Abstract 13158: Hospitalization for De Novo versus Worsening Chronic Heart Failure: Insights From the ASCEND-HF Trial
Introduction: Heart failure (HF) is a heterogeneous syndrome and individual patient survival varies widely. It is unclear how hospitalized acute HF (AHF) patients who are long-term chronic HF survivors differ from those with more recent HF diagnoses.
Methods: The ASCEND-HF trial randomized 7,141 hospitalized AHF patients with reduced or preserved ejection fraction (EF) to nesiritide or placebo in addition to standard care. The present analysis compared patients by duration of HF diagnosis prior to index hospitalization using pre-specified cutpoints (0-1 month [i.e. “de novo”], >1-12 months, >12-60 months, >60 months).
Results: Overall, 5,741 (80.4%) patients had documentation of duration of HF diagnosis (de novo, N=1536; >1-12 months, N=1020; >12-60 months, N=1653; >60 months, N=1532). Mean age ranged from 64-66 years and mean EF from 29-32% across all HF duration groups. Compared to patients with longer HF duration, de novo patients were more likely to have non-ischemic HF etiology, fewer comorbidities, lower natriuretic peptide levels, and better baseline functional status (all P-value <0.01). After adjustment, compared to de novo patients, longer HF duration was associated with more persistent dyspnea at 24 hours and increased 180-day mortality (Table). The influence of HF duration on mortality did not differ by age, gender, race, etiology of HF, or EF (all P-value for interaction ≥0.05).
Conclusion: In this large AHF trial cohort, patient profile differed by duration of the HF diagnosis. De novo HF diagnosis was independently associated with greater early dyspnea relief and improved post-discharge survival compared to those with chronic HF diagnoses.
Author Disclosures: S.J. Greene: None. A.F. Hernandez: Other Research Support; Modest; Amylin and Scios/Johnson and Johnson. Consultant/Advisory Board; Modest; Sanofi, Johnson and Johnson, AstraZeneca, and Corthera. A. Dunning: None. A.P. Ambrosy: None. P.W. Armstrong: None. J. Butler: Other Research Support; Significant; National Institutes of Health, European Union, Health Resource Services Administration, and Food and Drug Administration, Amgen. Consultant/Advisory Board; Modest; Takeda, Medtronic, Z Pharma, Zensun, Celladon, Gambro, GE Healthcare, Janssen, Ono. Consultant/Advisory Board; Significant; Bayer, CardioCell, Merck, Novartis, Relypsa, Trevena,. L. Cerbin: None. A. Coles: None. J.A. Ezekowitz: Research Grant; Modest; Amgen and Johnson and Johnson. Consultant/Advisory Board; Modest; Pfizer, Abbott Laboratories, and Servier. M. Metra: Consultant/Advisory Board; Modest; Bayer, Novartis, and Servier. R.C. Starling: Research Grant; Modest; National Institutes of Health, Medtronic, Biotronik, Novartis, and Thoratec. Other Research Support; Modest; American Board of Internal Medicine. Ownership Interest; Modest; Cardiomems. Consultant/Advisory Board; Modest; Novartis, BioControl, and Medtronic. J.R. Teerlink: Consultant/Advisory Board; Modest; Amgen, Madeleine, Mast Therapeutics, Novartis, Relypsa, and Trevena. A.A. Voors: Consultant/Advisory Board; Modest; Alere, Amgen, Anexon, Bayer, Boehringer Ingelheim, Cardio3Biosciences, Celladon, Merck, Novartis, Servier, Torrent, and Vifor Pharma. C.M. O’Connor: Other Research Support; Modest; Otsuka, Roche Diagnostics, BG Medicine, Critical Diagnostics, Astellas, Gilead, GE Healthcare, and ResMed. Ownership Interest; Modest; Biscardia, LLC. Consultant/Advisory Board; Modest; Novella and Amgen. R.J. Mentz: Other Research Support; Modest; Amgen, Aztra Zeneca, Bristol Meyers Squibb, GlaxoSmithKline, Gilead, Medtronic, Novartis, Otsuka, ResMed. Honoraria; Modest; HeartWare, Janssen, Luitpold Pharmaceuticals, Novartis, ResMed, Thoratec/ St Jude. Consultant/Advisory Board; Modest; Luitpold Pharmaceuticals.
- © 2016 by American Heart Association, Inc.