Garus M, Jura M, Guzik M, Zymliński R, Iwanek G, Ponikowski P, Biegus J. Prognostic significance and clinical determinants of residual dyspnoea at discharge in acute heart failure: a single-centre, prospective observational study.
BMJ Open 2023;
13:e075302. [PMID:
37984947 PMCID:
PMC10661057 DOI:
10.1136/bmjopen-2023-075302]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE
This study aimed to assess the prognostic significance of residual (discharge) dyspnoea in acute heart failure (AHF) patients.
DESIGN
Single-centre, prospective observational study.
SETTING
Patients hospitalised for decompensated AHF in a single cardiology centre, in Poland.
PARTICIPANTS
All patients (n=202) who survived the hospitalisation with the primary diagnosis of AHF and were discharged from the hospital.
PRIMARY AND SECONDARY OUTCOME MEASURES
1-year all-cause mortality; and the composite endpoint of 1-year all-cause mortality and rehospitalisation for the HF (whichever occurred first).
RESULTS
On admission, 159 (78.7%) AHF patients presented dyspnoea at rest, while residual resting dyspnoea at discharge was present in 16 patients (7.9%). There were 48 (24%) patients with moderate/severe exertional dyspnoea at discharge. In the multivariable model, the resting dyspnoea at discharge was related to a higher risk of both 1-year mortality and composite outcome, with HR (95% CI) 8.0 (3.7 to 17.3) and 5.1 (2.6 to 10.2), respectively, both p<0.0001. Analogically, moderate or severe residual dyspnoea at discharge was related to the heightened risk of study both outcomes, with HR (95% CI) 3.1 (1.8 to 5.4) and 1.8 (1.1 to 2.9), respectively, p<0.01.
CONCLUSIONS
Among AHF patients the residual dyspnoea at discharge was unexpectedly common and was associated with an unfavourable outcome during 1-year follow-up.
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