title: Worsening heart failure, a critical event during hospital admission for acute heart failure: results from the VERITAS study.
abstract: OBJECTIVE
  Worsening heart failure (WHF) in the first 7 days after an admission for acute HF (AHF) has been proposed as a therapeutic target in several recent AHF studies and was a co-primary endpoint of the VERITAS studies.
  
  
  RESULTS
  Patients were randomized within 24 h of admission for AHF. WHF was defined as worsening or persistent signs and symptoms of HF requiring additional intravenous or mechanical therapy for HF or death within 7 days of randomization. Multivariable models were developed to predict the time to WHF through day 7. Unadjusted and multivariable-adjusted associations of WHF with the length of stay (LOS) of the index hospitalization, and 30- and 90-day outcomes were estimated. WHF occurred by day 7 in 27% of the 1347 patients enrolled. Age, co-morbidities, and markers of HF severity were moderately predictive of WHF; the C-index for a multivariable model for WHF was 0.66. After multivariable adjustment for baseline characteristics, WHF was associated with an increase in LOS of 4.33 days [95% confidence interval (CI) 3.54-5.13 days], a hazard ratio (HR) for 30-day HF readmission or death of 2.43 (95% CI 1.75-3.40), and a HR for 90-day mortality of 2.57 (95% CI 1.81-3.65), all with P < 0.0001.The associations of WHF with these outcomes remained largely unchanged after adjustment for both baseline characteristics and changes in markers of renal and hepatic dysfunction during the first day of admission.
  
  
  CONCLUSIONS
  In patients admitted for AHF, WHF is a significant clinical event that is associated with delays in discharge and higher rates for readmission and death.
authors.affiliation: Momentum Research, Inc., Durham, NC, USA.
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Beth A
authors.initials: BA
authors.lastname: Davison
authors.forename: Stefanie
authors.initials: S
authors.lastname: Senger
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bourge
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jondeau
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: John D
authors.initials: JD
authors.lastname: Parker
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Olga
authors.initials: O
authors.lastname: Milo
authors.forename: Isaac
authors.initials: I
authors.lastname: Kobrin
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rainisio
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
mesh_terms: D000208:Acute Disease; D000368:Aged; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010343:Patient Admission; D011725:Pyridines / Q000627:therapeutic use; D013777:Tetrazoles / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D011725:Pyridines; D013777:Tetrazoles; D014665:Vasodilator Agents; C120582:tezosentan
keywords: Acute heart failure; Death; Outcome; VERITAS study; Worsening heart failure