569 Advanced heart failure patients: insight clinical characteristics and prognosis. (8th December 2021)

• Record Type: Journal Article
• Authors: Ruocco, Gaetano; Pastorini, Guido; Rossi, Arianna; Testa, Marzia; Feola, Mauro
• Is Part Of: European heart journal supplements. Volume 23(2021)Supplement G
• Publication Date: 2021-12-08
• Subjects: Cardiology -- Periodicals; Cardiology -- Europe -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/suab139.048
• Languages: English
• ISSNs: 1520-765X

Abstract

Abstract: Aims: The prevalence of patients with advanced heart failure (HF) ranges from 1% to 10% of HF population. A recent position statement of Heart Failure Association (HFA) of European Society of Cardiology (ESC), defined advanced HF according four criteria including LV dysfunction, symptoms severity, and HF hospital admission. 1 In this study we would like to evaluate clinical and prognostic characteristics of HF patients in advanced stage. Methods and results: This is an observational retrospective study enrolling patients with diagnosis of acute heart failure (AHF) de novo or not, admitted to our department from January 2015 to January 2019 within 12 h from emergency department admission. Patients underwent to clinical examination, laboratory analysis (NTproBNP, renal function haemoglobin) and echocardiography. Advanced heart failure patients were defined on the basis of ESC recent criteria. 1 Patients were followed for 1 year after hospital discharge for the composite outcome of HF re-hospitalization and cardiovascular death through 1 year. A total of 601 AHF patients were included in this analysis. Median age was 78 (70–83) years, median of left ventricular ejection fraction (LVEF) was 45 (33–55)% and the median of serum levels of NTproBNP was 7851 (3222–17 543) pg/ml. In our sample we found 122 patients who met the criteria of advanced HF. Comparing patients with advanced HF and without we found that advanced HF patients were more frequent affected by not ischaemic cardiomyopathy with respect to patients not advanced (85% vs. 49%; P < 0.001). Moreover, patients not advanced were more frequent de novo HF with respect to advanced ones (54% vs. 34%; P < 0.001). Advanced heart failure patients showed higher values of NTproBNP [12 375 (5346–26 375) vs. 6652 (2552–13 782) pg/ml; P < 0.001] and creatinine [1.20 (0.88–1.99) vs. 1.07 (0.82–1.50) mg/dL; P = 0.002] and lower values of TAPSE [18 (15–20) vs. 16 (13–19) mm; P < 0.001], eGFR [48 (30–66) vs. 52 (38–38) ml/min/m 2 ; P = 0.05], and serum sodium [140 (138–143) vs. 139 (136–141) mEq/l; P = 0.001] with respect to not advanced HF patients. Univariate analysis showed that advanced HF was related to poor prognosis in terms of one year cardiovascular death or HF re-hospitalization [HR: 1.83 (1.32–2.54); P < 0.001] and in terms of in-hospital mortality [HR: 2.53 (1.01–6.53); P = 0.05]. Conclusions: Advanced HF patients showed a worse neuro-hormonal and renal pattern compared to not advanced ones. Similarly, these patients experienced a worse right ventricular function and were more prone no adverse events development at 1 year. Further study are mandatory to better manage these patients improving their outcome.