Prognostic impact of the updated 2018 HFA‐ESC definition of advanced heart failure: results from the HELP‐HF registry

Abstract

Aims The Heart Failure Association of the European Society of Cardiology (HFA‐ESC) proposed a definition of advanced heart failure (HF) that has not been validated, yet. We assessed its prognostic impact in a consecutive series of patients with high‐risk HF. Methods and results The HELP‐HF registry enrolled consecutive patients with HF and at least one high‐risk ‘I NEED HELP’ marker, evaluated at four Italian centres between 1st January 2020 and 30th November 2021. Patients meeting the HFA‐ESC advanced HF definition were compared to patients not meeting this definition. The primary endpoint was the composite of all‐cause mortality or first HF hospitalization. Out of 4753 patients with HF screened, 1149 (24.3%) patients with at least one high‐risk ‘I NEED HELP’ marker were included (mean age 75.1 ± 11.5 years, 67.3% male, median left ventricular ejection fraction [LVEF] 35% [interquartile range 25%–50%]). Among them, 193 (16.8%) patients met the HFA‐ESC advanced HF definition. As compared to others, these patients were younger, had lower LVEF, higher natriuretic peptides and a worse clinical profile. The 1‐year rate of the primary endpoint was 69.3% in patients with advanced HF according to the HFA‐ESC definition versus 41.8% in the others (hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.82–2.74, p < 0.001). The prognostic impact of the HFA‐ESC advanced HF definition was confirmed after multivariable adjustment for relevant covariates (adjusted HR 1.98, 95% CI 1.57–2.50, p < 0.001). Conclusions The HFA‐ESC advanced HF definition had a strong prognostic impact in a contemporary, real‐world, multicentre high‐risk cohort of patients with HF.

Heart failure: an update from the last years and a look at the near future

“…Out of 4753 patients with HF screened, 1149 (24.3%) patients had at least one high‐risk ‘I NEED HELP’ marker, and among them, 193 (16.8%) patients met the HFA‐ESC advanced HF definition. The HFA‐ESC advanced HF definition was associated with a higher risk of all‐cause mortality or first HF hospitalization (adjusted HR 1.98; 95% CI 1.57–2.50; P < 0.001) 321 . The efficacy and tolerability of GDMT in patients with the most advanced stages of HFrEF often remain unsettled 150,322,323 …”

“…The HFA-ESC advanced HF definition was associated with a higher risk of all-cause mortality or first HF hospitalization (adjusted HR 1.98; 95% CI 1.57-2.50; P < 0.001). 321 The efficacy and tolerability of GDMT in patients with the most advanced stages of HFrEF often remain unsettled. 150,322,323…”

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

“…Patients with an advanced stage of HF present severe symptoms, poor tolerance of guideline-directed medical therapy (GDMT), frequent episodes of decompensation, and an extremely poor prognosis 66 …”

Advanced heart failure: time to screen?

“…In part to address these challenges, the Heart Failure Association of the European Society of Cardiology (HFA‐ESC) published a simplified four criteria definition of advanced HF in 2018 2 . In this issue of the Journal, Pagnesi and colleagues provide a much needed validation of these criteria and their relation to subsequent prognosis 5 . This effort should be applauded, as this has not been directly evaluated in previous studies, and such analyses are essential for determining the value of disease stage definitions in terms of clinical application and, in turn, their dissemination.…”

“…2 In this issue of the Journal, Pagnesi and colleagues provide a much needed validation of these criteria and their relation to subsequent prognosis. 5 This effort should be applauded, as this has not been directly evaluated in previous studies, and such analyses are essential for determining the value of disease stage definitions in terms of clinical application and, in turn, their dissemination. The authors used data from a contemporary registry of high-risk HF patients (requiring ≥1 'I NEED HELP' criterion) from four high-volume Italian centres.…”