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Vol 69, No 10 (2011)
Original articles
Published online: 2011-10-14
Submitted: 2012-12-28
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Clinical characteristics and predictors of in−hospital mortality in 270 consecutive patients hospitalised due to acute heart failure in a single cardiology centre during one year

Jan Biegus, Robert Zymliński, Joanna Szachniewicz, Paweł Siwołowski, Aleksander Pawluś, Waldemar Banasiak, Ewa A. Jankowska, Piotr Ponikowski
Kardiol Pol 2011;69(10):997-1005.

open access

Vol 69, No 10 (2011)
Original articles
Published online: 2011-10-14
Submitted: 2012-12-28

Abstract

Background: Acute heart failure (HF) is an emerging problem in clinical practice, associated with high in-hospital mortality and a high short-term readmission rate.
Aim: To describe the clinical characteristics and define predictors of in-hospital mortality in patients with acute HF.
Methods: We conducted a prospective registry of all consecutive patients hospitalised due to acute HF from October 2008 to November 2009 in a single cardiology centre. Clinical status and laboratory parameters were analysed on admission and after 48 h. Results: We examined 270 patients (age 68 ± 13 years, 71% men, 27% with de novo acute HF, 55% with ischaemic aetiology, 56% with decompensated chronic HF, 80% with warm-wet haemodynamic profile). In-hospital mortality was 8.5% (n = 23). There were no differences between survivors vs non-survivors regarding age, gender, HF aetiology, prevalence of de novo acute HF, and baseline heart rate and body weight values and changes of these parameters during hospitalisation (p > 0.2 for all comparisons). Cardiogenic shock and isolated right-sided HF were more common in patients who died as compared to survivors (17% vs 1% and 22% vs 2%, respectively; p < 0.001), as were the cold-wet and cold-dry haemodynamic profiles (22% vs 2% and 17% vs 1%, respectively; p < 0.001). The most common factor precipitating decompensation in non-survivors was an acute coronary syndrome (17% vs 7%), while elevation of blood pressure and inadequate diuretic therapy were the most common causes of acute HF in survivors (26% vs 4% and 45% vs 22%, respectively; p < 0.05). Baseline mean blood pressure and serum Na+ level were higher in survivors than in non-survivors (94 ± 20 vs 79 ± 19 mm Hg and 140 ± 4 vs 136 ± 5 mmol/L, respectively; p < 0.001) and both remained higher during follow-up. There were no differences in baseline haemoglobin and serum K+ levels between these groups. Haemoglobin level decreased after 48 h of therapy only in patients who died (11.1 ± 2.4 vs 12.5 ± 2.1 g/dL; p < 0.01), whereas a reduction in serum K+ level after 48 h was observed only in survivors (4.2 ± 0.6 vs 3.9 ± 0.5 mmol/L; p < 0.05), probably reflecting effective diuretic therapy. Baseline renal function was more impared in non-survivors (serum creatinine 1.7 [1, 2.5] vs 1.2 [1, 1.6] mg/dL, and blood urea nitrogen 40 [24, 65] vs 24 [19, 33] mg/dL; p < 0.05) and deteriorated further during hospitalisation (serum creatinine 2.0 [1.2, 2.5] vs 1.2 [0.9, 1.5] mg/dL, blood urea nitrogen 64 [45, 77] vs 27 [19, 36] mg/dL; p < 0.01). Baseline plasma N-terminal proB-type natriuretic peptide (NT-proBNP) level did not differentiate these two groups, but plasma NT-proBNP level measured after 48 h was lower in survivors compared to non- -survivors (3560 [1711, 6738] vs 11780 [5371, 18912] pg/mL; p < 0.01); data are shown as medians [lower, upper quartile].
Conclusions: In our registry, in-hospital mortality in patients admitted due to acute HF was slightly higher compared to other reports. Baseline values of some parameters (e.g. blood pressure, serum Na+, renal function) as well as their changes during hospitalisation (e.g. serum K+, renal function, plasma NT-proBNP) can help identify acute HF patients at a higher risk of in-hospital mortality.
Kardiol Pol 2011; 69, 10: 997–1005

Abstract

Background: Acute heart failure (HF) is an emerging problem in clinical practice, associated with high in-hospital mortality and a high short-term readmission rate.
Aim: To describe the clinical characteristics and define predictors of in-hospital mortality in patients with acute HF.
Methods: We conducted a prospective registry of all consecutive patients hospitalised due to acute HF from October 2008 to November 2009 in a single cardiology centre. Clinical status and laboratory parameters were analysed on admission and after 48 h. Results: We examined 270 patients (age 68 ± 13 years, 71% men, 27% with de novo acute HF, 55% with ischaemic aetiology, 56% with decompensated chronic HF, 80% with warm-wet haemodynamic profile). In-hospital mortality was 8.5% (n = 23). There were no differences between survivors vs non-survivors regarding age, gender, HF aetiology, prevalence of de novo acute HF, and baseline heart rate and body weight values and changes of these parameters during hospitalisation (p > 0.2 for all comparisons). Cardiogenic shock and isolated right-sided HF were more common in patients who died as compared to survivors (17% vs 1% and 22% vs 2%, respectively; p < 0.001), as were the cold-wet and cold-dry haemodynamic profiles (22% vs 2% and 17% vs 1%, respectively; p < 0.001). The most common factor precipitating decompensation in non-survivors was an acute coronary syndrome (17% vs 7%), while elevation of blood pressure and inadequate diuretic therapy were the most common causes of acute HF in survivors (26% vs 4% and 45% vs 22%, respectively; p < 0.05). Baseline mean blood pressure and serum Na+ level were higher in survivors than in non-survivors (94 ± 20 vs 79 ± 19 mm Hg and 140 ± 4 vs 136 ± 5 mmol/L, respectively; p < 0.001) and both remained higher during follow-up. There were no differences in baseline haemoglobin and serum K+ levels between these groups. Haemoglobin level decreased after 48 h of therapy only in patients who died (11.1 ± 2.4 vs 12.5 ± 2.1 g/dL; p < 0.01), whereas a reduction in serum K+ level after 48 h was observed only in survivors (4.2 ± 0.6 vs 3.9 ± 0.5 mmol/L; p < 0.05), probably reflecting effective diuretic therapy. Baseline renal function was more impared in non-survivors (serum creatinine 1.7 [1, 2.5] vs 1.2 [1, 1.6] mg/dL, and blood urea nitrogen 40 [24, 65] vs 24 [19, 33] mg/dL; p < 0.05) and deteriorated further during hospitalisation (serum creatinine 2.0 [1.2, 2.5] vs 1.2 [0.9, 1.5] mg/dL, blood urea nitrogen 64 [45, 77] vs 27 [19, 36] mg/dL; p < 0.01). Baseline plasma N-terminal proB-type natriuretic peptide (NT-proBNP) level did not differentiate these two groups, but plasma NT-proBNP level measured after 48 h was lower in survivors compared to non- -survivors (3560 [1711, 6738] vs 11780 [5371, 18912] pg/mL; p < 0.01); data are shown as medians [lower, upper quartile].
Conclusions: In our registry, in-hospital mortality in patients admitted due to acute HF was slightly higher compared to other reports. Baseline values of some parameters (e.g. blood pressure, serum Na+, renal function) as well as their changes during hospitalisation (e.g. serum K+, renal function, plasma NT-proBNP) can help identify acute HF patients at a higher risk of in-hospital mortality.
Kardiol Pol 2011; 69, 10: 997–1005
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Keywords

acute heart failure; registry; risk stratification; prognosis

About this article
Title

Clinical characteristics and predictors of in−hospital mortality in 270 consecutive patients hospitalised due to acute heart failure in a single cardiology centre during one year

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 69, No 10 (2011)

Pages

997-1005

Published online

2011-10-14

Bibliographic record

Kardiol Pol 2011;69(10):997-1005.

Keywords

acute heart failure
registry
risk stratification
prognosis

Authors

Jan Biegus
Robert Zymliński
Joanna Szachniewicz
Paweł Siwołowski
Aleksander Pawluś
Waldemar Banasiak
Ewa A. Jankowska
Piotr Ponikowski

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