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Changes in clinical, neurohormonal, electrolyte, renal, hematological and hepatic profiles during and after hospitalization for acute decompensated heart failure: Analysis from the EVEREST trial.

Clinical Trial Update II

Heart Failure (HF)

Presenter report:

Gheorghiade, Mihai (United States of America)


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. 
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)






Clinical Trial Update II

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.