Phenotyping congestion in patients with acutely decompensated heart failure with preserved and reduced ejection fraction: The Decongestion duRing therapY for acute decOmpensated heart failure in HFpEF vs HFrEF- DRY-OFF study

Background: Thiazide diuretics are often utilized to overcome loop diuretic resistance when treating acute decompensated heart failure (ADHF). In addition to a large cost advantage, several pharmacokinetic advantages exist when administering oral metolazone (MTZ) compared with intravenous (IV) chlorothiazide (CTZ), yet many providers are reluctant to utilize an oral formulation to treat ADHF. The purpose of this study was to compare the increase in 24-hour total urine output (UOP) after adding MTZ or CTZ to IV loop diuretics (LD) in patients with heart failure with reduced ejection fraction (HFrEF). Methods and Results: From September 2013 to August 2016, 1002 patients admitted for ADHF received either MTZ or CTZ in addition to LD. Patients were excluded for heart failure with preserved ejection fraction (HFpEF) (n = 469), <24-hour LD or UOP data prior to drug initiation (n = 129), or low dose MTZ/CTZ (n = 91). A total of 168 patients were included with 64% receiving CTZ. No significant difference was observed between the increase in 24-hour total UOP after MTZ or CTZ initiation (1458 [514, 2401] mL vs 1820 [890, 2750] mL, P = .251). Conclusions: Both MTZ and CTZ similarly increased UOP when utilized as an adjunct to IV LD. These results suggest that while thiazide agents can substantially increase UOP in ADHF patients with HFrEF, MTZ and CTZ have comparable effects.

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EFFICACY AND SAFETY OUTCOMES OF VARIOUS RATE CONTROL STRATEGIES FOR PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE WITH REDUCED EJECTION FRACTION AND ATRIAL FIBRILLATION OR FLUTTER WITH RAPID VENTRICULAR RESPONSE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)60474-0 ◽

2015 ◽

Vol 65 (10) ◽

pp. A474

Author(s):

Siva Krothapalli ◽

Lee Joseph ◽

Omer Iqbal ◽

Olurotimi Mesubi ◽

Hardik Doshi ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Rate Control ◽

Acute Decompensated Heart Failure ◽

Control Strategies ◽

Decompensated Heart Failure ◽

Efficacy And Safety ◽

Reduced Ejection Fraction ◽

Ventricular Response

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Biomarkers in acutely decompensated heart failure with preserved or reduced ejection fraction

American Heart Journal ◽

10.1016/j.ahj.2012.08.014 ◽

2012 ◽

Vol 164 (5) ◽

pp. 763-770.e3 ◽

Cited By ~ 64

Author(s):

Kalkidan Bishu ◽

Anita Deswal ◽

Horng H. Chen ◽

Martin M. LeWinter ◽

Gregory D. Lewis ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Decompensated Heart Failure ◽

Reduced Ejection Fraction ◽

Acutely Decompensated Heart Failure

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Inflammation versus mechanical stretch biomarkers over time in acutely decompensated heart failure with reduced ejection fraction

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.10.038 ◽

2017 ◽

Vol 226 ◽

pp. 53-59 ◽

Cited By ~ 27

Author(s):

M. Boulogne ◽

M. Sadoune ◽

JM. Launay ◽

M. Baudet ◽

A. Cohen-Solal ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Mechanical Stretch ◽

Decompensated Heart Failure ◽

Reduced Ejection Fraction ◽

Acutely Decompensated Heart Failure ◽

Over Time

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Outcomes of de novo and acute decompensated heart failure patients according to ejection fraction

Heart ◽

10.1136/heartjnl-2017-311813 ◽

2017 ◽

Vol 104 (6) ◽

pp. 525-532 ◽

Cited By ~ 23

Author(s):

Ki Hong Choi ◽

Ga Yeon Lee ◽

Jin-Oh Choi ◽

Eun-Seok Jeon ◽

Hae-Young Lee ◽

...

Keyword(s):

Heart Failure ◽

Mortality Rate ◽

Ejection Fraction ◽

De Novo ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

First Year ◽

Preserved Ejection Fraction ◽

University Hospitals ◽

Reduced Ejection Fraction

ObjectiveThere are conflicting results among previous studies regarding the prognosis of heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF). This study aimed to compare the outcomes of patients with de novo acute heart failure (AHF) or acute decompensated HF (ADHF) according to HFpEF (EF≥50%), or HFrEF (EF<40%) and to define the prognosis of patients with HF with mid-range EF (HFmrEF, 40≤EF<50%).MethodsBetween March 2011 and February 2014, 5625 consecutive patients with AHF were recruited from 10 university hospitals. A total of 5414 (96.2%) patients with EF data were enrolled, which consisted of 2867 (53.0%) patients with de novo and 2547 (47.0%) with ADHF. Each of the enrolled group was stratified by EF.ResultsIn de novo, all-cause death rates were not significantly different between HFpEF and HFrEF (HFpEF vs HFrEF, 206/744 (27.7%) vs 438/1631 (26.9%), HRadj 1.15, 95% CI 0.96 to 1.38, p=0.14). However, among patients with ADHF, HFrEF had a significantly higher mortality rate compared with HFpEF (HFpEF vs HFrEF, 245/613 (40.0%) vs 694/1551 (44.7%), HRadj 1.25, 95% CI 1.06 to 1.47, p=0.007). Also, in ADHF, HFmrEF was associated with a significantly lower mortality rate within 1 year compared with HFrEF (HFmrEF vs HFrEF, 88/383 (23.0%) vs 430/1551 (27.7%), HRadj 1.31, 95% CI 1.03 to 1.65, p=0.03), but a significantly higher mortality rate after 1 year compared with HFpEF (HFmrEF vs HFpEF, 83/295 (28.1%) vs 101/469 (21.5%), HRadj 0.70, 95% CI 0.52 to 0.96, p=0.02).ConclusionsHFpEF may indicate a better prognosis compared with HFrEF in ADHF, but not in de novo AHF. For patients with ADHF, the prognosis associated with HFmrEF was similar to that of HFpEF within the first year following hospitalisation and similar to HFrEF 1 year after hospitalisation.

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Sex differences in clinical characteristics and long-term outcome in acute decompensated heart failure patients with preserved and reduced ejection fraction

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00602.2015 ◽

2016 ◽

Vol 310 (7) ◽

pp. H813-H820 ◽

Cited By ~ 21

Author(s):

Yasuki Nakada ◽

Rika Kawakami ◽

Tomoya Nakano ◽

Akihiro Takitsume ◽

Hitoshi Nakagawa ◽

...

Keyword(s):

Heart Failure ◽

Sex Differences ◽

Ejection Fraction ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Term Outcome ◽

Long Term Outcome ◽

Reduced Ejection Fraction ◽

Female Patients ◽

Male Patients

In patients with acute decompensated heart failure (ADHF), sex differences considering clinical and pathophysiologic features are not fully understood. We investigated sex differences in left ventricular (LV) ejection fraction (LVEF), plasma B-type natriuretic peptide (BNP) levels, and prognostic factors in patients with ADHF in Japan. We studied 748 consecutive ADHF patients of 821 patients registered in the ADHF registry between January 2007 and December 2014. Patients were divided into four groups based on sex and LVEF [reduced (ejection fraction, or EF, <50%, heart failure with reduced EF, or HFrEF) or preserved (EF ≥50%, heart failure with preserved LVEF, or HFpEF)]. The primary endpoint was the combination of cardiovascular death and heart failure (HF) admission. The present study consisted of 311 female patients (50% HFrEF, 50% HFpEF) and 437 male patients (63% HFrEF, 37% HFpEF). There was significant difference between sexes in the LVEF distribution profile. The ratio of HFpEF patients was significantly higher in female patients than in male patients ( P = 0.0004). Although there were no significant sex differences in median plasma BNP levels, the prognostic value of BNP levels was different between sexes. Kaplan-Meier analysis revealed that the high BNP group had worse prognosis than the low BNP group in male but not in female patients. In multivariate analysis, log transformed BNP at discharge predicted cardiovascular events in male but not in female HF patients (female, hazard ratio: 1.169; 95% confidence interval: 0.981–1.399; P = 0.0806; male, hazard ratio: 1.289; 95% confidence interval: 1.120–1.481; P = 0.0004). In patients with ADHF, the distribution of LV function and the prognostic significance of plasma BNP levels for long-term outcome were different between the sexes.

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