title: Hemodynamic profiles of advanced heart failure: association with clinical characteristics and long-term outcomes.
abstract: BACKGROUND
  Classifying patients with advanced congestive heart failure (CHF) by baseline measures of congestion and perfusion has been used to estimate hemodynamic status and to select and titrate therapy. We describe clinical characteristics of 4 hemodynamic profiles-wet/cold, wet/warm, dry/cold, and dry/warm-in patients with advanced CHF and assess relations between symptoms, physical signs, and outcomes with each profile.
  
  
  RESULTS
  We retrospectively assessed baseline symptoms, physical-examination variables, and 1-year outcomes of 440 patients in a randomized trial. With univariable and multivariable logistic regression, we examined relations of physical-examination variables to hemodynamic profiles. We also assessed the rates of death and death or readmission by profile. Severity of CHF symptoms did not predict the wet-versus-dry profile or cold-versus-warm status, despite significant differences in hemodynamics among groups. Of the physical-examination variables, only a lower proportional pulse pressure was a significant multivariable predictor of the wet category. Among wet patients (n = 348), this same variable was the only significant multivariable predictor of the cold category. For dry patients (n = 92), the cold category was predicted in multivariable analysis by supine heart rate and hepatomegaly. Survival was similar among profiles: wet/cold, 54.2% (n = 91); wet/warm, 58.3% (n = 105); dry/cold, 78.9% (n = 15); and dry/warm, 67.1%, P =.13 (n = 49). Event-free survival also was similar among profiles: wet/cold, 22.0% (n = 37); wet/warm, 29.4% (n = 53); dry/cold, 42.1% (n = 8); and dry/warm, 31.5%, P =.44 (n = 23).
  
  
  CONCLUSIONS
  The patient's history and physical examination alone may lead to inaccurate estimation of hemodynamic status and thus suboptimal management for patients with advanced CHF.
authors: Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
authors: M R
authors: MR
authors: Shah
authors: V
authors: V
authors: Hasselblad
authors: S S
authors: SS
authors: Stinnett
authors: M
authors: M
authors: Gheorghiade
authors: K
authors: K
authors: Swedberg
authors: R M
authors: RM
authors: Califf
authors: C M
authors: CM
authors: O'Connor
mesh_terms: D000368:Aged; D001775:Blood Circulation / Q000502:physiology; D005260:Female; D006321:Heart / Q000503:physiopathology; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors