Abstract 9964: Influence of Worsening Heart Failure During Hospitalization on the Prognosis in Patients with Acute Decompensated Heart Failure

Abstract

Introduction: Worsening heart failure (WHF) during hospitalization has been used as the one of endpoint in assessing treatments for acute decompensated heart failure (ADHF). However, there are few data on WHF and long-term prognosis, especially in Japanese population. Hypothesis: WHF during hospitalization can influence the long-term prognosis in patients with ADHF. Methods and Results: The Kyoto Congestive Heart Failure registry is a prospective multicenter cohort study enrolling 4056 consecutive patients hospitalized for ADHF in Japan. WHF was defined as additional intravenous inotropes, diuretics, respiratory management (noninvasive positive pressure ventilation or intubation), or extracorporeal ultrafiltration after 24 hours from admission. Among 4056 patients, 775 (19.4%) patients developed WHF during hospitalization. Inotropes use in emergency room was significantly higher (8.0% vs 2.7%, p<0.001), whereas diuretics use was significantly lower (45.6% vs 51.7%, p=0.002) in patients with WHF than those without WHF. In-hospital mortality was significantly higher in patients with WHF than in those without WHF (16.3% vs 4.0%, p<0.001). A composite of all-cause death and HF hospitalization at 1-year were compared in 3728 patients who were alive at discharge with available data. Patients with WHF (N=644, 18.3%) were younger (79 [70-85] vs 81 [7-85], p<0.001), more likely to be men (61.7 % vs 53.6%, p<0.001), and more likely to have diabetes (44.7% vs 35.2% p<0.001), chronic kidney disease (57.9% vs 41.3%, p<0.001), and ischemic etiology (41.6% vs 30.7%, p<0.001) than those without WHF (N=3084, 87.4%). After adjusting for confounders, the risk for primary outcome of WHF group remained significant (OR: 1.27, 95%CI: 1.02-1.58, p=0.03). Conclusions: The WHF during hospitalization was associated with worse 1-year clinical outcomes as well as in-hospital mortality in patients with ADHF.