Influence of Previous Heart Failure Hospitalization on Cardiovascular Events in Patients With Reduced and Preserved Ejection Fraction

Abstract

Background Hospitalization for acute heart failure (HF) is associated with high rates of subsequent mortality and readmission. We assessed the influence of the time interval between prior HF hospitalization and randomization in the CHARM trials on clinical outcomes in patients with both reduced and preserved ejection fraction. Methods and Results CHARM enrolled 7,599 patients with NYHA class II-IV heart failure, of whom 5,426 had a history of prior HF hospitalization. Cox proportional hazards regression models were utilized to assess the association between time from prior HF hospitalization and randomization and the primary outcome of cardiovascular death or unplanned admission to hospital for the management of worsening HF over a median of 36.6 months. For patients with HF and reduced (HFrEF) or preserved (HFpEF) ejection fraction, rates of CV mortality and HF hospitalization were higher among patients with prior HF hospitalization than those without. The risk for mortality and hospitalization varied inversely with the time interval between hospitalization and randomization. Rates were higher for HFrEF patients within each category. Event rates for those with HFpEF and a HF hospitalization in the 6 months prior to randomization were comparable to the rate in HFrEF patients with no prior HF hospitalization. Conclusions Rates of CV death or HF hospitalization are greatest in those who have been previously hospitalized for HF. Independent of EF, rates of death and readmission decline as time from HF hospitalization to trial enrollment increased. Recent HF hospitalization identifies a high risk population for future clinical trials in HFrEF and HFpEF. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00634400.

Serelaxin in addition to standard therapy in acute heart failure: rationale and design of the RELAX‐AHF‐2 study

“…This is consistent with previous trials testing drugs acting on peripheral vessels and/or renal function in patients with AHF 29, 30. The prognosis of the patients with AHF was not found to be related to left ventricular ejection fraction31 and a similar benefit of serelaxin on clinical outcomes was observed in both patients with preserved and reduced ejection fraction 32. However, to provide additional information on the potential beneficial effects of serelaxin in these groups of patients, echocardiograms are obtained during the index hospitalization in RELAX‐AHF‐2.…”

Regional Variation in Patients and Outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) Trial

“…[23][24][25][26][27][28][29][30] The additional protocol inclusion criterion in TOPCAT of either a prior hospitalization in which heart failure was a prominent feature or an elevated natriuretic peptide level was intended to both improve diagnostic certainty and to augment risk. The assumption that those with a prior hospitalization would have higher risk [31][32][33][34][35] was confirmed only for the patients randomized from the Americas, suggesting that the nonadjudicated qualifying hospitalization criterion enrolled different patient populations. However, multifold lower event rates were also observed in the patients qualifying by natriuretic peptides from Russia/Georgia.…”

Influence of Sacubitril/Valsartan (LCZ696) on 30-Day Readmission After Heart Failure Hospitalization

“…Recurrent hospitalizations are a primary driver of the burgeoning costs associated with HF care (3) and are a potent marker of risk for subsequent mortality (9,10). Although patients discharged with HF are at risk for readmission well beyond 30 days, the early post-discharge interval is known to be a particularly vulnerable period (11,12).…”