Acute heart failure in the emergency department: a follow-up study
Tóm tắt
Acute heart failure (AHF) is a major public health issue due to high incidence and poor prognosis. Only a few studies are available on the long-term prognosis and on outcome predictors in the unselected population attending the emergency department (ED) for AHF. We carried out a 1-year follow-up analysis of 1234 consecutive patients from selected Italian EDs from January 2011 to June 2012 for an episode of AHF. Their prognosis and outcome-associated factors were tested by Cox proportional hazard model. Patients’ mean age was 84, with 66.0 % over 80 years and 56.2 % females. Comorbidities were present in over 50 % of cases, principally a history of acute coronary syndrome, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, valvular heart disease. Death occurred within 6 h in 24 cases (1.9 %). At 30-day follow-up, death was registered in 123 cases (10.0 %): 110 cases (89.4 %) died of cardiovascular events and 13 (10.6 %) of non-cardiovascular causes (cancer, gastrointestinal hemorrhages, sepsis, trauma). At 1-year follow-up, all-cause death was recorded in 50.1 % (over 3 out of 4 cases for cardiovascular origin). Six variables (older age, diabetes, systolic arterial pressure <110 mm/Hg, high NT pro-BNP, high troponin levels and impaired cognitive status) were selected as outcome predictors, but with limited discriminant capacity (AUC = 0.649; SE 0.015). Recurrence of AHF was registered in 31.0 %. The study identifies a cluster of variables associated with 1-year mortality in AHF, but their predictive capacity is low. Old age and the presence of comorbidities, in particular diabetes are likely to play a major role in dictating the prognosis.
Tài liệu tham khảo
Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M et al (2014) The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 63:1123–1133
Oliva F, Mortara A, Cacciatore G, Chinaglia A, Di Lenarda A, Gorini M et al (2012) Acute heart failure patient profiles, management and in-hospital outcome: results of the Italian Registry on Heart Failure Outcome. Eur J Heart Fail 14:1208–1217
Maggioni AP, Dahlstrom U, Filippatos G, Chioncel O, Crespo Leiro M, Drozdz J et al (2013) EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 15:808–817
Logeart D, Isnard R, Resche-Rigon M, Seronde MF, de Groote P, Jondeau G et al (2013) Current aspects of the spectrum of acute heart failure syndromes in a real-life setting: the OFICA study. Eur J Heart Fail 15:465–476
Butler J, Kalogeropoulos A (2008) Worsening heart failure hospitalization epidemic we do not know how to prevent and we do not know how to treat! J Am Coll Cardiol 52:435–437
Gheorghiade M, Zannad F, Sopko G, Klein L, Pina IL, Konstam MA et al (2005) Acute heart failure syndromes: current state and framework for future research. Circulation 112:3958–3968
Hasegawa K, Tsugawa Y, Camargo CA Jr, Brown DF (2014) Frequent utilization of the emergency department for acute heart failure syndrome: a population-based study. Circ Cardiovasc Qual Outcomes 5:735–742
Joffe SW, Webster K, McManus DD, Kiernan MS, Lessard D, Yarzebski J et al (2013) Improved survival after heart failure: a community-based perspective. J Am Heart Assoc 2:e000053
Stiell IG, Clement CM, Brison RJ, Rowe BH, Borgundvaag B, Aaron SD et al (2013) A risk scoring system to identify emergency department patients with heart failure at high risk for serious adverse events. Acad Emerg Med 20:17–26
Lee DS, Stitt A, Austin PC, Stukel TA, Schull MJ, Chong A et al (2012) Prediction of heart failure mortality in emergent care: a cohort study. Ann Intern Med 156:767–775
Gloth FM, 3rd (2007) The 2005 White House Conference on Aging: a new day for White House conferences on aging and food for the future. J Am Geriatr Soc 55:305–307
Felker GM, Pang PS, Adams KF, Cleland JG, Cotter G, Dickstein K et al (2010) Clinical trials of pharmacological therapies in acute heart failure syndromes: lessons learned and directions forward. Circ Heart Fail 3:314–325
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K et al (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 14:803–869
Diercks DB, Fonarow GC, Kirk JD, Emerman CL, Hollander JE, Weber JE et al (2008) Risk stratification in women enrolled in the Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM). Acad Emerg Med 15:151–158
Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe AS, Katus HA (2010) Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem 56:254–261
Apple FS (2009) A new season for cardiac troponin assays: it’s time to keep a scorecard. Clin Chem 55:1303–1306
Chioncel O, Ambrosy AP, Filipescu D, Bubenek S, Vinereanu D, Petris A et al (2014) Patterns of intensive care unit admissions in patients hospitalized for heart failure: insights from the RO-AHFS registry. J Cardiovasc Med (Hagerstown)
Earley A, Miskulin D, Lamb EJ, Levey AS, Uhlig K (2012) Estimating equations for glomerular filtration rate in the era of creatinine standardization: a systematic review. Ann Intern Med 156:785–795
Harrell FE Jr, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387
Malek MH, Berger DE, Coburn JW (2007) On the inappropriateness of stepwise regression analysis for model building and testing. Eur J Appl Physiol 101:263–264 (author reply 265–266)
Ahluwalia SC, Gross CP, Chaudhry SI, Leo-Summers L, Van Ness PH, Fried TR (2011) Change in comorbidity prevalence with advancing age among persons with heart failure. J Gen Intern Med 26:1145–1151
Martin-Sanchez FJ, Marino-Genicio R, Rodriguez-Adrada E, Jacob J, Herrero P, Miro O et al (2013) Management of acute heart failure in spanish emergency departments based on age. Rev Esp Cardiol (Engl Ed) 66:715–720
Lee DS, Ezekowitz JA (2014) Risk stratification in acute heart failure. Can J Cardiol 30:312–319
Atherton JJ, Hayward CS, Wan Ahmad WA, Kwok B, Jorge J, Hernandez AF et al (2012) Patient characteristics from a regional multicenter database of acute decompensated heart failure in Asia Pacific (ADHERE International-Asia Pacific). J Card Fail 18:82–88
Mahjoub H, Rusinaru D, Souliere V, Durier C, Peltier M, Tribouilloy C (2008) Long-term survival in patients older than 80 years hospitalised for heart failure. A 5-year prospective study. Eur J Heart Fail 10:78–84
Komajda M, Hanon O, Hochadel M, Lopez-Sendon JL, Follath F, Ponikowski P et al (2009) Contemporary management of octogenarians hospitalized for heart failure in Europe: euro Heart Failure Survey II. Eur Heart J 30:478–486
Vorilhon C, Chenaf C, Mulliez A, Pereira B, Clerfond G, Authier N et al (2015) Heart failure prognosis and management in over-80-year-old patients: data from a French national observational retrospective cohort. Eur J Clin Pharmacol 71:251–260
Gustafsson F, Torp-Pedersen C, Seibaek M, Burchardt H, Kober L, Group Ds (2004) Effect of age on short and long-term mortality in patients admitted to hospital with congestive heart failure. Eur Heart J 25:1711–1717
Teerlink JR, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH et al (2013) Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet 381:29–39
O’Connor CM, Starling RC, Hernandez AF, Armstrong PW, Dickstein K, Hasselblad V et al (2011) Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med 365:32–43
Gheorghiade M, Abraham WT, Albert NM, Gattis Stough W, Greenberg BH, O’Connor CM et al (2007) Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 28:980–988
Butler J, Subacius H, Vaduganathan M, Fonarow GC, Ambrosy AP, Konstam MA et al (2013) Relationship between clinical trial site enrollment with participant characteristics, protocol completion, and outcomes: insights from the EVEREST (efficacy of vasopressin antagonism in heart failure: outcome study with tolvaptan) trial. J Am Coll Cardiol 61:571–579
Hsich EM, Pina IL (2009) Heart failure in women: a need for prospective data. J Am Coll Cardiol 54:491–498
Galvao M, Kalman J, DeMarco T, Fonarow GC, Galvin C, Ghali JK et al (2006) Gender differences in in-hospital management and outcomes in patients with decompensated heart failure: analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Card Fail 12:100–107
Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP et al (2006) EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J 27:2725–2736
Sarma S, Mentz RJ, Kwasny MJ, Fought AJ, Huffman M, Subacius H et al (2013) Association between diabetes mellitus and post-discharge outcomes in patients hospitalized with heart failure: findings from the EVEREST trial. Eur J Heart Fail 15:194–202
Jencks SF, Williams MV, Coleman EA (2009) Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 360:1418–1428
Ross JS, Mulvey GK, Stauffer B, Patlolla V, Bernheim SM, Keenan PS et al (2008) Statistical models and patient predictors of readmission for heart failure: a systematic review. Arch Intern Med 168:1371–1386
Vashi AA, Fox JP, Carr BG, D’Onofrio G, Pines JM, Ross JS et al (2013) Use of hospital-based acute care among patients recently discharged from the hospital. JAMA 309:364–371
Di Tano G, De Maria R, Gonzini L, Aspromonte N, Di Lenarda A, Feola M et al (2015) The 30-day metric in acute heart failure revisited: data from IN-HF Outcome, an Italian nationwide cardiology registry. Eur J Heart Fail. doi:10.1002/ejhf.290
Teerlink JR, Metra M, Felker GM, Ponikowski P, Voors AA, Weatherley BD et al (2009) Relaxin for the treatment of patients with acute heart failure (Pre-RELAX-AHF): a multicentre, randomised, placebo-controlled, parallel-group, dose-finding phase IIb study. Lancet 373:1429–1439
Fonarow GC, Peacock WF, Horwich TB, Phillips CO, Givertz MM, Lopatin M et al (2008) Usefulness of B-type natriuretic peptide and cardiac troponin levels to predict in-hospital mortality from ADHERE. Am J Cardiol 101:231–237