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Relation of Volume Overload to Clinical Outcomes in Acute Heart Failure (From ASCEND-HF).

Publication ,  Journal Article
Fudim, M; Parikh, KS; Dunning, A; DeVore, AD; Mentz, RJ; Schulte, PJ; Armstrong, PW; Ezekowitz, JA; Tang, WHW; McMurray, JJV; Voors, AA ...
Published in: Am J Cardiol
November 1, 2018

We aimed to study whether jugular venous distension (JVD) and peripheral edema were associated with worse outcomes in patients with acute heart failure in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure trial. Of 7,141 patients in Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure, 7,135 had complete data on baseline JVD and peripheral edema status. Patients were grouped according to baseline examination findings: (1) no JVD or peripheral edema; (2) JVD only; (3) peripheral edema only; (4) JVD and peripheral edema. We used unadjusted and adjusted logistic or Cox regression analyses to assess associations between groups and the outcomes of index length of stay (LOS), in-hospital mortality, 30- and 180-day all-cause mortality. Patients with peripheral edema (Groups 3 and 4) had higher body mass index, NT-proBNP and BNP values, and more co-morbid disease, and reduced left ventricular ejection fraction compared with patients in Groups 1-2. The median (25th-75th) LOS for Groups 1-4 was 6 (4-9), 5 (4-8), 7 (4-11), and 6 days (4-10), respectively. For the 30-day and 180-day outcomes, adjusted analyses found no significant difference in risk for patients presenting with JVD only or peripheral edema only as compared with patients without evidence of JVD or peripheral edema (p >0.05 for all). The presence of both JVD and peripheral edema was associated with an adjusted 24% increase in risk for all-cause mortality at 30 days, but no risk difference at 180 days. In conclusion, in patients with heart failure presenting to the hospital with dyspnea, the presence of peripheral edema is associated with a longer hospital LOS, but no difference in short- and long-term clinical outcomes when compared with patients wihout peripheral edema. The combination of peripheral edema and JVD identifies the highest risk cohort for poor clinical outcomes.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

November 1, 2018

Volume

122

Issue

9

Start / End Page

1506 / 1512

Location

United States

Related Subject Headings

  • Stroke Volume
  • Physical Examination
  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Middle Aged
  • Male
  • Logistic Models
  • Length of Stay
  • Jugular Veins
  • Humans
 

Citation

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Fudim, M., Parikh, K. S., Dunning, A., DeVore, A. D., Mentz, R. J., Schulte, P. J., … Patel, C. B. (2018). Relation of Volume Overload to Clinical Outcomes in Acute Heart Failure (From ASCEND-HF). Am J Cardiol, 122(9), 1506–1512. https://doi.org/10.1016/j.amjcard.2018.07.023
Fudim, Marat, Kishan S. Parikh, Allison Dunning, Adam D. DeVore, Robert J. Mentz, Phillip J. Schulte, Paul W. Armstrong, et al. “Relation of Volume Overload to Clinical Outcomes in Acute Heart Failure (From ASCEND-HF).Am J Cardiol 122, no. 9 (November 1, 2018): 1506–12. https://doi.org/10.1016/j.amjcard.2018.07.023.
Fudim M, Parikh KS, Dunning A, DeVore AD, Mentz RJ, Schulte PJ, et al. Relation of Volume Overload to Clinical Outcomes in Acute Heart Failure (From ASCEND-HF). Am J Cardiol. 2018 Nov 1;122(9):1506–12.
Fudim, Marat, et al. “Relation of Volume Overload to Clinical Outcomes in Acute Heart Failure (From ASCEND-HF).Am J Cardiol, vol. 122, no. 9, Nov. 2018, pp. 1506–12. Pubmed, doi:10.1016/j.amjcard.2018.07.023.
Fudim M, Parikh KS, Dunning A, DeVore AD, Mentz RJ, Schulte PJ, Armstrong PW, Ezekowitz JA, Tang WHW, McMurray JJV, Voors AA, Drazner MH, O’Connor CM, Hernandez AF, Patel CB. Relation of Volume Overload to Clinical Outcomes in Acute Heart Failure (From ASCEND-HF). Am J Cardiol. 2018 Nov 1;122(9):1506–1512.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

November 1, 2018

Volume

122

Issue

9

Start / End Page

1506 / 1512

Location

United States

Related Subject Headings

  • Stroke Volume
  • Physical Examination
  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Middle Aged
  • Male
  • Logistic Models
  • Length of Stay
  • Jugular Veins
  • Humans