Top

High Blood Pressure & Cardiovascular Prevention

Published in:

05-09-2023 | Heart Failure | Original article

Prognostic Clinical Phenotypes of Patients with Acute Decompensated Heart Failure

Authors: Tanya Mohammadi, Said Tofighi, Babak Mohammadi, Shadi Halimi, Farshad Gharebakhshi

Published in: High Blood Pressure & Cardiovascular Prevention | Issue 5/2023

Abstract

Introduction

Acute decompensated heart failure (AHF) is a clinical syndrome with a poor prognosis.

Aim

This study was conducted to identify clusters of inpatients with acute decompensated heart failure that shared similarities in their clinical features.

Methods

We analyzed data from a cohort of patients with acute decompensated heart failure hospitalized between February 2013 and January 2017 in a Department of Cardiology. Patients were clustered using factorial analysis of mixed data. The clusters (phenotypes) were then compared using log-rank tests and profiled using a logistic model. In total, 458 patients (255; 55.7% male) with a mean (SD) age of 72.7 (11.1) years were included in the analytic dataset. The demographic, clinical, and laboratory features were included in the cluster analysis.

Results

The two clusters were significantly different in terms of time to mortality and re-hospitalization (all P < 0.001). Cluster profiling yielded an accurate discriminating model (AUC = 0.934). Typically, high-risk patients were elderly females with a lower estimated glomerular filtration rate and hemoglobin on admission compared to the low-risk phenotype. Moreover, the high-risk phenotype had a higher likelihood of diabetes type 2, transient ischemic attack/cerebrovascular accident, previous heart failure or ischemic heart disease, and a higher serum potassium concentration on admission. Patients with the high-risk phenotype were of higher New York Heart Association functional classes and more positive in their medication history.

Conclusions

There are two phenotypes among patients with decompensated heart failure, high-risk and low-risk for mortality and re-hospitalization. They can be distinguished by easy-to-measure patients’ characteristics.

Fountoulaki K, Ventoulis I, Drokou A, Georgarakou K, Parissis J, Polyzogopoulou E. Emergency department risk assessment and disposition of acute heart failure patients: existing evidence and ongoing challenges. Heart Fail Rev. 2022;20:1–13. https://doi.org/10.1007/s10741-022-10272-4.CrossRef

Baldasseroni S, Virciglio S, Herbst A, Camartini V, Pratesi A, Salucci C, Franci Montorsi R, D’Errico G, Verga F, Ungar A, Fattirolli F, Marchionni N, Orso F. Predictors of 1-year outcome in very old patients managed in a Heart Failure Unit after an acute decompensation. Eur Geriatr Med. 2022;13(6):1417–24. https://doi.org/10.1007/s41999-022-00679-5.CrossRefPubMedPubMedCentral

Park J, Zhong X, Babaie Sarijaloo F, Wokhlu A. Tailored risk assessment of 90-day acute heart failure readmission or all-cause death to heart failure with preserved versus reduced ejection fraction. Clin Cardiol. 2022;45(4):370–8. https://doi.org/10.1002/clc.23780.CrossRefPubMedPubMedCentral

Crisanti L, Valli G, Cennamo E, Capolino A, Fratini P, Cesaro C, Adducchio G, De Magistris A, Terlizzi F, Ruggieri MP, Mirante E, Savoriti C, Sukruang K, Valeriano V, Pugliese FR, Travaglino F, Di Somma S. Usefulness of high-sensitivity troponin I in risk stratification and final disposition of patients with acute heart failure in the emergency department: comparison between HFpEF vs. HFrEF. Medicina (Kaunas). 2022. https://doi.org/10.3390/medicina59010007.CrossRefPubMed

Harrison NE, Favot MJ, Gowland L, Lenning J, Henry S, Gupta S, Abidov A, Levy P, Ehrman R. Point-of-care echocardiography of the right heart improves acute heart failure risk stratification for low-risk patients: The REED-AHF prospective study. Acad Emerg Med. 2022;29(11):1306–19. https://doi.org/10.1111/acem.14589.CrossRefPubMedPubMedCentral

Hunter BR, Martindale J, Abdel-Hafez O, Pang PS. Approach to acute heart failure in the emergency department. Prog Cardiovasc Dis. 2017;60(2):178–86. https://doi.org/10.1016/j.pcad.2017.08.008.CrossRefPubMed

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Burri H, Butler J, Celutkiene J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine SA, Group ESCSD. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–726. https://doi.org/10.1093/eurheartj/ehab368.CrossRefPubMed

Caraballo C, Desai NR, Mulder H, Alhanti B, Wilson FP, Fiuzat M, Felker GM, Pina IL, O’Connor CM, Lindenfeld J, Januzzi JL, Cohen LS, Ahmad T. Clinical implications of the New York Heart Association Classification. J Am Heart Assoc. 2019;8(23): e014240. https://doi.org/10.1161/JAHA.119.014240.CrossRefPubMedPubMedCentral

Mohammadi T, Mohammadi B. The long-term prognostic value provided by Coronary CT angiography. Eur J Intern Med. 2023;107:37–45. https://doi.org/10.1016/j.ejim.2022.10.020.CrossRefPubMed

10.

Zhao HL, Gao XL, Liu YH, Li SL, Zhang Q, Shan WC, Zheng Q, Zhou J, Liu YZ, Liu L, Guo N, Tian HS, Wei QM, Hu XT, Cui YK, Geng X, Wang Q, Cui W. Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China. BMC Cardiovasc Disord. 2022;22(1):307. https://doi.org/10.1186/s12872-022-02743-1.CrossRefPubMedPubMedCentral

11.

Roubille C, Eduin B, Breuker C, Zerkowski L, Letertre S, Mercuzot C, Bigot J, Du Cailar G, Roubille F, Fesler P. Predictive risk factors for death in elderly patients after hospitalization for acute heart failure in an internal medicine unit. Intern Emerg Med. 2022;17(6):1661–8. https://doi.org/10.1007/s11739-022-02982-2.CrossRefPubMed

12.

Ledwoch J, Krauth A, Kraxenberger J, Schneider A, Leidgschwendner K, Schneider V, Muller A, Laugwitz KL, Kupatt C, Martens E. Accuracy of high-sensitive troponin depending on renal function for clinical outcome prediction in patients with acute heart failure. Heart Vessels. 2022;37(1):69–76. https://doi.org/10.1007/s00380-021-01890-3.CrossRefPubMed

13.

Mohammadi T, Mohammadi B. Neuropsychological features in children and adults with congenital heart disease: an exploratory data analysis. Psychol Health Med. 2022;14:1–14. https://doi.org/10.1080/13548506.2022.2147558.CrossRef

14.

Sanchez-Serna J, Hernandez-Vicente A, Garrido-Bravo IP, Pastor-Perez F, Noguera-Velasco JA, Casas-Pina T, Rodriguez-Serrano AI, Nunez J, Pascual-Figal D. Impact of pre-hospital renal function on the detection of acute kidney injury in acute decompensated heart failure. Eur J Intern Med. 2020;77:66–72. https://doi.org/10.1016/j.ejim.2020.02.028.CrossRefPubMed

15.

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force M, Document R. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891–975. https://doi.org/10.1002/ejhf.592.CrossRefPubMed

16.

Bleumink GS, Knetsch AM, Sturkenboom MCJM, Straus SMJM, Hofman A, Deckers JW, Witteman JCM, Stricker BHC. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure: the Rotterdam Study. Eur Heart J. 2004;25(18):1614–9. https://doi.org/10.1016/j.ehj.2004.06.038.CrossRefPubMed

17.

Yamamoto E, Kato T, Yaku H, Morimoto T, Inuzuka Y, Tamaki Y, Ozasa N, Kitai T, Taniguchi R, Iguchi M, Kato M, Takahashi M, Jinnai T, Ikeda T, Himura Y, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Kawato M, Seko Y, Toyofuku M, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Shizuta S, Ono K, Sato Y, Kuwahara K, Kimura T. Sex differences in patients with acute decompensated heart failure in Japan: observation from the KCHF registry. ESC Heart Fail. 2020;7(5):2485–93. https://doi.org/10.1002/ehf2.12815.CrossRefPubMedPubMedCentral

18.

Vidan MT, Martin Sanchez FJ, Sanchez E, Ortiz FJ, Serra-Rexach JA, Martinez-Selles M, Bueno H. Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self-care: impact on outcomes. Eur J Heart Fail. 2019;21(11):1434–42. https://doi.org/10.1002/ejhf.1559.CrossRefPubMed

19.

Lopez-Vilella R, Marques-Sule E, Laymito Quispe RDP, Sanchez-Lazaro I, Donoso Trenado V, Martinez Dolz L, Almenar BL. The female sex confers different prognosis in heart failure: same mortality but more readmissions. Front Cardiovasc Med. 2021;8:618398. https://doi.org/10.3389/fcvm.2021.618398.CrossRefPubMedPubMedCentral

20.

Santas E, Palau P, Llacer P, de la Espriella R, Minana G, Nunez-Marin G, Lorenzo M, Heredia R, Sanchis J, Chorro FJ, Bayes-Genis A, Nunez J. Sex-related differences in mortality following admission for acute heart failure across the left ventricular ejection fraction spectrum. J Am Heart Assoc. 2022;11(1): e022404. https://doi.org/10.1161/JAHA.121.022404.CrossRefPubMed

21.

Lam CSP, Arnott C, Beale AL, Chandramouli C, Hilfiker-Kleiner D, Kaye DM, Ky B, Santema BT, Sliwa K, Voors AA. Sex differences in heart failure. Eur Heart J. 2019;40(47):3859–68. https://doi.org/10.1093/eurheartj/ehz835.CrossRefPubMed

22.

Lee HW, Huang CC, Yang CY, Leu HB, Huang PH, Wu TC, Lin SJ, Chen JW. Renal function during hospitalization and outcome in Chinese patients with acute decompensated heart failure: a retrospective study and literature review. Clin Cardiol. 2023;46(1):57–66. https://doi.org/10.1002/clc.23934.CrossRefPubMed

23.

Desai AS. Hemoglobin concentration in acute decompensated heart failure: a marker of volume status? J Am Coll Cardiol. 2013;61(19):1982–4. https://doi.org/10.1016/j.jacc.2013.02.021.CrossRefPubMed

24.

Caughey MC, Avery CL, Ni H, Solomon SD, Matsushita K, Wruck LM, Rosamond WD, Loehr LR. Outcomes of patients with anemia and acute decompensated heart failure with preserved versus reduced ejection fraction (from the ARIC study community surveillance). Am J Cardiol. 2014;114(12):1850–4. https://doi.org/10.1016/j.amjcard.2014.09.024.CrossRefPubMedPubMedCentral

25.

Zhao K, Zheng Q, Zhou J, Zhang Q, Gao X, Liu Y, Li S, Shan W, Liu L, Guo N, Tian H, Wei Q, Hu X, Cui Y, Geng X, Wang Q, Cui W. Associations between serum electrolyte and short-term outcomes in patients with acute decompensated heart failure. Ann Med. 2023;55(1):155–67. https://doi.org/10.1080/07853890.2022.2156595.CrossRefPubMed

26.

Tromp J, Ter Maaten JM, Damman K, O’Connor CM, Metra M, Dittrich HC, Ponikowski P, Teerlink JR, Cotter G, Davison B, Cleland JG, Givertz MM, Bloomfield DM, van der Wal MH, Jaarsma T, van Veldhuisen DJ, Hillege HL, Voors AA, van der Meer P. Serum potassium levels and outcome in acute heart failure (Data from the PROTECT and COACH Trials). Am J Cardiol. 2017;119(2):290–6. https://doi.org/10.1016/j.amjcard.2016.09.038.CrossRefPubMed

27.

Hu W, Yuan L, Wang X, Zang B, Zhang Y, Yan X, Zhao W, Chao Y. Predictive value of arterial blood lactic acid concentration on the risk of in-hospital all-cause death in patients with acute heart failure. Int J Clin Pract. 2022. https://doi.org/10.1155/2022/7644535.CrossRefPubMedPubMedCentral

28.

Ezekowitz JA, Kaul P, Bakal JA, Armstrong PW, Welsh RC, McAlister FA. Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction. J Am Coll Cardiol. 2009;53(1):13–20. https://doi.org/10.1016/j.jacc.2008.08.067.CrossRefPubMed

29.

Kapłon-Cieślicka A, Balsam P, Ozierański K, Tymińska A, Peller M, Galas M, Wyzgał M, Marchel M, Drożdż J, Opolski G. Resting heart rate at hospital admission and its relation to hospital outcome in patients with heart failure. Cardiol J. 2014;21(4):425–33. https://doi.org/10.5603/CJ.a2013.0147.CrossRefPubMed

30.

Kotecha D, Flather MD, Altman DG, Holmes J, Rosano G, Wikstrand J, Packer M, Coats AJS, Manzano L, Böhm M, van Veldhuisen DJ, Andersson B, Wedel H, von Lueder TG, Rigby AS, Hjalmarson Å, Kjekshus J, Cleland JGF. Heart rate and rhythm and the benefit of beta-blockers in patients with heart failure. J Am Coll Cardiol. 2017;69(24):2885–96. https://doi.org/10.1016/j.jacc.2017.04.001.CrossRefPubMed

31.

Castagno D, Skali H, Takeuchi M, Swedberg K, Yusuf S, Granger CB, Michelson EL, Pfeffer MA, McMurray JJV, Solomon SD. Association of Heart Rate and Outcomes in a Broad Spectrum of Patients With Chronic Heart Failure: Results From the CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and morbidity) Program. J Ame Coll Cardiol. 2012;59(20):1785–95. https://doi.org/10.1016/j.jacc.2011.12.044.CrossRef

32.

Suzuki S, Motoki H, Kanzaki Y, Maruyama T, Hashizume N, Kozuka A, Yahikozawa K, Kuwahara K. Prognostic significance of resting heart rate in atrial fibrillation patients with heart failure with reduced ejection fraction. Heart Vessels. 2020;35(8):1109–15. https://doi.org/10.1007/s00380-020-01573-5.CrossRefPubMed

33.

Lourenço P, Ribeiro A, Cunha FM, Pintalhão M, Marques P, Cunha F, Silva S, Bettencourt P. Is there a heart rate paradox in acute heart failure? Int J Cardiol. 2016;15(203):409–14. https://doi.org/10.1016/j.ijcard.2015.10.129.CrossRef

34.

Zurek M, Maeder MT, Rickli H, Muzzarelli S, Sanders-van Wijk S, Abbühl H, Handschin R, Jeker U, Pfisterer M, Brunner-la Rocca HP. Differential prognostic impact of resting heart rate in older compared with younger patients with chronic heart failure–insights from TIME-CHF. J Card Fail. 2015;21(4):347–54. https://doi.org/10.1016/j.cardfail.2014.12.014.CrossRefPubMed

35.

Kurmani S, Squire I. Acute heart failure: definition, classification and epidemiology. Curr Heart Fail Rep. 2017;14(5):385–92. https://doi.org/10.1007/s11897-017-0351-y.CrossRefPubMedPubMedCentral

36.

Mangini S, Pires PV, Braga FG, Bacal F. Decompensated heart failure. Einstein (Sao Paulo, Brazil). 2013;11(3):383–91. https://doi.org/10.1590/s1679-45082013000300022.CrossRefPubMedPubMedCentral

37.

Urban S, Blaziak M, Jura M, Iwanek G, Zdanowicz A, Guzik M, Borkowski A, Gajewski P, Biegus J, Siennicka A, Pondel M, Berka P, Ponikowski P, Zymlinski R. Novel phenotyping for acute heart failure-unsupervised machine learning-based approach. Biomedicines. 2022. https://doi.org/10.3390/biomedicines10071514.CrossRefPubMedPubMedCentral

38.

Zhou X, Nakamura K, Sahara N, Asami M, Toyoda Y, Enomoto Y, Hara H, Noro M, Sugi K, Moroi M, Nakamura M, Huang M, Zhu X. Exploring and identifying prognostic phenotypes of patients with heart failure guided by explainable machine learning. Life (Basel). 2022. https://doi.org/10.3390/life12060776.CrossRefPubMedPubMedCentral

39.

Muiesan ML, Salvetti M, Virdis A, Masi S, Casiglia E, Tikhonoff V, Barbagallo CM, Bombelli M, Cicero AFG, Cirillo M, Cirillo P, Desideri G, D’Eliak L, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Iaccarino G, Mallamaci F, Maloberti A, Mazza A, Nazzaro P, Palatini P, Parati G, Pontremoli R, Rattazzi M, Rivasi G, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Grassi G, Borghi C. Serum uric acid, predicts heart failure in a large Italian cohort: search for a cut-off value the URic acid Right for heArt Health study. J Hypertens. 2021;39(1):62–9. https://doi.org/10.1097/hjh.0000000000002589.CrossRefPubMed

40.

Rebora P, Centola M, Morici N, Sacco A, Occhino G, Viola G, Oreglia J, Castini D, Persampieri S, Sabatelli L, Ferrante G, Lucreziotti S, Carugo S, Valsecchi MG, Oliva F, Giannattasio C, Maloberti A. Uric acid associated with acute heart failure presentation in Acute Coronary Syndrome patients. Eur J Intern Med. 2022;99:30–7. https://doi.org/10.1016/j.ejim.2022.01.018.CrossRefPubMed

Title: Prognostic Clinical Phenotypes of Patients with Acute Decompensated Heart Failure
Authors: Tanya Mohammadi
Said Tofighi
Babak Mohammadi
Shadi Halimi
Farshad Gharebakhshi
Publication date: 05-09-2023
Publisher: Springer International Publishing
Keyword: Heart Failure
Published in: High Blood Pressure & Cardiovascular Prevention / Issue 5/2023
Print ISSN: 1120-9879
Electronic ISSN: 1179-1985
DOI: https://doi.org/10.1007/s40292-023-00598-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prognostic Clinical Phenotypes of Patients with Acute Decompensated Heart Failure

Abstract

Introduction

Aim

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Aim

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2023

Trends in Serum Total Cholesterol and High Total Cholesterol Prevalence Among Royal Thai Army Personnel in Thailand, 2017–2022

Risk of Arterial Hypertension After COVID-19 Recovery

Efficacy and Safety of Azelnidipine as an Antihypertensive Compared to Amlodipine: A Systematic Review and Meta-analysis

Psychometric Properties of a Brief Version of the Perception of Risk of Heart Disease Scale in an Italian Sample

Arterial Stiffness in Overweight and Obesity: Association with Sex, Age, and Blood Pressure

Epicardial Fat Volume as a Good Predictor for Multivessel Coronary Artery Disease