Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes

Javaloyes, P.; Bibiano, C.; Llorens, P.; Martin, E.; Garcia, G.L.; Rossello, X.; Hernandez, N.; Alquezar-Arbe, A.; Nicolas, J.A.S.; Valero, A.; Takagi, K.; Noval, A.; Padial, E.D.; Pedragosa, M.A.; Mojarro, E.M.; Amores Arriaga, B.; Torres, J.M.; Bergua, B.S.; Perez-Llantada, E.; Cabello, I.; Garcia, M.G.; Perez-Dura, M.J.; Martin-Sanchez, F.J.; Aguirre, A.; Garrido, J.M.; Ramon, S.S.; Brouzet, B.; Miranda, B.R.; Escoda, R.; Burillo, G.; Salvo, E.; Parissis, J.; Becquer, L.T.; Ferrer, E.S.; Juan, M.A.; Jave, L.E.C.; Ruiz, F.; Mebazaa, A.; Pinera, P.; Marquina, V.; Calvache, R.; Jimenez, I.; Gil, V.; Haro, A.; Serralta, M.T.L.; Rodriguez, B.; Lopez-Grima, M.L.; Jimenez, B.S.A.; Alonso, H.; Urbano, C.A.; Donea, R.; Gaya, R.; Rizzi, M.A.; Xipell, C.; Andueza, J.A.; Tost, J.; Chioncel, O.; LaSalle, G.C.; Mecina, A.B.; Fuentes, M.; Richard, F.; Rodriguez-Adrada, E.; Romero, R.; Llauger, L.; Miro, O.; Jerez, A.; Maso, S.M.; Garcia, L.L.; Lucas-Imbernon, F.J.; Pavon, J.; Alonso, M.I.; Soto, A.B.G.; Cadenas, M.S.; Mir, M.; Berenguer, M.; Garate, R.T.; Gil, C.; Garcia, B.P.; Diez, M.P.L.; Sanchez, C.; Espinosa, B.; Perez, J.M.A.; Alvarez, J.V.; Jacob, J.; Herrero, P.; Gonzalez, M.S.; Herrera, S.; Franco, J.M.; Carballo, J.L.; Ruiz, M.; Rodriguez, V.C.

doi:10.1002/ejhf.1502

000100725 001__ 100725
000100725 005__ 20210316104639.0
000100725 0247_ $$2doi$$a10.1002/ejhf.1502
000100725 0248_ $$2sideral$$a123438
000100725 037__ $$aART-2019-123438
000100725 041__ $$aeng
000100725 100__ $$aJavaloyes, P.
000100725 245__ $$aClinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes
000100725 260__ $$c2019
000100725 5060_ $$aAccess copy available to the general public$$fUnrestricted
000100725 5203_ $$aObjective 
To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). 
Methods and results 
Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm+ wet, 1929 (17.1%) cold+ wet, 675 (6.0%) warm+ dry, and 99 (0.9%) cold+ dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm+ wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm+ dry, the adjusted hazard ratios were significantly increased for cold+ wet (1.660; 95% confidence interval 1.400-1.968) and cold+ dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. 
Conclusions 
Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival.
000100725 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII/PI15-00773$$9info:eu-repo/grantAgreement/ES/ISCIII/PI15-01019$$9info:eu-repo/grantAgreement/ES/ISCIII/PI18-00393$$9info:eu-repo/grantAgreement/ES/ISCIII/PI18-00456
000100725 540__ $$9info:eu-repo/semantics/openAccess$$aAll rights reserved$$uhttp://www.europeana.eu/rights/rr-f/
000100725 590__ $$a11.627$$b2019
000100725 591__ $$aCARDIAC & CARDIOVASCULAR SYSTEMS$$b9 / 138 = 0.065$$c2019$$dQ1$$eT1
000100725 592__ $$a5.556$$b2019
000100725 593__ $$aCardiology and Cardiovascular Medicine$$c2019$$dQ1
000100725 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/acceptedVersion
000100725 700__ $$aMiro, O.
000100725 700__ $$aGil, V.
000100725 700__ $$aMartin-Sanchez, F.J.
000100725 700__ $$aJacob, J.
000100725 700__ $$aHerrero, P.
000100725 700__ $$aTakagi, K.
000100725 700__ $$aAlquezar-Arbe, A.
000100725 700__ $$aDiez, M.P.L.
000100725 700__ $$aMartin, E.
000100725 700__ $$aBibiano, C.
000100725 700__ $$aEscoda, R.
000100725 700__ $$aGil, C.
000100725 700__ $$aFuentes, M.
000100725 700__ $$aGarcia, G.L.
000100725 700__ $$aPerez, J.M.A.
000100725 700__ $$aJerez, A.
000100725 700__ $$aTost, J.
000100725 700__ $$aLlauger, L.
000100725 700__ $$aRomero, R.
000100725 700__ $$aGarrido, J.M.
000100725 700__ $$aRodriguez-Adrada, E.
000100725 700__ $$aSanchez, C.
000100725 700__ $$aRossello, X.
000100725 700__ $$aParissis, J.
000100725 700__ $$aMebazaa, A.
000100725 700__ $$aChioncel, O.
000100725 700__ $$aLlorens, P.
000100725 700__ $$aAlonso, H.
000100725 700__ $$aPerez-Llantada, E.
000100725 700__ $$aCadenas, M.S.
000100725 700__ $$aXipell, C.
000100725 700__ $$aPerez-Dura, M.J.
000100725 700__ $$aSalvo, E.
000100725 700__ $$aPavon, J.
000100725 700__ $$aNoval, A.
000100725 700__ $$aTorres, J.M.
000100725 700__ $$aLopez-Grima, M.L.
000100725 700__ $$aValero, A.
000100725 700__ $$aJuan, M.A.
000100725 700__ $$aAguirre, A.
000100725 700__ $$aPedragosa, M.A.
000100725 700__ $$aMaso, S.M.
000100725 700__ $$aAlonso, M.I.
000100725 700__ $$aRuiz, F.
000100725 700__ $$0(orcid)0000-0003-3608-8342$$aFranco, J.M.
000100725 700__ $$aMecina, A.B.
000100725 700__ $$aBerenguer, M.
000100725 700__ $$aDonea, R.
000100725 700__ $$aRamon, S.S.
000100725 700__ $$aRodriguez, V.C.
000100725 700__ $$aPinera, P.
000100725 700__ $$aNicolas, J.A.S.
000100725 700__ $$aGarate, R.T.
000100725 700__ $$aRizzi, M.A.
000100725 700__ $$aHerrera, S.
000100725 700__ $$aCabello, I.
000100725 700__ $$aHaro, A.
000100725 700__ $$aRichard, F.
000100725 700__ $$aDiez, M.P.L.
000100725 700__ $$aAlvarez, J.V.
000100725 700__ $$aGarcia, B.P.
000100725 700__ $$aGarcia, M.G.
000100725 700__ $$aGonzalez, M.S.
000100725 700__ $$aMarquina, V.
000100725 700__ $$aJimenez, I.
000100725 700__ $$aHernandez, N.
000100725 700__ $$aBrouzet, B.
000100725 700__ $$aEspinosa, B.
000100725 700__ $$aAndueza, J.A.
000100725 700__ $$aRuiz, M.
000100725 700__ $$aCalvache, R.
000100725 700__ $$aSerralta, M.T.L.
000100725 700__ $$aJave, L.E.C.
000100725 700__ $$0(orcid)0000-0001-6613-0359$$aAmores Arriaga, B.$$uUniversidad de Zaragoza
000100725 700__ $$aBergua, B.S.
000100725 700__ $$aMojarro, E.M.
000100725 700__ $$aJimenez, B.S.A.
000100725 700__ $$aBecquer, L.T.
000100725 700__ $$aBurillo, G.
000100725 700__ $$aGarcia, L.L.
000100725 700__ $$aLaSalle, G.C.
000100725 700__ $$aUrbano, C.A.
000100725 700__ $$aSoto, A.B.G.
000100725 700__ $$aPadial, E.D.
000100725 700__ $$aFerrer, E.S.
000100725 700__ $$aLucas-Imbernon, F.J.
000100725 700__ $$aGaya, R.
000100725 700__ $$aMir, M.
000100725 700__ $$aRodriguez, B.
000100725 700__ $$aCarballo, J.L.
000100725 700__ $$aMiranda, B.R.
000100725 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000100725 773__ $$g21, 11 (2019), 1353-1365$$pEur. j. heart fail.$$tEuropean Journal of Heart Failure$$x1388-9842
000100725 8564_ $$s939490$$uhttps://zaguan.unizar.es/record/100725/files/texto_completo.pdf$$yPostprint
000100725 8564_ $$s2245321$$uhttps://zaguan.unizar.es/record/100725/files/texto_completo.jpg?subformat=icon$$xicon$$yPostprint
000100725 909CO $$ooai:zaguan.unizar.es:100725$$particulos$$pdriver
000100725 951__ $$a2021-03-16-07:58:19
000100725 980__ $$aARTICLE

Universidad de Zaragoza Repository