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Duration of HF associated with variations in dyspnea, mortality
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Patients with recently diagnosed HF had greater early dyspnea relief and improved survival after hospital discharge vs. those with chronic HF, according to published findings.
“Although overall event rates are high, HF is a heterogeneous clinical syndrome coinciding with various cardiac and noncardiac disease processes, and individual patient survival after hospitalization may vary widely,” Stephen J. Greene, MD, of the Duke University Medical Center and the Duke Clinical Research Institute, and colleagues wrote. “It is unclear how hospitalized patients who are previous long-term chronic HF survivors differ from those with more recent or de novo HF diagnoses. Determining the characteristics of long-term HF survivors and whether they continue to experience favorable post-discharge prognoses may offer incremental insights into risk stratification, therapeutic management and clinical trial design.”
Greene and colleagues used data from the ASCEND-HF trial, which randomly assigned 7,141 patients hospitalized for acute HF with reduced or preserved ejection fraction to nesiritide (Natrecor, Scios) or placebo. Diagnosis of HF was categorized as 0 to 1 month from hospitalization (recently diagnosed), more than 1 to 12 months, more than 12 to 60 months and more than 60 months.
HF duration and outcomes
Overall, 80.4% (n = 5,741) of participants had documentation of HF diagnosis (recently diagnosed, n = 1,536; > 1 to 12 months, n = 1,020; > 12 to 60 months, n = 1,653; and > 60 months, n = 1,532). Mean ejection fraction ranged from 29% to 32% across groups, and mean age ranged from 64 to 66 years.
Recently diagnosed participants were more likely to be women with nonischemic HF etiology and have higher baseline BP, better renal function and fewer comorbidities vs. those with longer HF duration.
Compared with recently diagnosed participants, those with longer HF duration were associated with more persistent dyspnea at 24 hours (> 1 to 12 months, OR = 1.2; 95% CI, 0.97-1.48; > 12 to 60 months, OR = 1.34; 95% CI, 1.11-1.62; > 60 months; OR = 1.31; 95% CI, 1.08-1.6) and increased 180-day mortality (> 1 to 12 months, HR = 1.89; 95% CI, 1.35-2.65; > 12 to 60 months, HR = 1.82; 95% CI, 1.33-2.48; > 60 months, HR = 2.02; 95% CI, 1.47-2.77).
Among women, the influence of HF duration on mortality was more pronounced (P for interaction = .05). The associations between HF duration and dyspnea and mortality were independent of age, race, prior ischemic heart disease or ejection fraction (P for all interactions ≥ .23).
Better classification
In an accompanying editorial, Scott D. Solomon, MD, and Akshay S. Desai, MD, MPH, of Brigham and Women’s Hospital, wrote: “The data argue for more careful segmentation of the acute HF population at the time of trial entry, as well as a more thorough ascertainment of worsening HF endpoints, independent of the treatment context in which they occur. Importantly, these data represent only one step toward a more granular classification of acute HF syndromes. Current guidelines postulate that there may be value to further subcategorization of patients based on hemodynamic profiles at presentation, admitting [BP], precipitating factors (eg, [ACS], arrhythmias, valvular disease, pulmonary embolism), and clinical features (eg, the presence or absence of pulmonary edema); however, none of these designations has been systematically used in the design of clinical trials of novel therapeutics in practice.” – by Cassie Homer
Disclosures: Greene reports no relevant financial disclosures. Please see the study for the other researchers’ relevant financial disclosures. Desai reports receiving consultant fees and research grants from Novartis; and consultant fees from Abbott, AstraZeneca, Janssen, Relypsa and Sanofi. Solomon reports receiving research grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Celladon, Gilead, GlaxoSmithKline, Ionis Pharmaceuticals, Lone Star Heart, Mesoblast, MyoKardia, Novartis, Sanofi Pasteur and Theracos; and consultant fees from Alnylam, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Corvia, Gilead, GlaxoSmithKline, Ironwood, Merck, Novartis, Pfizer, Takeda and Theracos.
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