Optimal Endpoints of Acute Heart Failure Therapy

Huston, Jessica; Ferre, Robinson M.; Pang, Peter S.; Chioncel, Ovidiu; Butler, Javed; Collins, Sean P.

doi:10.1097/mjt.0000000000000792

Cited by 4 publications

(3 citation statements)

References 71 publications

(74 reference statements)

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“…Also, in a post‐hoc analysis including patients from DOSE‐AHF and CARESS‐HF, 48% of patients had signs of congestion at discharge, and in particular had higher mortality and rehospitalization rates at 60 days . Ensuring decongestion is an essential goal during AHF hospitalization, but there is no standardized method for evaluating congestion before discharge and what defines adequate decongestion is currently unclear . Although clinical trials proposed a ‘definition for decongestion’, assessment of decongestion based strictly on trial pre‐defined clinical signs may be non‐sensitive and non‐specific, and has not been investigated in real‐life clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…19 Ensuring decongestion is an essential goal during AHF hospitalization, but there is no standardized method for evaluating congestion before discharge and what defines adequate decongestion is currently unclear. 20 Although clinical trials 17,21 proposed a 'definition for decongestion', assessment of decongestion based strictly on trial pre-defined clinical signs may be non-sensitive and non-specific, and has not been investigated in real-life clinical practice. Furthermore, clinicians often limit decongestion interventions due to fear of WRF, but growing evidence suggests that apparent WRF that is due to decongestion is both reversible and not associated with harm.…”

Section: Figurementioning

confidence: 99%

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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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184

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%

Section: Figurementioning

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

184

173

View full text Add to dashboard Cite

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“… 3 , 27 Because residual congestion is associated with the risk of rehospitalization and death, adequate decongestion is an essential goal of patient management. 28 , 29 However, decongestion targets are not well defined, 30 , 31 probably because of the absence of a clear congestion‐evaluation strategy and the differences in individual decongestion targets. Furthermore, clinicians often limit decongestion interventions to avoid increasing serum creatinine levels, although such an increase reflects effective decongestion, is reversible, and is not associated with acute tubular injury 32 or increased mortality.…”

Section: Discussionmentioning

confidence: 99%

Changes in Doppler‐Derived Kidney Venous Flow and Adverse Cardiorenal Outcomes in Patients With Heart Failure

Husain‐Syed

Singam

Viehman

et al. 2023

JAHA

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Background The impact of changes in Doppler‐derived kidney venous flow in heart failure (HF) is not well studied. We aimed to investigate the association of Doppler‐derived kidney venous stasis index (KVSI) and intrakidney venous‐flow (IKVF) patterns with adverse cardiorenal outcomes in patients with HF. Methods and Results In this observational cohort study, consecutive inpatients with HF referred to a nephrologist because of a history of diuretic resistance and abnormal kidney function (n=216) underwent spectral kidney assessments after admission (Doppler 1) and 25 to 35 days later (Doppler 2) to identify IKVF patterns (continuous/pulsatile/biphasic/monophasic) and KVSI levels. Cox proportional hazard regression models were used to evaluate the associations between KVSI/IKVF patterns at Doppler 1 as well as changes from Doppler 1 to Doppler 2 and risk of cardiorenal events up to 18 months after admission. Worsening HF or death occurred in 126 patients. Both baseline KVSI (hazard ratio [HR], 1.49 [95% CI, 1.37–1.61] per 0.1‐unit increase) and baseline IKVF pattern (HR, 2.47 [95% CI, 2.01–3.04] per 1 pattern severity increase) were significantly associated with worsening HF/death. Increases in both KVSI and IKVF pattern severity from Doppler 1 to 2 were also associated with an increased risk of worsening HF/death (HR, 3.00 [95% CI, 2.08–4.32] per 0.1‐unit increase change; and HR, 6.73 [95% CI, 3.27–13.86] per 1 pattern increase in severity change, respectively). Similar results were observed for kidney outcomes. Conclusions Baseline kidney venous flow predicted adverse cardiorenal events, and inclusion of serial kidney venous flow in cardiorenal risk stratification could facilitate clinical decision‐making for patients with HF. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03039959.

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