A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days

Analysis from the EVEREST trial

Mihai Gheorghiade, Peter Pang, Andrew P. Ambrosy, Gloria Lan, Philip Schmidt, Gerasimos Filippatos, Marvin Konstam, Karl Swedberg, Thomas Cook, Brian Traver, Aldo Maggioni, John Burnett, Liliana Grinfeld, James Udelson, Faiez Zannad

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Hospitalization for worsening chronic heart failure results in high post-discharge mortality, morbidity, and cost. However, thorough characterization, soon after discharge of patients with early post-discharge events has not been previously performed. The objectives of this study were to describe the baseline, in-hospital, and post-discharge clinical, laboratory, and neurohormonal profiles of patients hospitalized for worsening heart failure with reduced ejection fraction (EF) who die or are re-admitted for cardiovascular (CV) causes within 90 days of initial hospitalization. Retrospective analysis of 4,133 patients hospitalized for worsening heart failure with EF B40% in the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) trial, which randomized patients to tolvaptan or placebo, both in addition to standard therapy. Clinical and laboratory parameters were obtained within 48 h of admission, during hospitalization, and post-discharge weeks 1, 4, 8, and every 8 weeks thereafter for a median of 9.9 months. Patients with events within 90 days were compared with those with later/no events. All-cause mortality (ACM) and CV re-hospitalization were independently adjudicated. Within 90 days of admission, 395 patients (9.6%) died and 801 patients (19.4%) were re-hospitalized for CV causes. Significant baseline and longitudinal differences were seen between groups with early versus later ([90 days) or no events at 12 months post-randomization. Post-discharge outcomes were similar in the tolvaptan and placebo groups. Patients with early post-discharge events experienced clinically significant worsening in signs and symptoms, laboratory values, and neurohormonal parameters soon after discharge. Identifying these abnormalities may facilitate efforts to reduce post-discharge mortality and re-hospitalization.

Original languageEnglish (US)
Pages (from-to)485-509
Number of pages25
JournalHeart Failure Reviews
Volume17
Issue number3
DOIs
StatePublished - May 2012
Externally publishedYes

Fingerprint

Heart Failure
Hospitalization
Mortality
Placebos
Patient Discharge
Patient Admission
Random Allocation
Vasopressins
Signs and Symptoms
Outcome Assessment (Health Care)
Morbidity
Costs and Cost Analysis
tolvaptan
Therapeutics

Keywords

  • Acute heart failure
  • Characterization
  • Mortality
  • Patient profiles
  • Re-hospitalization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days : Analysis from the EVEREST trial. / Gheorghiade, Mihai; Pang, Peter; Ambrosy, Andrew P.; Lan, Gloria; Schmidt, Philip; Filippatos, Gerasimos; Konstam, Marvin; Swedberg, Karl; Cook, Thomas; Traver, Brian; Maggioni, Aldo; Burnett, John; Grinfeld, Liliana; Udelson, James; Zannad, Faiez.

In: Heart Failure Reviews, Vol. 17, No. 3, 05.2012, p. 485-509.

Research output: Contribution to journalArticle

Gheorghiade, M, Pang, P, Ambrosy, AP, Lan, G, Schmidt, P, Filippatos, G, Konstam, M, Swedberg, K, Cook, T, Traver, B, Maggioni, A, Burnett, J, Grinfeld, L, Udelson, J & Zannad, F 2012, 'A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days: Analysis from the EVEREST trial', Heart Failure Reviews, vol. 17, no. 3, pp. 485-509. https://doi.org/10.1007/s10741-011-9280-0
Gheorghiade, Mihai ; Pang, Peter ; Ambrosy, Andrew P. ; Lan, Gloria ; Schmidt, Philip ; Filippatos, Gerasimos ; Konstam, Marvin ; Swedberg, Karl ; Cook, Thomas ; Traver, Brian ; Maggioni, Aldo ; Burnett, John ; Grinfeld, Liliana ; Udelson, James ; Zannad, Faiez. / A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days : Analysis from the EVEREST trial. In: Heart Failure Reviews. 2012 ; Vol. 17, No. 3. pp. 485-509.
@article{54840c87ba3942b29217b8d22efbb9bc,
title = "A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days: Analysis from the EVEREST trial",
abstract = "Hospitalization for worsening chronic heart failure results in high post-discharge mortality, morbidity, and cost. However, thorough characterization, soon after discharge of patients with early post-discharge events has not been previously performed. The objectives of this study were to describe the baseline, in-hospital, and post-discharge clinical, laboratory, and neurohormonal profiles of patients hospitalized for worsening heart failure with reduced ejection fraction (EF) who die or are re-admitted for cardiovascular (CV) causes within 90 days of initial hospitalization. Retrospective analysis of 4,133 patients hospitalized for worsening heart failure with EF B40{\%} in the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) trial, which randomized patients to tolvaptan or placebo, both in addition to standard therapy. Clinical and laboratory parameters were obtained within 48 h of admission, during hospitalization, and post-discharge weeks 1, 4, 8, and every 8 weeks thereafter for a median of 9.9 months. Patients with events within 90 days were compared with those with later/no events. All-cause mortality (ACM) and CV re-hospitalization were independently adjudicated. Within 90 days of admission, 395 patients (9.6{\%}) died and 801 patients (19.4{\%}) were re-hospitalized for CV causes. Significant baseline and longitudinal differences were seen between groups with early versus later ([90 days) or no events at 12 months post-randomization. Post-discharge outcomes were similar in the tolvaptan and placebo groups. Patients with early post-discharge events experienced clinically significant worsening in signs and symptoms, laboratory values, and neurohormonal parameters soon after discharge. Identifying these abnormalities may facilitate efforts to reduce post-discharge mortality and re-hospitalization.",
keywords = "Acute heart failure, Characterization, Mortality, Patient profiles, Re-hospitalization",
author = "Mihai Gheorghiade and Peter Pang and Ambrosy, {Andrew P.} and Gloria Lan and Philip Schmidt and Gerasimos Filippatos and Marvin Konstam and Karl Swedberg and Thomas Cook and Brian Traver and Aldo Maggioni and John Burnett and Liliana Grinfeld and James Udelson and Faiez Zannad",
year = "2012",
month = "5",
doi = "10.1007/s10741-011-9280-0",
language = "English (US)",
volume = "17",
pages = "485--509",
journal = "Heart Failure Reviews",
issn = "1382-4147",
publisher = "Springer Netherlands",
number = "3",

}

TY - JOUR

T1 - A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days

T2 - Analysis from the EVEREST trial

AU - Gheorghiade, Mihai

AU - Pang, Peter

AU - Ambrosy, Andrew P.

AU - Lan, Gloria

AU - Schmidt, Philip

AU - Filippatos, Gerasimos

AU - Konstam, Marvin

AU - Swedberg, Karl

AU - Cook, Thomas

AU - Traver, Brian

AU - Maggioni, Aldo

AU - Burnett, John

AU - Grinfeld, Liliana

AU - Udelson, James

AU - Zannad, Faiez

PY - 2012/5

Y1 - 2012/5

N2 - Hospitalization for worsening chronic heart failure results in high post-discharge mortality, morbidity, and cost. However, thorough characterization, soon after discharge of patients with early post-discharge events has not been previously performed. The objectives of this study were to describe the baseline, in-hospital, and post-discharge clinical, laboratory, and neurohormonal profiles of patients hospitalized for worsening heart failure with reduced ejection fraction (EF) who die or are re-admitted for cardiovascular (CV) causes within 90 days of initial hospitalization. Retrospective analysis of 4,133 patients hospitalized for worsening heart failure with EF B40% in the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) trial, which randomized patients to tolvaptan or placebo, both in addition to standard therapy. Clinical and laboratory parameters were obtained within 48 h of admission, during hospitalization, and post-discharge weeks 1, 4, 8, and every 8 weeks thereafter for a median of 9.9 months. Patients with events within 90 days were compared with those with later/no events. All-cause mortality (ACM) and CV re-hospitalization were independently adjudicated. Within 90 days of admission, 395 patients (9.6%) died and 801 patients (19.4%) were re-hospitalized for CV causes. Significant baseline and longitudinal differences were seen between groups with early versus later ([90 days) or no events at 12 months post-randomization. Post-discharge outcomes were similar in the tolvaptan and placebo groups. Patients with early post-discharge events experienced clinically significant worsening in signs and symptoms, laboratory values, and neurohormonal parameters soon after discharge. Identifying these abnormalities may facilitate efforts to reduce post-discharge mortality and re-hospitalization.

AB - Hospitalization for worsening chronic heart failure results in high post-discharge mortality, morbidity, and cost. However, thorough characterization, soon after discharge of patients with early post-discharge events has not been previously performed. The objectives of this study were to describe the baseline, in-hospital, and post-discharge clinical, laboratory, and neurohormonal profiles of patients hospitalized for worsening heart failure with reduced ejection fraction (EF) who die or are re-admitted for cardiovascular (CV) causes within 90 days of initial hospitalization. Retrospective analysis of 4,133 patients hospitalized for worsening heart failure with EF B40% in the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) trial, which randomized patients to tolvaptan or placebo, both in addition to standard therapy. Clinical and laboratory parameters were obtained within 48 h of admission, during hospitalization, and post-discharge weeks 1, 4, 8, and every 8 weeks thereafter for a median of 9.9 months. Patients with events within 90 days were compared with those with later/no events. All-cause mortality (ACM) and CV re-hospitalization were independently adjudicated. Within 90 days of admission, 395 patients (9.6%) died and 801 patients (19.4%) were re-hospitalized for CV causes. Significant baseline and longitudinal differences were seen between groups with early versus later ([90 days) or no events at 12 months post-randomization. Post-discharge outcomes were similar in the tolvaptan and placebo groups. Patients with early post-discharge events experienced clinically significant worsening in signs and symptoms, laboratory values, and neurohormonal parameters soon after discharge. Identifying these abnormalities may facilitate efforts to reduce post-discharge mortality and re-hospitalization.

KW - Acute heart failure

KW - Characterization

KW - Mortality

KW - Patient profiles

KW - Re-hospitalization

UR - http://www.scopus.com/inward/record.url?scp=84861553275&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861553275&partnerID=8YFLogxK

U2 - 10.1007/s10741-011-9280-0

DO - 10.1007/s10741-011-9280-0

M3 - Article

VL - 17

SP - 485

EP - 509

JO - Heart Failure Reviews

JF - Heart Failure Reviews

SN - 1382-4147

IS - 3

ER -