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Haemoconcentration, renal function, and post‐discharge outcomes among patients hospitalized for heart failure with reduced ejection fraction: insights from the EVEREST trial
Author(s) -
Greene Stephen J.,
Gheorghiade Mihai,
Vaduganathan Muthiah,
Ambrosy Andrew P.,
Mentz Robert J.,
Subacius Haris,
Maggioni Aldo P.,
Nodari Savina,
Konstam Marvin A.,
Butler Javed,
Filippatos Gerasimos
Publication year - 2013
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hft110
Subject(s) - medicine , heart failure , ejection fraction , hazard ratio , renal function , hemoconcentration , tolvaptan , cardiology , confidence interval , hematocrit , placebo , alternative medicine , pathology
Aims Haemoconcentration has been studied as a marker of decongestion in patients with hospitalization for heart failure (HHF). We describe the relationship between haemoconcentration, worsening renal function, post‐discharge outcomes, and clinical and laboratory markers of congestion in a large multinational cohort of patients with HHF. Methods and results In 1684 patients with HHF with ejection fraction (EF) ≤40% assigned to the placebo arm of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, absolute in‐hospital haematocrit change was calculated as the change between baseline and discharge or day 7 (whichever occurred first). Patient characteristics, changes in renal function, and outcomes over a median follow‐up of 9.9 months were compared by in‐hospital haematocrit change. Overall, 26% of patients had evidence of haemoconcentration (i.e. ≥3% absolute increase in haematocrit). Patients with greater increases in haematocrit tended to have better baseline renal function. Haemoconcentration correlated with greater risk of in‐hospital worsening renal function, but renal parameters generally returned to baseline within 4 weeks post‐discharge. Patients with haemoconcentration were less likely to have clinical congestion at discharge, and experienced greater in‐hospital decreases in body weight and natriuretic peptide levels. After adjustment for baseline clinical risk factors, every 5% increase of in‐hospital haematocrit change was associated with a decreased risk of all‐cause death [hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.70–0.95]. Haematocrit change was also associated with decreased cardiovascular mortality or heart failure (HF) hospitalization at ≤100 days post‐randomization (HR 0.73, 95% CI 0.71–0.76). Conclusion In this large cohort of patients with HHF with reduced EF, haemoconcentration was associated with greater improvements in congestion and decreased mortality and HF re‐hospitalization despite an increased risk of in‐hospital worsening renal function.