Abstract 13820: Temporal Trends and Prognosis of Physical Exam Findings in Patients Hospitalized With Acute Decompensated Heart Failure With Preserved versus Reduced Ejection Fraction the Aric Study Community Surveillance

Introduction: Bedside evaluation of congestion remains important in both heart failure (HF) with reduced and preserved ejection fraction (HFrEF and HFpEF). Whether presence of physical exam findings have changed over time, or if prognosis of physical examination differs by HF type is uncertain. Methods: From 2005-2014, the Atherosclerosis Risk in Communities (ARIC) Study conducted hospital surveillance of acute decompensated heart failure (ADHF). Events were verified by physician review, and clinical data were abstracted from the medical record. We examined presence of 3 physical exam findings suggesting congestion: lower extremity edema, jugular venous distension, and pulmonary rales > 1/3 of the lung field. Analyses were weighted by sampling fractions. Results: Of 24,937 hospitalizations for ADHF (mean age 75 years, 53% women, 32% black), 47% were HFpEF. Presence of edema increased from 2005-2009 to 2010-2014, both for HFpEF (66% to 72%; P for annual trend = 0.002) and HFrEF (62% to 67%; P for annual trend = 0.009), while presence of rales and jugular distention remained stable. There were 2640 (11%) and 7766 (31%) deaths within 28 days and 1 year of hospitalization, respectively. Patients with HFpEF and all 3 physical exam signs had a greater risk of short- and long-term mortality ( Figure ). After adjustments for demographics and length of stay, there was a differential association between clinical signs and 28-day mortality by HF type ( P for interaction = 0.02). Presence of all 3 vs. Conclusion: The presence of edema on physical examination of patients with ADHF has increased in recent years, both for HFpEF and HFrEF. However, the prognostic utility of physical exam signs of congestion may differ by HF type.