Prognostic impact of residual symptoms at discharge in patients hospitalized for worsening heart failure

Background An early improvement of dyspnea after hospitalization, though often set as an important endpoint, did not predict prognosis in many intervention studies for worsening heart failure (HF). However, the prognostic impact of residual symptoms at discharge, simply defined by the New York Heart Association (NYHA) class, remains unclear in patients hospitalized for worsening HF. Purpose To evaluate the prognostic impact of residual symptoms at discharge in patients hospitalized for worsening HF. Methods We carried out a sub-analysis of FRAGILE-HF including 1272 consecutive older (>=65 years) hospitalized patients with HF (median age 80; 57.2% male; LVEF 46±17%). NYHA class was documented at the time of discharge to assess residual symptoms. The patients were prospectively followed-up for two years after discharge. Results At the time of discharge, 715 patients (56%) remained symptomatic (NYHA II-IV) whereas 557 patients (44%) were asymptomatic (NYHA I). During the follow-up period, 571 combined endpoints of rehospitalization due to HF and all-cause death and 266 all-cause deaths were observed. Adjusted hazard ratio for combined endpoint and all-cause death was 1.44 [95% confidence interval: 1.20-1.73], p<0.001 and 1.72 [1.31-2.26], p<0.001 in patients with residual symptoms at discharge, in comparison with those without residual symptoms as a reference, respectively (Figure). Residual symptoms at discharge were still prognostic after further adjustment with gait speed and leg edema, with no interaction between each other (p for interaction: 0.393 and 0.713 for all-cause death, respectively). Conclusions The presence of residual symptoms at the time of discharge was a simple prognostic marker associated with combined endpoint and all-cause death in patients hospitalized for worsening HF. These results highlight the importance to assess residual symptoms at discharge and support treating patients with symptom relief as a goal.