Physicians' Academy for Cardiovascular Education

Classifying acute heart failure patients may improve quality of care and outcomes

Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry

Chioncel O, Mebazaa A, Harjola V-P, et al. - Eur J Heart Fail (2017) 19, 1242–1254

Background

Several registries describe the demographic, clinical, and therapeutic characteristics of acute heart failure (AHF) patients. A drawback is that descriptions are mainly restricted to the inpatient phase or the initial weeks post-discharge [1-3]. Moreover, some of these registries included limited numbers of centers or clinical settings, sometimes in only one country.

The ESC-HF-LT Registry is a prospective, multicenter, observational study of patients admitted to 211 cardiology centers from 21 European and Mediterranean countries. In the present analysis of the ESC-HF-LT Registry, all patients admitted for AHF were included, with either de novo, or worsening of pre-existing HF, for whom iv therapy with inotropes, vasodilators, or diuretics was needed. Differences in clinical characteristics, in-hospital treatment and outcomes were identified, in AHF patients stratified according to well-specified clinical profiles, according to the ESC guidelines: decompensated HF (DHF), cardiogenic shock (CS), pulmonary edema (PE), right HF (RHF), hypertensive HF (HT-HF) and ACS-HF.

Another two classifications, including SBP at presentation (<85 mmHg, 85–110 mmHg, 110–140mmHg and >140 mmHg) and a classification based on the presence of clinical signs of congestion and/or hypo-perfusion (no congestion and no hypo-perfusion; congestion without hypo-perfusion; hypo-perfusion without congestion; hypo-perfusion and congestion) were used for reporting in-hospital and 1-year adverse outcomes.

Main results

Conclusion

In the ESC-HF-LT Registry, rates of adverse outcomes in patients admitted for AHF remain very high, both in-hospital and during the follow-up period. Substantial differences were found when patients were stratified by clinical profile, SBP, or congestion/hypo-perfusion phenotypes, although differences in 1-year outcome rates tend to diminish. These findings show that classifying AHF patients on the basis of clinical relevant data may mediate improvements in quality of care and outcomes.

Editorial comment

In their editorial article [4], Ambrosy and Gheorghiade note that although HF is a heterogeneous syndrome, clinical studies have not matched the right drug with the right patient. They conclude: ‘Although the proposed approaches to patient phenotyping in the acute setting (i.e. clinical profiles, SBP and congestion/perfusion status) are informative and complementary, none of these classification systems provides a comprehensive assessment in isolation and additional research is required before their use to guide treatment decisions in routine practice can be recommended. In an era of ‘omics’ and personalized medicine, future research should focus on the role of a multimarker approach and the application of cluster analysis to identify novel and clinically meaningful patient profiles in an effort to develop new therapies and improve the quality of care.’

References

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Find this article online at Eur J Heart Fail