TY - JOUR
T1 - Temporal Trends and Prognosis of Physical Examination Findings in Patients with Acute Decompensated Heart Failure
T2 - The ARIC Study Community Surveillance
AU - Kolupoti, Abhigna
AU - Fudim, Marat
AU - Pandey, Ambarish
AU - Kucharska-Newton, Anna
AU - Hall, Michael E.
AU - Vaduganathan, Muthiah
AU - Mentz, Robert J.
AU - Caughey, Melissa C.
N1 - Publisher Copyright:
© 2021 American Heart Association, Inc.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - 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.
AB - 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.
KW - Heart failure
KW - Mortality
KW - Obesity
KW - Physical examination
KW - Population
UR - http://www.scopus.com/inward/record.url?scp=85122283963&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85122283963&partnerID=8YFLogxK
U2 - 10.1161/CIRCHEARTFAILURE.121.008403
DO - 10.1161/CIRCHEARTFAILURE.121.008403
M3 - Article
C2 - 34702047
AN - SCOPUS:85122283963
SN - 1941-3289
VL - 14
SP - E008403
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
IS - 12
ER -