Characteristics and outcome of acute heart failure patients according to the severity of peripheral oedema

Shoaib, Ahmad; Mamas, Mamas A.; Ahmad, Qazi S.; McDonagh, Theresa M.; Hardman, Suzanna M.C.; Rashid, Muhammad; Butler, Robert; Duckett, Simon; Satchithananda, Duwarakan; Nolan, James; Dargie, Henry J.; Clark, Andrew L.; Cleland, John G.F.

Abstract

Background: Most trials of patients hospitalized for heart failure focus on breathlessness (alveolar pulmonary oedema) but worsening peripheral oedema is also an important presentation. We investigated the relationship between the severity of peripheral oedema on admission and outcome amongst patients with a primary discharge death or diagnosis of heart failure. Objectives: We tested the hypothesis that severity of peripheral oedema is associated with length of hospital stay and mortality. Methods: Patient variables reported to the National Heart Failure Audit for England & Wales between April 2008 and March 2013 were included in this analysis. Peripheral oedema was classified as ‘none’, ‘mild’, ‘moderate’ or 'severe’. Length of stay, mortality during the index admission and for up to three years after discharge are reported. Results: Of 121,214 patients, peripheral oedema on admission was absent in 24%, mild in 24%, moderate in 33% and severe in 18%. Median length of stay was, respectively, 6, 7, 9 and 12 days (P- < 0.001), index admission mortality was 7%, 8%, 10% and 16% (P- < 0.001) and mortality at a median follow-up of 344 (IQR 94–766) days was 39%, 46%, 52% and 59%. In an adjusted multi-variable Cox model, the hazard ratio for death was 1.51 for severe (P- < 0.001, CI 1.50–1.53), 1.21 for moderate (P- < 0.001, CI 1.20–1.22) and 1.04 (P- < 0.001, CI 1.02–1.05) for mild peripheral oedema compared to patients without peripheral oedema at presentation. Conclusion: Length of hospital stay and mortality during index admission and after discharge increased progressively with increasing severity of peripheral oedema at admission.

Citation

Shoaib, A., Mamas, M. A., Ahmad, Q. S., McDonagh, T. M., Hardman, S. M., Rashid, M., Butler, R., Duckett, S., Satchithananda, D., Nolan, J., Dargie, H. J., Clark, A. L., & Cleland, J. G. (2019). Characteristics and outcome of acute heart failure patients according to the severity of peripheral oedema. International journal of cardiology, 285, 40-46. https://doi.org/10.1016/j.ijcard.2019.03.020

• Journal Article Type: Article
• Acceptance Date: Mar 11, 2019
• Online Publication Date: Mar 15, 2019
• Publication Date: Jun 15, 2019
• Deposit Date: Mar 14, 2019
• Publicly Available Date: Mar 16, 2020
• Journal: International Journal of Cardiology
• Print ISSN: 0167-5273
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 285
• Pages: 40-46
• DOI: https://doi.org/10.1016/j.ijcard.2019.03.020
• Keywords: Acute heart failure; Peripheral oedema; Breathlessness; Mortality
• Public URL: https://hull-repository.worktribe.com/output/1378964
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0167527318347557
• Additional Information: This is the accepted manuscript of an article published in International Journal of Cardiology, 2019. The version of record is available at the DOI link in this record.
• Contract Date: Mar 15, 2019