Short- and Long-Term Prognostic Implications of Jugular Venous Distension in Patients Hospitalized With Acute Heart Failure

doi:10.1016/j.amjcard.2016.04.035

The American Journal of Cardiology

Volume 118, Issue 2, 15 July 2016, Pages 226-231

https://doi.org/10.1016/j.amjcard.2016.04.035 Get rights and content

The present study was designed to assess the role of jugular venous distension (JVD) as a predictor of short- and long-term mortality in a “real-life” setting. The independent association between the presence of admission JVD and the 30-day, 1- and 10-year mortality was assessed among 2,212 patients hospitalized with acute heart failure (HF) who were enrolled in the Heart Failure Survey in Israel (2003). Independent predictors of JVD finding in study patients included: the presence of significant hyponatremia (odds ratio [OR] 1.48; p = 0.03), reduced left ventricular ejection fraction ([LVEF] OR 1.24; p = 0.03), anemia (OR 1.3; p = 0.01), New York Heart Association III to IV (OR 1.34; p <0.01) and age >75 years (OR 1.32; p = 0.01). The presence of JVD versus its absence at the time of HF hospitalization was associated with increased 30-day mortality (7.2% vs 4.9%, respectively; p = 0.02), 1-year (33% vs 28%, respectively; p <0.001), and greater 10-year mortality (91.8% vs 87.2%, respectively; p <0.001). Consistently, interaction term analysis demonstrated that the presence of JVD at the time of the index HF hospitalization was independently associated with a significant increased risk for 10-year mortality, with a more pronounced effect among younger patients, patients with reduced LVEF, preserved renal function, and chronic HF. In conclusion, in patients admitted with HF, JVD is associated with specific risk factors and is independently associated with increased risk of both short- and long-term mortality. These findings can be used for improved risk assessment and management of this high-risk population.

Section snippets

Methods

Baseline characteristics and admission data of patients admitted with acute HF were obtained from the Heart Failure Survey in Israel (HFSIS 2003) survey database. The design and methods of the HFSIS have been described previously.11, 12 Briefly, the survey was conducted during March 2013 to April 2003 in all 25 public hospitals in Israel. The study included 93 of the 98 internal medicine and 24 of the 25 cardiology departments in Israel at that time.

The survey enrolled 4,102 patients of which

Results

The HFSIS survey included 2,212 hospitalized patients for congestive HF, of whom 1,395 (63%) had JVD on admission. The baseline demographic, clinical characteristics and hospitalization data of study patients are presented in Table 1. The mean age of total survey population was 75 T10 years. Sex and cardiovascular risk factors were similar between the 2 groups. However, patients with JVD displayed several important differences in their clinical characteristics compared with those without JVD at

Discussion

The present study demonstrates that assessment of JVD in patients admitted to the hospital with acute HF has important short- and long-term prognostic implications. We have shown that JVD finding is associated with increased likelihood of in-hospital adverse events, increased 30-day and 1-year all-cause mortality, as well as being independently associated with long-term, 10-year, all-cause mortality after adjustment for multiple factors known to significantly associated with outcomes.

Although

Disclosures

The authors have no conflicts of interest to disclose.

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Citation Excerpt :
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: Drs. Chernomordik, Berkovitch, and Klempfner contributed equally to the work.

: See page 230 for disclosure information.

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Heart FailureShort- and Long-Term Prognostic Implications of Jugular Venous Distension in Patients Hospitalized With Acute Heart Failure

Section snippets

Methods

Results

Discussion

Disclosures

Am J Med

Am J Cardiol

Am J Med

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

JACC Cardiovasc Imaging

Circulation

The EuroHeart Failure Survey Programme– a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis

Eur Heart J

The EuroHeart Failure Survey Programme–a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment

Eur Heart J

Heart Failure
Short- and Long-Term Prognostic Implications of Jugular Venous Distension in Patients Hospitalized With Acute Heart Failure