What are the predictors of worsening symptoms and signs of heart failure in HFREF?
T Popov, A Gvozdenovic, S Cemerlic Maksimovic, D Andric, V Todic, I Popov, V Lecic, J TripunovicAbstract
Introduction
Frequent rehospitalizations of patients with heart failure worsen the patient's quality of life and burden the healthcare system. One of the main tasks of heart failure clinics should be to recognize patients at risk and timely modification of therapy to prevent significant worsening of symptoms that require hospital care.
Objective
Determining the clinical characteristics of a patient with worsening symptoms and signs of heart failure.
Methods
The research included 277 patients with HFREF who during 2022/23 were hospitalized at the Heart Failure Clinic, of which 123 were treated for acute heart failure, and 154 as elective, without symptoms and signs of acute deterioration, for the purpose of monitoring and titration of therapy. We compared clinical findings in acutely decompensated and elective patients.
Results
Patients who were hospitalized due to exacerbation of chronic heart failure had lower stroke volume, higher left ventricular filling pressure (E/e'), thicker left ventricular walls, higher degree of regurgitation on the mitral, aortic and tricuspid valves, larger right ventricular diameter, lower TAPSE, higher RVSP, higher NTproBNP, bilirubin, transaminases, renal failure, anemia, higher TSH, higher CRP. Acutely decompensated patients more often had ischemic heart disease, diabetes mellitus and renal failure. An independent predictor of hospitalization is elevated TSH (OR 2.22; CI 1.12-4.42; p=0.022)
Conclusion
Patients with acutely decompensated HFrEF have worse right ventricular function, signs of congestion, more frequent comorbidities; reduced thyroid gland function is an independent predictor, so these patients should be monitored more often to prevent deterioration.