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Do Patients With Acute Heart Failure and Preserved Ejection Fraction Have Heart Failure at Follow-Up: Implications of the Framingham Criteria
- Source :
- Journal of Cardiac Failure, Journal of Cardiac Failure, 2020, 26 (8), pp.673-684. ⟨10.1016/j.cardfail.2019.04.013⟩, Journal of Cardiac Failure, Elsevier, 2020, 26 (8), pp.673-684. ⟨10.1016/j.cardfail.2019.04.013⟩
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- International audience; Background - Heart failure (HF) with preserved ejection fraction (HFpEF) may be misdiagnosed. We assessed prevalence and consistency of Framingham criteria signs and symptoms in acute vs subsequent stable HFpEF. Methods - Three hundred ninety-nine patients with acute HFpEF according to Framingham criteria were re-assessed in stable condition. Four definitions of HFpEF at follow-up: (1) Framingham criteria alone, (2) Framingham criteria and natriuretic peptides (NPs), (3) Framingham criteria, NPs, and European Society of Cardiology HF guidelines echocardiographic criteria, (4) Framingham criteria, NPs, and the Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction (PARAGON) trial echocardiographic criteria. Results - At follow-up, HFpEF was still present in 27%, 22%, 21%, and 22%, respectively. Most prevalent in acute HFpEF were dyspnea at exertion (90%), pulmonary rales (71%), persisting at follow-up in 70% and 13%, respectively. Characteristics at acute HF with greater or lesser odds of stable HFpEF; (1) jugular venous distention (odds ratio [OR] 1.80, 95% confidence interval [CI] 1.13-2.87; P = .013) and pleural effusion (OR 0.45, 95% CI 0.24-0.85; P = .014) and (4), older age (1.04, 95% CI 1.01-1.08; P = .014) and tachycardia (>100 bpm) 0.52, 95% CI 0.27-1.00; P = .048). Conclusions - In patients with acute HFpEF, one-quarter met the HF definition according to Framingham criteria at ambulatory follow-up. The proportion of patients with postdischarge HFpEF was largely unaffected by additional echocardiographic or NP criteria Older age and jugular venous distention at acute presentation predicted persistent HFpEF at follow-up, whereas pleural effusion and tachycardia may yield false HFpEF diagnoses. This finding has implications for HFpEF trial design.
- Subjects :
- Tachycardia
medicine.medical_specialty
Diastolic function
Pleural effusion
Aftercare
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Internal medicine
medicine
Humans
030212 general & internal medicine
Aged
Heart Failure
[SDV.IB] Life Sciences [q-bio]/Bioengineering
Framingham Risk Score
Ejection fraction
Framingham criteria
business.industry
Stroke Volume
Odds ratio
Prognosis
HFpEF
Heart failure diagnosis
medicine.disease
Patient Discharge
[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
3. Good health
Valsartan
Heart failure
Ambulatory
Cardiology
[SDV.IB]Life Sciences [q-bio]/Bioengineering
medicine.symptom
Cardiology and Cardiovascular Medicine
business
medicine.drug
Subjects
Details
- ISSN :
- 10719164
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Journal of Cardiac Failure
- Accession number :
- edsair.doi.dedup.....1642abcc7b0593b50b7eff3388837816