Acute pulmonary oedema: clinical characteristics, prognostic factors, and in‐hospital management

Abstract

Aims Acute pulmonary oedema (APE) is the second, after acutely decompensated chronic heart failure (ADHF), most frequent form of acute heart failure (AHF). This subanalysis examines the clinical profile, prognostic factors, and management of APE patients (n = 1820, 36.7%) included in the Acute Heart Failure Global Survey of Standard Treatment (ALARM‐HF). Methods and results ALARM‐HF included a total of 4953 patients hospitalized for AHF in Europe, Latin America, and Australia. The final diagnosis was made at discharge, and patients were classified according to European Society of Cardiology guidelines. Patients with APE had higher in‐hospital mortality (7.4 vs. 6.0%, P = 0.057) compared with ADHF patients (n = 1911, 38.5%), and APE patients exhibited higher systolic blood pressures (P < 0.001) at admission and higher left ventricular ejection fraction (LVEF, P < 0.01) than those with ADHF. These patients also had a higher prevalence of diabetes (P < 0.01), arterial hypertension (P < 0.001), peripheral vascular disease (P < 0.001), and chronic renal disease (P < 0.05). They were also more likely to receive intravenous (i.v.) diuretics (P < 0.001), i.v. nitrates (P < 0.01), dopamine (P < 0.05), and non‐invasive ventilation (P < 0.001). Low systolic blood pressure (P < 0.001), low LVEF (<0.05), serum creatinine ≥1.4 mg/dL (P < 0.001), history of cardiomyopathy (P < 0.05), and previous cardiovascular event (P < 0.001) were independently associated with increased in‐hospital mortality in the APE population. Conclusion APE differs in clinical profile, in‐hospital management, and mortality compared with ADHF. Admission characteristics (systolic blood pressure and LVEF), renal function, and history may identify high‐risk APE patients.

Hospital and 4‐Year Mortality Predictors in Patients With Acute Pulmonary Edema With and Without Coronary Artery Disease

“…Nevertheless, in patients admitted to critical care areas—such as in our study—hospital mortality is higher (32%), at least in the only reported series that involved 199 patients 24. In our work, hospital mortality was somewhat lower (25%), but it was higher than in patients not admitted to critical care areas,7, 10, 18, 22, 23 likely because of the more severe respiratory and/or hemodynamic condition, as indicated by the high need for endotracheal intubation or inotropic agents (26% and 29%), respectively. Another possible explanation was the high proportion of de novo cases of APE (>80%), a fact that has also been associated with higher hospital mortality 20.…”

“…Also of importance is the fact that identification of CAD patients was based not only on clinical grounds, but also on coronary angiography data available in 69% of them, but also in 43% of those with non‐CAD. This is in contrast to most existing series of APE7, 10, 23 or acute heart failure,1, 2, 3, 4, 5, 13 where angiographic data are not provided. Of interest is the documentation of significant coronary artery stenosis in 32% of non‐CAD patients who underwent cardiac catheterization, pointing to the concomitant presence of CAD in patients with the primary diagnosis of valvular heart disease.…”

“…In patients with APE, in‐hospital mortality seems comparable to patients with acute heart failure ranging also from 7.4% to 17%,7, 10, 18, 22, 23 although in small and earlier reports,7, 18 mortality was higher (12% and 17%) than in larger, more recent studies (7.4%–9.6%) 10, 22, 23. Nevertheless, in patients admitted to critical care areas—such as in our study—hospital mortality is higher (32%), at least in the only reported series that involved 199 patients 24.…”

“…Although these presentations have their own profile, reports generally pool data from the different subsets and outcomes are presented as from a single entity 1, 2, 3, 5, 6. APE, however, may be considered a distinct condition because it develops abruptly, most often within the first hour from symptom onset, and it is often triggered by elements different from those causing a gradual decompensation of chronic heart failure 1, 7, 8, 9, 10. Hence, it is suspected that mechanisms of APE may vary from those of decompensated heart failure 1, 10…”

“Medicine of the Whole Patient”: A Modern Perusal of Classical Clinician’s Text

“…По дан-ным исследования ALARM-HF, включающего 4953 пациента, госпитализированных по поводу ОСН в Европе, Латинской Америке и Австралии, острый отек легких был диагностирован у 36,7% (n=1820 пациентов), по сравнению с ОДСН, которая была диагностирована у 38,5% (n=1911 пациентов). У пациентов с острым отеком легких была выше госпитальная смертность (7,4 против 6,0%, p=0,057) по сравнению с пациентами с ОДСН [39].…”