Abstract 3802: Presenting Symptoms and Responses to Therapy During Heart Failure Hospitalization
Background Pts with acute decompensated heart failure (HF) present with varying symptoms, which might be useful to guide therapy. We hypothesized that pts describing different ‘worst’ symptoms would have different responses to the standard therapy.
Methods At enrollment in the ESCAPE trial comparing invasive to clinical assessment to guide relief of congestion, pts selected the ‘worst’ symptom that bothered them most from Breathing (Brth), Fatigue (Ftg), Abdominal Discomfort (Abd), and Body Swelling (Swl). Changes in clinical and hemodynamic parameters during hospitalization were compared among 3 groups with a different ‘worst’ symptom (Brth, Ftg vs. Abd+Swl). Days alive after discharge during 6 months follow up were analyzed using a Cox proportional hazards model.
Results Among 346 pts with complete data, ages (54±13, 56±14, 57±14 yrs) and ejection fractions (18±6, 19±6, 19±7 %) in Abd+Swl (n=30+26), Brth (n=163) and Ftg (n=123) were comparable. Changes in weight and RAP were similar among 3 groups, with trend for less PCWP reduction in Abd+Swl (p=0.139) (Table⇓). Increase in BUN in Abd+Swl was significantly higher than that in Brth and Ftg (p=0.014) (Table⇓). Although not statistically significant, pts in Abd+Swl tended to have worse age and gender-adjusted mortality (Hazard ratio=1.63 [0.96 –2.77], p=0.069) compared to other groups.
Conclusions Pts presenting with dominant symptoms of right-HF with Abd or Swl had similar diuresis as pts presenting with Brth or Ftg. However, these presenting symptoms were associated with less decrease in filling pressures and greater increase in BUN during hospitalization, which may contribute to the trend for worse outcome after discharge.