Acute Pulmonary Congestion in Patients with Systolic Heart Failure Versus Diastolic Heart Failure: Experience of a Heart Emergency Unit

Background: Acute pulmonary congestion can be caused by systolic and diastolic heart failure. Whether this distinction is reflected in clinical outcome is unknown.

Aim: To compare outcome after an episode of acute pulmonary congestion in patients with systolic heart failure and diastolic heart failure.

Methods: A retrospective, descriptive study was conducted on consecutive patients who presented with acute pulmonary congestion. Clinical outcome was evaluated based on mortality, number of hospital re-admissions, visits to the cardiology outpatient clinic and cardiovascular events.

Results: Altogether 86 patients were enrolled in this study: 59 patients (68%) had systolic dysfunction and 27 (32%) had diastolic dysfunction. Mean age was 75.6±11.0 in the systolic heart failure group and 80.1±9.4 years in the diastolic heart failure group. Mean follow-up was 427 days. Men and women were equally distributed between both patient groups. Re-admission and mortality rates were comparable between both groups. When combining cardiovascular events and mortality, patients with diastolic heart failure had more favourable outcome after acute pulmonary congestion than patients with systolic heart failure (37 vs. 70%, p=0.03).

Conclusion: The proportions of patients presenting with acute pulmonary congestion due to diastolic heart failure were comparable with those found in literature. Patients were mainly elderly and as often male as female. Readmission and mortality rates were comparable between both patient groups. However, patients with diastolic heart failure had a more favourable prognosis when combining cardiovascular events and mortality.