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Epidemiology, pathophysiology, and in-hospital management of pulmonary edema: data from the Romanian Acute Heart Failure Syndromes registry

Chioncel, Ovidiu; Ambrosy, Andrew P.; Bubenek, Serban; Filipescu, Daniela; Vinereanu, Dragos; Petris, Antoniu; Christodorescu, Ruxandra; Macarie, Cezar; Gheorghiade, Mihai; Collins, Sean P.on behalf of the Romanian Acute Heart Failure Syndromes study investigators

Journal of Cardiovascular Medicine: February 2016 - Volume 17 - Issue 2 - p 92–104
doi: 10.2459/JCM.0000000000000192

Aim The objective of this study was to evaluate the clinical presentation, inpatient management, and in-hospital outcome of patients hospitalized for acute heart failure syndromes (AHFS) and classified as pulmonary edema (PE).

Methods The Romanian Acute Heart Failure Syndromes (RO-AHFS) study was a prospective, national, multicenter registry of all consecutive patients admitted with AHFS over a 12-month period. Patients were classified at initial presentation by clinician-investigators into the following clinical profiles: acute decompensated HF, cardiogenic shock, PE, right HF, or hypertensive HF.

Results RO-AHFS enrolled 3224 patients and 28.7% (n = 924) were classified as PE. PE patients were more likely to present with pulmonary congestion, tachypnea, tachycardia, and elevated systolic blood pressure and less likely to have peripheral congestion and body weight increases. Mechanical ventilation was required in 8.8% of PE patients. PE patients received higher doses (i.e. 101.4 ± 27.1 mg) of IV furosemide for a shorter duration (i.e. 69.3 ± 22.3 hours). Vasodilators were given to 73.6% of PE patients. In-hospital all-cause mortality (ACM) in PE patients was 7.4%, and 57% of deaths occurred on day one. Increasing age, concurrent acute coronary syndromes, life-threatening ventricular arrhythmias, elevated BUN, left bundle branch block, inotrope therapy, and requirement for invasive mechanical ventilation were independent risk factors for ACM.

Conclusions In this national registry, the PE profile was found to be a high-acuity clinical presentation with distinctive treatment patterns and a poor short-term prognosis. Advances in the management of PE may necessitate both the development of novel targeted therapies as well as systems-based strategies to identify high-risk patients early in their course.

aInstitute of Emergency for Cardiovascular Diseases ‘Prof. C.C. Iliescu’, University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania

bDivision of Cardiology, Duke University Medical Center, Durham NC, USA

cUniversity Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Bucuresti

dEmergency Hospital ‘Sf. Spiridon’, University of Medicine and Pharmacy Gr.T.Popa, Iasi

eASCAR Timisoara, University of Medicine and Pharmacy, Victor Babes Romania

fCenter for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois

gDepartment of Emergency Medicine Vanderbilt University - Nashville, Tennessee, USA

Correspondence to Ovidiu Chioncel, MD, PhD, Institute of Emergency for Cardiovascular Diseases ‘Prof. C.C. Iliescu’, University of Medicine and Pharmacy Carol Davila, Bucuresti 950474, Romania Tel: +0040 745400498; fax: +0040 213175224; e-mail:

Received 30 March, 2014

Revised 1 July, 2014

Accepted 1 July, 2014

© 2016 Italian Federation of Cardiology. All rights reserved.