Key result
Persistently poor post-HF health status trajectory linked to ~2.3-fold higher mortality.
Why the study?
Improving health status is a major goal in heart failure management, but little is known regarding long-term individual trajectories of health status in patients with acute heart failure following discharge.
Do unfavorable health status trajectories during the first year post-discharge predict long-term all-cause death in heart failure survivors?
Cohort (n=2,328)
Yes
Do unfavorable health status trajectories during the first year post-discharge predict long-term all-cause death in heart failure survivors?
Identifying patients with persistently poor or regressing health status trajectories over the first year after acute heart failure hospitalization provides an important risk stratification tool for long-term mortality.
Supports serial KCCQ monitoring for post-discharge HF risk stratification; leaves open whether modifying unfavorable trajectories improves survival.
Background Improving health status is one of the major goals in the management of heart failure (HF). However, little is known about the long‐term individual trajectories of health status in patients with acute HF after discharge. Methods and Results We enrolled 2328 patients hospitalized for HF from 51 hospitals prospectively and measured their health status via the Kansas City Cardiomyopathy Questionnaire–12 at admission and 1, 6, and 12 months after discharge, respectively. The median age of the patients included was 66 years, and 63.3% were men. Six patterns of Kansas City Cardiomyopathy Questionnaire–12 trajectories were identified by a latent class trajectory model: persistently good (34.0%), rapidly improving (35.5%), slowly improving (10.4%), moderately regressing (7.4%), severely regressing (7.5%), and persistently poor (5.3%). Advanced age, decompensated chronic HF, HF with mildly reduced ejection fraction, HF with preserved ejection fraction, depression symptoms, cognitive impairment, and each additional HF rehospitalization within 1 year of discharge were associated with unfavorable health status (moderately regressing, severely regressing, and persistently poor) ( P <0.05). Compared with the pattern of persistently good, slowly improving (hazard ratio [HR], 1.50 [95% CI, 1.06–2.12]), moderately regressing (HR, 1.92 [1.43–2.58]), severely regressing (HR, 2.26 [1.54–3.31]), and persistently poor (HR, 2.34 [1.55–3.53]) were associated with increased risks of all‐cause death. Conclusions One‐fifth of 1‐year survivors after hospitalization for HF experienced unfavorable health status trajectories and had a substantially increased risk of death during the following years. Our findings help inform the understanding of disease progression from a patient perception perspective and its relationship with long‐term survival. Registration URL: https://www.clinicaltrials.gov ; unique identifier: NCT02878811.
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Zhang et al. (2023) conducted a cohort in Acute heart failure (1-year survivors) (n=2,328). Persistently poor health status trajectory (KCCQ-12) vs. Persistently good health status trajectory was evaluated on All-cause death (HR 2.34, 95% CI 1.55-3.53, p=<0.05). Compared with a persistently good trajectory, a persistently poor health status trajectory during the first year after acute heart failure hospitalization was associated with a significantly increased risk of all-cause death (HR 2.34).
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