Clinical Profiles in Acute Heart Failure

Abstract Background:Phenotypes could be more frequently related to outcomes than classical classifications of AHF. Our goal was to identify clinical profiles for acute heart failure (AHF) based on clinical variables at the time of the patient arrival to the Emergency Department (ED).Methods:Design: Prospective cohort study. Participants: Patients with symptoms of AHF were recruited at the EDs of seven Spanish National Health Service hospitals between April 2013 and December 2014. Main measures: Information on sociodemographic, baseline functional status, medical history, and time since diagnosis was collected when the patient arrived at the ED. In addition, the MLWHF questionnaire was administered at arrival and at 1 year after discharge from the ED. Change in MLWHF score and mortality, revisits and readmissions during this first year were considered as outcomes. We combined multiple correspondence analysis (MCA) and cluster analysis (CA) to create clinical profiles.Results:A total of 1599 subjects were included in the study. Patients were located on two axes: one was defined as duration of HF and the other as cardiovascular comorbidity. Cluster analysis identified three subtypes of patient (A, B, and C), group B being most frequently corresponding to a “de novo” case. Differences in outcome, including mortality, readmissions and changes in MLWHF score, were encountered between group B and the rest of the groups, results being similar in groups A and C.Conclusions:The clinical phenotypes found were associated with clinical and patient-reported outcomes. Such clinical phenotypes could be useful in decision making processes in ED settings.Clinical registration:ClinicalTrials.gov ID: NCT03512704