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 S. 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

82 Scopus citations

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 1 2012
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Gheorghiade, M., Pang, P. S., Ambrosy, A. P., 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, 17(3), 485-509. https://doi.org/10.1007/s10741-011-9280-0