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In-hospital worsening heart failure: a clinically relevant endpoint?

journal contribution
posted on 16.04.2018, 14:51 by Andrew L. Clark, Myriam Cherif, Theresa A. McDonagh, Iain B. Squire
Outcome measures used for the clinical evaluation of patients with acute heart failure differ between studies and may neither adequately address the characteristic presenting symptoms and signs nor reflect the pathophysiological processes involved. In-hospital worsening of heart failure (WHF) is associated with poor outcomes and thus a potential endpoint conveying clinically meaningful prognostic information. Current definitions of WHF are based on the combination of worsening symptoms and signs and the intensification of treatment during admission. Definitions vary across studies and do not fully account for baseline therapy or circumstances in which there is failure to respond to treatment. Further, there are limited data to inform healthcare professionals as to which patients are most at risk of developing in-hospital WHF. In this opinion piece, we review the definitions for WHF used in recent and ongoing clinical trials and propose a novel definition, which captures failure to respond to treatment as well as clinical worsening (deterioration of symptoms and signs) of the patient's condition. Such a definition, applied consistently across studies, would help clarify the characteristics of patients likely to develop in-hospital WHF, allow comparative assessments of the effectiveness of interventions, and help guide appropriate patient management in order to improve outcomes.

History

Citation

ESC Heart Failure, 2018, 5 (1), pp. 9-18

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

ESC Heart Failure

Publisher

Wiley Open Access

eissn

2055-5822

Acceptance date

20/06/2017

Copyright date

2018

Available date

16/04/2018

Publisher version

https://onlinelibrary.wiley.com/doi/abs/10.1002/ehf2.12195

Language

en

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