title: Acute pulmonary oedema: clinical characteristics, prognostic factors, and in-hospital management.
abstract: OBJECTIVE
  Acute pulmonary oedema (APE) is the second, after acutely decompensated chronic heart failure (ADHF), most frequent form of acute heart failure (AHF). This subanalysis examines the clinical profile, prognostic factors, and management of APE patients (n = 1820, 36.7%) included in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF).
  
  
  RESULTS
  ALARM-HF included a total of 4953 patients hospitalized for AHF in Europe, Latin America, and Australia. The final diagnosis was made at discharge, and patients were classified according to European Society of Cardiology guidelines. Patients with APE had higher in-hospital mortality (7.4 vs. 6.0%, P = 0.057) compared with ADHF patients (n = 1911, 38.5%), and APE patients exhibited higher systolic blood pressures (P < 0.001) at admission and higher left ventricular ejection fraction (LVEF, P < 0.01) than those with ADHF. These patients also had a higher prevalence of diabetes (P < 0.01), arterial hypertension (P < 0.001), peripheral vascular disease (P < 0.001), and chronic renal disease (P < 0.05). They were also more likely to receive intravenous (i.v.) diuretics (P < 0.001), i.v. nitrates (P < 0.01), dopamine (P < 0.05), and non-invasive ventilation (P < 0.001). Low systolic blood pressure (P < 0.001), low LVEF (<0.05), serum creatinine ≥1.4 mg/dL (P < 0.001), history of cardiomyopathy (P < 0.05), and previous cardiovascular event (P < 0.001) were independently associated with increased in-hospital mortality in the APE population.
  
  
  CONCLUSIONS
  APE differs in clinical profile, in-hospital management, and mortality compared with ADHF. Admission characteristics (systolic blood pressure and LVEF), renal function, and history may identify high-risk APE patients.
authors.affiliation: Heart Failure Clinic and Second Cardiology Department, Attikon University Hospital, University of Athens, Athens, Greece. jparissis@yahoo.com
authors.forename: John T
authors.initials: JT
authors.lastname: Parissis
authors.forename: Maria
authors.initials: M
authors.lastname: Nikolaou
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado
authors.forename: Fabio
authors.initials: F
authors.lastname: Vilas-Boas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Paraskevaidis
authors.forename: Antony
authors.initials: A
authors.lastname: Mc Lean
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kremastinos
authors.forename: Ferenc
authors.initials: F
authors.lastname: Follath
mesh_terms: D000368:Aged; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011654:Pulmonary Edema / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D012372:ROC Curve; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology
chemical_list: D003404:Creatinine