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Which congestion presentation pattern on the physical findings is associated with future adverse events? A cluster analysis in the multicenter acute heart failure registry

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Abstract

Background

Clinical congestion is the most frequent reason for hospital admission in patients with acute heart failure (AHF). However, few studies have investigated the patterns and prognostic implication of the physical congestion using unbiased and robust statistical methods.

Methods

A hierarchical agglomerative clustering analysis was performed in the multicenter Japanese AHF registry (N = 3151) with the distance calculated by Jaccard's distance for jugular vein distention (JVD), leg edema, S3, crackles, and orthopnea. The primary outcome was a composite of cardiac death and heart failure readmission within 1-year.

Results

At the time of admission, the median number of prevalent congestive signs was 2. We identified three phenogroups: ‘no physical congestions’ (N = 251); ‘congestion without JVD’ (N = 1415); and ‘congestion with JVD’ (N = 1495). Patients in ‘no physical congestion’ were the youngest (median 75 [62, 83] years) with the lowest systolic blood pressure (122 [106, 142] mmHg). Patients in ‘congestion without JVD’, and ‘congestion with JVD’ were similar in terms of age (77 [67, 84] vs. 78 [69, 84] years) and systolic blood pressure (138 [118, 160] vs. 137 [118, 158] mmHg). While 30-day mortality was similar (4.0%, 3.7%, and 4.3% in ‘no physical congestion,’ ‘congestion without JVD,’ and ‘congestion with JVD’, respectively), the patients in ‘congestion with JVD’ were at the highest risk for the primary outcome (adjusted hazard ratio 1.79, 95% CI 1.26–2.55 when ‘no physical congestion’ was a reference).

Conclusions

Our clustering analysis demonstrated that congestion signs, particularly JVD, allowed identification of AHF phenogroups with distinct clinical characteristics and long-term outcomes.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This study was supported by Aid for Young Scientists [Japan Society for the Promotion of Science KAKENHI, #18K15860 (Y.S.), #23K15168 (Y.S.), #20K08408 (T.K.)], Grant-in-Aid for Scientific Research (C) [#23591062 (T.Y.), #26461088 (T.Y.), #16K09469 (Y.N.), #17K09526 (T.K.), #18K08056 (T.Y.), #20K08408 (T.K.), #21K08142 (T.Y.)], Grant-in-Aid for Scientific Research (B) [#16H05215 (S.K.), #20H03915 (S.K.)], Health Labour Sciences Research Grant [#14528506 (S.K.)], the Sakakibara Clinical Research Grant for the Promotion of Sciences [T.Y. 2012-2020], the Japan Agency for Medical Research and Development [201439013C (S.K.)], and the Grant-in-Aid for Clinical Research from the Japanese Circulation Society [Y.S. 2019].

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Authors and Affiliations

  1. Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, Japan

    Nozomi Niimi, Shun Kohsaka, Yasuyuki Shiraishi, Nobuhiro Ikemura, Taku Inohara, Ikuko Ueda & Keiichi Fukuda

  2. Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan

    Makoto Takei

  3. Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan

    Takashi Kohno

  4. Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan

    Shintaro Nakano

  5. Department of Cardiology, National Defense Medical College, Tokorozawa, Japan

    Yuji Nagatomo

  6. Department of Cardiology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan

    Munehisa Sakamoto

  7. Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan

    Mike Saji & Tsutomu Yoshikawa

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  1. Nozomi Niimi
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  2. Shun Kohsaka
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Contributions

Conceptualization, NN, SK, and YS; methodology, NN, SK, and YS; software, NN; validation, NN, and SK; formal analysis, NN; investigation, NN, YS, SK; resources, YS and SK; data curation, YS and SK; writing—original draft preparation, NN; writing—review and editing, NN, SK, YS, MT, TK, SN, YN, MS, MS, NI, TI, IU, KF, and TY; visualization, NN and YS; supervision, YS and SK; project administration, NN, YS and SK; funding acquisition, YS and SK. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Shun Kohsaka.

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Conflict of interest

S.K. received an unrestricted research grant for the Department of Cardiology, Keio University School of Medicine, from Novartis Pharma Co., Ltd and honoraria from Bayer, Bristol Myers Squibb and Pfizer. Y.S. is affiliated with an endowed department by Nippon Shinyaku Co., Ltd., Medtronic Japan Co., Ltd., and BIOTRONIK JAPAN Inc., and received research grants from the SECOM Science and Technology Foundation and the Uehara Memorial Foundation and honoraria from Otsuka Pharmaceuticals Co., Ltd., and Ono Pharmaceuticals Co., Ltd. N.I. received an unrestricted research grant for the Department of Cardiology, Keio University School of Medicine from Bristol Myer Squibb. Other authors have no conflicts of interest to disclose.

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Niimi, N., Kohsaka, S., Shiraishi, Y. et al. Which congestion presentation pattern on the physical findings is associated with future adverse events? A cluster analysis in the multicenter acute heart failure registry. Clin Res Cardiol 112, 1108–1118 (2023). https://doi.org/10.1007/s00392-023-02201-8

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