What are the causes of recurrent heart failure (HF) exacerbation?

From the Guidelines

Recurrent heart failure exacerbation is most commonly caused by medication non-adherence, dietary indiscretion with excessive sodium intake, uncontrolled hypertension, and progression of underlying cardiac disease, as highlighted in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1. The causes of recurrent heart failure exacerbation can be multifactorial, including:

• Medication non-adherence, which can lead to decompensation and hospitalization
• Dietary indiscretion with excessive sodium intake, which can increase cardiac workload and worsen symptoms
• Uncontrolled hypertension, which can contribute to cardiac remodeling and dysfunction
• Progression of underlying cardiac disease, such as coronary artery disease or cardiomyopathy Other important contributors include:
• Acute infections, particularly respiratory infections like pneumonia or bronchitis, which can significantly stress the cardiovascular system and trigger decompensation 1
• Arrhythmias, especially atrial fibrillation, which can reduce cardiac output and worsen heart failure symptoms
• Myocardial ischemia, anemia, thyroid dysfunction, alcohol or drug use, and medication interactions, which can all impact cardiac function and contribute to exacerbations
• Environmental factors such as extreme temperatures, which can increase cardiac workload and worsen symptoms
• Poor self-monitoring of symptoms and weight changes, which can lead to delayed medical attention and increased risk of hospitalization Effective management of heart failure requires a comprehensive approach that addresses these factors through:
• Medication optimization, including the use of ACE inhibitors, beta-blockers, and diuretics
• Patient education about sodium restriction, daily weight monitoring, and recognition of early warning signs
• Regular follow-up care and multidisciplinary team involvement to assess and manage ischemia, arrhythmia, and other precipitating factors and comorbidities 1 By addressing these causes and implementing a comprehensive management plan, healthcare providers can significantly reduce hospitalization rates and improve quality of life for heart failure patients.

From the FDA Drug Label

The etiology of heart failure was ischemic in 55%, and non-ischemic in 45% There was a history of myocardial infarction in 28%, of hypertension in 24%, and of diabetes in 22%.

The causes of recurrent heart failure (HF) exacerbation are not directly stated in the provided drug labels. However, the labels mention the etiology of heart failure and the history of myocardial infarction, hypertension, and diabetes in the study population.

• Ischemic heart failure: 55% of patients had ischemic heart failure.
• Non-ischemic heart failure: 45% of patients had non-ischemic heart failure.
• History of myocardial infarction: 28% of patients had a history of myocardial infarction.
• History of hypertension: 24% of patients had a history of hypertension.
• History of diabetes: 22% of patients had a history of diabetes 2.

From the Research

Causes of Recurrent Heart Failure (HF) Exacerbation

• Non-adherence to prescribed medications is a significant cause of recurrent HF exacerbation, as it can lead to increased hospitalizations, reduced physical function, and even death 3
• Worsening of chronic heart failure is characterized by episodes of worsening symptoms and signs, which can be triggered by various factors, including inadequate treatment or non-adherence to treatment 4
• Inadequate diuretic therapy or incorrect choice of diuretic can also contribute to recurrent HF exacerbation, as diuretics play a crucial role in managing hypervolemia in HF patients 5
• Other factors, such as underlying cardiac disorders, comorbidities, and poor management of HF, can also contribute to recurrent HF exacerbation 6, 7

Factors Contributing to Non-Adherence

• Rural residence and lack of education are associated with non-adherence to prescribed medications in HF patients 3
• Complexity of treatment regimens and lack of patient education can also contribute to non-adherence 3

Importance of Adherence and Proper Management

• Adherence to prescribed medications and proper management of HF are crucial in preventing recurrent HF exacerbation and improving patient outcomes 6, 4
• Early and rapid administration of guideline-recommended medical therapy (GRMT) can help prevent worsening HF and reduce the risk of hospitalization and death 4