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Journal Articles European Journal of Heart Failure Year : 2021

Is acute heart failure a distinctive disorder? An analysis from BIOSTAT‐CHF

1 Momentum Research Inc., Durham
2 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
3 UMCG - University Medical Center Groningen [Groningen]
4 UNC - University of North Carolina [Chapel Hill]
5 Hôpitaux Universitaires Saint-Louis, Lariboisière, Fernand-Widal
6 UiB - University of Bergen
7 Stavanger University Hospital
8 NIHR Leicester Biomedical Research Centre, Glenfield Hospital
9 Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia [Brescia]
10 Charité Campus Virchow-Klinikum (CVK)
11 Berlin-Brandenburg Center for Regenerative Therapies [Berlin, Germany]
12 BCRT - Berlin Institute of Health Center for Regenerative Therapies
13 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
14 DZHK - German Center for Cardiovascular Research
15 NHLI - National Heart and Lung Institute [London]
16 Imperial College London
17 Ninewells Hospital and Medical School [Dundee]
18 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
19 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
20 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
21 Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]
22 NKUA - National and Kapodistrian University of Athens
23 University of Groningen [Groningen]
24 Wrocław Medical University
25 UV - Universitat de València
26 INCLIVA - Biomedical Research Institute [Valencia, Spain]
27 GTPUH - Germans Trias i Pujol University Hospital [Badalona, Barcelona, Spain]

Abstract

Aims: This retrospective analysis sought to identify markers that might distinguish between acute heart failure (HF) and worsening HF in chronic outpatients. Methods and Results: The BIOSTAT-CHF index cohort included 2516 patients with new or worsening HF symptoms: 1694 enrolled as inpatients (acute HF) and 822 as outpatients (worsening HF in chronic outpatients). A validation cohort included 935 inpatients and 803 outpatients. Multivariable models were developed in the index cohort using clinical characteristics, routine laboratory values, and proteomics data to examine which factors predict adverse outcomes in both conditions and to determine which factors differ between acute HF and worsening HF in chronic outpatients, validated in the validation cohort. Patients with acute HF had substantially higher morbidity and mortality (6 months mortality was 12..3% for acute HF and 4..7% for worsening HF in chronic outpatients). Multivariable models predicting 180-day mortality and 180-day HF re-admission differed substantially between acute HF and worsening HF in chronic outpatients. CA-125 was the strongest single biomarker to distinguish acute HF from worsening HF in chronic outpatients, but only yielded a C-index of 0..71. A model including multiple biomarkers and clinical variables achieved a high degree of discrimination with a C-index of 0..913 in the index cohort and 0..901 in the validation cohort. Conclusion: The study identifies different characteristics and predictors of outcome in acute HF patients as compared to outpatients with chronic HF developing worsening HF. The markers identified may be useful in better diagnosing acute HF and may become targets for treatment development.
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Dates and versions

hal-03759089 , version 1 (23-08-2022)

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Beth A Davison, Stefanie Senger, Iziah Sama, Gary G Koch, Alexandre Mebazaa, et al.. Is acute heart failure a distinctive disorder? An analysis from BIOSTAT‐CHF. European Journal of Heart Failure, 2021, 23 (1), pp.43-57. ⟨10.1002/ejhf.2077⟩. ⟨hal-03759089⟩
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