AIMS Classification of acute heart failure (AHF) patients into four clinical profiles defined by evidence of congestion and perfusion is advocated by the 2016 European Society of Cardiology (ESC)guidelines. Based on the ESC-EORP-HFA Heart Failure Long-Term Registry, we compared differences in baseline characteristics, in-hospital management and outcomes among congestion/perfusion profiles using this classification. METHODS AND RESULTS We included 7865 AHF patients classified at admission as: 'dry-warm' (9.9%), 'wet-warm' (69.9%), 'wet-cold' (19.8%) and 'dry-cold' (0.4%). These groups differed significantly in terms of baseline characteristics, in-hospital management and outcomes. In-hospital mortality was 2.0% in 'dry-warm', 3.8% in 'wet-warm', 9.1% in 'dry-cold' and 12.1% in 'wet-cold' patients. Based on clinical classification at admission, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: 'wet-warm' vs. 'dry-warm' 1.78 (1.43-2.21) and 'wet-cold' vs. 'wet-warm' 1.33 (1.19-1.48). For profiles resulting from discharge classification, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: 'wet-warm' vs. 'dry-warm' 1.46 (1.31-1.63) and 'wet-cold' vs. 'wet-warm' 2.20 (1.89-2.56). Among patients discharged alive, 30.9% had residual congestion, and these patients had higher 1-year mortality compared to patients discharged without congestion (28.0 vs. 18.5%). Tricuspid regurgitation, diabetes, anaemia and high New York Heart Association class were independently associated with higher risk of congestion at discharge, while beta-blockers at admission, de novo heart failure, or any cardiovascular procedure during hospitalization were associated with lower risk of residual congestion. CONCLUSION Classification based on congestion/perfusion status provides clinically relevant information at hospital admission and discharge. A better understanding of the clinical course of the two entities could play an important role towards the implementation of targeted strategies that may improve outcomes.

中文翻译：

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急性心力衰竭的充血和灌注状态-临床分类对医院内和长期结局的影响；从ESC-EORP-HFA心力衰竭长期注册中获得的见解。

AIMS 2016年欧洲心脏病学会（ESC）指南倡导将急性心力衰竭（AHF）患者分为四个临床特征，根据充血和灌注的证据进行定义。基于ESC-EORP-HFA心力衰竭长期注册，我们使用此分类比较了充血/灌注状况中基线特征，医院内管理和预后的差异。方法和结果我们纳入了7865名AHF患者，入院时分为：“干热”（9.9％），“湿热”（69.9％），“湿冷”（19.8％）和“干冷”（0.4） ％）。这些组在基线特征，院内管理和结局方面存在显着差异。“干热”的住院死亡率为2.0％，“湿热”的为3.8％，“干冷”的为9.1％，“干冷”的为12.1％。湿冷患者。根据入院时的临床分类，调整的1年死亡率危险比（95％置信区间）为：“湿热” vs.“干热” 1.78（1.43-2.21）和“湿冷” vs.“冷热”vs。 ``温暖''1.33（1.19-1.48）。对于根据出院分类得出的资料，针对1年死亡率的调整后的危险比（95％置信区间）为：“湿热” vs.“干热” 1.46（1.31-1.63），“湿冷” vs.“冷热”vs。 ``温暖''2.20（1.89-2.56）。在活着出院的患者中，有30.9％的患者有残余充血，与没有充血的患者相比，这些患者的1年死亡率更高（28.0 vs. 18.5％）。三尖瓣关闭不全，糖尿病，贫血和纽约心脏协会高级别人士与出院时充血的较高风险独立相关，而入院时的β受体阻滞剂，从头心力衰竭或住院期间的任何心血管手术均与残余充血的较低风险相关。结论基于充血/灌注状态的分类提供了住院和出院时的临床相关信息。更好地了解这两个实体的临床过程可能对实施可改善结果的靶向策略起重要作用。结论基于充血/灌注状态的分类提供了住院和出院时的临床相关信息。更好地了解这两个实体的临床过程可能对实施可改善结果的靶向策略起重要作用。结论基于充血/灌注状态的分类提供了住院和出院时的临床相关信息。更好地了解这两个实体的临床过程可能对实施可改善结果的靶向策略起重要作用。