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Temporal Trends and Prognosis of Physical Examination Findings in Patients With Acute Decompensated Heart Failure: The ARIC Study Community Surveillance.

Publication ,  Journal Article
Kolupoti, A; Fudim, M; Pandey, A; Kucharska-Newton, A; Hall, ME; Vaduganathan, M; Mentz, RJ; Caughey, MC
Published in: Circ Heart Fail
December 2021

BACKGROUND: Bedside evaluation of congestion is a mainstay of heart failure (HF) management. Whether detected physical examination signs have changed over time as obesity prevalence has increased in HF populations, or if the associated prognosis differs for HF with reduced or preserved ejection fraction (HFrEF or HFpEF) is uncertain. METHODS: From 2005 to 2014, the ARIC study (Atherosclerosis Risk in Communities) conducted adjudicated hospital surveillance of acute decompensated HF. We analyzed trends in physical examination findings, imaging signs, and symptoms related to congestion, both over time and by obesity class, and associated 28-day mortality risks. RESULTS: Of 24 937 weighted hospitalizations for acute decompensated HF (mean age 75 years, 53% women, 32% Black), 47% had HFpEF. The prevalence of obesity increased from 2005 to 2014 for both HF types. With increasing obesity category, detected edema increased, while jugular venous distension decreased, and rales remained stable. Detected edema also increased over time, for both HF types. Associations between 28-day mortality and individual signs and symptoms of congestion were similar for HFpEF and HFrEF; however, the adjusted mortality risk with all 3 (edema, rales, and jugular venous distension) versus <3 physical examination findings was higher for patients with HFpEF (odds ratio, 2.41 [95% CI, 1.53-3.79]) than HFrEF (odds ratio, 1.30 [95% CI, 0.87-1.93]); P for interaction by HF type =0.02. CONCLUSIONS: In patients hospitalized with acute decompensated HF, detected physical examination findings differ both temporally and by obesity. Combined findings from the physical examination are more prognostic of 28-day mortality for patients with HFpEF than HFrEF.

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Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

December 2021

Volume

14

Issue

12

Start / End Page

e008403

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Prognosis
  • Physical Examination
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
 

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Kolupoti, A., Fudim, M., Pandey, A., Kucharska-Newton, A., Hall, M. E., Vaduganathan, M., … Caughey, M. C. (2021). Temporal Trends and Prognosis of Physical Examination Findings in Patients With Acute Decompensated Heart Failure: The ARIC Study Community Surveillance. Circ Heart Fail, 14(12), e008403. https://doi.org/10.1161/CIRCHEARTFAILURE.121.008403
Kolupoti, Abhigna, Marat Fudim, Ambarish Pandey, Anna Kucharska-Newton, Michael E. Hall, Muthiah Vaduganathan, Robert J. Mentz, and Melissa C. Caughey. “Temporal Trends and Prognosis of Physical Examination Findings in Patients With Acute Decompensated Heart Failure: The ARIC Study Community Surveillance.Circ Heart Fail 14, no. 12 (December 2021): e008403. https://doi.org/10.1161/CIRCHEARTFAILURE.121.008403.
Kolupoti A, Fudim M, Pandey A, Kucharska-Newton A, Hall ME, Vaduganathan M, et al. Temporal Trends and Prognosis of Physical Examination Findings in Patients With Acute Decompensated Heart Failure: The ARIC Study Community Surveillance. Circ Heart Fail. 2021 Dec;14(12):e008403.
Kolupoti, Abhigna, et al. “Temporal Trends and Prognosis of Physical Examination Findings in Patients With Acute Decompensated Heart Failure: The ARIC Study Community Surveillance.Circ Heart Fail, vol. 14, no. 12, Dec. 2021, p. e008403. Pubmed, doi:10.1161/CIRCHEARTFAILURE.121.008403.
Kolupoti A, Fudim M, Pandey A, Kucharska-Newton A, Hall ME, Vaduganathan M, Mentz RJ, Caughey MC. Temporal Trends and Prognosis of Physical Examination Findings in Patients With Acute Decompensated Heart Failure: The ARIC Study Community Surveillance. Circ Heart Fail. 2021 Dec;14(12):e008403.

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

December 2021

Volume

14

Issue

12

Start / End Page

e008403

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Prognosis
  • Physical Examination
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Female