Mode of presentation and mortality amongst patients hospitalized with heart failure?: a report from The First Euro Heart Failure Survey

Shoaib, Ahmad; Farag, M.; Nolan, J.; Rigby, A.; Patwala, A.; Rashid, M.; Kwok, C.S.; Perveen, R.; Clark, A.L.; Komajda, M.; Cleland, J.G.F.

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:
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%), 2,479 (24%), 1,040 (10%), 703 (7%), and 4,691 (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. Key words: Acute heart failure, Presentation of Heart failure, Mortality.

Citation

Shoaib, A., Farag, M., Nolan, J., Rigby, A., Patwala, A., Rashid, M., Kwok, C., Perveen, R., Clark, A., Komajda, M., & Cleland, J. (2019). Mode of presentation and mortality amongst patients hospitalized with heart failure?: a report from The First Euro Heart Failure Survey. Zeitschrift für Kardiologie, 108, 510-519. https://doi.org/10.1007/s00392-018-1380-6

• Journal Article Type: Article
• Acceptance Date: Oct 11, 2018
• Publication Date: May 1, 2019
• Journal: Clinical Research in Cardiology
• Print ISSN: 0300-5860
• Electronic ISSN: 1435-1285
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 108
• Pages: 510-519
• DOI: https://doi.org/10.1007/s00392-018-1380-6
• Keywords: acute heart failure, Presentation of heart failure, mortality
• Public URL: https://keele-repository.worktribe.com/output/412077
• Publisher URL: http://doi.org/10.1007/s00392-018-1380-6