Clinical findings and prognosis of patients hospitalized for acute decompensated heart failure: Analysis of the influence of Chagas etiology and ventricular function

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.

Impact of pharmaceutical care on the quality of life of patients with heart failure due to chronic Chagas disease: Randomized clinical trial

“…Moreover, a poorer quality of life in patients with HF evaluated by the MLHFQ questionnaire is associated with an increased risk of death from all causes or a higher combined risk of cardiac death or hospitalization due to HF . In patients with ChD, HF is associated with worse mortality and quality of life than in patients with HF due to other aetiologies. This underscores the need of studies, such as ours, that address interventions specifically in this neglected population.…”

“…One of the hallmarks of the CCC is heart failure (HF) and the consequent decrease in survival, functional capacity and quality of life of the affected individuals . Furthermore, HF due to ChD has higher mortality than HF due to other aetiologies both in patients hospitalized for acute decompensated HF and in outpatients with HF . Quality of life is also worse in patients with HF due to ChD than other aetiologies .…”

Prognosis and risk stratification in patients with decompensated heart failure receiving inotropic therapy

“…Hospital admissions are frequent among patients with heart failure (HF)1 with a broad range of clinical presentations and haemodynamic profiles. It has been estimated that half of patients have either arterial hypotension or other signs of tissue hypoperfusion at hospital admission,2 3 and a significant proportion of these patients receive inotropic therapy during the course of hospitalisation 4…”

EPOCHA-D-CHF: gender differences in the prognosis of patients with CHF af-ter acute decompensation (part 2*)

“…Учитывая наличие стадийности в развитии левожелудочковой СН, формирование клинической картины застойных явлений по большому и малому кругу кровообращения (отеки нижних конечностей, асцит, положение ортопноэ) свидетельствует о более тяжелом поражении миокарда с плохим краткосрочным прогнозом [22,23]. При наличии данных симптомов отдаленный прогноз пациента глубоко не исследовался, хотя результаты четырехлетнего наблюдения показывают, что прогноз становится в 1,5-3,5 раза хуже, чем у пациента, для которого ведущим симптомом декомпенсации является одышка.…”