Presentation of acute heart failure and its consequences

Shoaib, Ahmad

December 2015

Thesis or dissertation

© 2015 Ahmad Shoaib. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

Background: Acute heart failure (AHF) is a heterogeneous in aetiology, pathophysiology and presentation and very difficult to classify. Despite this diversity, clinical trials in AHF deal with this syndrome as a single entity, which may be one reason for repeated failures. It is generally believed that patients with AHF present with severe breathlessness at rest but epidemiological data suggest otherwise.

Methods: Different data sets were used to assess the presentation of AHF and its consequences. I conducted a detailed case note review to determine what proportions of patients were Short Of Breath At Rest (SOBAR) and Comfortable At Rest but Breathless On Slight Exertion (CARBOSE). Euro Heart Failure Survey 1 (EHFS1) screened consecutive deaths and discharges during 2000-2001 in 24 countries, to ascertain patients with known or suspected Heart Failure (HF). Information on presenting symptoms and signs were gathered. Mortality was assessed during hospital admission and then 3 months after discharge.

Results: Of 697 patients, those with SOBAR (45%) had higher median heart rate blood pressure and respiratory rate and these changed quickly in first 24 hours after presentation as compare to CARBOSE (55%) but had better long term prognosis. Of all 10,701 patients admitted with suspected HF in EHFS1, Heart failure was considered to be the primary reason for admission in 4,234 (40%), secondary reason for admission if complicated or prolonged stay in further 1,772 (17%), and in 4,695 (43%) it was uncertain that HF is actively contributing in index admission. Mortality was highest in the secondary heart failure group and lowest in the uncertain group. Heart failure with cardiac arrest/ventricle arrhythmia had worst mortality followed by HF with ACS but considerable number of patients died in uncertain group.

Conclusion: AHF is complex, with diverse presentations that are associated with very different subsequent prognosis. Attempts to investigate the effect of agents in all patients with a diagnosis of AHF may be futile. A more coherent approach of focused and tighter patient selection for drug therapy targeted by clinical presentation is more likely to succeed.

Hull York Medical School, The University of Hull and University of York
Clark, Andrew L. (Andrew Lawrence)
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