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.
10.1097/CM9.0000000000001617
- Author:
Yang LI
1
;
Xiao-Lu SUN
1
;
Hong QIU
1
;
Jian QIN
2
;
Chun-Sheng LI
3
;
Xue-Zhong YU
4
;
Guo-Xing WANG
5
;
Yan FU
6
;
Ya-An ZHENG
7
;
Bin ZHAO
8
;
Dong-Ming YU
9
;
Si-Jia WANG
1
;
Guo-Gan WANG
1
Author Information
1. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
2. Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100037, China.
3. Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
4. Department of Emergency, Peking Union Medical College Hospital, Beijing 100730, China.
5. Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
6. Department of Emergency, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
7. Department of Emergency, Peking University Third Hospital, Beijing 100191, China.
8. Department of Emergency, Beijing Jishuitan Hospital, Beijing 100035, China.
9. Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
- Publication Type:Multicenter Study
- MeSH:
Angiotensin Receptor Antagonists;
Angiotensin-Converting Enzyme Inhibitors;
Beijing/epidemiology*;
Biomarkers;
Cohort Studies;
Emergency Service, Hospital;
Follow-Up Studies;
Heart Failure/mortality*;
Humans;
Natriuretic Peptide, Brain;
Peptide Fragments;
Prognosis;
Prospective Studies
- From:
Chinese Medical Journal
2021;134(15):1803-1811
- CountryChina
- Language:English
-
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.
