Impact of congestion and perfusion status in the emergency department on severity of decompensation and short-term prognosis in patients with acute heart failure
Authors: Espinosa Begoña , Llorens Pere , Gil Víctor , Jacob Javier , Alquézar-Arbé Aitor , Masip Josep , Llauger Lluís , Tost Josep , Andueza Juan Antonio , Garrido José Manuel , Soy-Ferrer Ester , Agüera-Urbano Carmen , Herrero Pablo , Gil-Rodrigo Adriana , Millán Javier , Mecina Ana Belén , Torres-Gárate Raquel , Cabrera-González Nayra , Núñez Julio , Miró Òscar ,   the ICA-SEMES Research Group, Fuentes Marta , Gil Cristina , Alonso Héctor , Pérez-Llantada Enrique , Martín-Sánchez Francisco Javier , García Guillermo Llopis , Cadenas Mar Suárez , Miró Òscar , Gil Víctor , Escoda Rosa , Aguiló Sira , Sánchez Carolina , Millán Javier , Pavón José , González Nayra Cabrera , Noval Antonio , Rodríguez Rafael Calvo , Reyes Juan Antonio Vega , López-Grima María Luisa , Valero Amparo , Juan María Ángeles , Aguirre Alfons , Masó Silvia Mínguez , Castillero Lluis Enric , Alonso María Isabel , Ruiz Francisco , Franco José Miguel , Mecina Ana Belén , Tost Josep , Berenguer Marta , Donea Ruxandra , Ramón Susana Sánchez , Rodríguez Virginia Carbajosa , Piñera Pascual , Nicolás José Andrés Sánchez , Aragües Paula Lazaro , Garate Raquel Torres , Alquézar-Arbé Aitor , Rizzi Miguel Alberto , Herrera Sergio , Jacob Javier , Roset Alex , Cabello Irene , Haro Antonio , Richard Fernando , Pérez José María Álvarez , Diez María Pilar López , Puente Pablo Herrero , Álvarez Joaquín Vázquez , García Belén Prieto , García María García , González Marta Sánchez , Llorens Pere , Jiménez Inmaculada , Hernández Néstor , Brouzet Benjamín , Espinosa Begoña , Gil Adriana , García Tamara , Jodar María Dolores , Andueza Juan Antonio , Romero Rodolfo , Ruíz Martín , Serralta María Teresa Lorca , Jave Luis Ernesto Calderón , Arriaga Beatriz Amores , Bergua Beatriz Sierra , Mojarro Enrique Martín , Jiménez Brigitte Silvana Alarcón , Bécquer Lisette Travería , Burillo Guillermo , García Lluís Llauger , LaSalle Gerard Corominas , Urbano Carmen Agüera , Soto Ana Belén García , Padial Elisa Delgado , Ferrer Ester Soy , Múñoz María Adroher , Garrido José Manuel , Lucas-Imbernón Francisco Javier , Gaya Rut , Bibiano Carlos , Mir María , Rodríguez Beatriz , Carballo José Luis , Rodríguez-Adrada Esther , Miranda Belén Rodríguez , Martín Monika Vicente , Casanova Pere Coma , Alvarós Joan Espinach 
Published: September 2022

Aims

To assess whether symptoms/signs of congestion and perfusion in acute heart failure (AHF) evaluated at patient arrival to the emergency department (ED) can predict the severity of decompensation and short-term outcomes.

Methods and results

We included patients from the Epidemiology of AHF Emergency Registry (EAHFE Registry). We registered seven clinical surrogates of congestion and five of hypoperfusion. Patients were grouped according to severity of congestion/hypoperfusion. We assessed the need for hospitalization, in-hospital all-cause mortality for patients needing hospitalization, and prolonged hospitalization for patients surviving the decompensation episode. Outcomes were adjusted for patient characteristics and the coexistence of congestion and hypoperfusion. We analysed 18 120 patients (median = 83 years, interquartile range = 76–88; women = 55.7%). Seventy-two per cent presented &gt;2 signs/symptoms of congestion and 18% had at least 1 sign/symptom of hypoperfusion. Seventy-five per cent were hospitalized with in-hospital death in 9% and prolonged hospitalization in 47% discharged alive. The presence of congestion/hypoperfusion was independently associated with poorer outcomes. An increase in the number of signs/symptoms of congestion was associated with increased risk of hospitalization (P &lt; 0.001) and prolonged stay (P = 0.011), but not mortality (P = 0.06). Increased signs/symptoms of hypoperfusion were associated with hospitalization (P &lt; 0.001) and mortality (P &lt; 0.001), but not prolonged stay (P = 0.227). In the combined model, including congestion and hypoperfusion, both had additive effects on hospitalization, in-hospital mortality was driven by hypoperfusion and no differences were observed for prolonged hospitalization.

Conclusion

The presence of congestion/hypoperfusion at ED arrival is a simple clinical marker associated with a higher risk of severity/adverse short-term outcomes.