Abstract 13302: Worsening Heart Failure During Acute Heart Failure Hospitalization: Insights from ASCEND-HF
Background: After presentation with acute heart failure (AHF), some patients will worsen despite initial standard therapy during the hospitalization. This group of patients with worsening heart failure (WHF) is proposed as an endpoint in AHF trials, but limited data exist regarding the association between WHF and clinical outcomes. We assessed the characteristics and outcomes of patients with and without WHF in the ASCEND-HF trial.
Methods: WHF was defined as having at least one sign, symptom or radiologic evidence of new, persistent or WHF requiring new therapy during the index hospitalization. We assessed the relationship between WHF and the endpoints of 30-day death or HF hospitalization, 30-day death and 180-day death using logistic regression and Cox proportional hazards models. We also assessed whether there was a differential association between early (day 1-3) vs. late (day ≥4) WHF and outcomes.
Results: Of 7,141 AHF patients, 5% (N=354) experienced WHF. At baseline, patients with WHF were more often male, have a history of atrial fibrillation or diabetes, a lower blood pressure or ejection fraction, and higher creatinine or natriuretic peptide levels. WHF was associated with increased risk for 30- and 180-day outcomes even after risk adjustment (Table). There was no evidence of a differential association between early and late WHF with post-discharge outcomes.
Conclusions: In the setting of a large AHF trial, 5% of patients developed WHF during the index hospitalization, which was associated with marked increased risk for 30-day mortality or readmission and 180-day mortality. WHF represents an important, patient-centered outcome that should be a focus of future treatments.
Author Disclosures: J.P. Kelly: None. R.J. Mentz: Research Grant; Significant; BMS, AstraZeneca, GSK, Novartis, Gilead, Otsuka. V. Hasselblad: None. J.A. Ezekowitz: Research Grant; Significant; Alere, Amgen, Servier, Trevena, Ortho-Biotech. Honoraria; Modest; Bristol-Myers Squibb, Pfizer, Servier, Johnson & Johnson, Bayer. P.W. Armstrong: Research Grant; Significant; Merck Sharp & Dohme Corp with DCRI, GlaxoSmithKline, Amylin Pharmaceuticals, Inc with DCRI, Merck & Company Inc, Sanofi-aventis Recherche & Développement. Honoraria; Modest; AstraZeneca, GlaxoSmithKline, Merck & Company Inc. Consultant/Advisory Board; Modest; Axio/ Orexigen - DSMB, Merck, Eli Lilly - DSMB, Bayer - DSMB. Consultant/Advisory Board; Significant; F. Hoffmann-La Roche Ltd. - DSMB. F. Zannad: Research Grant; Significant; BG Medicine, Roche Diagnostics. Honoraria; Modest; Pfizer, Bayer, Alere, AstraZeneca, Biotronik, Boehringer Ingelheim, Boston Scientific, Novartis, Relypsa, Servier, Takeda, Resmed. R.M. Califf: Research Grant; Significant; Amylin, BMS, Eli Lilly & Company, Janssen Research & Development, LLC, Merck, Novartis. Ownership Interest; Significant; N30 Pharma, Portola. Consultant/Advisory Board; Modest; Medscape LLC/heart.org. Consultant/Advisory Board; Significant; Novartis, Amgen. A.F. Hernandez: Research Grant; Significant; Portola Pharmaceutical, Medtronic, Merck & Co., The Medicines Company, Glaxo SmithKline, Bristol Myers Squibb. Honoraria; Modest; Ortho-McNeil-Janssen Pharmaceuticals, Inc., Novartis Pharmaceutical Company, Pluristem Therapeutics, Inc., Gilead Sciences, Inc, Bristol Myers Squibb, Boston Scientific, Janssen, Medtronic. C.M. O’Connor: Honoraria; Modest; Amgen, AstraZeneca, Corthera, Forest, Medtronic, Merck, Roche.
- © 2014 by American Heart Association, Inc.