Prognostic Value of the Physical Examination in Patients with Heart Failure and Atrial Fibrillation: Insights from the AF-CHF Trial

Abstract

(Table). Absence of congestion was defined as the absence of jugular venous distension, dyspnea, rales, and pedal or sacral edema on hospital day 7 or discharge. The associations between Loop Dose, discharge congestion status, and all-cause mortality and worsening HF events (HF hospitalization; unscheduled outpatient or emergency department visit associated with IV therapy for HF; or death from HF) within 90 days of randomization were assessed. Results: Median Loop Dose for all subjects was 93 mg and did not differ in 2558 subjects with discharge congestion (89 mg) vs. 600 subjects without discharge congestion (107 mg), p50.36. At 90 days, mortality and worsening HF events occurred in 7.5% and 15.4% of subjects respectively. Higher Loop Dose was associated with clinical markers of more severe disease (Table) and increased risk of mortality (HR 1.37, p!0.001 for one unit increase in natural-log-transformed dose) and worsening HF (HR 1.68/2.35 as compared to Medium/Low Doses, p!0.001). The association between Loop Dose and outcome events did not differ in patients with or without persistent congestion at the time of hospital discharge (for all-cause mortality, with congestion HR 1.44 vs. without congestion HR 0.94, p50.10 for interaction term; and for worsening HF, with congestion HR 1.57 vs. without congestion HR 1.28, p50.18 for interaction term). Conclusion: Higher Loop Dose during hospitalization was associated with worse clinical status, increased short-term all-cause mortality, and increased risk of worsening HF events. The association between in-hospital diuretic dose and clinical outcomes did not differ in patients with or without clinical signs and symptoms of congestion at hospital discharge.