Physician-determined worsening heart failure: a novel definition for early worsening heart failure in patients hospitalized for acute heart failure--association with signs and symptoms, hospitalization duration, and 60-day outcomes.

Journal Article (Journal Article;Multicenter Study)

OBJECTIVES: To evaluate physician-determined worsening heart failure (PD-WHF) in patients admitted with acute heart failure (AHF). METHODS: The PROTECT pilot study evaluated rolofylline, an adenosine A(1) receptor antagonist, versus placebo in patients with AHF and renal impairment. Signs and symptoms of heart failure (HF) and diuretic administration were prospectively recorded daily for 7 days and patients were followed for 60 days. Patients were categorized into three groups: (A) PD-WHF, based on worsening symptoms and signs of HF and need for additional intravenous (IV) or mechanical therapy (n = 29); (B) increased IV diuretic therapy without PD-WHF (n = 61), and (C) neither PD-WHF nor increase in IV diuretic dose (n = 211). RESULTS: Patients in group A had slower resolution of dyspnea, longer mean (+/-SD) length of hospitalization (13.8 +/- 6.8 vs. 10.5 +/- 8.5 and 9.3 +/- 5.9 days in groups B and C, respectively; p < 0.05 for both), and higher 60-day death and cardiovascular or renal readmission rates [49.7 (95% confidence interval: 33.1-69.1) vs. 37.3 (26.4-50.9) vs. 19.5% (14.7-25.6) in groups B and C, respectively]. PD-WHF was a strong independent predictor of length of stay and 60-day death and cardiovascular or renal readmission. CONCLUSIONS: PD-WHF may be an indicator of short-term risk and treatment efficacy in AHF.

Full Text

Duke Authors

Cited Authors

  • Cotter, G; Metra, M; Weatherley, BD; Dittrich, HC; Massie, BM; Ponikowski, P; Bloomfield, DM; O'Connor, CM

Published Date

  • 2010

Published In

Volume / Issue

  • 115 / 1

Start / End Page

  • 29 - 36

PubMed ID

  • 19844102

Electronic International Standard Serial Number (EISSN)

  • 1421-9751

Digital Object Identifier (DOI)

  • 10.1159/000249280


  • eng

Conference Location

  • Switzerland