急性心不全の管理に関する知見

Risk stratification of patients with acutely decompensated heart failure should improve after a number of predictive, modifiable variables were identified during analysis of data from the EuroHeart Survey on Heart Failure, according to a presentation at the annual meeting of the European Society of Cardiology.

The EuroHeart Survey on Heart Failure collected data on 3,579 patients admitted acutely for heart failure by 133 centers in 30 countries. Patients with cardiogenic shock were excluded from analysis because their short-term mortality is so high that specific models for risk stratification are less useful: All patients require intensive management.

The database of the remaining 3,441 patients included in the EuroHeart Survey on Heart Failure showed that in-hospital all-cause mortality of patients with acute decompensation of already known heart failure condition was 5.3 percent (116/2202 patients), while total in-hospital mortality of patients with de novo acute heart failure was 5.4 percent (67/1239 patients).

Within the average mortality rate of 5.3 percent, risk for death greatly varied from less than 1 percent to more than 50 percent according to the presence or absence of clinical variables that significantly influence in-hospital death.

In both situations (worsening or de novo heart failure), the strongest independent predictors of short-term, all-cause mortality were the following: advanced age, low systolic blood pressure, renal dysfunction, signs of peripheral hypoperfusion, and an acute coronary syndrome as precipitating factor for heart failure. With the exception of age, all of these clinical conditions can be appropriately managed in a timely way to reduce in-hospital mortality.

These simple variables, easy to detect in any clinical setting, can be used immediately by physicians to predict which patients need care in an intensive or coronary care unit and can personalize treatment strategy accordingly.