Long-term outcomes and independent predictors of mortality in patients presenting to emergency departments with acute heart failure in Beijing: a multicenter cohort study with a 5-year follow-up

Abstract

Background: Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors. Methods: This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors. Results: The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR]: 1.027, 95 confidence interval [CI]: 1.023–1.030), body mass index (BMI) (HR: 0.971, 95% CI: 0.958–0.983), fatigue (HR: 1.127, 95% CI: 1.009–1.258), ascites (HR: 1.190, 95% CI: 1.057–1.340), hepatic jugular reflux (HR: 1.339, 95% CI: 1.140–1.572), New York Heart Association (NYHA) class III to IV (HR: 1.511, 95% CI: 1.291–1.769), heart rate (HR: 1.003, 95% CI: 1.001–1.005), diastolic blood pressure (DBP) (HR: 0.996, 95% CI: 0.993–0.999), blood urea nitrogen (BUN) (HR: 1.014, 95% CI: 1.008–1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR: 1.426, 95% CI: 1.220–1.668) or fourth quartile (HR: 1.437, 95% CI: 1.223–1.690), serum sodium (HR: 0.980, 95% CI: 0.972–0.988), serum albumin (HR: 0.981, 95% CI: 0.971–0.992), ischemic heart diseases (HR: 1.195, 95% CI: 1.073–1.331), primary cardiomyopathy (HR: 1.382, 95% CI: 1.183–1.614), diabetes (HR: 1.118, 95% CI: 1.010–1.237), stroke (HR: 1.252, 95% CI: 1.121–1.397), and the use of diuretics (HR: 0.714, 95% CI: 0.626–0.814), β-blockers (HR: 0.673, 95% CI: 0.588–0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR: 0.714, 95% CI: 0.604–0.845), angiotensin-II receptor blockers (ARBs) (HR: 0.790, 95% CI: 0.646–0.965), spironolactone (HR: 0.814, 95% CI: 0.663–0.999), calcium antagonists (HR: 0.624, 95% CI: 0.531–0.733), nitrates (HR: 0.715, 95% CI: 0.631–0.811), and digoxin (HR: 0.579, 95% CI: 0.465–0.721). Conclusions: The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, β-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.

Construction of a web‐based dynamic nomogram for predicting the prognosis in acute heart failure

“…Results of DBP in patients with AHF and in the real‐world setting were generally consistent with those seen in several studies 44,45 . Elevated SBP has been shown to prolong survival time in patients with AHF 46 ; however, we found that DBP was more relevant to the risk of all‐cause mortality than SBP, suggesting that we should consider DBP in addition to SBP in further studies regarding the prognosis or clinical prediction models in patients with AHF.…”

“…Results of DBP in patients with AHF and in the real-world setting were generally consistent with those seen in several studies. 44,45 Elevated SBP has been shown to prolong survival time in patients with AHF 46 ; however, we found that DBP was more relevant to the risk of all-cause mortality than SBP, suggesting that we should consider DBP in addition to SBP in further studies regarding the prognosis or clinical prediction models in patients with AHF. While the exact mechanism by which higher DBP improves survival outcomes is yet to be established, it is presumed that the haemodynamic ability to elevate blood pressure (BP) and tolerate an increased afterload represents preserved cardiac function, and thus may correlate with the extent and severity of HF.…”

Predictive value of blood urea nitrogen in heart failure: a systematic review and meta-analysis

“…Among the remaining 4,979 papers, a series of publications unrelated to heart failure research, such as conference studies and case reports, were excluded, and 131 articles were obtained. A re-screening of data types and outcome indicators of blood urine nitrogen was performed on the 131 articles, and 19 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) of them were finally included (Figure 1).…”

Elevated level of high-sensitivity cardiac troponin I as a predictor of adverse cardiovascular events in patients with heart failure with preserved ejection fraction

“…These abnormal clinical features include long duration, high mortality, and poor prognosis. [ 1 ] The state of HF is characterized by recurrence, slow progression, and progressive worsening. Epidemiological studies in China found that the incidence of HF in subjects >65 years of age was 6–10%, while at the age of 35–64 years, the incidence was 0.9%.…”