Intermediate term risk for patients surviving worsening heart failure managed in the community remains a concern

Introduction

Worsening heart failure (WHF) is increasingly managed in the outpatient setting, reducing the need for hospital admission. However, evidence demonstrating the success of this strategy is largely derived from randomised controlled trials, with comparatively limited data reflecting outcomes in routine community heart failure populations. Furthermore, existing studies have predominantly focused on short-term endpoints, leaving the longer-term clinical significance of WHF episodes insufficiently defined.

In this study, we report on the extended follow-up from 3 to 12 months post index presentation for WHF, to assess the subsequent risk of death and further outpatient decompensation. We have previously reported on the immediate three-month period post stabilisation demonstrating a 25% risk of recurrent WHF.

Methods

This is a single centre, ongoing, prospective analysis, using data obtained from within our outpatient community virtual ward for management of WHF. WHF is defined as signs and symptoms of WHF, accompanied by biochemical evidence of decompensation, and/or imaging demonstrating hypervolaemia. We defined stability as resolution of signs and symptoms, as well as euvolemia on exam.

The primary endpoint is death and/or patients experiencing recurrent WHF managed in the community or requiring hospitalisation. We also noted non-heart failure cardiac and non-cardiac emergency admissions.

Results

To date, we are reporting on 301 patients in which 12 months have passed since their index WHF allowing for the assessment of the 3–9-month period post stabilisation. The average age of our population is 78.2 years, with 56.5% of the population being male and 62.1% of the population being diagnosed with heart failure with reduced ejection fraction. The primary endpoint of all-cause mortality and/or further WHF event occurred in 46.5% of patients. Of those experiencing WHF the majority (76.4%) were managed in the community. In addition, 6.6 % and 26% of the population experienced non-HF-cardiac and non-cardiac emergency admissions. 7.6% experienced more than one episode of WHF resulting in a total number of 26 WHF events in this population between 3 and 12 months post the index WHF.

Conclusion

Our ongoing analysis while demonstrating reduced frequency of WHF events in the intermediate period, still highlights a very concerning prognosis for this population.