Characteristics and outcome of acute heart failure patients according to the severity of peripheral oedema.
Acute heart failure
Breathlessness
Mortality
Peripheral oedema
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
15 06 2019
15 06 2019
Historique:
received:
31
08
2018
revised:
10
01
2019
accepted:
11
03
2019
pubmed:
25
3
2019
medline:
6
2
2020
entrez:
26
3
2019
Statut:
ppublish
Résumé
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. We tested the hypothesis that severity of peripheral oedema is associated with length of hospital stay and mortality. 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. 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. Length of hospital stay and mortality during index admission and after discharge increased progressively with increasing severity of peripheral oedema at admission.
Sections du résumé
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.
Identifiants
pubmed: 30905515
pii: S0167-5273(18)34755-7
doi: 10.1016/j.ijcard.2019.03.020
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
40-46Informations de copyright
Copyright © 2019. Published by Elsevier B.V.