DURHAM, NC – How are long-term chronic heart failure (HF) survivors who are hospitalized for acute exacerbation different from patients with more recent HF diagnoses?
A study led by Duke University and involving researchers from the San Francisco VAMC sought to answer that question, evaluating the influence of HF chronicity on acute HF patient profiles and outcomes. The results were published recently in the Journal of the American College of Cardiology.1
The ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial randomized 7,141 hospitalized patients with acute HF with reduced or preserved ejection fraction (EF) to receive nesiritide or placebo in addition to standard care.
Researchers compared patients according to duration of HF diagnosis before index hospitalization by using pre-specified cutoffs — 0 to 1 month was defined as “recently diagnosed,” and the other groups were less than one month to a year, more than a year to 60 months and greater than 60 months.
As a whole, 80.4% of the 5,741patients had documentation of duration of HF diagnosis, with the average age ranging 64 to 66 years, and mean ejection fraction varying from 29% to 32%.
Results indicate that, compared with patients with longer HF duration, recently diagnosed patients were more likely to be women with non-ischemic HF etiology, higher baseline blood pressure, better baseline renal function, and fewer comorbidities.
After adjustment, compared with recently diagnosed patients, patients with longer HF duration were associated with more persistent dyspnea at 24 hours and increased 180-day mortality:
- 1 to 12 months, odds ratio [OR]: 1.20 and hazard ratio [HR]: 1.89, respectively;
- >12 to 60 months, OR: 1.34 and HR: 1.82, respectively;
- >60 months, OR: 1.31 and HR 2.02, respectively.
“The influence of HF duration on mortality was potentially more pronounced among female patients (interaction p = 0.05), but did not differ according to age, race, prior ischemic heart disease, or ejection fraction (all interactions, p ≥ 0.23),” the authors noted.
They concluded, “In this acute HF trial, patient profile differed according to duration of the HF diagnosis. A diagnosis of HF for ≤1 month before hospitalization was independently associated with greater early dyspnea relief and improved post-discharge survival compared to patients with chronic HF diagnoses. The distinction between de novo or recently diagnosed HF and worsening chronic HF should be considered in the design of future acute HF trials.”
- Greene SJ, Hernandez AF, Dunning A, Ambrosy AP, Armstrong PW, Butler J, Cerbin LP, Coles A, Ezekowitz JA, Metra M, Starling RC, Teerlink JR, Voors AA, O’Connor CM, Mentz RJ. Hospitalization for Recently Diagnosed Versus Worsening Chronic Heart Failure: From the ASCEND-HF Trial. J Am Coll Cardiol. 2017 Jun 27;69(25):3029-3039. doi: 10.1016/j.jacc.2017.04.043. PubMed PMID: 28641792.