Relation of volume overload to clinical outcomes in acute heart failure (from ASCEND-HF)

Fudim, M. et al. (2018) Relation of volume overload to clinical outcomes in acute heart failure (from ASCEND-HF). American Journal of Cardiology, 122(9), pp. 1506-1512. (doi: 10.1016/j.amjcard.2018.07.023) (PMID:30172362) (PMCID:PMC6924269)

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We aimed to study whether jugular venous distension (JVD) and peripheral edema were associated with worse outcomes in patients with acute heart failure in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure trial. Of 7,141 patients in Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure, 7,135 had complete data on baseline JVD and peripheral edema status. Patients were grouped according to baseline examination findings: (1) no JVD or peripheral edema; (2) JVD only; (3) peripheral edema only; (4) JVD and peripheral edema. We used unadjusted and adjusted logistic or Cox regression analyses to assess associations between groups and the outcomes of index length of stay (LOS), in-hospital mortality, 30- and 180-day all-cause mortality. Patients with peripheral edema (Groups 3 and 4) had higher body mass index, NT-proBNP and BNP values, and more co-morbid disease, and reduced left ventricular ejection fraction compared with patients in Groups 1–2. The median (25th–75th) LOS for Groups 1–4 was 6 (4–9), 5 (4–8), 7 (4–11), and 6 days (4–10), respectively. For the 30-day and 180-day outcomes, adjusted analyses found no significant difference in risk for patients presenting with JVD only or peripheral edema only as compared with patients without evidence of JVD or peripheral edema (p >0.05 for all). The presence of both JVD and peripheral edema was associated with an adjusted 24% increase in risk for all-cause mortality at 30 days, but no risk difference at 180 days. In conclusion, in patients with heart failure presenting to the hospital with dyspnea, the presence of peripheral edema is associated with a longer hospital LOS, but no difference in short- and long-term clinical outcomes when compared with patients wihout peripheral edema. The combination of peripheral edema and JVD identifies the highest risk cohort for poor clinical outcomes.

Item Type:Articles
Additional Information:Funding: Scios Inc., now Johnson and Johnson, provided financial and material support for the ASCEND-HF trial. MF: Axon Therapies, Coridea, Cibiem. GE Healthcare, Supported by AHA Grant 17MCPRP33460225 and the NHLBI T32 postdoctoral training grant 5T32HL007101-42. RJM: Amgen, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Novartis, Otsuka, ResMed, Thoratec. JAE: Abbott Labs, Amgen, Johnson and Johnson, Pfizer, Servier. AAV: Amgen, Bayer, Boehringer Ingelheim, Merck, Novartis, Servier. CMO: Amgen, Astellas, GE Healthcare, Gilead, Novella, Otsuka, Roche Diagnostics, Resmed. AFH: Sanofi, Johnson and Johnson, AstraZeneca, Corthera.
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Fudim, M., Parikh, K. S., Dunning, A., DeVore, A. D., Mentz, R. J., Schulte, P. J., Armstrong, P. W., Ezekowitz, J. A., Tang, W.H. W., McMurray, J. J.V., Voors, A. A., Drazner, M. H., O'Connor, C. M., Hernandez, A. F., and Patel, C. B.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:American Journal of Cardiology
ISSN (Online):1879-1913
Published Online:03 August 2018

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