Acute heart failure: epidemiology, classification, and pathophysiology

2021 ◽  
pp. 603-616
Author(s):  
Dimitrios Farmakis ◽  
Gerasimos Filippatos
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Renal Dysfunction ◽  
Acute Heart Failure ◽  
De Novo ◽  
Rapid Development ◽  
Previous History ◽  
Cardiovascular Comorbidities ◽  
History Of ◽  
Artery Disease

Acute heart failure (AHF) is defined as the rapid development or change of symptoms and signs of heart failure that requires urgent medical attention and usually hospitalization. it represents the first reason for hospital admission in individuals aged 65 or more and accounts for nearly 70% of the total healthcare expenditure for heart failure. It is generally characterized by adverse prognosis, with an in-hospital mortality rate of 4-7%, a 2 to 3-month post-discharge mortality of 7-11% and a 2 to 3-month readmission rate of 25-30%. The majority of patients have a previous history of heart failure and present with symptoms and/or signs of congestion and normal or increased blood pressure, while about half of them have preserved left ventricular ejection fraction. A high prevalence of cardiovascular or non-cardiovascular comorbidities is further observed, including coronary artery disease, arterial hypertension, atrial fibrillation, diabetes mellitus, renal dysfunction, chronic lung disease, anemia and iron deficiency. Different classification criteria have been proposed for AHF, reflecting the clinical heterogeneity of the syndrome. Classifications according to the past history of heart failure (acutely decompensated chronic or de novo), the systolic blood pressure upon presentation (hypertensive, normotensive or hypotensive) and the presence or absence of congestion and peripheral hypoperfusion are among the most widely used. The pathophysiology of AHF involves several mechanisms, including volume overload, pressure overload, myocardial loss and restrictive filling, while several cardiovascular and non-cardiovascular precipitating factors lead to AHF. Regardless of the underlying mechanism, peripheral and/or pulmonary congestion is present in the vast majority of AHF, resulting from fluid retention and/or fluid redistribution, while a marked reduction in cardiac output with peripheral hypoperfusion occurs in a minority of cases. Myocardial injury and renal dysfunction are important factor involved in the precipitation and progression of the syndrome.

scholarly journals ACUTE HEART FAILURE

2018 ◽  
Vol 25 (09) ◽  
pp. 1392-1396
Author(s):  
Jasia Reham Din ◽  
Shahid Maqbool ◽  
Shakeel ur Rehman ◽  
Naeem Hameed
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
De Novo ◽  
Past History ◽  
Previous History ◽  
Young Male ◽  
Uncontrolled Hypertension ◽  
Cross Sectional ◽  
History Of ◽  
Emergency Department Patients

Objectives: To determine the frequency of the major precipitating factorsamong the patients presenting with acute heart failure. Study Design: Cross sectional study.Setting: Faisalabad Institute of Cardiology, Faisalabad. Period: July 2014 to January 2015.Materials and Methods: 190 patients of acute heart failure were included after obtaininginformed consent from emergency department. Patients from age of 25 years to 80 years andof either sex either diabetic or non-diabetic were enrolled in study. ECG and CXR were takenin emergency with baseline investigations. Precipitating cause was identified from collectedhistory, clinical examination and ECG, CXR and lab results. Results: Mean age of these patientswere 54.4 + 8.92, 100 (52.6%) were male, 90 (47.4%) were females, 88 patients (46.3%) werediabetic, 102 patients (53.68%) were non-diabetic and 124 (65.3%) had previous history of heartfailure and 66 (34.7%) had no past history of heart failure. ACS was the common precipitatingfactor of Acute Heart Failure ( 31.57% ) among all the patients of the study with non-complianceof drugs 27.9% , arrhythmias 17.9% uncontrolled hypertension 17.36% and infections 5.3%.Conclusion: Young, male, diabetics and patients with history of chronic HF suffered more fromAHF. ACS was the most common precipitating factor while in patients with de novo Acute HeartFailure; it was ACS and non-compliance with drugs.

Acute heart failure: epidemiology, classification, and pathophysiology

2015 ◽  
Author(s):  
Dimitrios Farmakis ◽  
John Parissis ◽  
Gerasimos Filippatos
Keyword(s):  
Heart Failure ◽  
Renal Dysfunction ◽  
Acute Heart Failure ◽  
Rapid Development ◽  
Previous History ◽  
Left Ventricular ◽  
Classification Systems ◽  
Left Ventricular Ejection ◽  
Medical Attention ◽  
Ventricular Ejection Fraction

Acute heart failure is defined as the rapid development or change of symptoms and signs of heart failure that requires urgent medical attention and usually hospitalization. Acute heart failure is the first reason for hospital admission in individuals aged 65 or more and accounts for nearly 70% of the total health care expenditure for heart failure. It is characterized by an adverse prognosis, with an in-hospital mortality rate of 4-7%, a 2-3-month post-discharge mortality of 7-11%, and a 2-3-month readmission rate of 25-30%. The majority of patients have a previous history of heart failure and present with normal or increased blood pressure, while about half of them have a preserved left ventricular ejection fraction. A high prevalence of cardiovascular or non-cardiovascular comordid conditions is further observed, including coronary artery disease, arterial hypertension, atrial fibrillation, diabetes mellitus, renal dysfunction, chronic lung disease, and anaemia. Different classification systems have been proposed for acute heart failure, reflecting the clinical heterogeneity of the syndrome; the categorization to acutely decompensated chronic heart failure vs de novo acute heart failure and to hypertensive, normotensive, and hypotensive acute heart failure are among the most widely used and clinically relevant classifications. The pathophysiology of acute heart failure involves several pathogenetic mechanisms, including volume overload, pressure overload, myocardial loss, and restrictive filling, while several cardiovascular and non-cardiovascular causes or precipitating factors lead to acute heart failure through a single of these mechanisms or a combination of them. Regardless of the underlying mechanism, peripheral and/or pulmonary congestion is the hallmark of acute heart failure, resulting from fluid retention and/or fluid redistribution. Myocardial injury and renal dysfunction are also involved in the precipitation and progression of the syndrome.

Beta-Blockers and Cardiovascular Outcomes in Acute Heart Failure with a History of Coronary Artery Disease and an Ejection Fraction ≥ 40%

2020 ◽  
Vol 18 (6) ◽  
pp. 644-651 ◽  
Author(s):  
Charbel Abi Khalil ◽  
Kadhim Sulaiman ◽  
Nidal Asaad ◽  
Khalid F. AlHabib ◽  
Alawi Alsheikh-Ali ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Beta Blockers ◽  
Previous History ◽  
Left Ventricular Ejection ◽  
History Of ◽  
Artery Disease

The prognostic impact of beta-blockers (BB) in coronary artery disease (CAD) is controversial, especially in the post-reperfusion era. We studied in-hospital cardiovascular events in patients hospitalized for acute HF, a previous history of CAD and a left ventricular ejection fraction (LVEF) ≥40%, in relation to BB on admission; and 1-year outcome in relation to BB on discharge, in the GULF aCute heArt failuRe (GULF-CARE) registry. From a total of 5005 patients included in the GULF-CARE registry, 303 patients with a previous history of CAD and a LVEF ≥40% on BB were propensity-matched to 303 patients without BB on admission. In-hospital mortality (OR= 0.82; 95% CI [0.35-1.94]), stroke and cardiogenic shock were not reduced by BB. On discharge, 306 patients on BB, including the ones newly diagnosed with myocardial infarction as a precipitating cause of HF, were propensity-scored matched with 306 patients without BB. Mortality (OR= 0.86; 95%CI [0.51-1.45], hospitalization for HF or PCI/CABG at 1 year were also not reduced by BB at discharge. In summary, our data show that BB have a neutral effect on in-hospital and 1-year outcomes in acute heart failure patients with a previous history of CAD and a LVEF ≥40%.

Abstract 17352: Differences in Clinical Characteristics, Risk Factors, Rate of Recurrence and 1-year Outcome Between Acute Heart Failure Patients With Stroke or TIA and Those Without This Co-morbidity. Results From the Gulf aCute heArt failuRe rEgistry (gulf Care)

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Mohammed A Al Hashemi ◽  
Kadhim Sulaiman ◽  
Jassim Al-Suwaidi ◽  
Khalid F AlHabib ◽  
Husam AlFaleh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Clinical Characteristics ◽  
De Novo ◽  
Stroke Patients ◽  
Lv Dysfunction ◽  
Co Morbidity ◽  
History Of ◽  
One Year ◽  
Ischemic Attack

Background: Chronic heart failure (CHF) is a known risk for stroke and morbidities and mortalities are known to be higher in CHF patients compared to stroke patients without CHF we here study the prevalence and the clinical significance in a group of patient with stroke or transient ischemic attack (TIA) who were admitted to hospital with acute heart failure (AHF) compared to those without stroke and are admitted with acute heart failure Methods: Data were derived from a prospective, multicenter, multinational study of 5005 patients hospitalized with AHF from February 2013 to November 2012. Data were analyzed according to the presence or absence of Stroke or bronchial TIA. Demographic, management, in-hospital and 1-year outcomes were compared Results: Stroke patients were likely to have a decompensation of chronic failure rather than De-Novo AHF when compared to those without Stroke/TIA (see table). Stroke patients were older; more likely to be female, have history of DM, HTN, dyslipidemia and CKD. Stroke patients were likely to have Atrial fibrillation, PVD, systolic LV dysfunction as well as CAD when compared to those without Stroke, they were also more likely receive NIV, IV inotropes and likely to have had cardiac PCI prior to this admission with AHF. Stroke patients had higher recurrence of stroke and one-year mortality rates. Conclusion: Patients who presented with AHF and history of stroke/TIA were having different clinical characteristics as well as comorbidities as compared to those without Stroke, with worse in-hospital and one-year outcome. The current study underlies the need to aggressively manage these high-risk patients.

scholarly journals ACUTE HEART FAILURE PATIENTS

2016 ◽  
Vol 23 (10) ◽  
pp. 1281-1287
Author(s):  
Naeem Asghar ◽  
Shakeel Ahmad ◽  
Muhammad Nazim ◽  
Hafiz Muhammad Faiq Ilyas ◽  
Muhammad Nouman Ahmad
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Acute Heart Failure ◽  
De Novo ◽  
Uncontrolled Hypertension ◽  
Diabetic Patients ◽  
Study Group ◽  
Acute Decompensation ◽  
History Of ◽  
Precipitating Factor

Objectives: The objective of the study is to identify the precipitating factorsamong the patients presenting with AHF (Acute Heart Failure). Study Design: Cross sectionalstudy. Setting: Punjab Institute of Cardiology, Lahore. Duration of Study: 6 months. From01-01-2007 to 30-06-2007. Methodology: The calculated sample size was 170 cases with 5%margin of error, 95% confidence level taking expected percentage of uncontrolled hypertensioni.e. 12% (least percentage among all precipitating factors). Results: In the study group, mostlypatients of AHF were young with mean age of 55 + 6.99 years, male (61.8%), Diabetic (53.5%)and have history of chronic Heart Failure (63.5%). In male the most common precipitating factorof AHF was ACS (39.04%) while in female uncontrolled hypertension (38.46%). Conclusion:In diabetic patients the most common precipitating factor of AHF was ACS (30.7%). In patientswith acute decompensation of chronic heart failure the most common precipitating factor wasnon-compliance of medication (30.55%) while in patients with de novo Acute Heart Failure itwas ACS (41.93%). ACS was the common precipitating factor of Acute Heart Failure (28.2%)among the study group irrespective of gender, diabetes and history of Heart Failure.

scholarly journals Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

2021 ◽  
Vol 13 (2) ◽  
pp. 141-145
Author(s):  
Murat Selçuk ◽  
Muhammed Keskin ◽  
Tufan Çınar ◽  
Nuran Günay ◽  
Selami Doğan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Troponin I ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Previous History ◽  
Hospital Death ◽  
Elevated Glucose ◽  
History Of ◽  
Artery Disease

Introduction:The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods:A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results: A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95%CI:0.76-0.97). Conclusion: The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.

Abstract 15348: Higher Mortality in Patients with Undiagnosed Hypertension: Is the Electronic Medical Record the Key to Their Identification?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Olufunso W Odunukan ◽  
Stephen Cha ◽  
Parvez A Rahman ◽  
Daniel Roellinger ◽  
Mark A Nyman
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Proportional Hazards ◽  
Electronic Records ◽  
Cross Sectional ◽  
Cardiovascular Comorbidities ◽  
Undiagnosed Hypertension ◽  
Risk Patients ◽  
Artery Disease ◽  
Diagnosis Of Hypertension

Introduction: Patients with hypertension (HTN) may remain undiagnosed as the diagnosis requires systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg on ≥ 2 different occasions. Hypothesis: We sought to evaluate outcomes of patients without diagnosed hypertension who have elevated BP meeting current thresholds for hypertension on 2 consecutive episodes. Methods: Together with retrospective billing and clinical data, electronic records of all outpatient visits in 2009 were used to identify 24,277 patients with 2 consecutive visits (2CHBP) with SBP ≥ 140mmHg or DBP ≥ 90 mmHg and were compared with a previously identified cohort of 53,998 known hypertension patients. Among the 2CHBP group, 6,071 (25%) were identified without a prior diagnosis of hypertension and were categorized as undiagnosed hypertension. They were compared with patients with known hypertension who had ≥ 1 visit in 2009. Cross-sectional analysis of cardiovascular comorbidities and proportional hazards for survival were done. Results: Of 5,978 undiagnosed HTN patients, 49% were female compared to 51% of 10,311 known HTN. In the undiagnosed HTN group, 19.5% were ≥ 80 years compared to 30.4% of known HTN patients. Cardiovascular comorbidities were generally lower in the undiagnosed HTN group compared to the known HTN group - heart failure (7% v 8%; OR 0.88, 95% CI: 0.77 - 0.99; p < 0.038), atrial fibrillation (11% v 12%, OR 0.88 95% CI 0.79 - 0.97) and coronary artery disease (17% v 26%, OR 0.57 95% CI 0.52 - 0.61). However after a four year followup, mortality was higher in the undiagnosed HTN group with unadjusted hazard ratio HR 1.4 (95% CI 1.29 - 1.60, p<0.0001) and HR 2.41 (2.16 -2.68, p<0.0001) when adjusted for age, sex, heart failure and diabetes. Conclusions: Over a quarter of patients meeting current thresholds on 2 consecutive visits did not carry a known diagnosis of hypertension. Although younger and with less cardiovascular comorbidities than those with diagnosed hypertension, mortality after 4 years was significantly higher in those with undiagnosed hypertension. Electronic records can be used to identify these high risk patients.

Acute heart failure

2018 ◽  
Author(s):  
Dimitrios Farmakis ◽  
John Parissis ◽  
George Papingiotis ◽  
Gerasimos Filippatos
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Rapid Development ◽  
Health Care Expenditure ◽  
Previous History ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Medical Attention ◽  
Post Discharge ◽  
Ventricular Ejection Fraction

Acute heart failure is defined as the rapid development or change of symptoms and signs of heart failure that requires urgent medical attention and usually hospitalization. Acute heart failure is the first reason for hospital admission in individuals aged 65 or more and accounts for nearly 70% of the total health care expenditure for heart failure. It is characterized by an adverse prognosis, with an in-hospital mortality rate of 4–7%, a 2–3-month post-discharge mortality of 7–11%, and a 2–3-month readmission rate of 25–30%. The majority of patients have a previous history of heart failure and present with normal or increased blood pressure, while about half of them have preserved left ventricular ejection fraction. A high prevalence of cardiovascular or non-cardiovascular comordid conditions is further observed, including coronary artery disease, arterial hypertension, atrial fibrillation, diabetes mellitus, renal dysfunction, chronic lung disease, and anaemia.

scholarly journals Atypical Presentation and Intraoperative Complication in a Case of Aortic Dissection

1996 ◽  
Vol 2 (1) ◽  
Author(s):  
Felix Ma ◽  
JF Morin
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Inferior Wall ◽  
Atypical Presentation ◽  
Shortness Of Breath ◽  
Transient Ischemic Attacks ◽  
Intraoperative Complication ◽  
History Of ◽  
Artery Disease

A 68-year-old man, ex-smoker, with a history of hypertension, hypercholesterolemia, and intermittentclaudication secondary to severe aorto-iliac occlusive disease, was evaluated by a cardiologist for exertionalright-shoulder pain of one year's duration. The pain would typically last approximately five minutes andresolve with cessation of activity. He experienced no similar episodes at rest. There was no retrosternal chestpain, shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, palpitations, transient ischemic attacks,syncope, or pre-syncope. His medications included Norvasc, Prinivil, Novoflupam, Nitrospray, Novo-Timol,Pravacho, Entrophen, and Tylenol. Family history was positive for coronary artery disease. On physical examination, the patient was in no apparent distress with a blood pressure of 160/80 in both armsand a regular pulse of 70. There was a left carotid bruit. Femoral pulses were nearly absent bilaterally. Heartsounds were normal, with no murmurs, and there were no signs of heart failure. EKG showed normal sinusrhythm and no evidence of ischemia or previous infarction. However, thallium scan revealed a fixed deficit inthe inferior wall territory.

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