Clinical InvestigationHeart FailureWorsening heart failure during hospitalization for acute heart failure: Insights from the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF)
Section snippets
Methods
ASCEND-HF enrolled 7,141 patients with acute HF within 24 hours of their first intravenous HF-related therapy. ASCEND-HF was a randomized, double-blind, placebo-controlled trial of nesiritide in addition to standard care. The study design and results have been previously reported.7, 17 The 2 primary end points were a composite of all-cause mortality or HF readmission up to 30 days after randomization and the change in early dyspnea relief after study drug initiation. Each participating center's
Results
Worsening HF occurred in 354 (5%) patients enrolled in ASCEND-HF. The baseline characteristics of patients with and without WHF are presented in Table I. Patients with WHF were more often male and white with a history of atrial fibrillation, diabetes, and HF admission compared with those without WHF. There was similar use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and β-blockers in patients with and without WHF, but higher rates of aldosterone antagonism and
Discussion
In the largest clinical trial of acute HF, we characterized the end point of WHF, providing insight into a key population that has been poorly studied. Patients who experienced WHF had markedly worse outcomes at 30 and 180 days. Specifically, patients with WHF had more than a 13-fold increase in 30-day mortality and nearly a 7-fold increase in 30-day mortality or rehospitalization for HF. By 180 days, 41.5% of patients with WHF had died compared with 11.3% of patients without WHF. We found no
Conclusions
The results from this retrospective analysis of a large, international, clinical trial of patients with acute HF patients extend the findings of previous smaller acute HF studies. Worsening HF is strongly associated with significantly increased risk of rehospitalization and mortality at 30 and 180 days. Worsening HF portends a poor prognosis regardless of whether it occurs early or late during hospitalization. Worsening HF in hospitalized patients with acute HF represents a patient-centered
Disclosures
The ASCEND-HF study was funded by Scios. This analysis was funded by the Duke Clinical Research Institute.
All authors have approved the final article.
Kelly receives funding from Duke's T32 Training grant (National Institutes of Health Ruth L. Kirschstein NRSA Institutional Research Training Grant: 5 T32 HL 7101-39). Mentz receives honoraria from Thoratec and research support from Amgen, AstraZeneca, BMS, GSK, Gilead, Novartis, Otsuka, and ResMed. Hasselblad has hothing to report. Ezekowitz
Acknowledgement
Ms Elizabeth Cook and Ms Morgan deBlecourt provided editorial assistance.
References (21)
- et al.
Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)
Am Heart J
(2008) - et al.
Impact of dopamine infusion on renal function in hospitalized heart failure patients: results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial
J Card Fail
(2010) - et al.
Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial
Lancet
(2013) - et al.
Effect of levosimendan on the short-term clinical course of patients with acutely decompensated heart failure
JACC Heart Fail
(2013) - et al.
Early worsening heart failure in patients admitted for acute heart failure: time course, hemodynamic predictors, and outcome
J Card Fail
(2009) - et al.
Rationale and design of the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure Trial (ASCEND-HF)
Am Heart J
(2009) - et al.
The PROTECT pilot study: a randomized, placebo-controlled, dose-finding study of the adenosine A1 receptor antagonist rolofylline in patients with acute heart failure and renal impairment
J Card Fail
(2008) - et al.
In-hospital worsening heart failure and associations with mortality, readmission, and healthcare utilization
J Am Heart Assoc
(2014) - et al.
Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST Clinical Status Trials
JAMA
(2007) - et al.
Rolofylline, an adenosine A1-receptor antagonist, in acute heart failure
N Engl J Med
(2010)
Cited by (0)
Clinical Trial Registration: ClinicalTrials.gov; unique identifier: NCT00475852.
Guest Editor: W. H. Wilson Tang, MD served as guest editor for this article.