Long-Term Mortality Rates in Acute De Novo Versus Acute-on-Chronic Heart Failure

AlHabib, Khalid F.; Kashour, Tarek; Elasfar, Abdelfatah; AlFaleh, Hussam; Hersi, Ahmad; Alshamiri, Mostafa Q; Alshaer, Fayez; Mimish, Layth; Almasood, Ali; AlHabeeb, Waleed; Alghamdi, Saleh; Ghabashi, Abdullah; Asfina, KaziNur; Altaradi, Hani; Alnobani, Omar; Alkamel, Nour; Thalib, Lukman

doi:10.1177/0003319714563138

Cited by 21 publications

(13 citation statements)

References 26 publications

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“…The above-mentioned differences between the groups regarding the clinical characteristics observed in our AHF patients with worsening of CHF translated into a higher mortality rate, whereby the impact on 3-month mortality was more pronounced than the impact on hospital mortality. This is in line with two recent reports showing a strong association of the chronicity of HF with 6-month and 3-year mortality, but only a weak association with 1-month mortality 30 , 31 . In the present study, the strong association of worsening of CHF with 3-month mortality was weakened, but remained significant upon adjustment for comorbidities and established risk factors in HF 8 , 32 , 33 .…”

Section: Discussionsupporting

confidence: 93%

Acute Heart Failure developed as worsening of Chronic Heart Failure is associated with increased mortality compared to de novo cases

Degoricija

Trbušić

Potočnjak

et al. 2018

Sci Rep

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Acute heart failure (AHF) emerges either de novo or from worsening of chronic heart failure (CHF). The aim of the present study was to evaluate the association between worsening of CHF and mortality in AHF patients. Out of 152 included AHF patients, 47 (30.9%) were de novo AHF patients and 105 (69%) were AHF patients with worsening of CHF. The proportion dying in hospital (19.0% vs. 4.3%, p = 0.023) and within 3 months after hospitalization (36.6% vs. 6.7%, p < 0.001) was significantly higher in AHF patients with worsening of CHF. Logistic regression analyses also showed a significant positive association of AHF emerging as worsening of CHF with hospital mortality [odds ratio (OR) and 95% confidence interval (CI): 5.29 (1.46–34.10), p = 0.029] and 3-month mortality [8.09 (2.70–35.03), p = 0.001]. While the association with hospital mortality was no longer significant after adjusting for comorbidities and clinical as well as laboratory parameters known to be associated with mortality in heart failure patients, the association with 3-month mortality remained significant. We conclude that compared to de novo AHF, AHF evolved from worsening of CHF is a more severe condition and is associated with increased mortality.

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Section: Discussionsupporting

confidence: 93%

Acute Heart Failure developed as worsening of Chronic Heart Failure is associated with increased mortality compared to de novo cases

Degoricija

Trbušić

Potočnjak

et al. 2018

Sci Rep

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“…than in de novo HF decompensation. 2,3 Furthermore, patients who receive a mechanical circulatory support system earlier in the course of disease or CHF achieve better outcomes than those with longstanding CHF before implantation. 5 Finally, in patients with a shorter duration of CHF, a lower rate of cardiovascular death and HF hospitalization was observed after CRT device implantation than in patients with longstanding symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic heart failure (CHF) is a clinical syndrome frequently accompanied by a high load of co-morbidities and characterized by poor outcomes, despite the provision of optimal medical patients. 2,3 Cardiac resynchronization therapy (CRT) initiated early after emerging HF symptoms improved clinical outcomes more than it did when applied later after the development of clinical symptoms. 4 In patients requiring mechanical circulatory support, outcome was better in acute or sub-acute HF than in patients with worsening of CHF and longstanding symptoms.…”

Section: Introductionmentioning

confidence: 99%

Duration of chronic heart failure affects outcomes with preserved effects of heart rate reduction with ivabradine: findings from SHIFT

Böhm

Komajda

Borer

et al. 2017

European J of Heart Fail

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“…Our findings are in accordance with the findings of the Finnish Acute Heart Failure Study (FINN-AKVA) with respect to a higher risk of mortality in the short-term and an equivalent risk on the long-term but stand apart from another report that found that the long –term survival is lower in ACS-AHF patients [ 22 , 23 ]. A few reports have highlighted the unfavorable long-term outcome of acute on chronic HF compared to de novo HF, including a report from our group [ 24 – 27 ]. Yet patients with ACS-AHF in our study, the majority of whom had de novo AHF, were not only at higher risk for hospital adverse cardiovascular outcomes but also had similar long-term survival rates compared to patients with NACS-AHF who predominantly presented with acute on chronic HF.…”

Section: Discussionmentioning

confidence: 99%

Acute heart failure with and without acute coronary syndrome: clinical correlates and prognostic impact (From the HEARTS registry)

AlFaleh

Elasfar

Ullah

et al. 2016

BMC Cardiovasc Disord

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BackgroundLittle is know about the outcomes of acute heart failure (AHF) with acute coronary syndrome (ACS-AHF), compared to those without ACS (NACS-AHF).MethodsWe conducted a prospective registry of AHF patients involving 18 hospitals in Saudi Arabia between October 2009 and December 2010. In this sub-study, we compared the clinical correlates, management and hospital course, as well as short, and long-term outcomes between AHF patients with and without ACS.ResultsOf the 2609 AHF patients enrolled, 27.8 % presented with ACS. Compared to NACS-AHF patients, ACS-AHF patients were more likely to be old males (Mean age = 62.7 vs. 60.8 years, p = 0.003, and 73.8 % vs. 62.7 %, p < 0.001, respectively), and to present with De-novo heart failure (56.6 % vs. 28.1 %, p < 0.001). Additionally they were more likely to have history of ischemic heart disease, diabetes, dyslipidemia, and less likely to have chronic kidney disease (p < 0.001 for all comparisons). The prevalence of severe LV systolic dysfunction (EF < 30 %) was higher in ACS-AHF patients. During hospital stay, ACS-AHF patients were more likely to develop shock (p < 0.001), recurrent heart failure (p = 0.02) and needed more mechanical ventilation (p < 0.001). β blockers and Angiotensin Converting Enzyme inhibitors were used more often in ACS-AHF patients (p = 0.001 and, p = 0.004 respectively). ACS- AHF patients underwent more coronary angiography and had higher prevalence of multi-vessel coronary artery disease (p < 0.001 for all comparisons). The unadjusted hospital and one-month mortality were higher in ACS-AHF patients (OR = 1.6 (1.2–2.2), p = 0.003 and 1.4 (1.0–1.9), p = 0.026 respectively). A significant interaction existed between the level of left ventricular ejection fraction and ACS-AHF status. After adjustment, ACS-AHF status was only significantly associated with hospital mortality (OR = 1.6 (1.1–2.4), p = 0.019). The three-years survival following hospital discharge was not different between the two groups.ConclusionAHF patients presenting with ACS had worse hospital prognosis, and an equivalent long-term survival compared to AHF patients without ACS. These findings underscore the importance of timely recognition and management of AHF patients with concomitant ACS given their distinct presentation and underlying pathophysiology compared to other AHF patients.

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Long-Term Mortality Rates in Acute De Novo Versus Acute-on-Chronic Heart Failure

Abstract: Patients with ACHF had significantly higher long-term mortality rates than those with de novo acute heart failure (HF). Multidisciplinary HF disease management programs are highly needed for such high-risk populations.

Cited by 21 publications

References 26 publications

Acute Heart Failure developed as worsening of Chronic Heart Failure is associated with increased mortality compared to de novo cases

Acute Heart Failure developed as worsening of Chronic Heart Failure is associated with increased mortality compared to de novo cases

Duration of chronic heart failure affects outcomes with preserved effects of heart rate reduction with ivabradine: findings from SHIFT

Acute heart failure with and without acute coronary syndrome: clinical correlates and prognostic impact (From the HEARTS registry)

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