Angiotensin-converting enzyme inhibitors and beta-blockers provide life-saving benefits in most of the subpopulations assessed. Women with asymptomatic LV systolic dysfunction may not achieve a mortality benefit when treated with ACE inhibitors.

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During chronic therapy tailored to early hemodynamic response in advanced heart failure, acute vasodilator response persists, and near-normal filling pressures can be maintained in patients who survive without transplantation. Stroke volumes at low filling pressures increase further over time. Chronic hemodynamic improvement was accompanied by symptomatic improvement, but the contributions of the monitored hemodynamic approach, increased vasodilator doses, and comprehensive outpatient management have not yet been established.

The prognosis of patients with advanced heart failure and atrial fibrillation is improving. These findings support the practice of avoiding class I antiarrhythmic drugs in this group and may reflect recent beneficial changes in heart failure therapy.

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Background Readmission within 30 days after hospitalization for heart failure is a major public health problem. Objective To examine whether timing and type of post-discharge follow-up impacts risk of 30-day readmission in adults hospitalized for heart failure. Design Nested matched case-control study (January 1, 2006 to June 30, 2013). Setting A large, integrated healthcare delivery system in Northern California. Participants Hospitalized adults with a primary diagnosis of heart failure discharged to home without hospice care. Measurements Outpatient visits and telephone calls with cardiology and general medicine providers in non-emergency department and non-urgent care settings were counted as follow-up care. Statistical adjustments were made for differences in patient sociodemographic and clinical characteristics, acute severity of illness, hospitalization characteristics and post-discharge medication changes and laboratory testing. Results Among 11,985 eligible adults, early initial outpatient contact within 7 days after discharge was associated with lower odds of readmission (adjusted odds ratio [OR] 0.81, 95% CI: 0.70–0.94), whereas later outpatient contact between 8 and 30 days after hospital discharge was not significantly associated with readmission (adjusted OR 0.99, 95% CI: 0.82–1.19). Initial contact by telephone was associated with lower adjusted odds of 30-day readmission (adjusted OR 0.85, 95% CI 0.69–1.06) but was not statistically significant. Conclusions In adults discharged to home after hospitalization for heart failure, outpatient follow-up with a cardiology or general medicine provider within 7 days was associated with a lower chance of 30-day readmission.

A minority of patients with dilated cardiomyopathy and symptoms for < or = 6 months will have marked improvement in left ventricular function, after which prognosis is excellent despite previous referral for heart transplantation. Those with symptom duration > 3 months and more severe initial decompensation as reflected by higher filling pressures and lower serum sodium levels are unlikely to show improvement and may require earlier consideration for heart transplantation.