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Early and short-term intensive management after discharge for patients hospitalized with acute heart failure: a randomized study (ECAD-HF).

Authors :
Logeart D
Berthelot E
Bihry N
Eschalier R
Salvat M
Garcon P
Eicher JC
Cohen A
Tartiere JM
Samadi A
Donal E
deGroote P
Mewton N
Mansencal N
Raphael P
Ghanem N
Seronde MF
Chavelas C
Rosamel Y
Beauvais F
Kevorkian JP
Diallo A
Vicaut E
Isnard R
Source :
European journal of heart failure [Eur J Heart Fail] 2022 Jan; Vol. 24 (1), pp. 219-226. Date of Electronic Publication: 2021 Oct 21.
Publication Year :
2022

Abstract

Aims: Hospitalization for acute heart failure (HF) is followed by a vulnerable time with increased risk of readmission or death, thus requiring particular attention after discharge. In this study, we examined the impact of intensive, early follow-up among patients at high readmission risk at discharge after treatment for acute HF.<br />Methods and Results: Hospitalized acute HF patients were included with at least one of the following: previous acute HF < 6 months, systolic blood pressure ≤ 110 mmHg, creatininaemia ≥ 180 µmol/L, or B-type natriuretic peptide ≥ 350 pg/mL or N-terminal pro B-type natriuretic peptide ≥ 2200 pg/mL. Patients were randomized to either optimized care and education with serial consultations with HF specialist and dietician during the first 2-3 weeks, or to standard post-discharge care according to guidelines. The primary endpoint was all-cause death or first unplanned hospitalization during 6-month follow-up. Among 482 randomized patients (median age 77 and median left ventricular ejection fraction 35%), 224 were hospitalized or died. In the intensive group, loop diuretics (46%), beta-blockers (49%), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (39%) and mineralocorticoid receptor antagonists (47%) were titrated. No difference was observed between groups for the primary endpoint (hazard ratio 0.97; 95% confidence interval 0.74-1.26), nor for mortality at 6 or 12 months or unplanned HF rehospitalization. Additionally, no difference between groups according to age, previous HF and left ventricular ejection fraction was found.<br />Conclusions: In high-risk HF, intensive follow-up early post-discharge did not improve outcomes. This vulnerable post-discharge time requires further studies to clarify useful transitional care services.<br /> (© 2021 European Society of Cardiology.)

Details

Language :
English
ISSN :
1879-0844
Volume :
24
Issue :
1
Database :
MEDLINE
Journal :
European journal of heart failure
Publication Type :
Academic Journal
Accession number :
34628697
Full Text :
https://doi.org/10.1002/ejhf.2357