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Title: | Impact of Worsening Heart Failure on Long-Term Prognosis in Patients With Heart Failure With Reduced Ejection Fraction | Authors: | Chimed, Surenjav STASSEN, Jan Galloo, Xavier Meucci, Maria Chiara Bijl, Pieter van der Knuuti, Juhani Delgado, Victoria Marsan, Nina Ajmone Bax, Jeroen J. |
Issue Date: | 2022 | Publisher: | EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC | Source: | AMERICAN JOURNAL OF CARDIOLOGY, 184 , p. 63 -71 | Abstract: | Worsening heart failure (HF), defined as hospitalization for worsening signs and symp-toms of HF or the need for urgent intravenous diuretics, is often considered a surrogate of poor prognosis in clinical trials. However, data on the prognostic implications of worsen-ing HF in patients with HF and reduced ejection fraction is limited. Patients who had a first echocardiographic diagnosis of left ventricular systolic dysfunction, defined as left ventricular ejection fraction (LVEF) <= 45%, were identified. Worsening HF was defined as hospitalization for HF or urgent need for intravenous diuretics. All-cause mortality was chosen as the study end point. A total of 1,801 patients (mean age 64 </n> 12 years, 74% men) were analyzed. Worsening HF was observed in 275 patients (15%) during a median follow-up of 20 months, while, 435 patients (24%) died during a median follow-up of 60 months (Interquartile range 28 to 60 months). The 5-year survival rate was significantly lower in the worsening HF cohort compared with the non-worsening HF cohort (Log-rank p <0.0001), and it was significantly different between the worsening HF cohort and the nonworsening HF cohort for LVEF <= 25% (log-rank p <0.0001) and LVEF 26% to 34% (log-rank p = 0.038) but not for LVEF 35% to 45% (log-rank p = 0.14). After adjustment for important clinical and echocardiographic predictors, worsening HF was independently associated with a higher risk of all-cause mortality (hazard ratio 1.46, 95% confidence interval 1.09 to 1.96, p = 0.011). In conclusion, worsening HF, defined by HF hospitaliza-tion or the urgent need for intravenous diuretics, is independently associated with poor long-term prognosis in patients with HF and reduced ejection fraction. (c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) (Am J Cardiol 2022;184:63-71) | Notes: | Bax, JJ (corresponding author), Leiden Univ, Heart Lung Ctr, Dept Cardiol, Med Ctr, Leiden, Netherlands.; Bax, JJ (corresponding author), Univ Turku, Turku Univ Hosp, Heart Ctr, Turku, Finland. j.j.bax@lumc.nl |
Document URI: | http://hdl.handle.net/1942/38901 | ISSN: | 0002-9149 | e-ISSN: | 1879-1913 | DOI: | 10.1016/j.amjcard.2022.08.035 | ISI #: | 000877775500009 | Rights: | 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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Impact of Worsening Heart Failure on Long-Term Prognosis in Patients With Heart Failure With Reduced Ejection Fraction.pdf | Published version | 1.14 MB | Adobe PDF | View/Open |
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