The importance of changes in prognostic markers during the management of HFrEF: Reassessment better predicts the outcomes than the initial evaluation - 06/01/20
Résumé |
Purpose |
Risk scores in HFrEF are based on an analysis of prognostic markers at one point during the follow-up regardless of the patient's treatment evolution. However, patient's management and therapy response will change their prognosis.
Objectives |
To appreciate the impact of therapy optimization on usual prognostic markers in patients with HFrEF and to compare the prognostic value of these markers before and after therapy optimization.
Methods |
All patients hospitalized at our institution from 1st May 2011 to 30th April 2015 with LVEF<40% at first visit (M0) and at least a 2nd visit 6 months after (M6) were included and followed for 3 years. Data on treatment and usual prognostic markers were collected at M0 and M6. The primary outcome was a composite of death, heart transplantation, need of mechanical circulatory support or hospitalization for HF.
Results |
Among the 328 patients included at M0, 81% were men, mean age was 57 years, 42% had ischemic HF, 39% were in NYHA class I or II, mean duration of HF was 6,5±10,1 years, average BNP was 584pg/mL (IQR 211-777) and LVEF was 28±7%. The exposure to HF therapy was significantly higher at M6 when compared with M0. Primary outcome occurred in 20% of the patients at 1 year and in 35% at 3 years with an all-cause mortality of 2,6% and 10,4% respectively. During follow-up, there were significant changes on prognostic markers: 86% NYHA class I-II at M6 versus 39% at M0 (P<0,001), BNP (394ng/mL versus 584pg/mL, P<0,001) and LVEF (35±12% versus 28±7%, P<0,001). On multivariate analysis, better predictors of outcomes were: BNP level at M6 (HR 6,25; IC 95% 3,13–12,51; P<0,001), NYHA at M6 (HR 3,76; IC 95% 2,06-6,86; P<0,001), GFR at M6 (HR 2,28; IC 95% 1,33-3,89; p=0,003), RV S’ wave at M6 (HR 2,28; IC 95% 1,23–4,24; P=0,009) and HR at M0 (HR 1,3; IC 95% 1,04–1,62; P=0,021).
Conclusion |
Assessment of usual markers after therapy optimization better predicts prognosis than the same markers collected 6 months earlier.
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Vol 12 - N° 1
P. 47 - janvier 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.