The Burden of Congestion in Patients Hospitalized With Acute Decompensated Heart Failure
Section snippets
Methods
OPTIMIZE-HF was a multicenter registry of patients hospitalized with ADHF, with a primary or secondary diagnosis of systolic or diastolic HF, in the United States.7 Overall, over 48,000 patients from 259 hospitals were enrolled in the registry between January 2003 and December 2004.8 Each participating center had institutional review board approval for participation in the registry.
Medicare fee-for-service (FFS) standard analytic claims files were obtained from the Centers for Medicare and
Results
There were 29,230 hospitalizations in the OPTIMIZE-HF registry linked to Medicare claims where the patient did not leave against medical advice, 25,844 of which were index hospitalizations (Supplemental Figure 1). There were 24,724 patients with Medicare FFS eligibility during the index hospitalization and through 365 days postdischarge or until death, and these patients were included in the primary study cohort. Analyses of postdischarge outcomes were restricted to the 23,676 patients who were
Discussion
In this analysis from the OPTIMIZE-HF registry, we were able to categorize the severity of congestion for patients with HF at the time of hospital admission and discharge in a real-world clinical practice setting. We found the following: (1) most patients have some degree of congestion on hospital admission, (2) congestion improves during hospitalization, but many patients still have signs and symptoms of congestion at discharge, (3) worse congestion at hospital admission is associated with
Financial Disclosures
Dr. Cooper reported receiving research support from Abbott. Dr. Lippmann reported receiving research support from GlaxoSmithKline during the conduct of the study. Dr. DiBello was an employee and stockholder of GlaxoSmithKline during the conduct of the study. Dr. Gorsh was an employee and stockholder of GlaxoSmithKline during the conduct of the study. Dr. Curtis reports receiving research support from Boston Scientific, Gilead, GlaxoSmithKline, Novartis, and St. Jude Medical. Dr. Sikirica
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2023, European Journal of Pharmaceutical SciencesPrognosis of acute heart failure based on clinical data of congestion
2022, Revista Clinica EspanolaLoop Diuretic Prescription and Long-Term Outcomes in Heart Failure: Association Modification by Congestion
2021, American Journal of MedicineCitation Excerpt :We also observed a lower risk for worse 30-day outcomes in the subgroup with congestion.6,7 Fluid retention underlies congestion in patients with heart failure,33 and is associated with a higher risk of readmission and mortality.22 Loop diuretics improve congestion by increasing urinary sodium excretion in the loop of Henle,34-38 which may explain the improved short-term outcomes in heart failure patients with congestion.6
Prognostic value of multimodal assessment of congestion in acute heart failure
2021, Revista Clinica EspanolaLoop Diuretic Prescription and 30-Day Outcomes in Older Patients With Heart Failure
2020, Journal of the American College of CardiologyCitation Excerpt :The lower risk of 30-day all-cause mortality in the diuretic group is intriguing but may be mediated by improved HF symptoms and lower HF readmission risk. Continued congestion and hospitalization after discharge have been shown to be associated with a higher risk of death in patients with HF (27–30). Several observations from our study suggest that the associations observed in our study may be an underestimation of the true associations of outcomes with loop diuretics.
Funding/Support: This project was supported by a research agreement (HO-15-16139) between Glaxo Smith Kline Pharmaceuticals Corporation (Wilmington, DE) and Duke University (Durham, NC).