title: Symptom presentation in patients hospitalized with acute heart failure.
abstract: OBJECTIVE
  The objectives of this study were to examine the type and frequency of symptoms in patients hospitalized with acute heart failure (HF) as well as the relationship between symptom patterns and patient characteristics, treatment practices, and hospital outcomes in patients hospitalized with decompensated HF.
  
  
  METHODS
  The study sample consisted of 4537 residents of the Worcester, MA metropolitan area hospitalized for decompensated HF at 11 greater Worcester medical centers in 1995 and 2000.
  
  
  RESULTS
  The average age of the study sample was 76 years; the majority (57%) were women, and three-quarters of our patient population had been previously diagnosed with HF. Dyspnea (93%) was the most frequent complaint reported by patients followed by the presence of peripheral edema (70%), cough (51%), orthopnea (37%), and chest pain/discomfort (30%). Patients reporting few cardiac symptoms were less likely to be treated with effective cardiac therapies during hospitalization than patients with multiple cardiac signs and symptoms and experienced higher hospital (9.7% vs. 7.7%) as well as 30-day (17.1% vs. 10.2%) death rates (P < 0.05).
  
  
  CONCLUSIONS
  The results of this study in residents of a large New England community suggest that patients with fewer reported symptoms of decompensated HF were less likely to receive effective cardiac treatments and had worse short-term outcomes. Reasons for these differences in treatment practices and short-term outcomes need to be elucidated and attention directed to these high-risk patients.
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. Robert.Goldberg@umassmed.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Mariana
authors.initials: M
authors.lastname: Szklo-Coxe
authors.forename: Mayra
authors.initials: M
authors.lastname: Tisminetzky
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: William
authors.initials: W
authors.lastname: Gaasch
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology; D003371:Cough / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D004487:Edema / Q000209:etiology; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome