title: Worsening heart failure during hospitalization for acute heart failure: Insights from the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF).
abstract: BACKGROUND
  Despite initial in-hospital treatment of acute heart failure (HF), some patients experience worsening HF (WHF). There are limited data about the outcomes and characteristics of patients who experience in-hospital WHF.
  
  
  RESULTS
  We assessed the characteristics and outcomes of patients with and without WHF in the ASCEND-HF trial. Worsening HF was defined as at least 1 symptom or sign of new, persistent, or WHF requiring additional intravenous inotropic/vasodilator or mechanical therapy during index hospitalization. We assessed the relationship between WHF and 30-day mortality, 30-day mortality or HF hospitalization, and 180-day mortality. We also assessed whether there was a differential association between early (days 1-3) vs late (day ≥4) WHF and outcomes. Of 7,141 patients with acute HF, 354 (5%) experienced WHF. Patients with WHF were more often male and had a history of atrial fibrillation or diabetes, lower blood pressure, and higher creatinine. After risk adjustment, WHF was associated with increased 30-day mortality (odds ratio 13.37, 95% CI 9.85-18.14), 30-day mortality or HF rehospitalization (odds ratio 6.78, 95% CI 5.25-8.76), and 180-day mortality (hazard ratio 3.90, 95% CI 3.14-4.86) (all P values < .0001). There was no evidence of a difference in outcomes between early and late WHF (all P values for comparison ≥ .2).
  
  
  CONCLUSIONS
  Worsening HF during index hospitalization was associated with worse 30- and 180-day outcomes. Worsening HF may represent an important patient-centered outcome in acute HF and a focus of future treatments.
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. Electronic address: Jacob.kelly@duke.edu.
authors: Jacob P
authors: JP
authors: Kelly
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Robert J
authors: RJ
authors: Mentz
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Vic
authors: V
authors: Hasselblad
authors: University of Alberta, Edmonton, Canada.
authors: Justin A
authors: JA
authors: Ezekowitz
authors: University of Alberta, Edmonton, Canada.
authors: Paul W
authors: PW
authors: Armstrong
authors: Centre Hospitalier Universitaire, Department of Cardiology, Nancy University, Université de Lorraine, Nancy, France.
authors: Faiez
authors: F
authors: Zannad
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: G Michael
authors: GM
authors: Felker
authors: Duke Translational Medicine Institute, Duke Medicine, Durham, NC.
authors: Robert M
authors: RM
authors: Califf
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Christopher M
authors: CM
authors: O'Connor
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Adrian F
authors: AF
authors: Hernandez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage*; D009657:North Carolina / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
chemical_list: D020097:Natriuretic Peptide, Brain