Transient heart failure occurring in the acute and/or rehabilitative phase after coronaryrevascularization as a determinant of 1-year prognosis

Transient heart failure (THF) after cardiac events is associated to worse cardiovascular prognosis, however little is known about THF occurring in the acute and rehabilitative phase following coronary artery bypass grafting and percutaneous coronary intervention interventions. To address this issue, patients in the Italian survey on cardiac rehabilitation and secondary prevention after cardiac revascularization (ICAROS) were analysed for time of onset, associated factors, and outcome of THF. ICAROS was a prospective, multicentre registry involving 1,262 patients discharged from 62 cardiac rehabilitation (CR) facilities nationwide, comprehensive of risk factors, lifestyle habits, drug treatments, and major cardiovascular events (MACE) assessment during a 1-year follow-up. THF was defined either as signs and symptoms consistent with decompensation or patients presenting with either cardiogenic shock or pulmonary oedema. Overall, 96 (7.6%) patients developed THF after coronary revascularization, with 69.8% of cases in acute wards, 22.9% during CR, and 7.3% in both settings. THF affected more frequently patients with chronic heart failure or long history of coronary artery disease (42.7% versus 30.6% in patients without chronic cardiac condition, p < 0.005). Age 75 years (33.3%), chronic obstructive pulmonary disease (19.8%), and chronic renal failure (17.7%) were also significantly more represented in the THF group. At the end of CR, THF patients were prescribed more diuretics (78.9% non-potassium sparing, 36.8% potassium sparing) insulin (17.9%), and anticoagulants (32.3%). During follow-up, THF patients maintained similar rates of ongoing cardioprotective drugs as compared to controls, with less prescription of statins (64.6% versus 82.2%, p < 0.001). The case crossover comparison between the end of CR and after one year showed good persistence of reninangiotensin- aldosterone system modulators (90.6%) and beta-blockers (83.3%). Mortality (8.3% versus 1.6%, p < 0.001) and MACEs (21.9% versus 8.1%, p < 0.001) occurred more frequently among THF patients; further episodes of decompensated heart failure (10.4 versus 2.4%, p < 0.001) were the most represented events. THF independently predicted adverse outcome with a OR for recurrent events of 2.451 (CI 1.403-4.282), as compared to patients without THF. THF is a major determinant of prognosis after coronary revascularization, with a good predictive value also for episodes occurring during the CR program.