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 Presenter report:
Gheorghiade, Mihai (United States of America)
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Patients admitted with Acute Heart Failure Syndromes (AHFS) have a post-discharge mortality and re-hospitalization that can be as high as 15% and 30%, respectively, within 60-90 days post-discharge. The clinical and laboratory profiles of these patients in the early post-discharge phase have not been well studied. Identifying potential targets for therapy during the immediate post-discharge period is important in order to reduce the high event rate.
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Objectives: The objectives of this retrospective analysis of prospectively collected data were 1) to establish the clinical, electrolyte, renal, hepatic, and neurohormonal profile post-discharge in patients who died or were re-hospitalized within 3 months, within 3-12 months, and those with no events at 1 year post-discharge, and 2) to determine the prognostic value of post-discharge clinical and laboratory parameters for mortality and readmission.
Methods: The EVEREST trial randomized 4133 patients admitted with worsening HF and an ejection fraction (EF) <40% to oral tolvaptan versus placebo in addition to standard therapy. Patients were followed for a median of 9.9 months. During hospitalization and post-discharge, the following parameters were collected prospectively on hospital day 1, day 7 or discharge, post-discharge weeks 1, 4, 8, and then every 8 weeks thereafter: blood pressure (BP), heart rate (HR), body weight, serum sodium, potassium, magnesium, blood urea nitrogen (BUN), creatinine, estimated glomerular filtration rate (eGFR), liver function and B-type natriuretic peptide (BNP) or N-terminal pro-BNP, aldosterone, arginine vasopressin (AVP).
Results: Post-discharge signs and symptoms of HF resulting from abnormal hemodynamics, as well as neurohormonal and renal abnormalities appear to predict high early post-discharge mortality and re-hospitalization rates, in spite of evidence-based therapies (ACEI/ARB, BB, Aldosterone-blocking agents). In the multivariate time-dependent analysis, the major post-discharge predictor for early mortality was worsening renal function (change in BUN). An increase in body weight was the major predictor for early re-hospitalization. This data suggests new therapies aimed at safely improving hemodynamics, neurohormonal profile, and renal function are needed.
Discussant: Tendera, Michal (Poland)