Journal Article

Reduction of Hospitalization and Mortality by Echocardiography-Guided Treatment in Advanced Heart Failure

Sergey Pepoyan, Mariam Hovhannisyan, Gor Martirosyan, Armine Minasyan, Hamayak Sisakian, Armine Chopikyan, Ashkhen Maghaqelyan, Syuzanna Shahnazaryan, Yury Lopatin, Sona Melik-Stepanyan

2022

Overview

In advanced heart failure (AHF) clinical evaluation fails to detect subclinical HF deterioration in outpatient settings. The aim of the study was to determine whether the strategy of intensive outpatient echocardiographic monitoring, followed by treatment modification, reduces mortality and re-hospitalizations at 12 months. Methods: 214 patients with ejection fraction < 30% and >1 hospitalization during the last year underwent clinical evaluation and echocardiography at discharge and were divided into intensive (IMG; N = 143) or standard monitoring group (SMG; N = 71). In IMG, volemic status and left ventricular filling pressure were assessed 14, 30, 90, 180 and 365 days after discharge. HF treatment, particularly diuretic therapy, was temporarily intensified when HF deterioration signs and E/e’ > 15 were detected. In SMG, standard outpatient monitoring without obligatory echocardiography at outpatient visits was performed. Results: We observed lower hospitalization (absolute risk reduction [ARR]-0.343, CI-95%: 0.287–0.434, p < 0.05; number needed to treat [NNT]-2.91) and mortality (ARR-0.159, CI 95%: 0.127–0.224, p < 0.05; NNT-6.29) in IMG at 12 months. One-year survival was 88.8% in IMG and 71.8% in SMG (p < 0.05). Conclusion: In AHF, outpatient monitoring of volemic status and intracardiac filling pressures to individualize treatment may potentially reduce hospitalizations and mortality at 12 months follow-up. Echocardiography-guided outpatient therapy is feasible and clinically beneficial, providing evidence for the larger application of this approach.

• Publisher: MDPI AG,MDPI
• Subject: advanced heart failure / advanced heart failure; outpatient monitoring; Tissue Doppler echocardiography; left ventricular filling pressure; mortality; rehospitalizations / Auscultation / Beta blockers / Cardiovascular disease / Diseases of the circulatory (Cardiovascular) system / Edema / Electrocardiography / Heart attacks / Heart failure / Hospitalization / left ventricular filling pressure / Mortality / outpatient monitoring / Patients / RC666-701 / rehospitalizations / Statistical analysis / Tissue Doppler echocardiography