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)

Autor: Jacob P. Kelly, Vic Hasselblad, Faiez Zannad, Robert J. Mentz, Robert M. Califf, Christopher M. O'Connor, G. Michael Felker, Paul W. Armstrong, Justin A. Ezekowitz, Adrian F. Hernandez
Přispěvatelé: Duke University Medical Center, University of Alberta, Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Duke Translational Medicine Institute, Duke University [Durham]
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Inotrope
Male
Time Factors
MESH: Hospitalization
030204 cardiovascular system & hematology
Ventricular Function
Left
MESH: Ventricular Function
Left
law.invention
Alberta
MESH: Dose-Response Relationship
Drug
0302 clinical medicine
Randomized controlled trial
law
Natriuretic Peptide
Brain
MESH: Double-Blind Method
030212 general & internal medicine
Hospital Mortality
MESH: Natriuretic Peptide
Brain
MESH: Treatment Outcome
MESH: Aged
MESH: Middle Aged
Hazard ratio
MESH: Alberta
Atrial fibrillation
MESH: North Carolina
MESH: Follow-Up Studies
Middle Aged
3. Good health
Hospitalization
Survival Rate
Treatment Outcome
Acute Disease
Injections
Intravenous
Cardiology
Disease Progression
MESH: Acute Disease
Female
MESH: Disease Progression
France
Cardiology and Cardiovascular Medicine
medicine.drug
medicine.medical_specialty
MESH: Survival Rate
Article
03 medical and health sciences
Double-Blind Method
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Internal medicine
medicine
North Carolina
Humans
MESH: Hospital Mortality
Survival rate
Aged
Nesiritide
Heart Failure
MESH: Humans
Dose-Response Relationship
Drug
business.industry
MESH: Time Factors
Odds ratio
medicine.disease
MESH: Injections
Intravenous
MESH: Male
MESH: France
Heart failure
MESH: Heart Failure
business
MESH: Female
Follow-Up Studies
Zdroj: American Heart Journal
American Heart Journal, Elsevier, 2015, 170 (2), pp.298-305. ⟨10.1016/j.ahj.2015.04.007⟩
ISSN: 0002-8703
DOI: 10.1016/j.ahj.2015.04.007⟩
Popis: International audience; BACKGROUND: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.METHODS AND RESULTS: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).CONCLUSIONS: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.
Databáze: OpenAIRE
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