Eur J Heart Fail. 2021 Oct 9. doi: 10.1002/ejhf.2357. Online ahead of print.
AIMS: Hospitalization for acute heart failure (HF) is followed by a vulnerable time with increased risk of readmission or death, thus requiring particular attention after discharge. In this study we examined the impact of intensive, early follow-up among patients at high readmission risk at discharge after treatment for acute HF.
METHODS AND RESULTS: Hospitalized acute HF patients were included with at least one of the following: previous acute HF < 6 months, systolic blood pressure ≤ 110 mmHg, creatininemia ≥180 μmol/L, or BNP ≥350 pg/mL or NTproBNP ≥2200 pg/mL. Patients were randomized to either optimized care and education with serial consultations with HF specialist and dietician during the first 2-3 weeks, or to standard post-discharge care according to guidelines. Primary end-point was all-cause death or first unplanned hospitalization during 6-month follow-up. Among 482 randomized patients (median age 77 and median left ventricular ejection fraction 35%), 224 were hospitalized or died. In the intensive group, loop diuretics (46%), betablockers (49%), ACE-inhibitors or angiotensin receptors blockers (39%) and mineralocorticoid receptor antagonists (47%) were titrated. No difference was observed between the two groups for primary end-point (HR 0.97; 95CI 0.74-1.26), nor for mortality at 6 or 12 months or unplanned HF rehospitalization. Additionally, no difference between the two groups according to age, previous HF and left ventricular ejection fraction was found.
CONCLUSION: In high-risk HF, we found intensive follow-up early post-discharge did not improve outcomes. This vulnerable post-discharge time requires further studies to clarify useful transitional care services. This article is protected by copyright. All rights reserved.