Recently Diagnosed Heart Failure vs Chronic, Worsening Heart Failure Associated with Better Outcomes: ASCEND-HF Substudy
- Investigators analyzed data from the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial to determine clinical outcomes differences among those with a recent heart failure diagnosis vs those with chronic or worsening heart failure.
- Authors concluded that recently diagnosed heart failure patients represent a lower risk phenotype of acute heart failure compared with patients with acute forms of chronic disease.
Reference: Greene SJ et al. JACC. 2017;69(25):3029-3039.
Hospitalization for heart failure is associated with a high risk of repeat hospitalization, with a 30% risk for mortality at 1 year.1,2 Appropriate and effective management of heart failure in its early stages is imperative for improving survival,3 compared with efforts to improve outcomes during progressive chronic disease. Medical therapy of acute decompensated heart failure has been largely unsuccessful in achieving a meaningful reduction in hospital readmission and mortality. Currently, there are few trials investigating the impact heart failure diagnosis duration has on patient outcomes.
Investigators analyzed data from the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial to determine clinical outcomes differences among those with a recent heart failure diagnosis vs those with chronic or worsening heart failure.4
The ASCEND-HF trial was a randomized, placebo-controlled, prospective trial which evaluated the effects of nesiritide on clinical outcomes for patients hospitalized with acute heart failure and reduced or preserved ejection fraction.5,6
Documentation of duration of a heart failure diagnosis was available in 5,741 out of 7,141 patients in the ASCEND-HF trial:
- Recently diagnosed (n = 1,536)
- >1 to 12 months (n = 1,020)
- >12 to 60 months (n = 1,653)
- and >60 months (n = 1,532)
Patients with the lowest rates of 30-day all-cause death or rehospitalization were more likely to have a recent heart failure diagnosis. These patients also featured lower 30- and 180-day all-cause death. Event rates at 30 and 180 days were consistently higher for patients with a heart failure diagnosis duration of >60 months.
The authors note that, after adjustment for characteristics such as systolic blood pressure and ejection fraction, the association between shorter heart failure diagnosis duration and better outcomes persisted. Factors among the studied population may have contributed to the event rates differences.
The authors found that recently diagnosed heart failure patients represent a lower risk phenotype of acute heart failure compared with patients with acute forms of chronic disease. Treatment-naive patients are typically those with newer heart failure onset; therefore, these patients are more likely to respond favorable to medical therapy.
According to an accompanying editorial by Solomon and Desai,7 “The implication is that heart failure hospitalization is a more efficient discriminator of risk in patients with an established heart failure diagnosis than in those with newly identified disease and that the response to therapy might similarly vary in these populations.”
Solomon and Desai also remark on the thresholds for “recent” heart failure onset and its effect on the final results: “Among those with heart failure duration >30 days, there was no clear, graded relationship between heart failure duration and clinical outcomes; thus, it would seem that the most relevant distinction may be between hospitalization for onset of truly ‘new’ heart failure (a de novo diagnosis) and worsening of established heart failure.”
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- Desai AS, Stevenson LW. Rehospitalization for heart failure: predict or prevent? Circulation. 2012;126:501–506.
- Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251-259.
- Advanced Heart Failure. American Heart Association website. http://www.heart.org/HEARTORG/Conditions/HeartFailure/Advanced-Heart-Failure_UCM_441925_Article.jsp#.WUqdy2aGPtg. Updated May 9, 2017. Accessed June 21, 2017.
- Greene SJ, Hernandez AF, Dunning A, et al. Hospitalization for Recently Diagnosed Versus Worsening Chronic Heart Failure: From the ASCEND-HF Trial. JACC. 2017;69(25):3029-3039.
- Hernandez AF, O'Connor CM, Starling RC, et al. Rationale and design of the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure Trial (ASCEND-HF). Am Heart J. 2009;157(2):271-277.
- O'Connor CM, Starling RC, Hernandez AF, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365(1):32-43.
- Solomon SD, Desai AS. Acute Heart Failure: One Syndrome or Many? JACC. 2017;69(25):3040-3041.