Abstract 3234: Both In And Outhospital Worsening Of Renal Function Predict Outcome In Patients With Acute Decompensated Heart Failure
Purpose. Renal impairment and inhospital worsening of renal function (WRF) are common in patients with acute heart failure (AHF) and associated with poor outcome. The effect of WRF after discharge on outcome in these patients is unknown.
Methods. The Coordinating Study Evaluating Outcome of Advising and Counseling in Heart Failure (COACH) included 1049 AHF patients. We assessed estimated glomerular filtration rate (eGFR) by the sMDRD formula and serum creatinine at admission, discharge, and 6 and 12 months after discharge. WRF was defined as increase in serum creatinine >0.3mg/dL. The primary outcome was a composite of all-cause mortality and heart failure admissions.
Results. Mean age was 71 ± 11 years, 62% were male. Mean eGFR at admission was 56 ± 22 mL/min/1.73m2 ,with mean LVEF 33 ± 14%. Inhospital WRF occurred in 13% of patients, while 19% and 12% experienced WRF from 0 to 6, and 6 to 12 months after discharge, respectively. WRF was in a landmark analysis associated with poor outcome: hazard ratio (HR) 1.39 (1.07 –1.81), P<0.05 for inhospital WRF, HR 2.70 (1.65 –4.43), P < 0.001 for WRF at 6 months and HR 3.44 (1.81–6.52), P < 0.001 for WRF between 6 –12 months (Figure⇓). In multivariate analysis, after adjustment for age, gender, LVEF, eGFR and NYHA class, WRF at any point in time was associated with worse outcome: HR 1.33 (1.01 –1.75), P < 0.05 for inhospital WRF, HR 2.50 (1.47 –4.26), P = 0.001 for WRF between 0 – 6 months, and HR 2.81 (1.38 – 5.73), P = 0.004 for WRF between 6 –12 months.
Conclusion. Both in and outhospital worsening of renal function are independently related to poor prognosis in patients with AHF, suggesting that renal function in AHF patients should be monitored long after discharge.