J Card Fail. 2021 May 25:S1071-9164(21)00195-0. doi: 10.1016/j.cardfail.2021.05.005. Online ahead of print.
ABSTRACT
BACKGROUND: Renal dysfunction is a strong predictor of outcomes in patients with acute heart failure (AHF). However, less is known about how sex may influence the prognostic import of renal function in AHF.
METHODS: In a post-hoc analysis of the ASCEND-HF trial including 5,377 patients with AHF (33% female), patients were categorized into three groups based on the changes in renal function during their hospital stay. Worsening, stable, and improving renal functions (RF) were defined as ≥20% decline, <20% change and ≥20% increase in the estimated glomerular filtration rate (eGFR), respectively. The primary outcome was the composite of 30-day all-cause mortality or heart failure rehospitalization.
RESULTS: Median baseline and discharge eGFR were 58.4 and 56.9 mL/min/1.73m2, respectively. Worsening, stable and improving RF was observed in 31.9%, 63.2, and 4.9% of patients, respectively. Worsening RF was associated with adverse outcomes at 30 days (Adjusted Hazard ratio, aHR 1.47, 95% confidence interval, 95%CI 1.22, 1.76). This association existed in both males and females (aHR=1.42 and aHR=1.56, respectively, both p<0.01). There was an interaction between renal function changes and sex (p=0.025), as improving RF was associated with better outcomes in men (aHR=0.29, 95%CI 0.13, 0.66) as compared to women (aHR, 1.18, 95%CI 0.59, 2.35). There was no interaction between ejection fraction and renal function in association with subsequent outcomes.
CONCLUSION: Irrespective of sex, worsening RF was associated with poorer outcomes at 30 days in patients with AHF. More studies are warranted to further delineate the possible sex differences in this setting.
PMID:34048917 | DOI:10.1016/j.cardfail.2021.05.005