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Implications of Using Different Definitions on Outcomes in Worsening Heart Failure.

Publication ,  Journal Article
Kelly, JP; Cooper, LB; Gallup, D; Anstrom, KJ; Chen, HH; Redfield, MM; O'Connor, CM; Mentz, RJ; Hernanadez, AF; Felker, GM
Published in: Circ Heart Fail
August 2016

BACKGROUND: In-hospital worsening heart failure (WHF) is an important event that has inconsistent definitions used across trials. We used data from 2 acute heart failure (HF) trials from the National Institutes of Health HF Network, DOSE (Diuretic Optimization Strategies Evaluation) and ROSE (Renal Optimization Strategies), to understand event rates associated with different WHF definitions. METHODS AND RESULTS: We pooled data from 668 patients in DOSE and ROSE and assessed the relationship between WHF and the composite end point of rehospitalization, emergency room visits for HF, and mortality through 60 days. We also assessed for a differential relationship between the timing of WHF development and outcomes. The overall incidence of WHF was 14.6% (24.1% in DOSE, 6.3% in ROSE, and 5.0% in DOSE using the ROSE definition). WHF was associated with an increase in the composite end point (hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.11-2.42; P=0.01). However, the association between WHF and outcomes was significantly stronger in ROSE than in DOSE (HR, 2.67; 95% CI, 1.45-4.91; P<0.01 and HR, 1.28; 95% CI, 0.79-2.08; P=0.31, respectively). Development of WHF between baseline to 24 hours compared with 24 to 48 hours or 48 to 72 hours demonstrated a trend toward improved outcomes (HR, 0.49; 95% CI, 0.21-1.17; P=0.11 and HR, 0.45; 95% CI, 0.20-1.04; P=0.06, respectively). CONCLUSIONS: A WHF definition that excluded the intensification of diuretics resulted in a lower event rate but a stronger association with outcomes. These data support the need for continued efforts to standardize WHF definitions in clinical trials. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00577135 (DOSE) and NCT01132846 (ROSE).

Duke Scholars

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

August 2016

Volume

9

Issue

8

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Terminology as Topic
  • Risk Factors
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Predictive Value of Tests
  • Patient Readmission
  • Middle Aged
  • Male
 

Citation

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MLA
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Kelly, J. P., Cooper, L. B., Gallup, D., Anstrom, K. J., Chen, H. H., Redfield, M. M., … Felker, G. M. (2016). Implications of Using Different Definitions on Outcomes in Worsening Heart Failure. Circ Heart Fail, 9(8). https://doi.org/10.1161/CIRCHEARTFAILURE.116.003048
Kelly, Jacob P., Lauren B. Cooper, Dianne Gallup, Kevin J. Anstrom, Horng H. Chen, Margaret M. Redfield, Christopher M. O’Connor, Robert J. Mentz, Adrian F. Hernanadez, and G Michael Felker. “Implications of Using Different Definitions on Outcomes in Worsening Heart Failure.Circ Heart Fail 9, no. 8 (August 2016). https://doi.org/10.1161/CIRCHEARTFAILURE.116.003048.
Kelly JP, Cooper LB, Gallup D, Anstrom KJ, Chen HH, Redfield MM, et al. Implications of Using Different Definitions on Outcomes in Worsening Heart Failure. Circ Heart Fail. 2016 Aug;9(8).
Kelly, Jacob P., et al. “Implications of Using Different Definitions on Outcomes in Worsening Heart Failure.Circ Heart Fail, vol. 9, no. 8, Aug. 2016. Pubmed, doi:10.1161/CIRCHEARTFAILURE.116.003048.
Kelly JP, Cooper LB, Gallup D, Anstrom KJ, Chen HH, Redfield MM, O’Connor CM, Mentz RJ, Hernanadez AF, Felker GM. Implications of Using Different Definitions on Outcomes in Worsening Heart Failure. Circ Heart Fail. 2016 Aug;9(8).

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

August 2016

Volume

9

Issue

8

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Terminology as Topic
  • Risk Factors
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Predictive Value of Tests
  • Patient Readmission
  • Middle Aged
  • Male