Key result
Higher admission osmolality linked to ~370% greater risk of cardiac death or readmission in acute HFpEF.
Why the study?
While plasma osmolality has prognostic importance in HFrEF, its prognostic meaning in HFpEF has not been elucidated.
Does elevated plasma osmolality on admission predict cardiac mortality or heart failure re-admission in acute decompensated HFpEF inpatients?
Observational (n=960)
Yes
Does elevated plasma osmolality on admission predict cardiac mortality or heart failure re-admission in acute decompensated HFpEF inpatients?
Effect estimate: HR 4.70 (95% CI 1.33-17.35)
p-value: p=0.0160
Elevated plasma osmolality on admission (>300.3 mOsm/kg) is an independent predictor of cardiac mortality and heart failure readmission in patients with acute decompensated HFpEF.
Admission osmolality may stratify risk in acute decompensated HFpEF but should not yet change practice; hypothesis-generating for prospective validation.
BackgroundComplicated pathophysiology makes it difficult to identify the prognosis of heart failure with preserved ejection fraction (HFpEF). While plasma osmolality has been reported to have prognostic importance, mainly in heart failure with reduced ejection fraction (HFrEF), its prognostic meaning for HFpEF has not been elucidated. MethodsWe prospectively studied 960 patients in PURSUIT-HFpEF, a multicenter observational study of acute decompensated HFpEF inpatients. We divided patients into three groups according to the quantile values of plasma osmolality on admission. During a follow-up averaging 366 days, we examined the primary composite endpoint of cardiac mortality or heart failure re-admission using Kaplan-Meier curve analysis and Cox proportional hazard testing. Results216 (22.5%) patients reached the primary endpoint. Kaplan-Meier curve analysis revealed that the highest quantile of plasma osmolality on admission (higher than 300.3 mOsm/kg) was significantly associated with adverse outcomes (Log-rank P = 0.0095). Univariable analysis in the Cox proportional hazard model also revealed significantly higher rates of adverse outcomes in the higher plasma osmolality on admission (hazard ratio [HR] 7.29; 95% confidence interval [CI] 2.25–23.92, P = 0.0009). Multivariable analysis in the Cox proportional hazard model also showed that higher plasma osmolality on admission was significantly associated with adverse outcomes (HR 4.70; 95% CI 1.33–17.35, P = 0.0160) independently from other confounding factors such as age, gender, comorbid of atrial fibrillation, hypertension history, diabetes, malnutrition, and N-terminal pro-B-type natriuretic peptide elevation. ConclusionsHigher plasma osmolality on admission was prognostically important for acute decompensated HFpEF inpatients.
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Nakagawa et al. (2020) conducted an observational in Acute Decompensated Heart Failure With Preserved Ejection Fraction (HFpEF) (n=960). Higher plasma osmolality on admission vs. Lower plasma osmolality on admission was evaluated on Composite of cardiac mortality or heart failure re-admission (HR 4.70, 95% CI 1.33-17.35, p=0.0160). Higher plasma osmolality on admission was independently associated with an increased risk of cardiac mortality or heart failure readmission in acute decompensated HFpEF patients (HR 4.70).
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