In-Hospital Worsening Heart Failure: A Clinically Relevant Endpoint?

Figures

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  Figure 1. In‐hospital worsening heart failure (WHF) and reported outcomes in recent clinical trials. Kaplan–Meier estimates of (A) cumulative risk of death or heart failure (HF) hospitalization through Day 30 by occurrence of WHF through Day 7, shown with 95% confidence intervals and number of subjects at risk in VERITAS.12 (B) Survival for patients with and without WHF within 7 days of admission.14 (C) Risk of all‐cause mortality through Day 180 shown with number of subjects at risk in RELAX‐AHF.17 (D) Observed all‐cause mortality up to 1 year post‐index hospitalization in ADHERE.19 ADHERE, Acute Decompensated Heart Failure National Registry; HR, hazard ratio; RELAX‐AHF, serelaxin in acute heart failure; VERITAS, Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Studies. Figure (A) reproduced with permission from Cotter et al.11; Figure (B) reproduced with permission from Weatherley et al.14; Figure (C) reproduced with permission from Metra et al.17; Figure (D) reproduced with permission from DeVore et al.19

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  Figure 2. Change in dyspnoea score by study day in patients with/without in‐hospital worsening heart failure (WHF). Mean patient‐reported dyspnoea change score over time on a Likert scale, in patients with and without in‐hospital WHF.11 i.v., intravenous. Figure reproduced with permission: Cotter G et al.11. © 2009 Karger AG, Basel.

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  Figure 3. Irrespective of definition, in‐hospital worsening heart failure (WHF) is associated with poor outcomes for patients with heart failure. The definition of in‐hospital WHF varies across studies but is consistently associated with adverse outcomes including longer length of stay, increased rate of re‐hospitalization, higher mortality rate, and greater economic burden.11, 12, 14, 15, 17, 19, 37