From the Guidelines
Heart failure exacerbation requires prompt management with diuretics, vasodilators, and addressing the underlying cause, with a focus on improving systemic perfusion and reducing fluid overload, as recommended by the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines 1. The prognosis of heart failure exacerbation varies based on several factors, including ejection fraction, comorbidities, and response to therapy. Key considerations in managing heart failure exacerbation include:
- Identifying and addressing precipitating factors, such as acute coronary syndromes, severe hypertension, atrial and ventricular arrhythmias, infections, pulmonary emboli, renal failure, and medical or dietary noncompliance 1
- Administering oxygen therapy to relieve symptoms related to hypoxemia, and using intravenous loop diuretics to treat significant fluid overload 1
- Monitoring the effect of heart failure treatment with careful measurement of fluid intake and output, vital signs, body weight, and clinical signs and symptoms of systemic perfusion and congestion 1
- Optimizing guideline-directed medical therapy, including ACE inhibitors/ARBs, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors, after stabilization and addressing the underlying cause of the exacerbation 1 Some important management strategies for heart failure exacerbation include:
- Using intravenous loop diuretics, such as furosemide, to relieve congestion and improve systemic perfusion 1
- Implementing non-invasive ventilation for respiratory distress, and considering invasive hemodynamic monitoring to guide therapy in patients with impaired perfusion or uncertain intracardiac filling pressures 1
- Reconciling medications and adjusting them as appropriate on admission to and discharge from the hospital, to ensure continuity of care and minimize the risk of adverse events 1 The prognosis of heart failure exacerbation is influenced by various factors, including the severity of the exacerbation, the presence of comorbidities, and the response to treatment. Mortality rates for heart failure exacerbation can range from 10-20% at one year after hospitalization, highlighting the importance of prompt and effective management, as well as close follow-up and monitoring after discharge 1.
From the FDA Drug Label
The SHIFT study demonstrated that ivabradine reduced the risk of the combined endpoint of hospitalization for worsening heart failure or cardiovascular death based on a time-to-event analysis (hazard ratio: 0.82,95% confidence interval [CI]: 0.75,0.90, p < 0.0001) 2. The PARAGON-HF study demonstrated that sacubitril and valsartan tablets had a numerical reduction in the rate of the composite endpoint of total (first and recurrent) HF hospitalizations and CV death, based on an analysis using a proportional rates model (rate ratio [RR] 0.87; 95% CI [0.75,1.01], p = 0.06) 3.
The prognosis of heart failure exacerbation is related to the underlying cause of the heart failure, with ischemic etiology being a common cause in 36% to 68% of patients 2, 3. The management of heart failure exacerbation includes the use of medications such as ivabradine and sacubitril/valsartan, which have been shown to reduce the risk of hospitalization for worsening heart failure or cardiovascular death 2, 3.
- Key points:
- Ivabradine reduces the risk of hospitalization for worsening heart failure or cardiovascular death.
- Sacubitril and valsartan tablets reduce the rate of total HF hospitalizations and CV death.
- Ischemic etiology is a common cause of heart failure exacerbation.
- Management of heart failure exacerbation includes the use of medications such as ivabradine and sacubitril/valsartan.
From the Research
Prognosis of Heart Failure Exacerbation
The prognosis of heart failure exacerbation is associated with high morbidity and mortality rates, mainly due to heart failure exacerbation or sudden cardiac death (SCD) 4. The cumulative incidence of heart failure is 20.6% at 12-year follow-up, with smoking and weight being independently associated with incident heart failure 5.
Etiology of Heart Failure Exacerbation
The etiology of heart failure exacerbation includes modifiable risk factors such as:
- Smoking
- Weight
- Myocardial infarction during follow-up
- Age
- Female sex
- Baseline left ventricular dysfunction 5 Other risk factors include hypertension and diabetes mellitus, which are targeted as major risk factors for heart failure 6.
Management of Heart Failure Exacerbation
The management of heart failure exacerbation includes the use of sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), which has been shown to reduce the severity of heart failure symptoms, the risk of hospitalization, and death 4, 7. The optimization of guideline-directed chronic heart failure therapy remains the mainstay to further improve quality of life, mortality, and heart failure hospitalizations for patients with heart failure with reduced ejection fraction (HFrEF) 7.
Health-Related Quality of Life
Patients with heart failure present with a constellation of bothersome symptoms, which range from physical to psychological and mental manifestations, leading to considerably high morbidity and mortality rates 8. Health-related quality of life (HRQOL) may differ significantly among patients with heart failure, with women, younger patients, and patients with higher New York Heart Association (NYHA) functional class displaying poorer HRQOL 8.
Key Factors Affecting Prognosis
Key factors affecting the prognosis of heart failure exacerbation include: