Impacts of ‘Warm & Wet’ and ‘Cold & Wet’ on Clinical Evaluations in the Real-World Acute Heart Failure Syndromes Patients: Data from Attend Registry

Background/Goal: Non-invasive clinical assessment suggested by Stevenson LW (CA) can be used to define profiles in admitted patients with systolic heart failure. It is, however, not clarified well whether or not CA is useful for clinical evaluations in the patients with acute heart failure syndromes (AHFS) including diastolic heart failure. Therefore, we assessed to reveal usefulness of CA in the real-world AHFS patients using the preliminary data from the ATTEND (acute decompensated heart failure syndromes) registry, which is the multicenter prospective observational cohort study in Japan. Methods: CA defined by signs of congestion and evidences of perfusion were reported by individual cardiologists in ATTEND registry. AHFS patients (n=1038) were divided to four profiles. The present study focused on two common profiles, i.e:, “warm & wet” (B) and “cold & wet” (C), and clarified the differences regarding patient characteristics and treatments. Results: There were no differences between B and C in age (73 ± 14 vs 71 ± 16 yrs, respectively), gender (male 60% vs 63%, respectively) and etiologies of AHFS. In C, clinical presentations such as paroxysmal nocturnal dyspnea, orthopnea, third heart sound, jugular venous distension, and cold extremities were significantly (P<0.01) observed and significantly higher heart rate (108 ± 35 vs 98 ± 29 bpm in B, P<0.001), B-type natriuretic peptide (median:910 vs 710 pg/ml in B, P=0.001), and C-reactive protein (median: 1.01 vs 0.60 mg/dl, P=0.004), and lower estimated glomerular filtrated rate (45.2 ± 26.3 vs 52.1 ± 35.0 ml/min/1.73m2, P=0.014) and left ventricular ejection fraction (LVEF≤40%):66.1% vs 55.5%, P=0.007) on admission. Inotropes was used more frequently in C (36.7% vs 16% in B, p<0.001), although uses of vasodilators were not different in both groups. In hospital mortalities, there were significant differences between B and C, i.e., total death: 14.1% vs 6% in B, P<0.001, cardiac death: 10.2% vs 3.7% in B, p<0.001). Conclusions: Thus, the real-world AHFS patients in profile C were more critical and inotropes were chosen more, suggesting that CA has been the useful clinical evaluations for the real-world AHFS patients.