Abstract 14073: Trajectory of Congestion Metrics by Ejection Fraction in Acute Heart Failure - Findings From the Heart Failure Network
Background: Differences in the clinical course of congestion by underlying ejection fraction (EF) have not been well-characterized in acute heart failure (AHF).
Methods: A post-hoc analysis was performed using pooled data from the DOSE, CARRESS, and ROSE trials. All patients were admitted for primary diagnosis of AHF defined by the presence of one symptom and one sign of HF. Patients were grouped as reduced EF ≤40%, borderline EF = 41-49%, or preserved EF ≥50%. Pearson χ2 and Kruskal-Wallis tests were used to compare clinical characteristics. Multivariable regression analysis was used to assess the association between measures of congestion and the composite of death, rehospitalization, or unscheduled outpatient visits at 60 days.
Results: Overall, 732 (86%) patients had EF documentation within the prior year. Mean age was 68±13 years and 74% were male. Patients with preserved EF were older, more likely to be female, less likely to have an ischemic HF etiology, and had a higher prevalence of atrial fibrillation/flutter and chronic obstructive pulmonary disease (Table). At baseline, compared to patients with borderline or reduced EF, preserved EF patients had lower NT-proBNP levels. In general, there were few differences in the clinical course of congestion as measured by signs and symptoms of HF, change in NT-proBNP levels, body weight change, and net fluid loss. After adjusting for potential confounders, a greater improvement in global visual analogue scale (VAS) was associated with lower risk of the composite of death, rehospitalization, or unscheduled outpatient visits at day 60 (Hazard Ratio 0.94, 95% Confidence Interval 0.89-0.995; p-value =0.03). This relationship did not differ by EF (interaction p-value = 0.54).
Conclusion: Among patients hospitalized for AHF, despite baseline differences in demographics and clinical characteristics, there were few systematic differences in the in-hospital trajectory of routine markers of congestion by EF.
Author Disclosures: A.P. Ambrosy: None. A. Bhatt: None. D. Gallup: None. K. Anstrom: 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,. A.D. DeVore: Other Research Support; Modest; American Heart Association, Amgen, Novartis. G.M. Felker: None. 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. J.P. Kelly: None. 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.