PMID- 26083764
OWN - NLM
STAT- MEDLINE
DCOM- 20160524
LR  - 20171117
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 17
IP  - 7
DP  - 2015 Jul
TI  - Early vs. late worsening heart failure during acute heart failure
      hospitalization: insights from the PROTECT trial.
PG  - 697-706
LID - 10.1002/ejhf.308 [doi]
AB  - BACKGROUND: Worsening heart failure (WHF) symptoms despite initial therapy during
      admission for acute heart failure (AHF) is associated with worse outcomes. The
      association between the time of the WHF event and the intensity of WHF therapy
      with outcomes is unknown. METHODS AND RESULTS: In the PROTECT trial of 2033 AHF
      patients, we investigated the association between time of occurrence of WHF and
      intensity of therapy, with subsequent outcomes. WHF was defined by standardized, 
      physician-determined assessment. Early WHF was defined as occurring on days 2-3
      and late on days 4-7. Low intensity included restarting/increasing diuretics or
      vasodilators and high intensity included initiation of inotropes, vasopressors,
      inodilators, or mechanical support. Outcomes were death or cardiovascular/renal
      hospitalization over 60 days and death over 180 days. Of the 1879 patients with
      complete follow-up after day 7, 12.7% (n = 238) experienced WHF: 47.9% early and 
      52.1% late. Treatment intensity was low in 72.3% and high in 24.8% (2.9%
      missing). After adjusting for baseline predictors of outcome, WHF was associated 
      with a trend toward increased 60-day death or cardiovascular/renal
      hospitalization [hazard ratio (HR) 1.26; 95% confidence interval (CI) 0.99-1.60; 
      P = 0.063] and increased 180-day death (HR 1.77; 95% CI 1.33-2.34; P < 0.001).
      There was no evidence of a differential association between the time of
      occurrence of WHF and outcomes. High-intensity therapy was not significantly
      associated with increased event rates (180-day mortality: HR 1.44; 95% CI
      0.80-2.59 vs. low). CONCLUSIONS: Inhospital WHF was associated with increased
      180-day death. The time of occurrence and intensity of WHF therapy may provide
      less prognostic information than whether or not WHF occurred.
CI  - (c) 2015 The Authors. European Journal of Heart Failure (c) 2015 European Society
      of Cardiology.
FAU - Mentz, Robert J
AU  - Mentz RJ
AD  - Duke University Hospital, Medicine, Division of Cardiology, 2301 Erwin Road,
      Durham, NC 27713, USA.
AD  - Duke Clinical Research Institute, Durham, NC, USA.
FAU - Metra, Marco
AU  - Metra M
AD  - University of Brescia, Brescia, Italy.
FAU - Cotter, Gad
AU  - Cotter G
AD  - Momentum Research, Durham, NC, USA.
FAU - Milo, Olga
AU  - Milo O
AD  - Momentum Research, Durham, NC, USA.
FAU - McKendry, Colleen
AU  - McKendry C
AD  - Duke Clinical Research Institute, Durham, NC, USA.
FAU - Chiswell, Karen
AU  - Chiswell K
AD  - Duke Clinical Research Institute, Durham, NC, USA.
FAU - Davison, Beth A
AU  - Davison BA
AD  - Momentum Research, Durham, NC, USA.
FAU - Cleland, John G F
AU  - Cleland JG
AD  - National Heart and Lung Institute, Imperial College London (Royal Brompton &
      Harefield Hospitals) and Department of Cardiology, Castle Hill Hospital,
      University of Hull, Kingston-upon-Hull, UK.
FAU - Bloomfield, Daniel M
AU  - Bloomfield DM
AD  - Merck Research Laboratories, Rahway, NJ, USA.
FAU - Dittrich, Howard C
AU  - Dittrich HC
AD  - University of Iowa Carver College of Medicine Cardiovascular Research Center,
      Iowa City, IA, USA.
FAU - Fiuzat, Mona
AU  - Fiuzat M
AD  - Duke University Hospital, Medicine, Division of Cardiology, 2301 Erwin Road,
      Durham, NC 27713, USA.
AD  - Duke Clinical Research Institute, Durham, NC, USA.
FAU - Ponikowski, Piotr
AU  - Ponikowski P
AD  - Medical University, Military Hospital, Wroclaw, Poland.
FAU - Givertz, Michael M
AU  - Givertz MM
AD  - Brigham and Women's Hospital, Boston, MA, USA.
FAU - Voors, Adriaan A
AU  - Voors AA
AD  - University of Groningen, Groningen, the Netherlands.
FAU - Teerlink, John R
AU  - Teerlink JR
AD  - University of California at San Francisco (SF) and SF Veterans Affairs Medical
      Center, SF, CA, USA.
FAU - O'Connor, Christopher M
AU  - O'Connor CM
AD  - Duke University Hospital, Medicine, Division of Cardiology, 2301 Erwin Road,
      Durham, NC 27713, USA.
AD  - Duke Clinical Research Institute, Durham, NC, USA.
LA  - eng
GR  - T32 HL079896/HL/NHLBI NIH HHS/United States
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20150617
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
RN  - 0 (Diuretics)
RN  - 0 (Vasoconstrictor Agents)
RN  - 0 (Vasodilator Agents)
SB  - IM
MH  - Aged
MH  - Disease Progression
MH  - Diuretics/therapeutic use
MH  - Female
MH  - Heart Failure/*diagnosis/drug therapy/physiopathology
MH  - *Hospitalization
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Random Allocation
MH  - Time Factors
MH  - Vasoconstrictor Agents/therapeutic use
MH  - Vasodilator Agents/therapeutic use
PMC - PMC5687792
MID - NIHMS917092
OTO - NOTNLM
OT  - Acute heart failure
OT  - Intensity
OT  - Outcomes
OT  - Timing
OT  - Worsening heart failure
EDAT- 2015/06/18 06:00
MHDA- 2016/05/25 06:00
CRDT- 2015/06/18 06:00
PHST- 2015/02/17 00:00 [received]
PHST- 2015/03/31 00:00 [revised]
PHST- 2015/04/22 00:00 [accepted]
PHST- 2015/06/18 06:00 [entrez]
PHST- 2015/06/18 06:00 [pubmed]
PHST- 2016/05/25 06:00 [medline]
AID - 10.1002/ejhf.308 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2015 Jul;17(7):697-706. doi: 10.1002/ejhf.308. Epub 2015 Jun
      17.