April 3, 2016 – The study’s findings underscore the difficulty of determining the appropriate intensity and duration of therapy for heart failure patients.
Weight change, urine output, and difficulty breathing are poorly correlated in acute heart failure patients, making it challenging to determine the appropriate intensity and duration of therapy.
Many patients seeking medical attention for heart failure have symptoms related to fluid retention, such as short-term body weight gain and difficulty breathing (dyspnea). These factors are routinely monitored in hospitalized heart failure patients, along with net fluid balance, as a way to assess response to standard therapy.
A post-hoc analysis of the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure) trial, the largest trial every conducted in acute heart failure, was carried out to determine the relationship between body weight change during hospitalization and outcomes. The new analysis also examined how well body weight changes in hospital correlated with urine output and difficulty breathing.
The results of the study were presented at the annual Scientific Sessions of the American College of Cardiology in Chicago on Sunday.
“Heart failure is a huge public health problem affecting almost six million Americans, resulting in one million hospitalizations each year, and costing as much as $40 billion annually,” said lead author and Duke Fellow Andrew Ambrosy, MD. “These results will give us a better sense of how best to evaluate patients for congestion during hospitalization, and determine the appropriate duration and intensity of therapy.”
The ASCEND-HF trial enrolled 7,141 patients hospitalized for acute heart failure within 24 hours of the first intravenous heart failure-related treatment. The final analytical cohort included 4,172 patients discharged alive and with available body weight measurements at baseline and discharge or day 10. In-hospital body weight change was categorized as significant loss (more than 5 kg), moderate loss (between 1 and 5 kg), minimal loss or gain (a weight loss of up to 1 kg or a gain of up to 1 kg), and gain (with a weight increase of 1 kg or more).
More than 30 percent of patients admitted for a primary diagnosis of acute heart failure reported minimal weight loss or weight gain during hospitalization. Among these patients, an increase in body weight was correlated with a poor prognosis, including higher 30-day readmissions and a trend towards increased mortality at 180 days. There was also a lack of correlation between early relief of difficulty breathing and both body weight change and urinary output, underscoring the challenges of evaluating congestion and determining the appropriate intensity and duration of therapy.
Additional research is necessary to prospectively validate goal-oriented decongestion strategies, the authors conclude.
In addition to Ambrosy, other Duke authors on the paper were: Lukasz Cerbin, MD; Adrian Coles, PhD; Adam DeVore, MD; Marat Fudim, MD; Stephen Greene, MD; Adrian Hernandez, MD, MHS; Christopher O’Connor, MD; Philip Schulte, PhD; and Robert Mentz, MD.