Journal Article

Relation of Decongestion and Time to Diuretics to Biomarker Changes and Outcomes in Acute Heart Failure

Barnett, Olga, Mueller, Christian, Kontos, Michael C., Murray, Patrick T., Nowak, Richard, Hogan, Christopher, McDonald, Kenneth, Filippatos, Gerasimos, Briguori, Carlo, Horiuchi, Yu, Birkhahn, Robert, Vilke, Gary M., Müeller, Gerhard A., Passino, Claudio, Maisel, Alan, Wettersten, Nicholas, Taub, Pam, van Veldhuisen, Dirk J., Nuñez, Julio, Mahon, Niall, Cannon, Chad M.

2021

Overview

•Prompt initiation of diuretic therapy was not correlated with faster decongestion in acute heart failure.•The timing of decongestion but not diuretics was associated with better biomarker trajectories.•Residual congestion rather than the timing of decongestion or diuretics predicted prognosis. Prompt treatment may mitigate the adverse effects of congestion in the early phase of heart failure (HF) hospitalization, which may lead to improved outcomes. We analyzed 814 acute HF patients for the relationships between time to first intravenous loop diuretics, changes in biomarkers of congestion and multiorgan dysfunction, and 1-year composite end point of death or HF hospitalization. B-type natriuretic peptide (BNP), high sensitivity cardiac troponin I (hscTnI), urine and serum neutrophil gelatinase–associated lipocalin, and galectin 3 were measured at hospital admission, hospital day 1, 2, 3 and discharge. Time to diuretics was not correlated with the timing of decongestion defined as BNP decrease ≥ 30% compared with admission. Earlier BNP decreases but not time to diuretics were associated with earlier and greater decreases in hscTnI and urine neutrophil gelatinase–associated lipocalin, and lower incidence of the composite end point. After adjustment for confounders, only no BNP decrease at discharge was significantly associated with mortality but not the composite end point (p = 0.006 and p = 0.062, respectively). In conclusion, earlier time to decongestion but not the time to diuretics was associated with better biomarker trajectories. Residual congestion at discharge rather than the timing of decongestion predicted a worse prognosis.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Acute Disease / Aged / Aged, 80 and over / Biomarkers / Biomarkers - metabolism / Blood pressure / Brain natriuretic peptide / Calcium-binding protein / Cardiovascular disease / Clinical outcomes / Congestion / Congestive heart failure / Creatinine / Diuretics / Diuretics - administration & dosage / Drug Administration Schedule / Drug dosages / Female / Galectin 3 - blood / Gelatinase / Heart failure / Heart Failure - drug therapy / Heart Failure - metabolism / Heart Failure - mortality / Hospitalization / Humans / Intravenous administration / Kidney diseases / Leukocytes (neutrophilic) / Lipocalin / Lipocalin-2 - blood / Lipocalin-2 - urine / Male / Middle Aged / Mortality / Natriuretic Peptide, Brain - blood / Regression analysis / Retrospective Studies / Survival Rate / Time-to-Treatment / Troponin / Troponin I / Troponin I - blood / Urine