Epidemiology, pathophysiology, and in-hospital management of pulmonary edema
| Autor: | Andrew P. Ambrosy, Antoniu Petris, Sean P. Collins, Daniela Filipescu, Cezar Macarie, Mihai Gheorghiade, Ruxandra Christodorescu, Serban Bubenek, Ovidiu Chioncel, Dragos Vinereanu |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Inotrope Tachycardia medicine.medical_specialty medicine.medical_treatment Pulmonary Edema 030204 cardiovascular system & hematology Tachypnea 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Registries 030212 general & internal medicine Aged Aged 80 and over Heart Failure Mechanical ventilation Romania Left bundle branch block business.industry Cardiogenic shock General Medicine Length of Stay Middle Aged medicine.disease Pulmonary edema Heart failure Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiovascular Medicine. 17:92-104 |
| ISSN: | 1558-2027 |
| Popis: | Aim The objective of this study was to evaluate the clinical presentation, inpatient management, and in-hospital outcome of patients hospitalized for acute heart failure syndromes (AHFS) and classified as pulmonary edema (PE). Methods The Romanian Acute Heart Failure Syndromes (RO-AHFS) study was a prospective, national, multicenter registry of all consecutive patients admitted with AHFS over a 12-month period. Patients were classified at initial presentation by clinician-investigators into the following clinical profiles: acute decompensated HF, cardiogenic shock, PE, right HF, or hypertensive HF. Results RO-AHFS enrolled 3224 patients and 28.7% (n = 924) were classified as PE. PE patients were more likely to present with pulmonary congestion, tachypnea, tachycardia, and elevated systolic blood pressure and less likely to have peripheral congestion and body weight increases. Mechanical ventilation was required in 8.8% of PE patients. PE patients received higher doses (i.e. 101.4 ± 27.1 mg) of IV furosemide for a shorter duration (i.e. 69.3 ± 22.3 hours). Vasodilators were given to 73.6% of PE patients. In-hospital all-cause mortality (ACM) in PE patients was 7.4%, and 57% of deaths occurred on day one. Increasing age, concurrent acute coronary syndromes, life-threatening ventricular arrhythmias, elevated BUN, left bundle branch block, inotrope therapy, and requirement for invasive mechanical ventilation were independent risk factors for ACM. Conclusions In this national registry, the PE profile was found to be a high-acuity clinical presentation with distinctive treatment patterns and a poor short-term prognosis. Advances in the management of PE may necessitate both the development of novel targeted therapies as well as systems-based strategies to identify high-risk patients early in their course. |
| Databáze: | OpenAIRE |
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