Effects of serelaxin on the outcome of patients with or without substantial peripheral edema: A subgroup analysis from the RELAX-AHF trial

Gimpelewicz, Claudio; Metra, Marco; Cleland, John G.F.; Szecsödy, Peter; Wun, Chuan-Chuan; Boer-Martins, Leandro; Cotter, Gad; Davison, Beth A.; Felker, G. Michael; Filippatos, Gerasimos; Greenberg, Barry; Pang, Peter S.; Ponikowski, Piotr; Severin, Thomas; Voors, A.A.; Teerlink, John R.

doi:10.1016/j.ahj.2017.05.012

Cited by 11 publications

(12 citation statements)

References 26 publications

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“…Fewer than half of patients presented with severe breathlessness at rest and yet this has been the main focus of trials of AHF until now. Patients presenting primarily with increasing oedema appear to be a common, but neglected group of patients [ 24 ]; recent post-hoc analyses suggests that such patients might account for the response observed to agents for AHF such as serelaxin [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the First Euro Heart Failure Survey

et al. 2018

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Background Heart failure is heterogeneous in aetiology, pathophysiology, and presentation. Despite this diversity, clinical trials of patients hospitalized for HF deal with this problem as a single entity, which may be one reason for repeated failures. Methods The first EuroHeart Failure Survey screened consecutive deaths and discharges of patients with suspected heart failure during 2000–2001. Patients were sorted into seven mutually exclusive hierarchical presentations: (1) with cardiac arrest/ventricular arrhythmia; (2) with acute coronary syndrome; (3) with rapid atrial fibrillation; (4) with acute breathlessness; (5) with other symptoms/signs such as peripheral oedema; (6) with stable symptoms; and (7) others in whom the contribution of HF to admission was not clear. Results The 10,701 patients enrolled were classified into the above seven presentations as follows: 260 (2%), 560 (5%), 799 (8%), 2479 (24%), 1040 (10%), 703 (7%), and 4691 (45%) for which index-admission mortality was 26%, 20%, 10%, 8%, 6%, 6%, and 4%, respectively. Compared to those in group 7, the hazard ratios for death during the index admission were 4.9 ( p ≤ 0.001), 4.0 ( p < 0.001), 2.2 ( p < 0.001), 2.1 ( p < 0.001), 1.4 ( p < 0.04) and 1.4 ( p = 0.04), respectively. These differences were no longer statistically significant by 12 weeks. Conclusion There is great diversity in the presentation of heart failure that is associated with very different short-term outcomes. Only a minority of hospitalizations associated with suspected heart failure are associated with acute breathlessness. This should be taken into account in the design of future clinical trials.

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Section: Discussionmentioning

confidence: 99%

Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the First Euro Heart Failure Survey

et al. 2018

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“…(26) More data are available for patients enrolled in randomised trials but these are inevitably highly- with moderate/severe oedema had a worse prognosis as compare to no/mild oedema but had similar relative but possibly greater absolute benefit from administration of serelaxin. (13) There are many possible reasons for the higher mortality amongst those with more severe peripheral oedema. It is likely that they have higher right atrial pressures, reflecting more severe pulmonary hypertension, due in part to more severe left heart disease, more severe right ventricular dysfunction and more tricuspid regurgitation.…”

Section: Apart From Optimize-hf (Organized Program To Initiate Lifesamentioning

confidence: 99%

“…Peripheral oedema has been associated with longer lengths of stay and higher risks of re-admission and death, although these reports included a relatively small number of patients. (2,13) Accordingly, we investigated the clinical characteristics, length of stay and mortality, both during the index admission and after discharge, according to severity of peripheral oedema at presentation in patients enrolled in National Heart Failure Audit (NHFA) for England & Wales.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcome of acute heart failure patients according to the severity of peripheral oedema

Shoaib

Mamas

Ahmad

et al. 2019

International Journal of Cardiology

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Background: Most trials of patients hospitalised for heart failure focus on breathlessness (alveolar pulmonary oedema) but worsening peripheral oedema is also an important presentation. We investigated the relationship between the severity of peripheral oedema on admission and outcome amongst patients with a primary discharge death or diagnosis of heart failure. Objectives:We tested the hypothesis that severity of peripheral oedema is associated with length of hospital stay and mortality. Methods: Patient variables reported to the National Heart Failure Audit for England & Wales between April 2008 and March 2013 were included in this analysis. Peripheral oedema was classified as 'none', 'mild', 'moderate' or 'severe'. Length of stay, mortality during the index admission and for up to three years after discharge are reported.Results: Of 121,214 patients, peripheral oedema on admission was absent in 24%, mild in 24%, moderate in 33% and severe in 18%. Median length of stay was, respectively, 6, 7, 9 and 12 days (P-<0.001), index admission mortality was 7%, 8%, 10% and 16% (P-<0.001) and mortality at a median follow-up of 344 (IQR 94-766) days was 39%, 46%, 52% and 59%. In an adjusted multi-variable Cox model, the hazard ratio for death was 1.51 for severe (P-<0.001, CI 1.50-1.53), 1.21 for moderate (P-<0.001, CI 1.20-1.22) and 1.04 (P-<0.001, CI 1.02-1.05) for mild peripheral oedema compared to patients without peripheral oedema at presentation. Page 3 of 23Conclusion: Length of hospital stay and mortality during index admission and after discharge increased progressively with increasing severity of peripheral oedema at admission.

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“…Improving haemodynamics pharmacologically with either inotropic or vasodilator agents has been met with limited success in managing DHF (7); as has ultrafiltration (8). Percutaneous mechanical support devices might be useful, if safe, convenient and cost-effective but there are few data on their effects on diuresis and congestion in patients with DHF (9,10).…”

Section: Introductionmentioning

confidence: 99%

Percutaneous haemodynamic and renal support in patients presenting with decompensated heart failure: A multi-centre efficacy study using the Reitan Catheter Pump (RCP)

Karamasis

Rothman

Ricksten

et al. 2019

International Journal of Cardiology

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Effects of serelaxin on the outcome of patients with or without substantial peripheral edema: A subgroup analysis from the RELAX-AHF trial

Abstract: Overall, patients with AHF and moderate/severe peripheral edema have a worse prognosis but appear to receive similar relative benefit and perhaps greater absolute benefit from serelaxin administration.

Cited by 11 publications

References 26 publications

Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the First Euro Heart Failure Survey

Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the First Euro Heart Failure Survey

Characteristics and outcome of acute heart failure patients according to the severity of peripheral oedema

Percutaneous haemodynamic and renal support in patients presenting with decompensated heart failure: A multi-centre efficacy study using the Reitan Catheter Pump (RCP)

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