[show abstract][hide abstract] ABSTRACT: Initial risk stratification in patients with acute heart failure (AHF) is poorly validated. Previous studies tended to evaluate the prognostic significance of only one or two selected ECG parameters. The aim of this study was to evaluate the impact of multiple ECG parameters on mortality in AHF. The Acute Heart Failure Database (AHEAD) registry collected data from 4,153 patients admitted for AHF to seven hospitals with Catheter Laboratory facilities. Clinical variables, heart rate, duration of QRS, QT and QTC intervals, type of rhythm and ST-T segment changes on admission were collected in a web-based database. 12.7 % patients died during hospitalisation, the remainder were discharged and followed for a median of 16.2 months. The most important parameters were a prolonged QRS and a junctional rhythm, which independently predict both in-hospital mortality [QRS > 100 ms, odds ratio (OR) 1.329, 95 % CI 1.052-1.680; junctional rhythm, OR 3.715, 95 % CI 1.748-7.896] and long-term mortality (QRS > 120 ms, OR 1.428, 95 % CI 1.160-1.757; junctional rhythm, OR 2.629, 95 % CI 1.538-4.496). Increased hospitalisation mortality is predicted by ST segment elevation (OR 1.771, 95 % CI 1.383-2.269) and prolonged QTC interval >475 ms (OR 1.483, 95 % CI 1.016-2.164). Presence of atrial fibrillation and bundle branch block is associated with increased unadjusted long-term mortality, but mostly reflects more advanced heart disease, and their predictive significance is attenuated in the multivariate analysis. ECG in patients admitted for acute heart failure carries significant short- and long-term prognostic information, and should be carefully evaluated.
Internal and Emergency Medicine 10/2012; · 2.35 Impact Factor
[show abstract][hide abstract] ABSTRACT: Heart failure is a syndrome with increasing prevalence and poor prognosis. The aim of the article is to describe the characteristics, etiology, treatment and short-term prognosis of consecutive patients hospitalized for acute heart failure (AHF) in a regional hospital without Cardiocentre.
From 1/2007 to 5/2009 in total 752 patients were hospitalized in Hospital in Frýdek-Místek with diagnosis of AHF, 18% of them were in that period re-hospitalized. Data collection was performed by doctors using the National registry of acute heart failure AHEAD. Systematic sorting of patients with heart failure was made on the basis of guidelines for the diagnosis and treatment of acute heart failure (2005). Statistical analysis was performed at the Institute of Biostatistics and Analyses Masaryk University in Brno.
AHF was a reason of 9% of all hospital admissions. This represents approximately 250 hospitalizations due to AHF per 100 000 inhabitants/year. A median of hospital stay was 6.5 days. Patients with de-novo AHF formed 40.8% of all hospitalizations. The most common syndromes of AHF were acute decompensated heart failure (57.7%) and pulmonary oedema (19.8%). According to laboratory tests the incidence of renal insufficiency was in 35.6% of patients, anemia in 39.9%, blood glucose on admission above 10 mmol/l in 29.5% and hyponatremia < 135 mmol/l in 19.1%. During hospitalization, there was a significant increase in the treatment of heart failure. Diuretics were receiving 91% of discharged patients, ACE inhibitors and/or AT2 blockers 85.7% and beta-blockers 69.6% of patients. A total of 30% of discharged patients were not self-sufficient. The total 30-day mortality was 16.8%. Using univariante logistic regression factors most affecting the 30-day mortality were identified: cardiogenic shock, female gender, age over 70 years, acute coronary syndrome, hypotension on admission, atrial fibrillation, renal insufficiency, chronic obstructive pulmonary disease, anemia, hyperglycemia, hyperkalemia, and hyponatremia.
The paper provides an overview and characteristics of consecutive patients hospitalized in the regional hospital. We identified factors pointing to the adverse short-term prognosis. The work draws attention to social problems, up to 30% of patients hospitalized for acute heart failure were not self-sufficient at discharged.
[show abstract][hide abstract] ABSTRACT: The effect of previous long-term hypertension on mortality in acute heart failure (HF), regardless of blood pressure values, has not been well studied.
Acute Heart Failure Database (AHEAD) - Czech HF registry enrolled 4153 consecutive patients with acute HF. We excluded severe forms (cardiogenic shock, pulmonary oedema, right HF) and analysed 2421 patients with known presence or absence of previous hypertension. Demographic, clinical and laboratory profile, treatment and mortality rates were assessed and predictors of outcome were identified.
Patients with previous hypertension (71.5%) were older, more of female gender, with worse pre-hospitalisation NYHA class, increased incidence of co-morbidities and higher left ventricular ejection fraction (LVEF). Although in-hospital mortality was similar in both cohorts (2.6%), survival at 1, 2 and 3-year was worse in the hypertensive group (75.6%, 65.9% and 58.7% vs. 80.7%, 74.2% and 69.8%; P<0.001). Nevertheless, hypertension was not associated with mortality in multivariate analysis and stronger predictors of outcome were identified (P<0.05): new-onset acute HF [hazard ratio (HR) 0.62] and increased body mass index (HR 0.68) proved to have a protective role. Advanced age (HR 1.86), diabetes (HR 1.45), lower LVEF (HR 1.28) and admission blood pressure (HR 1.54), elevated serum creatinine (HR 1.63), hyponatremia (HR 1.77) and anaemia (HR 1.40) were associated with worse survival.
Antecedent hypertension is frequent in patients with acute HF and contributes to organ and vascular impairment. However its presence has no independent influence on short- and medium-term mortality, which is influenced by other related co-morbidities.
European Journal of Internal Medicine 12/2011; 22(6):591-6. · 2.05 Impact Factor