Table 1.
Patients’ characteristics and management.
| Baseline Characteristics | N = 392 |
|---|---|
| Age (years) | 73 ± 10.2 |
| Age > 75 (years) | 191 (48.7) |
| Female sex (%) | 121 (30.9) |
| Prior HF hospitalisation | 125 (31.9) |
| History of chronic heart failure | 214 (54.6) |
| Systolic blood pressure at admission (mmHg) | 131 ± 41.2 |
| Heart rate at admission (beats/min) | 87 ± 25.9 |
| Smoking status (%) | |
| Non-smoker | 224 (57.1) |
| Former smoker | 126 (32.2) |
| Current smoker | 42 (10.7) |
| Hypertension * | 329 (83.9) |
| Type of diabetes | |
| Type 1 | 12 (3.1) |
| Type 2 | 378 (96.4) |
| Secondary (chronic pancreatitis) | 2 (0.5) |
| HbA1c (%) | 7.38 ± 1.48 |
| Total cholesterol (mg/dL) | 159 ± 57 |
| LDL cholesterol (mg/dL) | 96 ± 48 |
| HDL cholesterol (mg/dL) | 42 ± 16 |
| TG (mg/dL) | 262 ± 209 |
| BMI (kg/m2) | 29.1 ± 6.5 |
| Family history of CAD (%) | 33 (8.4) |
| Personal history of CAD (%) | 163 (41.6) |
| Atrial fibrillation | 76 (19.4) |
| Chronic respiratory failure (%) | 96 (24.5) |
| eGFR (mL/min/1.73 m2) † | 55.1 ± 29.2 |
| CKD with RRT (%) | 8 (2.0) |
| Left ventricular ejection fraction (LVEF) (%) | 43.3 ± 13.0 |
| LVEF < 30% | 81 (20.7) |
| LVEF 30–40% | 72 (18.4) |
| LVEF 40–49% | 95 (24.2) |
| LVEF ≥ 50% | 144 (36.7) |
| Pre-existent aetiologies of cardiopathies predisposing to AHF | |
| Ischaemic heart disease | 142 (36.2) |
| Toxic damage | 19 (4.8) |
| Immune-mediated and inflammatory damage | 2 (0.5) |
| Infiltration | 2 (0.5) |
| Metabolic derangements | 5 (1.3) |
| Genetic abnormalities | 20 (5.1) |
| Valve and myocardium structural defects | 102 (26.0) |
| Pericardial and endomyocardial pathologies | 5 (1.3) |
| Tachycardia-induced cardiomyopathy | 7 (1.8) |
| Prior HF hospitalisation in patient with preserved LVEF | 36 (9.2) |
| No pre-existent cardiopathy | 52 (13.3) |
| Factors triggering AHF | |
| Acute coronary syndrome (ACS) | 159 (40.6) |
| Myocardial rupture complicating ACS ‡ | 3 (0.7) |
| Hypertensive emergency | 40 (10.2) |
| Tachyarrhythmia | 50 (12.8) |
| Bradyarrhythmia | 12 (3.1) |
| Acute native or prosthetic valve incompetence § | 27 (6.9) |
| Vigorous fluid administration | 10 (7.7) |
| Non-adherence with salt/fluid intake or medications | 32 (8.2) |
| Worsening renal failure | 20 (5.1) |
| Severe anaemia ¶ | 20 (5.1) |
| Infection (e.g., pneumonia, sepsis) | 76 (19.4) |
| Stress-related cardiomyopathy | 3 (0.7) |
| Metabolic/hormonal derangements # | 7 (1.8) |
| Toxic substances, cardiodepressant and other drugs ** | 5 (1.3) |
| BNP value at admission (pg/mL) | 597 (348–1300) |
| Arterial pH at admission (n = 200) | 7.35 ± 0.11 |
| Arterial blood lactate at admission (mmol/L) (n = 200) | 2.35 ± 2.57 |
| Acute kidney failure †† (%) | 145 (37.0) |
| Cardiogenic shock ‡‡ | 52 (13.3) |
| Peak troponin I (ng/mL) (normal < 0.04) §§ | 0.34 (0.09–6) |
| Presence and extent of CAD (%) | |
| No invasive angiography | 174 (44.4) |
| No CAD | 22 (5.6) |
| No significant stenosis | 44 (11.2) |
| One-vessel disease | 40 (10.2) |
| Two-vessel disease | 44 (11.2) |
| Left main and/or three-vessel disease | 68 (17.4) |
| SYNTAX score | 20.0 ± 13.2 |
| GRACE Score (n = 159) | 168 ± 37 |
| GRACE Score > 140 | 118 (74.2) |
| Management | |
| Oxygen therapy | 385 (98.2) |
| Diuretics | 375 (95.7) |
| Intravenous vasodilators | 104 (26.5) |
| Inotropic agents ¶¶ | 65 (16.6) |
| Vasopressors ## | 43 (11.0) |
| Non-invasive positive pressure ventilation | 114 (29.1) |
| Mechanical ventilation | 47 (12.0) |
| Duration of mechanical ventilation (days) | 3.3 ± 5.6 |
| Renal replacement therapy | 34 (8.7) |
| Intra-aortic balloon pump | 8 (2.0) |
| Mechanical circulatory support *** | 10 (2.6) |
| Heart transplantation | 2 (0.5) |
| Myocardial revascularisation | |
| PCI | 126 (32.1) |
| CABG | 23 (5.9) |
| Hybrid strategy | 2 (0.5) |
| Medical treatment only ††† | 8 (2.0) |
| Electrical cardioversion | 20 (5.1) |
| Ablation for arrhythmias | 5 (1.2) |
| Pacemaker | 14 (3.6) |
| Non-surgical device treatment of heart failure | |
| Cardiac resynchronisation therapy | 9 (2.3) |
| Implantable cardioverter-defibrillator | 5 (1.2) |
| Valvular heart disease treatment | |
| Trans-aortic valve replacement | 14 (3.6) |
| Valve surgery | 22 (5.6) |
| Treatment at hospital discharge | |
| Diuretics | 301 (76.8) |
| RAASI | 241 (61.5) |
| ARNi | 5 (1.2) |
| ß-Blocker | 260 (66.3) |
| Mineralocorticoid antagonists | 124 (31.6) |
| Antithrombotic treatment (%) | |
| Single APT (SAPT) | 77 (19.6) |
| DAPT | 96 (24.5) |
| OAC monotherapy | 75 (19.1) |
| Dual therapy (OAC + SAPT) | 62 (15.8) |
| Triple therapy (OAC + DAPT) | 27 (6.9) |
| Statin | 269 (68.6) |
| Oral glucose-lowering therapies | 197 (50.3) |
| Biguanides | 116 (29.6) |
| Sulfonylureas and meglitinides | 123 (31.4) |
| α-glucosidase inhibitors | 5 (1.2) |
| DDP-4 inhibitors | 49 (12.5) |
| GLP-1 receptor agonists | 5 (1.2) |
| Insulin therapy | 193 (49.2) |
| Glycaemic status | |
| Glycaemia assays per patient | 45 (23–78) |
| Glycaemia assays per patient per day | 5 (3–8) |
| Admission glycaemia (mg/dL) | 193 (87) |
| Mean glycaemia (mg/dL) | 164 (32) |
| Percentage of hypoglycaemia ‡‡‡ (%) | 0.9 |
| Number of patients with hypoglycaemia (%) | 84 (21.4) |
| Hypoglycaemia events per patient, n | 2 (1–2) |
| Percentage of hyperglycaemia §§§ (%) | 32.6 |
| Number of patients with hyperglycaemia (%) | 357 (91.1) |
| Glycaemic variability (SD, mg/dL) | 53 (22) |
Data shown are number (%), median (25th–75th percentiles) or mean ± SD. ACS: acute coronary syndrome; AHF: acute heart failure; APT: antiplatelet therapy; ARNi: angiotensin receptor-neprilysin inhibitor; BNP: B-type natriuretic peptide; BMI: body mass index; CABG: coronary artery bypass graft surgery; CAD: coronary artery disease; CKD with RRT: chronic kidney disease to renal replacement therapy; DAPT: dual antiplatelet therapy; eGFR: estimated glomerular filtration rate; GRACE: Global Registry of Acute Coronary Events; HDL: high-density lipoprotein; HF: heart failure; LDL: low-density lipoprotein; LVEF: left ventricular ejection fraction; OAC: oral anticoagulation therapy; PCI: percutaneous coronary intervention; RAASI: renin-angiotensin-aldosterone system inhibitors; SAPT: single antiplatelet therapy; SYNTAX: Synergy between PCI with Taxus and Cardiac Surgery. TG: triglyceride. * Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg or treatment with oral antihypertensive drugs. † eGFR was calculated with the use of the simplified Modification of Diet in Renal Disease formula. ‡ Myocardial rupture complicating ACS (free wall rupture, ventricular septal defect, acute mitral regurgitation). § Acute native or prosthetic valve incompetence secondary to endocarditis, aortic dissection or thrombosis. ¶ Severe anaemia defined as haemoglobin level between 4 g/dL and 8 g/dL. # Metabolic/hormonal derangements defined as thyroid dysfunction, adrenal dysfunction or pregnancy and peripartum-related abnormalities. ** Toxic substances (alcohol, recreational drugs), cardiodepressant and other treatments (non-steroidal anti-inflammatory drugs, corticosteroids, negative inotropic substances, cardiotoxic chemotherapeutics). †† Acute kidney failure defined according to AKIN network (stage ≥ 1: absolute increase of serum creatinine 1.5–2.0 times from baseline or ≥0.3 mg/dL (≥26.5 µmol/L)). ‡‡ Cardiogenic shock was defined as hypotension (systolic blood pressure < 90 mmHg) despite adequate filling status associated with clinical and biological markers of hypoperfusion. §§ Troponin I assay was performed in biochemistry central lab on multiparametric automate Access/DXi 800 Beckman, as BNP. ¶¶ Inotropic agents: dobutamine, dopamine, levosimendan. ## Vasopressors: norepinephrine or epinephrine. *** Mechanical circulatory support includes Impella® device and veno-arterial extracorporeal membrane oxygenation. ††† Medical treatment strategy or failure of revascularisation. ‡‡‡ Detection of glucose concentration < 54 mg/dL (or <3 mmol/L) among all measurements obtained in all patients at any time during hospitalisation. §§§ Detection of glucose concentration ≥ 180 mg/dL (or ≥10 mmol/L) among all measurements obtained in all patients at any time during hospitalisation.