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Patients admitted with acute heart failure at an intensive care department - comparison between the clinical profiles of patients with preserved vs. reduced left ventricular ejection fraction
Session:
Posters (Sessão 4 - Écran 4) - Insuficiência Cardíaca 4 - Vários 2
Speaker:
Ana Rita Moura
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.6 Acute Heart Failure - Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Ana Rita Moura; Marta Reina-Couto; Roberto Roncon de Albuquerque; José Artur Paiva
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Heart failure (HF) is one of the major contemporary clinical challenges. Its prognosis is worse in the presence of exacerbations that require intensive care. Data regarding characterization and prognosis of critical acute heart failure (AHF) in the contemporary era is lacking. <strong>Aims</strong>: describe and compare the clinical profile of patients with preserved vs. reduced left ventricular ejection fraction (LVEF) admitted with AHF to a general Intensive Care Unit (ICU) at a tertiary center. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: retrospective study of patients admitted at an ICU with the diagnosis of AHF between January and December of 2018 in a tertiary care hospital. Patients were dichotomized according to LVEF at discharge (preserved - ≥50% or reduced - <50%) and compared regarding clinical data, <em>triggers</em> and in-hospital and long-term prognosis<span style="color:#222222">.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: 239 patients were included, mostly men (60.7%), with a mean age of 69.5±14.8 years old. Patients admitted with preserved LVEF (28.9%; n=69) were a minority. This group was significantly older (73.7 vs. 66.2 years; p=0.001) and had a higher prevalence of female gender (59.4% vs. 32.5%; p<0.001). There was no difference in the prevalence of the majority of previous co-morbidities. Mean maximum brain natriuretic peptide was similar (1365 vs. 1418 pg/mL, p=0.82). Although acute coronary syndrome was the most prevalent <em>trigger</em> in both groups, it assumed a lighter representativity in the preserved LVEF patients (21.7% vs. 46.3%); instead, pulmonary embolism (14.5% vs. 1.6%) and infection (18.8% vs. 13.8%) assumed more relevant roles in this subgroup. Regarding clinical status, patients with preserved LVEF had a lower probability of low peripheral perfusion status at admission (p<0.001) that was reflected in a lesser use of aminergic support (21.7% vs. 52.8%, p<0.001) and mechanical circulatory support (used in 2 cases of high-risk pulmonary embolism). Patients with preserved LVEF also had a significantly lower in-hospital death (7.2% vs. 20.3%; p=0.02). There wasn´t a difference in the duration of mean hospital stay (5.25 vs. 6.5 days; p=0.20), nor in the probability of death (p=0.98) or new HF hospitalization within 12 months after discharge (p=0.44).</span></span></p> <p style="text-align:justify"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusions</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">: this registry shows that only a minority of patients admitted with AHF at an ICU has preserved LVEF. As compared with HF patients with reduced LVEF, these individuals are more likely to be older, women, to have pulmonary embolism as a <em>trigger</em>; and to exhibit less severe clinical status and a better short-term prognosis. However, there weren´t significant differences in terms of mortality and rehospitalization for AHF at 12 months. These findings demonstrate the relatively poor prognostic value of LVEF in this context in terms of long-term prognosis prediction and emphasizes the need of continued monitoring of these patients.</span></span></p>
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