Epidemiology, pathophysiology, and in-hospital management of pulmonary edema: Data from the Romanian Acute Heart Failure Syndromes registry

Ovidiu Chioncel*, Andrew P. Ambrosy, Serban Bubenek, Daniela Filipescu, Dragos Vinereanu, Antoniu Petris, Ruxandra Christodorescu, Cezar Macarie, Mihai Gheorghiade, Sean P. Collins

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

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. 101.4W27.1 mg) of IV furosemide for a shorter duration (i.e. 69.3W22.3 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, lifethreatening 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.

Original languageEnglish (US)
Pages (from-to)92-104
Number of pages13
JournalJournal of Cardiovascular Medicine
Volume17
Issue number2
DOIs
StatePublished - Jan 1 2016

Keywords

  • In-hospital therapies
  • Outcomes
  • Pulmonary edema

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Chioncel, O., Ambrosy, A. P., Bubenek, S., Filipescu, D., Vinereanu, D., Petris, A., Christodorescu, R., Macarie, C., Gheorghiade, M., & Collins, S. P. (2016). Epidemiology, pathophysiology, and in-hospital management of pulmonary edema: Data from the Romanian Acute Heart Failure Syndromes registry. Journal of Cardiovascular Medicine, 17(2), 92-104. https://doi.org/10.2459/JCM.0000000000000192