40: Changes In the Neurohormonal Profile of Patients Hospitalized for Acute Heart Failure Syndromes During the Early Post-Discharge Period According to Early, Late, or No Heart Failure Re-Hospitalization or Mortality Events: Analysis From the EVEREST Trials

Abstract

The majority of patients admitted with acute heart failure syndromes (AHFS) improve in terms of signs and symptoms during hospitalization, with associated improvements in natriuretic peptide levels. Despite these improvements, post-discharge re-hospitalization and mortality from acute heart failure syndromes (AHFS) approaches 35% within 90 days, with the greatest risk seen within the first 30 days. Neurohormones play an important role in the pathophysiology of AHFS; however, there are limited data regarding the neurohormonal profile of AHFS patients during the early post-discharge period. Describe changes in the neurohormonal profile of patients during the early post-discharge period according to event status, defined as early, late, or no all-cause mortality (ACM) or heart failure (HF) re-hospitalization at 1 year. Retrospective analysis from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, which randomized 4,133 patients with reduced ejection fraction (<40%) requiring hospitalization due to worsening HF. Patients were randomized to tolvaptan in addition to standard therapy versus standard therapy alone and were followed for a median of 9.9 months. Both placebo and tolvaptan arms were combined as there were no significant differences between groups regarding long-term outcomes or safety. Aldosterone, arginine vasopressin (AVP), BNP or NT-proBNP were prospectively collected during hospitalization, and then at 1 and 4 weeks post-discharge. A descriptive analysis of the neurohormonal profile is presented as well as changes from week 1 to week 4 follow-up visits based on patient status; early events (< 3 months post-discharge), later events (3-12 months post-discharge) and no events, at one year. All events were independently adjudicated. Patients with earlier events have a significantly worse neurohormonal profile, both at baseline and during early follow up. (See table) In general, greater changes in neurohormones were also seen in patients with earlier events.Tabled 1 Assessing changes in the neurohormonal profile during the early post-discharge phase may identify patients at higher risk; these may be potential targets for future interventional studies.