had lower 1 year all‐cause mortality (12 vs. 28 vs. 29%; all P < 0.05). Presence of peripheral congestion on admission was independent predictor for all‐cause mortality within 1 year [hazard ratio (95% confidence interval): 2.68 (1.06–6.79); P = 0.04]. Conclusions Patterns of congestion in AHF are associated with differences in clinical characteristics, treatment response, and outcomes. It needs to be considered once planning clinical trials in AHF. |
topic |
Heart failure Cardiac failure Congestive heart failure Clinical trials Signs and symptoms |
url |
https://doi.org/10.1002/ehf2.12973 |
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