Clinical and prognostic implications of heart failure hospitalization in patients with advanced heart failure
Matteo Pagnesi, Antonio Maria Sammartino, Mauro Chiarito, Davide Stolfo, Luca Baldetti, Marianna Adamo, Giuseppe Maggi, Riccardo Maria Inciardi, Daniela Tomasoni, Ferdinando Loiacono, Marta Maccallini, Alessandro Villaschi, Gaia Gasparini, Marco Montella, Stefano Contessi, Daniele Cocianni, Maria Perotto, Giuseppe Barone, Marco Merlo, Alberto Maria Cappelletti, Gianfranco Sinagra, Daniela Pini, Marco Metra, Carlo Mario Lombardi- Cardiology and Cardiovascular Medicine
- General Medicine
Background
Hospitalization is associated with poor outcomes in patients with heart failure, but its prognostic role in advanced heart failure is still unsettled. We evaluated the prognostic role of heart failure hospitalization in patients with advanced heart failure.
Methods
The multicenter HELP-HF registry enrolled consecutive patients with heart failure and at least one high-risk ‘I NEED HELP’ marker. Characteristics and outcomes were compared between patients who were hospitalized for decompensated heart failure (inpatients) or not (outpatients) at the time of enrolment. The primary endpoint was the composite of all-cause mortality or first heart failure hospitalization.
Results
Among the 1149 patients included [mean age 75.1 ± 11.5 years, 67.3% men, median left ventricular ejection fraction (LVEF) 35% (IQR 25–50%)], 777 (67.6%) were inpatients at the time of enrolment. As compared with outpatients, inpatients had lower LVEF, higher natriuretic peptides and a worse clinical profile. The 1-year rate of the primary endpoint was 50.9% in inpatients versus 36.8% in outpatients [crude hazard ratio 1.70, 95% confidence interval (CI) 1.39–2.07,
Conclusion
Hospitalization for heart failure in patients with at least one high-risk ‘I NEED HELP’ marker is associated with an extremely poor prognosis supporting the need for specific interventions, such as mechanical circulatory support or heart transplantation.