Clinical Scenario Classification for Characterization and Outcome Prediction of Acute Decompensated Heart Failure...

Area of Science:

• Cardiology
• Clinical Medicine
• Heart Failure Research

Background:

• Clinical Scenario (CS) classification is used for acute decompensated heart failure (ADHF) management.
• The West Tokyo-Heart Failure (WET-HF) Registry collected data on hospitalized ADHF patients.

Purpose of the Study:

• To evaluate the prognostic value of CS classification based on admission systolic blood pressure (SBP) in ADHF patients.
• To investigate the relationship between CS, left ventricular (LV) remodeling, and outcomes in HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF).

Main Methods:

• Prospective cohort study of 4,000 hospitalized ADHF patients (2006-2017).
• Patients classified into three CS groups based on admission SBP: CS1 (≥140 mmHg), CS2 (100-139 mmHg), CS3 (<100 mmHg).
• Analysis of long-term all-cause death/ADHF re-hospitalization, body weight changes, diuretic use, and LV chamber size in relation to CS, stratified by ejection fraction.

Main Results:

• CS1 patients showed higher fluid retention and greater weight reduction at discharge, with most frequent in-hospital diuretic use.
• Long-term adverse events were more common in advanced CS groups, but no significant difference was observed in HFpEF patients.
• Advanced CS correlated with larger LV size in HFrEF but smaller LV size in HFpEF.

Conclusions:

• The long-term prognostic value of CS classification is limited in HFpEF.
• CS is strongly associated with LV remodeling in HFrEF.
• Smaller LV chamber size in HFpEF may indicate lower cardiovascular functional reserve.