Abstract
AimsExplore the association between clinical findings and prognosis in patients with acute decompensated heart failure (ADHF) and analyze the influence of etiology on clinical presentation and prognosis.Methods and resultsProspective cohort of 500 patients admitted with ADHF from Aug/2013-Feb/2016; patients were predominantly male (61.8%), median age was 58 (IQ25-75% 47–66 years); etiology was dilated cardiomyopathy in 141 (28.2%), ischemic heart disease in 137 (27.4%), and Chagas heart disease in 113 (22.6%). Patients who died (154 [30.8%]) or underwent heart transplantation (53[10.6%]) were younger (56 years [IQ25-75% 45–64 vs 60 years, IQ25-75% 49–67], P = 0.032), more frequently admitted for cardiogenic shock (20.3% vs 6.8%, P<0.001), had longer duration of symptoms (14 days [IQ25-75% 4–32.8 vs 7.5 days, IQ25-75% 2–31], P = 0.004), had signs of congestion (90.8% vs 76.5%, P<0.001) and inadequate perfusion more frequently (45.9% vs 28%, P<0.001), and had lower blood pressure (90 [IQ25-75% 80–100 vs 100, IQ25-75% 90–120], P<0.001). In a logistic regression model analysis, systolic blood pressure (P<0.001, OR 0.97 [95%CI 0.96–0.98] per mmHg) and jugular distention (P = 0.004, OR 1.923 [95%CI 1.232–3.001]) were significant. Chagas patients were more frequently admitted for cardiogenic shock (15%) and syncope/arrhythmia (20.4%). Pulmonary congestion was rare among Chagas patients and blood pressure was lower. The rate of in-hospital death or heart transplant was higher among patients with Chagas (50.5%).ConclusionsA physical exam may identify patients at higher risk in a contemporaneous population. Our findings support specific therapies targeted at Chagas patients in the setting of ADHF.
Highlights
Advances in technologies applied to medical diagnosis have broadened medical understanding of patients and opened new possibilities for therapeutic interventions; it is recognized that the clinical evaluation of patients remains the basis for the characterization of diseases, data interpretation, and patient care.[1]
The present study sought to analyze the importance of clinical findings in a contemporaneous cohort of patients admitted with decompensated heart failure
The study population consisted of 500 patients admitted with heart failure between August 2013 and February 2016 (Table 1); patients were predominantly male (61.8%), with a median age of 58 years; main etiologies were dilated cardiomyopathy in 141(28.2%) patients, ischemic heart disease in 137 (27.4%), and Chagas heart disease in 113 (22.6%)
Summary
Advances in technologies applied to medical diagnosis have broadened medical understanding of patients and opened new possibilities for therapeutic interventions; it is recognized that the clinical evaluation of patients remains the basis for the characterization of diseases, data interpretation, and patient care.[1] Despite the value of clinical history to medical practice, incorporation of technological methods has challenged the way cardiologists’ value history and clinical examination.[2] there has been concern regarding the possibility that clinical skills may be lost in face of the extensive technological evaluation currently available.[3] This is the case with heart failure,[4] a clinical syndrome that results from different processes affecting the cardiovascular system. Even though some findings, such as the presence of a third heart sound[7] and persistent congestion,[8] have been associated with a worse prognosis, detailed clinical features, and their associations with prognosis and therapy have not been fully evaluated during episodes of acute decompensation in recent series that included a broad spectrum of etiologies.[9,10,11,12]
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