Mild or moderate aortic stenosis in acute heart failure was not independently associated with cardiovascular death or readmission after multivariable adjustment (adjusted HR 1.04; 95% CI 0.82-1.32).
Cohort (n=6,241)
Does the presence of mild or moderate aortic stenosis worsen clinical outcomes in patients hospitalized with acute heart failure?
In patients with acute heart failure, mild or moderate aortic stenosis is a marker of older age and greater comorbidity burden, but it is not an independent predictor of 180-day cardiovascular mortality or readmission.
Effect estimate: adjusted HR 1.04 (95% CI 0.82-1.32)
Abstract Background Aortic stenosis leads to increased afterload, which may be detrimental in a failing left ventricle and has been associated with increased risk of heart failure hospitalizations and mortality in chronic heart failure. The prevalence and impact of aortic stenosis in acute heart failure is less well described. Purpose We aimed to evaluate the prevalence and prognostic impact of aortic stenosis in a large cohort of patients hospitalized with acute heart failure. Methods All patients from the Relaxin in Acute Heart Failure 2 (RELAX-AHF-2) trial with data available on aortic stenosis severity were included in the present analysis (n = 6241). Patients with severe aortic stenosis were ineligible for RELAX-AHF-2. Baseline characteristics, in-hospital outcomes, and 180-day clinical outcomes were compared between patients with and without aortic stenosis. Results Mild or moderate aortic stenosis was present in 454 (7.3%) patients. Patients with aortic stenosis were older, more often female, had more comorbidities and a higher left ventricular ejection fraction compared to patients without aortic stenosis. Mild or moderate aortic stenosis was associated with a higher risk of cardiovascular mortality or readmission for heart or renal failure (unadjusted Hazard Ratio (HR) 1.32, 95% CI 1.11 – 1.57). This association was maintained when adjusting for age and sex, but not after comprehensive multivariable adjustment (adjusted HR 1.04, 95% CI 0.82 – 1.32). Conclusion The presence of mild or moderate aortic stenosis reflects an increased risk for poor clinical outcome in patients with acute heart failure.Graphical Abstract
Venema et al. (Sat,) conducted a cohort in acute heart failure (n=6,241). Mild or moderate aortic stenosis vs. No aortic stenosis was evaluated on Cardiovascular mortality or readmission for heart or renal failure (adjusted HR 1.04, 95% CI 0.82-1.32). Mild or moderate aortic stenosis in acute heart failure was not independently associated with cardiovascular death or readmission after multivariable adjustment (adjusted HR 1.04; 95% CI 0.82-1.32).
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