title: A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days: analysis from the EVEREST trial.
abstract: Hospitalization for worsening chronic heart failure results in high post-discharge mortality, morbidity, and cost. However, thorough characterization, soon after discharge of patients with early post-discharge events has not been previously performed. The objectives of this study were to describe the baseline, in-hospital, and post-discharge clinical, laboratory, and neurohormonal profiles of patients hospitalized for worsening heart failure with reduced ejection fraction (EF) who die or are re-admitted for cardiovascular (CV) causes within 90 days of initial hospitalization. Retrospective analysis of 4,133 patients hospitalized for worsening heart failure with EF ≤40% in the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) trial, which randomized patients to tolvaptan or placebo, both in addition to standard therapy. Clinical and laboratory parameters were obtained within 48 h of admission, during hospitalization, and post-discharge weeks 1, 4, 8, and every 8 weeks thereafter for a median of 9.9 months. Patients with events within 90 days were compared with those with later/no events. All-cause mortality (ACM) and CV re-hospitalization were independently adjudicated. Within 90 days of admission, 395 patients (9.6%) died and 801 patients (19.4%) were re-hospitalized for CV causes. Significant baseline and longitudinal differences were seen between groups with early versus later (>90 days) or no events at 12 months post-randomization. Post-discharge outcomes were similar in the tolvaptan and placebo groups. Patients with early post-discharge events experienced clinically significant worsening in signs and symptoms, laboratory values, and neurohormonal parameters soon after discharge. Identifying these abnormalities may facilitate efforts to reduce post-discharge mortality and re-hospitalization.
authors.affiliation: Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. m-gheorghiade@northwestern.edu
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Ambrosy
authors.forename: Gloria
authors.initials: G
authors.lastname: Lan
authors.forename: Philip
authors.initials: P
authors.lastname: Schmidt
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.forename: Marvin
authors.initials: M
authors.lastname: Konstam
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Cook
authors.forename: Brian
authors.initials: B
authors.lastname: Traver
authors.forename: Aldo
authors.initials: A
authors.lastname: Maggioni
authors.forename: John
authors.initials: J
authors.lastname: Burnett
authors.forename: Liliana
authors.initials: L
authors.lastname: Grinfeld
authors.forename: James
authors.initials: J
authors.lastname: Udelson
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
mesh_terms: D001552:Benzazepines / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D018377:Neurotransmitter Agents / Q000502:physiology*; D010359:Patient Readmission; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D017483:Receptors, Vasopressin / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077602:Tolvaptan
chemical_list: D001552:Benzazepines; D018377:Neurotransmitter Agents; D017483:Receptors, Vasopressin; D000077602:Tolvaptan