Assessment and prevalence of pulmonary oedema in contemporary acute heart failure trials: a systematic review

Platz, E., Jhund, P. S. , Campbell, R. T. and McMurray, J. (2015) Assessment and prevalence of pulmonary oedema in contemporary acute heart failure trials: a systematic review. European Journal of Heart Failure, 17(9), pp. 906-916. (doi:10.1002/ejhf.321) (PMID:26230356) (PMCID:PMC4725064)

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Abstract

Aims Pulmonary oedema is a common and important finding in acute heart failure (AHF). We conducted a systematic review to describe the methods used to assess pulmonary oedema in recent randomized AHF trials and report its prevalence in these trials. Methods and results Of 23 AHF trials published between 2002 and 2013, six were excluded because they were very small or not randomized, or missing full-length publications. Of the remaining 17 (n = 200–7141) trials, six enrolled patients with HF and reduced ejection fraction (HF-REF) and 11, patients with both HF-REF and HF with preserved ejection fraction (HF-PEF). Pulmonary oedema was an essential inclusion criterion, in most trials, based upon findings on physical examination (‘rales’), radiographic criteria (‘signs of congestion’), or both. The prevalence of pulmonary oedema in HF-REF trials ranged from 75% to 83% and in combined HF-REF and HF-PEF trials from 51% to 100%. Five trials did not report the prevalence or extent of pulmonary oedema assessed by either clinical examination or chest x-ray. Improvement of pulmonary congestion with treatment was inconsistently reported and commonly grouped with other signs of congestion into a score. One trial suggested that patients with rales over >2/3 of the lung fields on admission were at higher risk of adverse outcomes than those without. Conclusion Although pulmonary oedema is a common finding in AHF, represents a therapeutic target, and may be of prognostic importance, recent trials used inconsistent criteria to define it, and did not consistently report its severity at baseline or its response to treatment. Consistent and ideally quantitative, methods for the assessment of pulmonary oedema in AHF trials are needed.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Jhund, Dr Pardeep and Campbell, Dr Ross and McMurray, Professor John
Authors: Platz, E., Jhund, P. S., Campbell, R. T., and McMurray, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:European Journal of Heart Failure
Publisher:John Wiley & Sons Ltd.
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:31 July 2010
Copyright Holders:Copyright © 2016 Wiley
First Published:First published in European Journal of Heart Failure 17(9):906-916
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
615391Palliative Care Needs in Patients with Heart FailureJohn McmurrayBritish Heart Foundation (BHF)PG/13/17/30050RI CARDIOVASCULAR & MEDICAL SCIENCES