Acute pulmonary oedema: clinical characteristics, prognostic factors, and in-hospital management.
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.
Parissis
John T
JT
Heart Failure Clinic and Second Cardiology Department, Attikon University Hospital, University of Athens, Athens, Greece. jparissis@yahoo.com
Nikolaou
Maria
M
Mebazaa
Alexandre
A
Ikonomidis
Ignatios
I
Delgado
Juan
J
Vilas-Boas
Fabio
F
Paraskevaidis
Ioannis
I
Mc Lean
Antony
A
Kremastinos
Dimitrios
D
Follath
Ferenc
F
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
D003404:Creatinine