In an ED-based AHF cohort, IRVF and CS were independently associated with worse 1-year outcomes, supporting phenotype-based risk stratification in the ED.
One-year all-cause mortality rates differed substantially across the four ESC-defined AHF phenotypes in the emergency department.
Isolated right ventricular failure (IRVF) was independently associated with increased risk of both all-cause and cardiovascular mortality at one year.
Cardiogenic shock (CS) was independently associated with the highest risks of all-cause and cardiovascular mortality at one year.
Clinical characteristics and treatment patterns differed substantially across the four AHF phenotypes in the emergency department.
ADHF and APO had comparably low one-year all-cause mortality rates relative to IRVF and CS.
This research suggests that patients who arrive at the emergency department with acute heart failure do not all face the same risks — the specific type, or 'phenotype,' of heart failure matters greatly for predicting who is most likely to die within the following year. The study followed nearly 3,000 emergency department patients with acute heart failure and grouped them into four categories defined by European cardiology guidelines: standard acute decompensated heart failure, acute pulmonary edema (fluid in the lungs), isolated right ventricular failure (failure of the right side of the heart), and cardiogenic shock (the heart is too weak to supply enough blood). One year later, patients with cardiogenic shock had by far the worst outcomes, with nearly 59% dying, compared to about 10–11% for the two most common types. Patients with isolated right ventricular failure also fared considerably worse, with about 25% dying within a year. Importantly, even after accounting for other health factors and the treatments patients received, both cardiogenic shock and isolated right ventricular failure remained independently linked to higher risks of death from any cause and from cardiovascular causes specifically. This means the phenotype itself — not just the patient's other health problems — carries meaningful prognostic information. This research suggests that classifying acute heart failure patients by these ESC-defined phenotypes upon arrival in the emergency department could help clinicians quickly identify who is at greatest risk and potentially tailor monitoring and treatment accordingly. It also highlights that isolated right ventricular failure, which may sometimes receive less attention than cardiogenic shock, also represents a high-risk group deserving close attention.
Liang H, Wang Y, Xin Y, Li Y, Zhang C, Yang Y. (2026). Clinical characteristics and prognostic differences among acute heart failure phenotypes in the emergency department: a real-world study.. BMC emergency medicine. https://doi.org/10.1186/s12873-026-01628-2