Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(10), 1163–1172. https://doi.org/10.1002/clc.24080 Dr. Lauren Cooper et al.
Points
- Approximately 1/3 of patients with acute decompensated heart failure (ADHF) are discharged with persistent congestion, which is associated with higher mortality and heart failure readmissions.
- Worsening renal function (WRF) occurs in about 50% of ADHF patients, increasing the risk of adverse outcomes.
- A multicenter, prospective registry enrolled 237 patients with ADHF, WRF, and persistent congestion to study current treatments and outcomes.
- Patients with persistent congestion had a high burden of clinical events during hospitalization, including intensive care unit transfers, intubation, left ventricular assist device implantation, and dialysis.
- At the 90-day follow-up, 33% of patients were readmitted for ADHF or died, highlighting the need for novel treatment strategies for this high-risk population.
Summary
This research paper presents findings from a multicenter, prospective registry that aimed to investigate the current treatments and outcomes for patients hospitalized with acute decompensated heart failure (ADHF) complicated by worsening renal function (WRF) and persistent congestion. The study enrolled 237 patients with ADHF, WRF, and persistent congestion, with an average age of 66 years. The results showed that patients with persistent congestion had a high burden of clinical events during hospitalization, including intensive care unit transfers, intubation, left ventricular assist device implantation, and dialysis. At the 90-day follow-up, 33% of patients were readmitted for ADHF or died. The study highlights the need for novel treatment strategies for this high-risk population.
Acute decompensated heart failure (ADHF) is a common condition, and approximately one-third of patients with ADHF are discharged with persistent congestion. Worsening renal function (WRF) is also prevalent in ADHF patients, occurring in around 50% of hospitalized cases. The combination of WRF and persistent congestion is associated with a higher risk of mortality and readmissions for heart failure. This study aimed to provide insights into the current treatments and outcomes for patients with ADHF complicated by WRF and persistent congestion, focusing on clinical events during hospitalization and the 90-day post-discharge period.
A multicenter, prospective registry was designed to enroll patients hospitalized with ADHF, WRF (defined as a creatinine increase ≥0.3 mg/dL), and persistent congestion at 96 hours. The study participants were followed during their hospitalization and the 90-day post-discharge period. An economic substudy was conducted to analyze the hospitalization costs. The registry aimed to describe the characteristics, treatments, outcomes, and costs associated with this patient population.
The study enrolled 237 patients with ADHF, WRF, and persistent congestion. The average age of the participants was 66 years, and 61% had a left ventricular ejection fraction (LVEF) of ≤40%. The mean baseline creatinine was 1.7 mg/dL. Patients with persistent congestion experienced a high burden of clinical events during their hospitalization, including intensive care unit transfers, intubation, left ventricular assist device implantation, and dialysis. At the 90-day follow-up, 33% of patients were readmitted for ADHF or died. The outcomes and costs were similar between patients with reduced and preserved LVEF, emphasizing the significance of persistent congestion and WRF in both groups.
The study highlights the high risk and poor outcomes associated with persistent congestion and WRF in patients hospitalized with ADHF. Despite diuresis, many patients continue to experience persistent congestion and are at increased risk of adverse events during hospitalization and early follow-up. The findings underscore the urgent need for novel treatment strategies to improve outcomes in this high-risk population. Further research and interventions are warranted to address patients’ ADHF, WRF, and persistent congestion challenges.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24080
References Cooper, L., DeVore, A., Cowger, J., Pinney, S., Baran, D., DeWald, T. A., Burt, T., Pietzsch, J. B., Walton, A., Aaronson, K., & Shah, P. (2023). Patients hospitalized with acute heart failure, worsening renal function, and persistent congestion are at high risk for adverse outcomes despite current medical therapy. Clinical Cardiology, 46(10), 1163–1172. https://doi.org/10.1002/clc.24080
