| Objectives:Acute heart failure(AHF)patients usually initially occur in the Emergency Department(ED),along with higher rates of morbility and mortality.In this study,aimed to optimize the management of AHF patients in ED,we investigated the correlation with the clinical characteristics and outcomes of AHF patients at a regional medical center in Tianjin,China.Methods:We conducted a observational,single-center study of 282 adult ED patients with AHF in Tianjin Medical University General Hospital during the period of July2017 to August 2018.Furthermore,the predictors of all-cause 90-day and 180-day mortality were analyzed by multivariable COX regression analysis.Based on ejection fraction,the clinical characteristics of all patients were categorized into heart failure with reduced ejection fraction(HFrEF,LVEF<40%),heart failure with mid-range ejection fraction(HFmrEF,40%~49%)and heart failure with preserved ejection fraction(HFpEF,LVEF?50%).The data of demographics,laboratory tests and physical examinations upon arrival to ED were collected,and differences of continuous variables between groups were analyzed using ANOVA analysis or Kruskal-Wallis test according to normal or non-normal distributions,categorical variables using the Pearson?2 test;Kaplan-Meier survival curves were used to describe the 90-day and 180-day survival differences between groups.Results:In this study,a total of 282 patients with AHF admitted to the ED were included.The mean age was 67.99±14.08 years old,and 63.1%were male.The most common previous history were hypertension(66.0%),coronary heart disease(59.6%)and diabetes mellitus(40.4%).Infection was the most common cause(49.3%).Laboratory examination showed that the indicators of heart failure and heart function impairment were significantly increased.The results of echocardiography indicated that LA and LV were significantly higher than the normal range.All subjects were followed up for 90 days,with 47 deaths(16.7%).Multivariate COX proportional risk model showed that age(OR 1.024,95%CI 1.001-1.047,p=0.043),diastolic blood pressure at admission(OR0.971,95%CI 0.949-0.993,p=0.011),Na~+<135mmol/L(OR 1.194,95%CI 1.011-3.623,p=0.046),and NT-proBNP(OR 1.000,95%CI1.000-1.000,p<0.001)can independently predict the 90-day prognosis of AHF patients.The optimal values of diastolic blood pressure and NT-proBNP were82.5mmHg and 9268pg/mL,respectively.A total of 79 cases died within 180 days(28.0%).Multivariate COX proportional risk model showed that diastolic blood pressure(OR 0.981,95%CI 0.964-0.998,p=0.033)and NT-proBNP(OR 1.000,95%CI 1.000-1.000,p<0.001)could independently predict the 180-day prognosis of AHF patients.The optimal value of NT-proBNP was 9268pg/mL.In addition,125patients were presented with HFrEF,72 with HFmrEF and 85 with HFpEF.Compared with patients with HFrEF,the group of HFpEF has a lower incidence in male(54.1%vs.71.2%),older(71.69±12.31 vs.65.42±13.57)patients,or in patients with lower heart rate,higher systolic blood pressure at admission,and less likely caused by ACS(21.2%vs.40.8%),and higher incidence of AHF in patients with lower level of hemoglobin,total bilirubin(TBil),CK,CKMB,BNP,NT-proBNP and decreased left ventricular volume.Compared with HFmrEF group,the group of HFpEF is also less liable to progress to AHF due to ACS at admission,and has lower lever of BNP?NT-proBNP and decreased left ventricular volume.Conclusion:Older age,Na~+<135mmol/L,diastolic blood pressure<82.5mmHg at admission and NT-proBNP?9268pg/mL can be used as independent risk factors to evaluate the prognosis of patients with AHF for 90 days.NT-proBNP?9268pg/mL at admission can independently predict the bad outcome of AHF patients at 180 days.In addition,the clinical characteristics of HFpEF group were significantly different from those of HFrEF group and HFmrEF group.Moreover,the 90-day prognosis of HFpEF group was better than that of HFrEF group. |
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