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

Shoaib, A. et al. (2019) Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from The First Euro Heart Failure Survey. Clinical Research in Cardiology, 108(5), pp. 510-519. (doi: 10.1007/s00392-018-1380-6) (PMID:30361818) (PMCID:PMC6484773)

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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: The 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%), 2479 (24%), 1040 (10%), 703 (7%), and 4691 (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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Shoaib, A., Farag, M., Nolan, J., Rigby, A., Patwala, A., Rashid, M., Kwok, C.S., Perveen, R., Clark, A.L., Komajda, M., and Cleland, J.G.F.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Clinical Research in Cardiology
ISSN (Online):1861-0692
Published Online:25 October 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Clinical Research in Cardiology 108(5): 510-519
Publisher Policy:Reproduced under a Creative Commons License

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