Worsening heart failure in ‘real‐world’ clinical practice: predictors and prognostic impact

AlFaleh, Hussam; Elasfar, Abdelfatah; Ullah, Anhar; AlHabib, Khalid F.; Hersi, Ahmad; Mimish, Layth; Almasood, Ali; Ghamdi, Saleh Al; Ghabashi, Abdullah; Malik, Asif; Hussein, Gamal; Al-Murayeh, Mushabab; Abuosa, Ahmed; Habeeb, Waleed Al; Kashour, Tarek

doi:10.1002/ejhf.515

Cited by 17 publications

(16 citation statements)

References 35 publications

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“…[38][39][40][41][42] Importantly, patients with subacute dyspnoea onset experienced in-hospital HF worsening twice as often vs. those with an acute onset. within 7 days preceding hospital admission) was associated with a distinct clinical pattern-elevated blood pressure and apparent pulmonary congestion (moderate-severe in one-third of these patients)-whereas peripheral congestion was less evident.…”

Section: Discussionmentioning

confidence: 99%

“…It is been consistently shown as strong and independent predictor of poor postdischarge outcomes. [38][39][40][41][42] Importantly, patients with subacute dyspnoea onset experienced in-hospital HF worsening twice as often vs. those with an acute onset. We believe that it cannot simply be explained on the basis of more severe/advanced disease status.…”

Section: Discussionmentioning

confidence: 99%

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Patterns of dyspnoea onset in patients with acute heart failure: clinical and prognostic implications

et al. 2018

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AimsDespite attempts to improve the management of patients with acute heart failure (HF), virtually all therapeutic agents investigated in large clinical trials failed to show any consistent reduction in mortality and morbidity. Complexity of the clinical syndrome of acute HF seems to be likely an underlying explanation. Traditionally, clinical trials studied mixed patient populations with acute HF, and only recently, better clinical characterization of patients has been proposed. Dyspnoea is the most common presenting symptom related to hospital admission for acute HF. Whether in patients with acute HF, the pattern of symptoms onset preceding hospital admission is associated with clinical characteristics, and the outcomes have not yet been established.Methods and resultsWe investigated 137 patients (mean age: 65 ± 13 years; 80% men) hospitalized due to acute HF with dyspnoea as major reported symptom, who were divided according to the time of its onset into those with acute (n = 98) vs. subacute (n = 39) onset (i.e. within 7 days vs. >7 days preceding hospital admission, respectively). On admission, the former group presented higher blood pressure (138 ± 33 vs. 121 ± 32 mmHg), more often moderate–severe pulmonary congestion (33 vs. 8%), and lower bilirubin level [1.07 (0.72–1.60) vs. 1.27 (0.87–2.06); P < 0.05 in all comparisons]. There were no other differences in baseline clinical characteristics and laboratory indices. Higher percentage of patients with an acute dyspnoea onset reported marked/moderate dyspnoea relief after 6 (18% vs. 7%), 24 (59% vs. 24%), and 48 h (80% vs. 46% assessed as an improvement of at least 5 points in self‐reported 10‐point Likert scale; P < 0.05 in all time points). In patients with an acute onset of dyspnoea after 48 h, a decrease of N‐terminal pro BNP was more frequently observed (83% vs. 65%), and the levels of endothelin‐1 were more reduced [−1.1 (−2.9–0.03) vs 0.4 (−2.2–1.4); all P < 0.05]. Patients with acute onset experienced less in‐hospital HF worsening (13% vs. 40%, P = 0.001), and 1 year cardiovascular mortality was significantly lower (20% vs. 41%, P = 0.01). On the multivariable analysis, subacute pattern of dyspnoea was independent predictor of 12 month cardiovascular mortality in patients with acute HF after adjusting for other prognostic factors: systolic blood pressure, urea, and HF de novo [hazard ratio (95% confidence interval): 2.32 (1.13–4.75), P = 0.02].ConclusionsIn patients with acute HF, the pattern of symptoms onset is associated with baseline differences in clinical characteristics, biomarker profile, response to standard treatment, and the long‐term outcomes. This is relevant information for planning future clinical trials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patterns of dyspnoea onset in patients with acute heart failure: clinical and prognostic implications

et al. 2018

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“…therapy and the initiation of inotropic drugs, ultrafiltration or mechanical support . The persistence of symptoms that caused the hospitalization has been included in the definition of WHF in some trials, but not in others ( Table ) . Worsening HF has several characteristics that make it a potentially useful outcome measurement in AHF.…”

Section: Studies Assessing the Prognostic Significance Of Worsening Hmentioning

confidence: 99%

“…In this issue of the journal, AlFaleh et al . report the clinical characteristics and prognostic significance of WHF in a consecutive series of 2609 patients hospitalized for AHF and enrolled in a multicentre prospective registry in Saudi Arabia . Worsening HF was defined as recurrence of HF symptoms following hospital admission and before discharge, requiring escalation of therapy (including i.v.…”

Section: Studies Assessing the Prognostic Significance Of Worsening Hmentioning

confidence: 99%

Understanding worsening heart failure as a therapeutic target: another step forward?

Metra

Ravera

Filippatos

2017

European J of Heart Fail

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“…12 Unplanned hospitalizations for HF and, in general, episodes of worsening HF are landmark events in patients' clinical course and are followed by a marked increase in mortality and rehospitalizations, compared with when the patients remain ambulatory. [13][14][15][16]…”

Section: Diagnosis and Prognosismentioning

confidence: 99%

Highlights in heart failure

et al. 2019

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Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in studies in patients hospitalized for acute HF. More recently, DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 (SGLT2) inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HFpEF research are summarized and reviewed in this article.A multiparametric approach is often proposed for risk stratification of HF patients. The prognostic accuracy of the metabolic exercise test data combined with cardiac and kidney indexes risk score was found as superior to the HF Survival Score and Seattle HF model risk scores in a cohort of 6112 1106 D. Tomasoni et al.

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Worsening heart failure in ‘real‐world’ clinical practice: predictors and prognostic impact

Abstract: In real-world clinical practice, WHF during hospitalization for AHF is a strong predictor for short- and intermediate-term mortality, and a cause for longer hospital stays.

Cited by 17 publications

References 35 publications

Patterns of dyspnoea onset in patients with acute heart failure: clinical and prognostic implications

Patterns of dyspnoea onset in patients with acute heart failure: clinical and prognostic implications

Understanding worsening heart failure as a therapeutic target: another step forward?

Highlights in heart failure

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