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Early recurrent congestion after an acute Heart Failure event: experience from a dedicated clinic
Session:
Painel 2 - Insuficiência Cardíaca 8
Speaker:
Gonçalo José Lopes Da Cunha
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Gonçalo Lopes Da Cunha; Bruno M. Rocha; Sara Trevas; Pedro Custódio; Tiago Pacheco; Diogo Faustino; Laura Moreira; Marta Roldão; Catarina Bastos; Juliana Campos; Inês Sarmento; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Background: </strong>Heart Failure (HF) patients are at an increased risk for hospital readmission within the so-called vulnerable phase, thus current recommendations emphasize early reevaluation as crucial to reduce HF readmissions. We aimed to assess the prognostic significance of recurrent congestion at early reevaluation after an acute HF (AHF) event, as per protocol in our HF management program.</p> <p><strong>Methods: </strong>This is a single-center retrospective cohort enrolling consecutive patients who were admitted in a dedicated HF unit for AHF in 2016-2018, regardless of left ventricular ejection fraction (LVEF). Decompensation at early (≤2 weeks) day-hospital reevaluation was defined as clinical evidence of <em>de novo </em>congestion, with a need for furosemide usual dose increment, and >30% NT-proBNP discharge-to-reevaluation elevation. Death or HF hospitalization was the primary composite endpoint.</p> <p><strong>Results: </strong>Overall, 211 HF patients [median age 77.8 (68.7-83.3) years; 70.1% male; 59.6% ischemic HF; 14.8% NYHA III-IV; 59.6% atrial fibrillation; median discharge NT-proBNP 2590 (IQR: 1197-5258) pg/mL], of whom 89 (42.2%) had a LVEF <40% (i.e., HFrEF) were assessed. Most (96.4%) received loop diuretic and fewer (11.3%) were on metolazone at discharge. At a median 11 (7-14) days to reevaluation, decompensation was detected in 20 (9.5%) patients. These were more likely to have had a significantly larger in-hospital reduction in median NT-proBNP (p=0.041) compared to stable patients. Additionally, the former were more likely to have been admitted for AHF with no identifiable precipitant factor compared to the latter (60.0 vs 32.6%; p=0.015). Over a median follow-up of 19.5 (IQR: 9.4-29.0) months, 68 (32.2%) patients died and 87 (41.2%) had at least one HF hospitalization. In multivariate analysis adjusted for age, estimated glomerular filtration rate and NT-proBNP, day-hospital decompensation remained predictive of the primary endpoint (HR: 1.81; CI: 1.05-3.13; p=0.033), mostly due to increased risk of HF hospitalization (HR: 1.87; CI: 1.01-3.46; p=0.046).</p> <p><strong>Conclusions:</strong></p> <p>Recurrent congestion after AHF in our HF management program is a significant event in the vulnerable phase, and it was an independent predictor of major outcomes. These results further unveil the pervasiveness and prognostic value of recurrent congestion despite assertive measures to optimize outpatient diuretic treatment.</p>
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