Long-term outcomes and independent predictors of mortality in patients presenting to emergency departments with acute heart failure in Beijing: a multicenter cohort study with a 5-year follow-up.

ABSTRACT

BACKGROUND: Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors. METHODS: This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors. RESULTS: The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR] 1.027, 95 confidence interval [CI] 1.023-1.030), body mass index (BMI) (HR 0.971, 95% CI 0.958-0.983), fatigue (HR 1.127, 95% CI 1.009-1.258), ascites (HR 1.190, 95% CI 1.057-1.340), hepatic jugular reflux (HR 1.339, 95% CI 1.140-1.572), New York Heart Association (NYHA) class III to IV (HR 1.511, 95% CI 1.291-1.769), heart rate (HR 1.003, 95% CI 1.001-1.005), diastolic blood pressure (DBP) (HR 0.996, 95% CI 0.993-0.999), blood urea nitrogen (BUN) (HR 1.014, 95% CI 1.008-1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR 1.426, 95% CI 1.220-1.668) or fourth quartile (HR 1.437, 95% CI 1.223-1.690), serum sodium (HR 0.980, 95% CI 0.972-0.988), serum albumin (HR 0.981, 95% CI 0.971-0.992), ischemic heart diseases (HR 1.195, 95% CI 1.073-1.331), primary cardiomyopathy (HR 1.382, 95% CI 1.183-1.614), diabetes (HR 1.118, 95% CI 1.010-1.237), stroke (HR 1.252, 95% CI 1.121-1.397), and the use of diuretics (HR 0.714, 95% CI 0.626-0.814), ß-blockers (HR 0.673, 95% CI 0.588-0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR 0.714, 95% CI 0.604-0.845), angiotensin-II receptor blockers (ARBs) (HR 0.790, 95% CI 0.646-0.965), spironolactone (HR 0.814, 95% CI 0.663-0.999), calcium antagonists (HR 0.624, 95% CI 0.531-0.733), nitrates (HR 0.715, 95% CI 0.631-0.811), and digoxin (HR 0.579, 95% CI 0.465-0.721). CONCLUSIONS: The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, ß-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.