Conference Coverage

Advanced heart failure symptoms linked to mortality


 

AT THE HFSA ANNUAL SCIENTIFIC MEETING

– Advanced heart failure patients who are hospitalized for heart failure and have a higher symptom burden at discharge have a significantly increased rate of death or rehospitalization over the next 6 months, based on an analysis of 393 patients enrolled in a heart failure trial.

The strong link between severe symptom burden and poor near-term outcomes persisted despite adjustment for various markers of heart failure severity, suggesting that treatment aimed at reducing symptoms may be able to reduce mortality or heart failure hospitalization in advanced heart failure patients, Ellen K. Hummel, MD, said at the annual scientific meeting of the Heart Failure Society of America.

In her analysis, a severe symptom burden at the time of hospital discharge linked with an adjusted 2.9-fold increased mortality rate and a 2.5-fold increased rate of days dead or hospitalized during the next 6 months, said Dr. Hummel, a geriatric and palliative care specialist at the University of Michigan in Ann Arbor. These elevated rate ratios for patients with severe symptoms at hospital discharge were in comparison to the ratios for advanced heart failure patients in the study with no symptoms at discharge.

Three symptoms contributed to the symptom score she used in her analysis: fatigue, scored on a scale of 0-3; dyspnea, also scored 0-3; and gastrointestinal distress, scored as 0-2, creating a maximum score of 8. Her analysis categorized mild as a total score of 1-4 and severe as 5 or greater. In the study population she used for her analysis, patients enrolled in the multicenter ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial, 111 of the 393 evaluable patients (28%) had none of these symptoms, 239 (61%) had mild symptoms, and 43 (11%) had severe symptoms. Scoring was done by patients based on their subjective self-assessment at the time of hospital discharge.

The absolute, observed 6-month mortality rates were roughly 45% among patients with severe symptoms, about 17% in patients with mild symptoms, and about 12% in those with no symptoms.

The primary purpose of ESCAPE was to assess the impact that routine collection of data from a pulmonary artery catheter during hospitalization has on outcomes; the results showed no significant link between improved outcomes and getting these data (JAMA. 2005 Oct 5;294[13]:1625-33). The study ran during 2000-2003 at 26 centers in the United States and Canada. Of the 433 advanced heart failure patients enrolled in ESCAPE, 393 had complete records to allow the current analysis.

The adjustments that Dr. Hummel made in the proportional hazard analysis took into account New York Heart Association class, and severity of disease at the time of hospital discharge measured by the ESCAPE Discharge Risk Score. This score takes into account age, 6-minute walk distance, blood urea nitrogen, brain natriuretic peptide levels, blood pressure, selected drug treatments, sodium level, and history of cardiopulmonary resuscitation or mechanical ventilation.

Dr. Hummel had no relevant financial disclosures.

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