Comprehensive in‐hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Harjola, Veli Pekka; Parissis, John; Rocca, Hans‐Peter Brunner‐La; Čelutkienė, Jelena; Chioncel, Ovidiu; Collins, Sean P.; Backer, Daniel De; Filippatos, Gerasimos; Gayat, Étienne; Hill, Loreena; Lainščak, Mitja; Lassus, Johan; Masip, Josep; Mebazaa, Alexandre; Miró, Òscar; Mortara, Andrea; Mueller, Christian; Mullens, Wilfried; Nieminen, Markku S.; Rudiger, Alain; Ruschitzka, Frank; Seferović, Petar; Sionís, Alessandro; Vieillard‐Baron, Antoine; Weinstein, Jean Marc; Boer, Rudolf R.A. de; Crespo-Leiro, María G.; Piepoli, Massimo F; Riley, Jillian J.P.

doi:10.1002/ejhf.1204

Cited by 62 publications

(47 citation statements)

References 171 publications

(264 reference statements)

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“…Furthermore, other biological variables as surrogate markers of haemodynamic congestion, a < 30% change in NP concentrations or decreased haematocrit during hospitalization, add significant prognostic information beyond residual clinical congestion. This underscores the need to integrate all data available from in‐hospital monitoring acquired with different tools …”

Section: Discussionmentioning

confidence: 99%

Acute heart failure congestion and perfusion status – impact of the clinical classification on in‐hospital and long‐term outcomes; insights from the ESC‐EORP‐HFA Heart Failure Long‐Term Registry

Chioncel

Mebazaa

Maggioni

et al. 2019

European J of Heart Fail

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207

173

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Aims Classification of acute heart failure (AHF) patients into four clinical profiles defined by evidence of congestion and perfusion is advocated by the 2016 European Society of Cardiology (ESC)guidelines. Based on the ESC‐EORP‐HFA Heart Failure Long‐Term Registry, we compared differences in baseline characteristics, in‐hospital management and outcomes among congestion/perfusion profiles using this classification. Methods and results We included 7865 AHF patients classified at admission as: ‘dry‐warm’ (9.9%), ‘wet‐warm’ (69.9%), ‘wet‐cold’ (19.8%) and ‘dry‐cold’ (0.4%). These groups differed significantly in terms of baseline characteristics, in‐hospital management and outcomes. In‐hospital mortality was 2.0% in ‘dry‐warm’, 3.8% in ‘wet‐warm’, 9.1% in ‘dry‐cold’ and 12.1% in ‘wet‐cold’ patients. Based on clinical classification at admission, the adjusted hazard ratios (95% confidence interval) for 1‐year mortality were: ‘wet‐warm’ vs. ‘dry‐warm’ 1.78 (1.43–2.21) and ‘wet‐cold’ vs. ‘wet‐warm’ 1.33 (1.19–1.48). For profiles resulting from discharge classification, the adjusted hazard ratios (95% confidence interval) for 1‐year mortality were: ‘wet‐warm’ vs. ‘dry‐warm’ 1.46 (1.31–1.63) and ‘wet‐cold’ vs. ‘wet‐warm’ 2.20 (1.89–2.56). Among patients discharged alive, 30.9% had residual congestion, and these patients had higher 1‐year mortality compared to patients discharged without congestion (28.0 vs. 18.5%). Tricuspid regurgitation, diabetes, anaemia and high New York Heart Association class were independently associated with higher risk of congestion at discharge, while beta‐blockers at admission, de novo heart failure, or any cardiovascular procedure during hospitalization were associated with lower risk of residual congestion. Conclusion Classification based on congestion/perfusion status provides clinically relevant information at hospital admission and discharge. A better understanding of the clinical course of the two entities could play an important role towards the implementation of targeted strategies that may improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Acute heart failure congestion and perfusion status – impact of the clinical classification on in‐hospital and long‐term outcomes; insights from the ESC‐EORP‐HFA Heart Failure Long‐Term Registry

Chioncel

Mebazaa

Maggioni

et al. 2019

European J of Heart Fail

Self Cite

207

173

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“…Despite improvements in therapy for patients with heart failure with a reduced ejection fraction, we have not been able to reduce the risk of heart failure readmissions after a hospitalization for worsening heart failure. Approximately 35–50% of heart failure patients are rehospitalized within 6 months of discharge, making heart failure the most frequent diagnosis for 30‐day readmissions and incurring billions in costs . Therefore, preventing hospital (re‐)admissions is recognized as a major unmet need in the treatment of heart failure.…”

Section: Introductionmentioning

confidence: 99%

Adrenomedullin in heart failure: pathophysiology and therapeutic application

Voors

Kremer

Geven

et al. 2018

European J of Heart Fail

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168

177

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Adrenomedullin (ADM) is a peptide hormone first discovered in 1993 in pheochromocytoma. It is synthesized by endothelial and vascular smooth muscle cells and diffuses freely between blood and interstitium. Excretion of ADM is stimulated by volume overload to maintain endothelial barrier function. Disruption of the ADM system therefore results in vascular leakage and systemic and pulmonary oedema. In addition, ADM inhibits the renin–angiotensin–aldosterone system. ADM is strongly elevated in patients with sepsis and in patients with acute heart failure. Since hallmarks of both conditions are vascular leakage and tissue oedema, we hypothesize that ADM plays a compensatory role and may exert protective properties against fluid overload and tissue congestion. Recently, a new immunoassay that specifically measures the biologically active ADM (bio‐ADM) has been developed, and might become a biomarker for tissue congestion. As a consequence, measurement of bio‐ADM might potentially be used to guide diuretic therapy in patients with heart failure. In addition, ADM might be used to guide treatment of (pulmonary) oedema or even become a target for therapy. Adrecizumab is a humanized, monoclonal, non‐neutralizing ADM‐binding antibody with a half‐life of 15 days. Adrecizumab binds at the N‐terminal epitope of ADM, leaving the C‐terminal side intact to bind to its receptor. Due to its high molecular weight, the antibody adrecizumab cannot cross the endothelial barrier and consequently remains in the circulation. The observation that adrecizumab increases plasma concentrations of ADM indicates that ADM‐binding by adrecizumab is able to drain ADM from the interstitium into the circulation. We therefore hypothesize that administration of adrecizumab improves vascular integrity, leading to improvement of tissue congestion and thereby may improve clinical outcomes in patients with acute decompensated heart failure. A phase II study with adrecizumab in patients with sepsis is ongoing and a phase II study on the effects of adrecizumab in patients with acute decompensated heart failure with elevated ADM is currently in preparation.

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“…15, [216][217][218] Multiple factors may contribute to the poor outcomes of the patients after the hospitalization for acute HF, including socioeconomic factors, poor patient support, and poor adherence to prescribed medications. 24, [223][224][225][226][227] Unfortunately, strategies aimed at a better medical treatment of the acute phase, have failed to improve outcomes in major multicentre trials. 222 Other mechanisms are more directly related with congestion and possibly with myocardial, renal, and hepatic injury with persistent organ dysfunction.…”

Section: Acute Heart Failurementioning

confidence: 99%

“…228,229 The role of sudden cardiac death (SCD) in postdischarge outcomes was investigated in an analysis from Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial. 225 Echocardiography allows an estimate of LV filling pressure and pulmonary artery pressure. 230 Clinical signs have a major role for the prognostic assessment and treatment selection in the patients with acute HF.…”

Section: Acute Heart Failurementioning

confidence: 99%

Highlights in heart failure

et al. 2019

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Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in studies in patients hospitalized for acute HF. More recently, DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 (SGLT2) inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HFpEF research are summarized and reviewed in this article.A multiparametric approach is often proposed for risk stratification of HF patients. The prognostic accuracy of the metabolic exercise test data combined with cardiac and kidney indexes risk score was found as superior to the HF Survival Score and Seattle HF model risk scores in a cohort of 6112 1106 D. Tomasoni et al.

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Comprehensive in‐hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Cited by 62 publications

References 171 publications

Acute heart failure congestion and perfusion status – impact of the clinical classification on in‐hospital and long‐term outcomes; insights from the ESC‐EORP‐HFA Heart Failure Long‐Term Registry

Acute heart failure congestion and perfusion status – impact of the clinical classification on in‐hospital and long‐term outcomes; insights from the ESC‐EORP‐HFA Heart Failure Long‐Term Registry

Adrenomedullin in heart failure: pathophysiology and therapeutic application

Highlights in heart failure

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