Abstract | AIMS: Haemoconcentration has been studied as a marker of decongestion in patients with hospitalization for heart failure (HHF). We describe the relationship between haemoconcentration, worsening renal function, post-discharge outcomes, and clinical and laboratory markers of congestion in a large multinational cohort of patients with HHF. METHODS AND RESULTS: In 1684 patients with HHF with ejection fraction (EF) ≤40% assigned to the placebo arm of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, absolute in-hospital haematocrit change was calculated as the change between baseline and discharge or day 7 (whichever occurred first). Patient characteristics, changes in renal function, and outcomes over a median follow-up of 9.9 months were compared by in-hospital haematocrit change. Overall, 26% of patients had evidence of haemoconcentration (i.e., ≥3% absolute increase in haematocrit). Patients with greater increases in haematocrit tended to have better baseline renal function. Haemoconcentration correlated with greater risk of in-hospital worsening renal function, but renal parameters generally returned to baseline within 4 weeks post-discharge. Patients with haemoconcentration were less likely to have clinical congestion at discharge, and experienced greater in-hospital decreases in body weight and natriuretic peptide levels. After adjustment for baseline clinical risk factors, every 5% increase of in-hospital haematocrit change was associated with a decreased risk of all-cause death [hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.70-0.95]. Haematocrit change was also associated with decreased cardiovascular mortality or heart failure (HF) hospitalization at ≤100 days post-randomization (HR 0.73, 95% CI 0.71-0.76). CONCLUSION: In this large cohort of patients with HHF with reduced EF, haemoconcentration was associated with greater improvements in congestion and decreased mortality and HF re-hospitalization despite an increased risk of in-hospital worsening renal function.
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Authors | Stephen J Greene, Mihai Gheorghiade, Muthiah Vaduganathan, Andrew P Ambrosy, Robert J Mentz, Haris Subacius, Aldo P Maggioni, Savina Nodari, Marvin A Konstam, Javed Butler, Gerasimos Filippatos, EVEREST Trial investigators |
Journal | European journal of heart failure
(Eur J Heart Fail)
Vol. 15
Issue 12
Pg. 1401-11
(Dec 2013)
ISSN: 1879-0844 [Electronic] England |
PMID | 23845795
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antidiuretic Hormone Receptor Antagonists
- Benzazepines
- Cardiovascular Agents
- Natriuretic Peptides
- Tolvaptan
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Topics |
- Aged
- Antidiuretic Hormone Receptor Antagonists
- Benzazepines
(therapeutic use)
- Cardiovascular Agents
(therapeutic use)
- Disease Progression
- Double-Blind Method
- Female
- Heart Failure
(blood, diagnosis, mortality, physiopathology)
- Hematocrit
(methods, statistics & numerical data)
- Hospitalization
(statistics & numerical data)
- Humans
- Kidney Function Tests
- Male
- Middle Aged
- Natriuretic Peptides
(blood)
- Outcome Assessment, Health Care
- Prognosis
- Renal Insufficiency
(diagnosis, etiology)
- Stroke Volume
- Survival Analysis
- Tolvaptan
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