Prognostic Impact of Pleural Effusion in Acute Heart Failure and Its Link to Diuretic Therapy
E Perez Pison, P Llacer, F Croset, J Campos, M Garcia, C Perez Medina, A Perez Nieva, M Vergara, P Cevallos, J E Rodriguez, C Sesmero, C Fernandez, M Fabregate, L ManzanoAbstract
Background
The prognostic significance of pleural effusion (PE) in patients with acute heart failure (AHF) remains insufficiently defined. Our objective was to evaluate the association between PE values and long-term outcomes, stratified by loop diuretic (LD) treatment.
Methods
This retrospective study included a total of 656 elderly patients hospitalized for AHF admitted to an Internal Medicine department. Patients were categorized according to the presence or absence of PE at admission. The endpoint of interest was the composite of time to all-cause death and/or heart failure readmission. A multivariable Cox proportional hazard regression model was constructed to analyse the endpoint, and an interaction analysis was performed between PE at admission and LD use at discharge.
Results
The median age was 87 (83-90) years, 65.5% were women, and 80.3% had heart failure with preserved ejection fraction (HFpEF). PE was identified in 40.5% of patients at admission. LD were prescribed in 65.7% of patients at admission and in 90.7% at discharge. After multivariate adjustment, a significant interaction was observed between PE and LD for combined endpoint (p for interaction = 0.043). In PE patients, the absence of LD prescription at discharge was associated with a higher risk of death and/or rehospitalization (HR 2.47, 95% CI 1.28–4.77, p = 0.007). In contrast, among patients who were discharged on LD, the presence of PE was not significantly associated with mortality and/or rehospitalization (HR 1.21, 95% CI 0.96–1.52, p = 0.101).
Conclusions
In patients hospitalized for acute heart failure, the presence of pleural effusion was associated with a higher risk of death and/or readmission. Adequate loop diuretic therapy at discharge appeared to attenuate this risk, underscoring the importance of individualized, congestion-guided treatment strategies in this population.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.