The 2021 European Society of Cardiology (ESC) guidelines divide acute heart failure (AHF) presentations into four clinical phenotypes: acute decompensated heart failure (ADHF), acute pulmonary oedema (APO), isolated right ventricular failure (IRVF), and cardiogenic shock (CS). How these phenotypes differ in baseline features, management in the emergency department (ED), and longer-term outcomes remains incompletely defined in routine clinical practice. This real-world study aimed to describe clinical characteristics and ED treatment patterns across ESC-defined phenotypes and to evaluate associations between phenotype and 1‑year all-cause and cardiovascular mortality in an ED cohort.
This investigation used a prospective-retrospective observational design enrolling consecutive adult patients presenting to the ED with AHF. Patients were categorized into the four ESC phenotypes (ADHF, APO, IRVF, CS) at presentation. The primary endpoints were 1‑year all-cause mortality and 1‑year cardiovascular mortality. Associations between phenotype and outcomes were assessed using Cox proportional hazards regression models with progressive adjustment for clinical covariates and treatments. The abstract reports adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for phenotype-specific risks.
A total of 2,960 patients were included. The investigators observed substantial differences in clinical characteristics and in-hospital treatment patterns across the four phenotypes; however, the abstract does not provide full tabulation of baseline demographics, comorbidities, hemodynamic or laboratory measures, or detailed treatment regimens by phenotype. The reported summary emphasizes heterogeneity in presentation and management across ESC-defined AHF phenotypes in the ED setting.
Phenotype-specific 1‑year all-cause mortality rates differed markedly (P < 0.001):
These unadjusted rates show the highest absolute 1‑year mortality among patients presenting with cardiogenic shock (CS) and substantially elevated mortality for isolated right ventricular failure (IRVF) compared with ADHF and APO.
In multivariable Cox regression analyses that adjusted for clinical variables and treatments (covariates used for adjustment are not listed in the abstract), phenotype remained an independent predictor of outcome for IRVF and CS. Reported adjusted associations include:
These adjusted effect estimates indicate that both IRVF and CS are independently associated with roughly twofold or greater increases in 1‑year risk of death, including cardiovascular death, after accounting for measured clinical factors and treatments in the models reported.
In this ED-based cohort of 2,960 patients with AHF, phenotype at presentation was associated with markedly different 1‑year outcomes. IRVF and cardiogenic shock (CS) were independently associated with worse 1‑year all-cause and cardiovascular mortality compared with other phenotypes. The findings support the use of ESC phenotype classification to inform risk stratification in the ED and to identify patients who may require intensified monitoring, urgent interventions, or early specialist involvement.
The abstract emphasizes phenotype-based prognostic differences but does not present detailed recommendations for phenotype-specific interventions or care pathways; such guidance would require access to the full manuscript or supplementary data.
The study protocol received approval from the Ethics Committee of Fuwai Hospital, Chinese Academy of Medical Sciences (approval No. 2024–2394) and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants, and written consent for publication was also obtained. The authors declare no competing interests.
Note: The abstract provides core results, adjusted hazard ratios, and mortality rates but does not report the full list of covariates included in the multivariable models, granular per-phenotype baseline data and treatment details, or an explicit limitations section within the abstract. Those details were not reported in the source abstract and would require consultation of the full published article for complete appraisal.