nyha 1 nyha 2 nyha 3 nyha 4 - bib.irb.hr · treatment of ahf: 1) worsening or decompensation of chf...
TRANSCRIPT
Aim: Heart failure (HF) is one of the leading causes of death worldwide. The aim of present study was to investigatepredictive value of classification systems in the Emergency Department (ED) patients (pts) presenting with acute HF(AHF).
Methods: In the hospital there were 22,713 ED pts in year 2010, 1,526 (6.7%) with diagnosis of AHF. Prospective,observational study included 726 AHF pts treated during six months period. Clinical presentation of AHF, New YorkHeart Association (NYHA) Functional Classification, Simplified Acute Physiology Score II (SAPS II) and AcutePhysiology and Chronic Health Evaluation II Score (APACHE II) were recorded.
Results: The pts were allocated into six groups according to the recently published ESC Guidelines for the diagnosis andtreatment of AHF: 1) Worsening or decompensation of CHF (49.5%); 2) Hypertensive HF (23.6%); 3) Isolated right HF(11.8%); 4) Pulmonary edema (7.5%); 5) Cardiogenic shock (3.8%); and 6) ACS and HF (3.8%). The overall mortality ratewas 67 pts (9.2%); autopsy was performed in 10.4% of non-survivors. There was statistically significant difference inoutcome according to the New York Heart Association (NYHA) Functional Classification. The pts were distributed byNYHA Classification as follows: NYHA I 1.8%, NYHA II 45.5%, NYHA III 42%, and NYHA IV 10.7%. Pts classified asNYHA II had significantly better survival than NYHA IV (48.5:7.2%, p<0.001). There was no gender dependent differencein survival for females (56.8:43.2%, p=0.319). Pts treated only in ED had significantly better survival rate than pts treatedin hospital (62.6:37.4, p<0.001). SAPS II and APACHE II were also calculated, mean value of SAPS II was 27.5 points, SD±7.7 with 10.3% mortality rate and APACHE II 10.96 points, SD ±4.6 with mortality rate 14.4%.
2%
45%
42%11%
NYHA 1 NYHA 2
NYHA 3 NYHA 4
Figure 1. Freaquency of AHF patient’s according to NYHA classification
Conclusion: Classification of AHF pts on their admission canpredict outcome. It can be used to increase quality oftherapeutic procedures. SAPS II has better prognostic value forAHF pts than APACHE II. NYHA Classification is excellentprognostic factor easy to implement in AHF treatment. Inproviding best care to complicated patients as AHF pts are it isnecessary to use mortality predictors.
STATEMENT: The authors declare that they have no conflict of interest. The authors declare no external financial support.