We aimed to study whether jugular venous distension (JVD) and peripheral edema were
associated with worse outcomes in patients with acute heart failure in the Acute Study
of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure trial. Of 7,141
patients in Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart
Failure, 7,135 had complete data on baseline JVD and peripheral edema status. Patients
were grouped according to baseline examination findings: (1) no JVD or peripheral
edema; (2) JVD only; (3) peripheral edema only; (4) JVD and peripheral edema. We used
unadjusted and adjusted logistic or Cox regression analyses to assess associations
between groups and the outcomes of index length of stay (LOS), in-hospital mortality,
30- and 180-day all-cause mortality. Patients with peripheral edema (Groups 3 and
4) had higher body mass index, NT-proBNP and BNP values, and more co-morbid disease,
and reduced left ventricular ejection fraction compared with patients in Groups 1–2.
The median (25th–75th) LOS for Groups 1–4 was 6 (4–9), 5 (4–8), 7 (4–11), and 6 days
(4–10), respectively. For the 30-day and 180-day outcomes, adjusted analyses found
no significant difference in risk for patients presenting with JVD only or peripheral
edema only as compared with patients without evidence of JVD or peripheral edema (p
>0.05 for all). The presence of both JVD and peripheral edema was associated with
an adjusted 24% increase in risk for all-cause mortality at 30 days, but no risk difference
at 180 days. In conclusion, in patients with heart failure presenting to the hospital
with dyspnea, the presence of peripheral edema is associated with a longer hospital
LOS, but no difference in short- and long-term clinical outcomes when compared with
patients wihout peripheral edema. The combination of peripheral edema and JVD identifies
the highest risk cohort for poor clinical outcomes.
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Article info
Publication history
Published online: August 03, 2018
Accepted:
July 18,
2018
Received in revised form:
July 15,
2018
Received:
June 17,
2018
Footnotes
See page 1511 for disclosure information.
Funding: Scios Inc., now Johnson & Johnson, provided financial and material support for the ASCEND-HF trial. MF: Axon Therapies, Coridea, Cibiem. GE Healthcare, Supported by AHA Grant 17MCPRP33460225 and the NHLBI T32 postdoctoral training grant 5T32HL007101-42. RJM: Amgen, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Novartis, Otsuka, ResMed, Thoratec. JAE: Abbott Labs, Amgen, Johnson&Johnson, Pfizer, Servier. AAV: Amgen, Bayer, Boehringer Ingelheim, Merck, Novartis, Servier. CMO: Amgen, Astellas, GE Healthcare, Gilead, Novella, Otsuka, Roche Diagnostics, Resmed. AFH: Sanofi, Johnson & Johnson, AstraZeneca, Corthera.
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