Clinical findings and prognosis of patients hospitalized for acute decompensated heart failure: Analysis of the influence of Chagas etiology and ventricular function

Author(s)

Terhoch, Caique Bueno ^[1] ; Moreira, Henry Fukuda ^[1] ; Ayub-Ferreira, Silvia Moreira ^[1] ; Conceicao-Souza, Germano Emilio ^[1] ; Cury Salemi, Vera Maria ^[1] ; Chizzola, Paulo Roberto ^[1] ; Oliveira, Jr., Mucio Tavares ^[1] ; Gelas Lage, Silvia Helena ^[1] ; Bocchi, Edimar Alcides ^[1] ; Issa, Victor Sarli ^[1]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Hosp Clin, Heart Failure Dept, Heart Inst InCor, Sao Paulo - Brazil

• Document type: Journal article
• Source: PLoS Neglected Tropical Diseases; v. 12, n. 2 FEB 2018.
• Web of Science Citations: 7

Abstract

Aims Explore the association between clinical findings and prognosis in patients with acute decompensated heart failure (ADHF) and analyze the influence of etiology on clinical presentation and prognosis. Methods and results Prospective cohort of 500 patients admitted with ADHF from Aug/2013-Feb/2016; patients were predominantly male (61.8%), median age was 58 (IQ(25-75%) 47-66 years); etiology was dilated cardiomyopathy in 141 (28.2%), ischemic heart disease in 137 (27.4%), and Chagas heart disease in 113 (22.6%). Patients who died (154 {[}30.8%]) or underwent heart transplantation (53{[}10.6%]) were younger (56 years {[}IQ(25-75%) 45-64 vs 60 years, IQ(25-75%) 4967], P=0.032), more frequently admitted for cardiogenic shock (20.3% vs 6.8%, P<0.001), had longer duration of symptoms (14 days {[}IQ(25-75%) 4-32.8 vs 7.5 days, IQ(25-75%) 2-31], P=0.004), had signs of congestion (90.8% vs 76.5%, P<0.001) and inadequate perfusion more frequently (45.9% vs 28%, P<0.001), and had lower blood pressure (90 {[}IQ(25-75%) 80-100 vs 100, IQ(25-75%) 90-120], P<0.001). In a logistic regression model analysis, systolic blood pressure (P<0.001, OR 0.97 {[}95% CI 10.96-0.98] per mmHg) and jugular distention (P=0.004, OR 1.923 {[}95% CI 1.232-3.001]) were significant. Chagas patients were more frequently admitted for cardiogenic shock (15%) and syncope/arrhythmia (20.4%). Pulmonary congestion was rare among Chagas patients and blood pressure was lower. The rate of in hospital death or heart transplant was higher among patients with Chagas (50.5%). Conclusions A physical exam may identify patients at higher risk in a contemporaneous population. Our findings support specific therapies targeted at Chagas patients in the setting of ADHF. (AU)

• FAPESP's process: 15/13063-6 - Study of the clinical characteristics of patients hospitalized with heart failure
• Grantee: Caíque Bueno Terhoch
• Support Opportunities: Scholarships in Brazil - Scientific Initiation