Journal Article

Worsening heart failure during hospitalization for acute heart failure: Insights from the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF)

Hernandez, Adrian F., Kelly, Jacob P., Califf, Robert M., Hasselblad, Vic, Mentz, Robert J., Armstrong, Paul W., Zannad, Faiez, Felker, G. Michael, O'Connor, Christopher M., Ezekowitz, Justin A.

2015

Overview

Despite initial in-hospital treatment of acute heart failure (HF), some patients experience worsening HF (WHF). There are limited data about the outcomes and characteristics of patients who experience in-hospital WHF. We assessed the characteristics and outcomes of patients with and without WHF in the ASCEND-HF trial. Worsening HF was defined as at least 1 symptom or sign of new, persistent, or WHF requiring additional intravenous inotropic/vasodilator or mechanical therapy during index hospitalization. We assessed the relationship between WHF and 30-day mortality, 30-day mortality or HF hospitalization, and 180-day mortality. We also assessed whether there was a differential association between early (days 1-3) vs late (day ≥4) WHF and outcomes. Of 7,141 patients with acute HF, 354 (5%) experienced WHF. Patients with WHF were more often male and had a history of atrial fibrillation or diabetes, lower blood pressure, and higher creatinine. After risk adjustment, WHF was associated with increased 30-day mortality (odds ratio 13.37, 95% CI 9.85-18.14), 30-day mortality or HF rehospitalization (odds ratio 6.78, 95% CI 5.25-8.76), and 180-day mortality (hazard ratio 3.90, 95% CI 3.14-4.86) (all P values < .0001). There was no evidence of a difference in outcomes between early and late WHF (all P values for comparison ≥ .2). Worsening HF during index hospitalization was associated with worse 30- and 180-day outcomes. Worsening HF may represent an important patient-centered outcome in acute HF and a focus of future treatments.

• Publisher: Elsevier Inc,Elsevier Limited,Elsevier
• Subject: Acute Disease / Aged / Alberta / Alberta - epidemiology / Cardiology and cardiovascular system / Cardiovascular / Clinical trials / Disease Progression / Dopamine / Dose-Response Relationship, Drug / Double-Blind Method / Edema / Female / Follow-Up Studies / France / France - epidemiology / Heart attacks / Heart Failure / Heart Failure - drug therapy / Heart Failure - mortality / Heart Failure - physiopathology / Hospital Mortality / Hospital Mortality - trends / Hospitalization / Human health and pathology / Humans / Injections, Intravenous / Life Sciences / Logistics / Male / Middle Aged / Mortality / Natriuretic Peptide, Brain / Natriuretic Peptide, Brain - administration & dosage / North Carolina / North Carolina - epidemiology / Patients / Sodium / Studies / Survival Rate / Survival Rate - trends / Time Factors / Treatment Outcome / Ventricular Function, Left / Ventricular Function, Left - drug effects / Ventricular Function, Left - physiology