HF Duration May Be Linked With Dyspnea, Mortality After Hospitalization

Patients who receive a heart failure (HF) diagnosis within 1 month prior to a hospitalization for acute HF have greater early dyspnea relief and improved survival post-hospitalization compared with chronic HF patients, according to a recent study.

Little is known about patients hospitalized for acute HF who are long-term chronic HF survivors vs those with more recently diagnosed HF.
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During the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial, 7141 hospitalized patients with acute HF and reduced or preserved ejection fraction (EF) were randomly assigned to receive either nesiritide or placebo, along with standard care.

Additionally, the researchers classified patients based on duration of HF diagnosis before hospitalization. Groups included “recently diagnosed” patients (0 to 1 month prior), 1 month to 12 months prior, 12 to 60 months prior, and more than 60 months prior.

Demographic information indicated mean patient age ranged from 64 years to 66 years. Recently diagnosed patients were more likely to be female with nonischemic HF etiology, higher baseline blood pressure, better baseline renal function, and fewer comorbidities vs patients with longer HF duration.

A total of 5741 patients (80.4%) had documented duration of HF diagnosis (recently diagnosed, n = 1536; 1 month to 12 months, n = 1020; 12 to 60 months, n = 1653; and more than 60 months, n = 1532). Across all groups, patients had a mean ejection fraction between 29% and 32%.

Results indicated that, compared with recently diagnosed patients, those with longer HF duration were associated with more persistent dyspnea at 24 hours and increased mortality within 180 days post-hospitalization.

The researchers noted that influence of HF duration on mortality was potentially more pronounced among female patients but did not differ according to age, race, prior ischemic heart disease, or ejection fraction.

“In this acute HF trial, patient profile differed according to duration of the HF diagnosis,” the researchers concluded. “A diagnosis of HF for [1 month or less] before hospitalization was independently associated with greater early dyspnea relief and improved post-discharge survival compared to patients with chronic HF diagnoses. The distinction between de novo or recently diagnosed HF and worsening chronic HF should be considered in the design of future acute HF trials.”

—Christina Vogt

Reference:

Greene SJ, Hernandez AF, Dunning A, et al. Hospitalization for recently diagnosed versus worsening chronic heart failure: from the ASCEND-HF trial. J Am Coll Cardiol. 2017;69(25). doi:10.1016/j.jacc.2017.04.043.