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

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

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.

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

• Journal Article Type: Review
• Acceptance Date: Jun 20, 2017
• Online Publication Date: Jul 18, 2017
• Publication Date: 2018-02
• Deposit Date: Jul 24, 2018
• Publicly Available Date: Jul 24, 2018
• Journal: ESC Heart Failure
• Electronic ISSN: 2055-5822
• Publisher: Wiley Open Access
• Peer Reviewed: Peer Reviewed
• Volume: 5
• Issue: 1
• Pages: 9-18
• DOI: https://doi.org/10.1002/ehf2.12195
• Keywords: Worsening heart failure; Acute heart failure; Endpoints
• Public URL: https://hull-repository.worktribe.com/output/942958
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1002/ehf2.12195
• Contract Date: Jul 24, 2018