Early and short-term intensive management after discharge for patients hospitalized with acute heart failure: a randomized study (ECAD-HF) - Archive ouverte HAL Access content directly
Journal Articles European Journal of Heart Failure Year : 2022

Early and short-term intensive management after discharge for patients hospitalized with acute heart failure: a randomized study (ECAD-HF)

Emmannuelle Berthelot
  • Function : Author
Nicolas Bihry
  • Function : Author
Muriel Salvat
  • Function : Author
Philippe Garcon
  • Function : Author
Ariel Cohen
  • Function : Author
Alireza Samadi
  • Function : Author
Pascal Degroote
  • Function : Author
Pierre Raphael
  • Function : Author
Nachwan Ghanem
  • Function : Author
Marie-France Seronde
  • Function : Author
Christophe Chavelas
  • Function : Author
Yann Rosamel
  • Function : Author
Florence Beauvais
  • Function : Author
Eric Vicaut
Richard Isnard

Abstract

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, creatininaemia >= 180 mu mol/L, or B-type natriuretic peptide >= 350 pg/mL or N-terminal pro B-type natriuretic peptide >= 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. The primary endpoint 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%), beta-blockers (49%), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (39%) and mineralocorticoid receptor antagonists (47%) were titrated. No difference was observed between groups for the primary endpoint (hazard ratio 0.97; 95% confidence interval 0.74-1.26), nor for mortality at 6 or 12 months or unplanned HF rehospitalization. Additionally, no difference between groups according to age, previous HF and left ventricular ejection fraction was found. Conclusions In high-risk HF, intensive follow-up early post-discharge did not improve outcomes. This vulnerable post-discharge time requires further studies to clarify useful transitional care services.
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hal-03476733 , version 1 (05-01-2022)

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Damien Logeart, Emmannuelle Berthelot, Nicolas Bihry, Romain Eschalier, Muriel Salvat, et al.. Early and short-term intensive management after discharge for patients hospitalized with acute heart failure: a randomized study (ECAD-HF). European Journal of Heart Failure, 2022, 24 (1), pp.219-226. ⟨10.1002/ejhf.2357⟩. ⟨hal-03476733⟩
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