Characteristics and outcome of patients according to the severity of peripheral oedema and breathlessness

Published Date: 06th June 2017

Publication Authors: Mohamed A

​Introduction

Heart failure is a common reason for hospital admission. Patients presenting with pulmonary and

peripheral oedema may be seen as two ends of a spectrum with many patients presenting with a mixed picture. The purpose of the present analysis is to describe patient characteristics according to the severity of oedema and NYHA class, their length of hospital stay and mortality during the index admission and after discharge.

Methods

National Audit Data were collected from April 2007 to March 2013 in more than 90% of hospitals in

England & Wales. Patients with a confirmed discharge diagnosis of heart failure were divided by severity of peripheral oedema (severe, moderate, mild and none) and NYHA class (IV, III, II/I) - creating 12 groups. Patients' characteristics and mortality during the index hospital admission for up to three years after discharge were reported. 

Results

Amongst 136,790 patients, the median age was 79 years, 58% were women, 81% were treated with ACEi/ARB, 67% with beta-blockers and 40% with MRA at discharge. Only 34% of patients had

breathlessness at rest or minimal exertion at the time of admission and 18% had severe peripheral oedema. Prevalence of LVSD was highest in group I-II/A (71%) and lowest in group I-II/D (49%). Median length of index admission stay was determined by the severity of peripheral oedema rather than NYHA class: 12 days for severe, 9 days for moderate, 7 days for mild and 6 days for no peripheral oedema. The highest index admission mortality during was observed in group IV/D (18%) followed by III/D (13%) and lowest in groups I-III/A (6%). After median follow-up 344 (IQR 94-766) days), mortality was 60% for IV/D and 56% for III/D compared to 46% for IV/A and 40% for III/A. Hazard ratios for death in the above groups were 2.26, 2.09, 1.49 and 1.28 respectively (for all P-<0.001) compared to group I-II/A. 

Conclusion

The severity of peripheral oedema rather than of breathlessness or LVSD is the more important determinant of length of stay and prognosis in patients with heart failure. However, the prognosis of patients recently hospitalised with heart failure remains poor despite a high uptake of disease modifying medication.

Shoaib, A; Mohamed, A et al. (2017). Characteristics and outcome of patients according to the severity of peripheral oedema and breathlessness, a report from national (England & Wales) heart failure audit . European Journal of Heart Failure. 19 (S1), 526

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