Hemodynamic profiles of advanced heart failure: Association with clinical characteristics and long-term outcomes

Background: Classifying patients with advanced congestive heart failure (CH F) by baseline measures of congestion and perfusion has been used to estima te hemodynamic status and to select and titrate therapy We describe clinica l characteristics of 4 hemodynamic profiles-wet/cold, wet/warm, dry/cold, a nd dry/warm-in patients with advanced CHF and assess relations between symp toms, physical signs, and outcomes with each profile. Methods and Results: We retrospectively assessed baseline symptoms, physica l-examination variables, and 1-year outcomes of 440 patients in a randomize d trial. With univariable and multivariable logistic regression, we examine d relations of physical-examination variables to hemodynamic profiles. We a lso assessed the rates of death and death or readmission by profile. Severi ty of CHP symptoms did not predict the wet-versus-dry profile or cold-versu s-warm status, despite significant differences in hemodynamics among groups . Of the physical-examination variables, only a lower proportional pulse pr essure was a significant multivariable predictor of the wet category. Among wet patients (n = 348), this same variable was the only significant multiv ariable predictor of the cold category. For dry patients (n = 92), the cold category was predicted in multivariable analysis by supine heart rate and hepatomegaly. Survival was similar among profiles: wet/cold, 54.2% (n = 91) ; wet/warm, 58.3% (n = 105); dry/cold, 78.9% (n = 15); and dry/warm, 67.1%, P = .13 (n = 49), Event-free survival also was similar among profiles: wet /cold, 22.08 (n = 37); wet/warm, 29.4% (n = 53); dry/cold, 42.1% (n = 8); a nd dry/warm, 31.5%, P = .44 (n = 23). Conclusions: The patient's history and physical examination alone may lead to inaccurate estimation of hemodynamic status and thus suboptimal manageme nt for patients with advanced CHF.