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Aims: We investigated which patients with heart failure (HF) should receive specialist palliative care (SPC) by first creating a definition of need for SPC in patients hospitalised with HF using patient-reported outcome measures (PROMs) and then testing this definition using the outcome of days alive and out of hospital (DAOH). We also evaluated which baseline variables predicted need for SPC and whether those with this need received SPC., Methods and Results: PROMs assessing quality of life (QoL), symptoms, and mood were administered at baseline and every 4 months. SPC need was defined as persistently severe impairment of any PROM without improvement (or severe impairment immediately preceding death). We then tested whether need for SPC, so defined, was reflected in DAOH, a measure which combines length of stay, days of hospital re-admission, and days lost due to death. Of 272 patients recruited, 74 (27%) met the definition of SPC needs. These patients lived one third fewer DAOH than those without SPC need (and less than a quarter of QoL-adjusted DAOH). A Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score of <29 identified patients who subsequently had SPC needs (area under receiver operating characteristic curve 0.78). Twenty-four per cent of patients with SPC needs actually received SPC (n = 18)., Conclusions: A quarter of patients hospitalised with HF had a need for SPC and were identified by a low KCCQ score on admission. Those with SPC need spent many fewer DAOH and their DAOH were of significantly worse quality. Very few patients with SPC needs accessed SPC services., (© 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology.)

Aims: The aim of this study was to examine the association between patient‐reported symptoms and the extent of pulmonary congestion in acute heart failure (AHF). Methods and results: In this prospective, observational study, patient‐reported symptoms were assessed at baseline using the Kansas City Cardiomyopathy Questionnaire total symptom score (KCCQ‐TSS) (range 0–100; 0 worst) in patients hospitalized for AHF. In a subset, patient‐reported dyspnoea at rest and on exertion was examined (range 0–10; 10 worst) at baseline. In addition, 4‐zone lung ultrasound (LUS) was performed at baseline at the time of echocardiography. B‐lines were quantified offline, blinded to clinical findings, by a core laboratory. Chest X‐ray (CXR) and physical examination findings were collected from the medical records. Among 322 patients (mean age 72, 60% men, mean left ventricular ejection fraction 39%) with AHF, the median KCCQ‐TSS score was 33 (interquartile range 18–48). Worse KCCQ‐TSS was associated with worse New York Heart Association class, dyspnoea at rest and on exertion, and peripheral oedema (p trend <0.001 for all). However, KCCQ‐TSS was not associated with the extent of pulmonary congestion, as assessed by the number of B‐lines on LUS, or findings on CXR, or physical examination (p trend >0.25 for all). Similarly, KCCQ‐TSS was not significantly associated with echocardiographic markers of left ventricular filling pressure, pulmonary pressure or with N‐terminal pro‐B‐type natriuretic peptide level. Conclusions: Among patients hospitalized for AHF, at baseline, KCCQ‐TSS was not associated with pulmonary congestion assessed by LUS, CXR, or physical examination. These findings suggest that the profound reduction in KCCQ‐TSS in patients with AHF may not be solely explained by pulmonary congestion. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text. Background: To describe characteristics and outcomes in women and men with heart failure with preserved ejection fraction. Methods: Baseline characteristics (including biomarkers and quality of life) and outcomes (primary outcome: composite of first heart failure hospitalization or cardiovascular death) were compared in 4458 women and 4010 men enrolled in CHARM-Preserved (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) (EF≥45%), I-Preserve (Irbesartan in heart failure with Preserved ejection fraction), and TOPCAT-Americas (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial). Results: Women were older and more often obese and hypertensive but less likely to have coronary artery disease or atrial fibrillation. Women had more symptoms and signs of congestion and worse quality of life. Despite this, the risk of the primary outcome was lower in women (hazard ratio, 0.80 [95% CI, 0.73–0.88]), as was the risk of cardiovascular death (hazard ratio, 0.70 [95% CI, 0.62–0.80]), but there was no difference in the rate for first hospitalization for heart failure (hazard ratio, 0.92 [95% CI, 0.82–1.02]). The lower risk of cardiovascular death in women, compared with men, was in part explained by a substantially lower risk of sudden death (hazard ratio, 0.53 [0.43–0.65]; P <0.001). E/A ratio was lower in women (1.1 versus 1.2). Conclusions: There are significant differences between women and men with heart failure with preserved ejection fraction. Despite worse symptoms, more congestion, and lower quality of life, women had similar rates of hospitalization and better survival than men. Their risk of sudden death was half that of men. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00853658, NCT01035255. [ABSTRACT FROM AUTHOR]