De novo acute heart failure: Clinical features and one-year mortality in the Spanish nationwide Registry of Acute Heart Failure

ObjectivesWe investigated the natural history of patients after a first episode of acute heart failure (FEAHF) requiring emergency department (ED) consultation, focusing on: the frequency of ED visits and hospitalisations, departments admitting patients during the first and subsequent hospitalisations, and factors associated with difficult disease control.We included consecutive patients diagnosed with FEAHF (either with or without previous heart failure diagnosis) in four EDs during 5 months in three different time periods (2009, 2011, 2014). Diagnosis was adjudicated by local principal investigators. The clinical characteristics of the index event were prospectively recorded, and all post-discharge ED visits and hospitalisations [related/unrelated to acute heart failure (AHF)], as well as departments involved in subsequent hospitalisations were retrospectively ascertained. 'Uncontrolled disease' during the first year after FEAHF was considered if patients were attended at ED (≥ 3 times) or hospitalised (≥ 2 times) for AHF or died. Overall, 505 patients with FEAHF were included and followed for a mean of 2.4 years. In-hospital mortality was 7.5%. Among 467 patients discharged alive, 288 died [median survival 3.9 years, 95% confidence interval (CI) 3.5-4.4], 421 (90%) revisited the ED (2342 ED visits; 42.4% requiring hospitalisation, 34.0% AHF-related) and 357 Ò. Miró et al.(77%) were hospitalised (1054 hospitalisations; 94.1% through ED, 51.4% AHF-related). AHF-related hospitalisations were mainly in internal medicine (28.0%), short-stay unit (26.3%), cardiology (20.8%), and geriatrics (14.1%). Only 47.4% of AHF-related hospitalisations were in the same department as the FEAHF, and internal medicine involvement significantly increased with subsequent hospitalisations (P = 0.01). Uncontrolled disease was observed in 31% of patients, which was independently related to age > 80 years [odds ratio (OR) 1.80, 95% CI 1.17-2.77], systolic blood pressure < 110 mmHg at ED arrival (OR 2.61, 95% CI 1. 26-5.38) and anaemia (OR 2.39, 95% CI

Section: Introductionmentioning

confidence: 99%

Departments involved during the first episode of acute heart failure and subsequent emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort

Sarasola

Fuenzalida

Calderón

et al. 2019

“…2,26 Importantly, this study provides further evidence that de novo patients are inherently different from those with a previous diagnosis of HF, with different baseline characteristics and a better prognosis. 11,12 The TRANSITION study design does not allow . any conclusions relating to differential improvements in prognosis associated with sacubitril/valsartan therapy and the study was not specifically designed or powered for the comparison of outcomes between the de novo and prior HFrEF groups.…”

Section: Discussionmentioning

confidence: 99%

“…6,13,14 In addition, de novo HF patients still have a poor prognosis, with 1-year mortality rates between 15% and 27%. 11,12,15 There are limited data describing the clinical course, biomarker profiles, safety and tolerability in relation to the initiation of chronic HF treatment in patients with de novo HFrEF who are stabilised following admission for ADHF.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Diagnosis of de novo HF is associated with a less severe disease profile, and longer-term prognosis is better than that of patients with prior HF. 11,12 However, patients hospitalised with de novo ADHF share the same mortality risk rate within the vulnerable 30-day post-ADHF period as patients with a prior diagnosis of HFrEF. 6,13,14 In addition, de novo HF patients still have a poor prognosis, with 1-year mortality rates between 15% and 27%.…”

Section: Introductionmentioning

confidence: 99%

“…Registry data suggests that de novo cases of HF represent approximately 25% to 29% of all cases of hospitalisation for ADHF . Diagnosis of de novo HF is associated with a less severe disease profile, and longer‐term prognosis is better than that of patients with prior HF . However, patients hospitalised with de novo ADHF share the same mortality risk rate within the vulnerable 30‐day post‐ADHF period as patients with a prior diagnosis of HFrEF .…”

Section: Introductionmentioning

confidence: 99%

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Initiation of sacubitril/valsartan shortly after hospitalisation for acutely decompensated heart failure in patients with newly diagnosed (de novo) heart failure: a subgroup analysis of the TRANSITION study

Senni

Wachter

Witte

et al. 2019

Aims Sacubitril/valsartan has shown efficacy and tolerability in patients with heart failure (HF) and reduced ejection fraction (HFrEF) in the ambulatory setting (PARADIGM‐HF), and following stabilisation of acutely decompensated HF (ADHF) (PIONEER‐HF and TRANSITION). However, data are lacking for the initiation of sacubitril/valsartan in newly diagnosed (de novo) HFrEF. Here, we assess the tolerability of initiating sacubitril/valsartan following ADHF in TRANSITION subgroups of patients with a de novo vs. prior diagnosis of HFrEF. Methods and results TRANSITION randomised 1002 patients to pre‐ and post‐discharge initiation of sacubitril/valsartan (analysis set n = 991, following exclusions for mis‐randomisation). In this post‐hoc analysis, tolerability to sacubitril/valsartan [proportion of patients achieving target dose (97/103 mg b.i.d.) at 10 weeks post‐randomisation], adverse events (AEs) and serious AEs (SAEs) were compared in de novo (n = 286) and prior HFrEF (n = 705) subgroups. More de novo than prior HFrEF patients achieved target dose at Week 10 (56% vs. 45%; relative risk ratio 1.30, 95% confidence interval 1.12–1.52, P < 0.001), and fewer had SAEs and permanent treatment discontinuations. Initiation of sacubitril/valsartan did not prevent the concomitant initiation and up‐titration of guideline‐directed HF therapies. De novo patients showed faster and greater decreases in N‐terminal pro‐B‐type natriuretic peptide and high‐sensitivity troponin‐T, and lower rates of HF and all‐cause rehospitalisation vs. prior HFrEF. Conclusions After ADHF, first‐line initiation of sacubitril/valsartan in de novo HFrEF, alongside the initiation of other guideline‐directed therapies, is feasible and is associated with a better risk–benefit profile than in patients with prior HFrEF. Early intervention with sacubitril/valsartan may be considered to delay disease progression in patients with de novo HFrEF. Clinical Trial Registration: http://www.clinicaltrials.gov, NCT02661217.

The different risk of new‐onset, chronic, worsening, and advanced heart failure: A systematic review and meta‐regression analysis

Shakoor,

Abou Kamar,

Malgie

et al. 2023

Background and aimsHeart failure (HF) is a chronic and progressive syndrome associated with a poor prognosis. While it may seem intuitive that the risk of adverse outcomes varies across the different stages of HF, an overview of these risks is lacking. This study aims to determine the risk of all‐cause mortality and HF hospitalizations associated with new‐onset HF, chronic HF (CHF), worsening HF (WHF), and advanced HF (adv. HF).MethodsWe performed a systematic review of observational studies from 2012 to 2022 using five different databases. The primary outcomes were 30‐day and one‐year all‐cause mortality, as well as one‐year HF hospitalization. Studies were pooled using random effects meta‐analysis, and mixed‐effects meta‐regression was used to compare the different HF groups.ResultsAmong the 15.759 studies screened, 66 were included representing 862.046 HF patients. Pooled 30‐day mortality rates did not reveal a significant distinction between hospital‐admitted patients, with rates of 10.13% for new‐onset HF and 8.11% for WHF (p = 0.10). However, the one‐year mortality risk differed and increased stepwise from CHF to adv. HF, with a rate of 8.47% (95% CI 7.24–9.89) for CHF, 21.15% (95% CI 17.78–24.95) for new‐onset HF, 26.84% (95% CI 23.74–30.19) for WHF, and 29.74% (95% CI 24.15–36.10) for adv HF. Readmission rates for HF at one year followed a similar trend.ConclusionsOur meta‐analysis of observational studies confirms the different risk for adverse outcomes across the distinct HF stages. Moreover, it emphasizes the negative prognostic value of WHF as the first progressive stage from CHF towards adv. HF.This article is protected by copyright. All rights reserved.