Trajectory of Congestion Metrics by Ejection Fraction in Patients with Acute Heart Failure (From the Heart Failure Network)

• Published in: The American journal of cardiology 2017-07, Vol.120 (1), p.98-105
• Main Authors: Ambrosy, Andrew P., MD, Bhatt, Ankeet S., MD, Gallup, Dianne, MS, Anstrom, Kevin J., PhD, Butler, Javed, MD, MPH, MBA, DeVore, Adam D., MD, MHS, Felker, G. Michael, MD, MHS, Fudim, Marat, MD, Greene, Stephen J., MD, Hernandez, Adrian F., MD, MHS, Kelly, Jacob P., MD, MHS, Samsky, Marc D., MD, Mentz, Robert J., MD
• Format: Article
• Language: English
• Subjects: Acute Disease; Age; Aged; Beta blockers; Body weight; Brain natriuretic peptide; Cardiovascular; Cause of Death - trends; Chronic obstructive pulmonary disease; Clinical trials; Congestion; Death; Diagnosis; Diuretics; Double-Blind Method; Dyspnea; Edema; Ejection fraction; Etiology; Female; Fibrillation; Flutter; Heart; Heart diseases; Heart failure; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Hospitalization; Hospitalization - trends; Humans; Ischemia; Kidneys; Lung diseases; Male; Markers; Medical prognosis; Middle Aged; Mortality; Natriuretic Peptide, Brain - blood; Obstructive lung disease; Optimization; Patients; Peptide Fragments - blood; Peptides; Prognosis; Prospective Studies; Regression analysis; Renal failure; Risk assessment; Risk Assessment - methods; Self evaluation; Severity of Illness Index; Signs and symptoms; Stroke Volume - physiology; Survival Rate - trends; Systole; Trajectories; United States - epidemiology; Vibration; Visual perception; Xenografts
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2017.03.249

Abstract Differences in the clinical course of congestion by underlying ejection fraction (EF) have not been well-characterized in acute heart failure (AHF). A post-hoc analysis was performed using pooled data from the DOSE-AHF, CARRESS-HF, and ROSE-AHF trials. All patients were admitted for a primary diagnosis of AHF. Patients were grouped as reduced EF < 40%, borderline 40%< EF 50%. Multivariable Cox regression analysis was used to assess the association between measures of congestion and the composite of unscheduled outpatient visits, rehospitalization, or death. Mean age was 68 + 13 years and 74% were male. Patients with a preserved EF were older, more likely to be female, less likely to have an ischemic etiology of HF, and had a higher prevalence of atrial fibrillation/flutter and chronic obstructive pulmonary disease. Compared to patients with a reduced EF, preserved EF patients had lower NT-proBNP levels at baseline (i.e. reduced: 5998 pg/mL [3009 pg/mL, 11414 pg/mL] vs. borderline: 4420 pg/mL [1740 pg/mL, 8057 pg/mL] vs. preserved: 3272 pg/mL [1687 pg/mL, 6536 pg/mL]) and experienced smaller changes during hospitalization. In general, there were few differences between EF groups in the clinical course of congestion as measured by signs and symptoms of HF, body weight change, and net fluid loss. After adjusting for potential confounders, a greater improvement in global visual analogue scale was associated with lower risk of unscheduled outpatient visits, rehospitalization, or death at day 60 (Hazard Ratio 0.94 per 10 mm increase, 95% Confidence Interval 0.89-0.995). This relationship did not differ by EF (p-value = 0.54). In conclusion, among patients hospitalized for AHF there were few differences in the in-hospital trajectory or prognostic value of routine markers of congestion by EF.