Clinical characteristics, treatment, and prognosis of patients with ischemic and nonischemic acute severe heart failure

INTRODUCTION There are limited data on the impact of ischemic etiology on the clinical status and long-term prognosis of patients with acute severe heart failure (HF) not associated with acute coronary syndrome (ACS). OBJECTIVES The aim of this study was to assess the clinical characteristics, treatment, and 12-month mortality of patients with acute severe HF not associated with ACS, according to the etiology of HF. PATIENTS AND METHODS Data from 112 patients with acute severe HF not associated with ACS were analyzed: 61 patients with ischemic HF and 51 patients with nonischemic HF. Acute severe HF was defined as acute HF on admission with at least one of the following characteristics: pulmonary congestion, cardiogenic shock, catecholamine or intraaortic balloon pump support, ultrafiltration, mechanical ventilation, prolonged use of intravenous diuretics, fluid in the body cavities requiring decompression, or multiorgan failure. RESULTS Patients with ischemic HF were older (62 vs 54 years, P = 0.001), predominately male (84% vs 65%, P = 0.02), had more comorbidities, and had lower left ventricular ejection fraction (21% vs 27%, P = 0.02). There were no significant differences in treatment modalities (ie, mechanical ventilation, hemodiafiltration, intraaortic balloon pump, left ventricular assist device, heart transplantation), except for 14 percutaneous coronary interventions in the ischemic group. In-hospital adverse events were similar between the groups. Among 83 discharged patients with available follow-up, death was reported for 15 patients with ischemic and 11 patients with nonischemic HF (34% vs 28%, P = 0.42). CONCLUSIONS Ischemic HF, accounting for approximately half of the cases of acute severe HF not related to ACS, was not associated with a significantly worse prognosis than nonischemic HF.