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In-hospital worsening heart failure: a clinically relevant endpoint?

Clark, Andrew L.; Cherif, Myriam; McDonagh, Theresa A.; Squire, Iain B.

Authors

Andrew L. Clark

Myriam Cherif

Theresa A. McDonagh

Iain B. Squire



Abstract

Outcome measures used for the clinical evaluation of patients with acute heart failure differ between studies and may neither adequately address the characteristic presenting symptoms and signs nor reflect the pathophysiological processes involved. In‐hospital worsening of heart failure (WHF) is associated with poor outcomes and thus a potential endpoint conveying clinically meaningful prognostic information.

Current definitions of WHF are based on the combination of worsening symptoms and signs and the intensification of treatment during admission. Definitions vary across studies and do not fully account for baseline therapy or circumstances in which there is failure to respond to treatment. Further, there are limited data to inform healthcare professionals as to which patients are most at risk of developing in‐hospital WHF.

In this opinion piece, we review the definitions for WHF used in recent and ongoing clinical trials and propose a novel definition, which captures failure to respond to treatment as well as clinical worsening (deterioration of symptoms and signs) of the patient's condition. Such a definition, applied consistently across studies, would help clarify the characteristics of patients likely to develop in‐hospital WHF, allow comparative assessments of the effectiveness of interventions, and help guide appropriate patient management in order to improve outcomes.

Journal Article Type Review
Publication Date 2018-02
Journal ESC Heart Failure
Electronic ISSN 2055-5822
Publisher Wiley Open Access
Peer Reviewed Peer Reviewed
Volume 5
Issue 1
Pages 9-18
APA6 Citation Clark, A. L., Cherif, M., McDonagh, T. A., & Squire, I. B. (2018). In-hospital worsening heart failure: a clinically relevant endpoint?. ESC Heart Failure, 5(1), 9-18. https://doi.org/10.1002/ehf2.12195
DOI https://doi.org/10.1002/ehf2.12195
Keywords Worsening heart failure; Acute heart failure; Endpoints
Publisher URL https://onlinelibrary.wiley.com/doi/abs/10.1002/ehf2.12195
Copyright Statement © 2017 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

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Copyright Statement
© 2017 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.





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