Abstract
Background
While modern therapy has improved outcomes in patients with heart failure with reduced ejection fraction (HFrEF) there is often conflict between therapy and renal function. The resulting variability in management strategies may adversely affect patient care. We explored the relationship between renal function and outcomes in acute decompensated (AD) HFrEF (EF<40%).
Methods
Flinders Medical Centre inpatients with a primary diagnosis of AD HFrEF were studied. Data is presented as median (25th, 75th percentile), statistical analysis by Mann-Whitney U and Chi-square test, p value <0.05 reported.
Results
One hundred and thirteen AD HFrEF patients aged 76 years (65, 87) with EF 28% (22, 35), creatinine 106mmol/L (85, 158) and urea 9 (6, 13) were recruited. Length of stay was 5 days (3, 9) with weight loss of 2.4kg (0.3, 3.9). During admission, creatinine increased 20% (5, 33) and urea 19% (-9.5, 38). After 2.5 years, 56 patients (50%) had either CV re-admission (45%) and/or death (36%). CKD was significantly associated (p<0.001) with death but not CV re-admission. Deterioration in creatinine and urea during admission were not significantly associated with death or CV readmissions. Indeed, while a decrease in eGFR of 30% during hospitalisation trended towards events (p=0.09); urea increase of 100% or creatinine increase of >50% still had no signal of association with events post-discharge (both p=0.9).
Conclusions
Whereas poor baseline renal function is strongly associated with mortality, a deterioration of renal function during admission was not associated with death and/or CV readmission, giving clinical priority to aggressive decongestion in AD HFrEF.
While modern therapy has improved outcomes in patients with heart failure with reduced ejection fraction (HFrEF) there is often conflict between therapy and renal function. The resulting variability in management strategies may adversely affect patient care. We explored the relationship between renal function and outcomes in acute decompensated (AD) HFrEF (EF<40%).
Methods
Flinders Medical Centre inpatients with a primary diagnosis of AD HFrEF were studied. Data is presented as median (25th, 75th percentile), statistical analysis by Mann-Whitney U and Chi-square test, p value <0.05 reported.
Results
One hundred and thirteen AD HFrEF patients aged 76 years (65, 87) with EF 28% (22, 35), creatinine 106mmol/L (85, 158) and urea 9 (6, 13) were recruited. Length of stay was 5 days (3, 9) with weight loss of 2.4kg (0.3, 3.9). During admission, creatinine increased 20% (5, 33) and urea 19% (-9.5, 38). After 2.5 years, 56 patients (50%) had either CV re-admission (45%) and/or death (36%). CKD was significantly associated (p<0.001) with death but not CV re-admission. Deterioration in creatinine and urea during admission were not significantly associated with death or CV readmissions. Indeed, while a decrease in eGFR of 30% during hospitalisation trended towards events (p=0.09); urea increase of 100% or creatinine increase of >50% still had no signal of association with events post-discharge (both p=0.9).
Conclusions
Whereas poor baseline renal function is strongly associated with mortality, a deterioration of renal function during admission was not associated with death and/or CV readmission, giving clinical priority to aggressive decongestion in AD HFrEF.
Original language | English |
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Pages (from-to) | S143-S144 |
Number of pages | 2 |
Journal | Heart, Lung and Circulation |
Volume | 30 |
Issue number | Supp. 3 |
DOIs | |
Publication status | Published - 1 Jan 2021 |
Externally published | Yes |
Keywords
- Heart Failure With Reduced Ejection Fraction
- HFrEF
- Renal function