Physician-determined worsening heart failure: a novel definition for early worsening heart failure in patients hospitalized for acute heart failure--association with signs and symptoms, hospitalization duration, and 60-day outcomes.
OBJECTIVE
To evaluate physician-determined worsening heart failure (PD-WHF) in patients admitted with acute heart failure (AHF).


METHODS
The PROTECT pilot study evaluated rolofylline, an adenosine A(1) receptor antagonist, versus placebo in patients with AHF and renal impairment. Signs and symptoms of heart failure (HF) and diuretic administration were prospectively recorded daily for 7 days and patients were followed for 60 days. Patients were categorized into three groups: (A) PD-WHF, based on worsening symptoms and signs of HF and need for additional intravenous (IV) or mechanical therapy (n = 29); (B) increased IV diuretic therapy without PD-WHF (n = 61), and (C) neither PD-WHF nor increase in IV diuretic dose (n = 211).


RESULTS
Patients in group A had slower resolution of dyspnea, longer mean (+/-SD) length of hospitalization (13.8 +/- 6.8 vs. 10.5 +/- 8.5 and 9.3 +/- 5.9 days in groups B and C, respectively; p < 0.05 for both), and higher 60-day death and cardiovascular or renal readmission rates [49.7 (95% confidence interval: 33.1-69.1) vs. 37.3 (26.4-50.9) vs. 19.5% (14.7-25.6) in groups B and C, respectively]. PD-WHF was a strong independent predictor of length of stay and 60-day death and cardiovascular or renal readmission.


CONCLUSIONS
PD-WHF may be an indicator of short-term risk and treatment efficacy in AHF.
Cotter
Gad
G
Momentum Research, Inc., Durham, NC 27514, USA. gadcotter @ momentum-research.com
Metra
Marco
M
Weatherley
Beth Davison
BD
Dittrich
Howard C
HC
Massie
Barry M
BM
Ponikowski
Piotr
P
Bloomfield
Daniel M
DM
O'Connor
Christopher M
CM
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality; D012720:Severity of Illness Index; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D014970:Xanthines / Q000627:therapeutic use
D049994:Sodium Potassium Chloride Symporter Inhibitors; D014970:Xanthines; C073525:rolofylline