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

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

Abstract

© 2018, The Author(s). 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.

Citation

Shoaib, A., Farag, M., Nolan, J., Rigby, A., Patwala, A., Rashid, M., Kwok, C. S., Perveen, R., Clark, A., Komajda, M., & Cleland, J. G. (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), 510-519. https://doi.org/10.1007/s00392-018-1380-6

• Journal Article Type: Article
• Acceptance Date: Sep 25, 2018
• Online Publication Date: Oct 25, 2018
• Publication Date: 2019-05
• Deposit Date: Dec 13, 2018
• Publicly Available Date: Dec 13, 2018
• Print ISSN: 1861-0684
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 108
• Issue: 5
• 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://hull-repository.worktribe.com/output/1073938
• Publisher URL: https://link.springer.com/article/10.1007%2Fs00392-018-1380-6
• Contract Date: Dec 13, 2018