The Impact of Worsening Heart Failure in the United States

Abstract

In-hospital worsening heart failure represents a clinical scenario wherein a patient hospitalized for acute heart failure experiences a worsening of their condition, requiring escalation of therapy. Worsening heart failure is associated with worse in-hospital and postdischarge outcomes. Worsening heart failure is increasingly being used as an endpoint or combined endpoint in clinical trials, as it is unique to episodes of acute heart failure and captures an important event during the inpatient course. While prediction models have been developed to identify worsening heart failure, there are no known FDA-approved medications associated with decreased worsening heart failure. Continued study is warranted.

Keywords: Clinical trials; Medications; Outcomes; Worsening heart failure.

Figure 1

Patient’s clinical trajectory after an episode of in-hospital worsening heart failure (dotted gray line) compared to clinical trajectory without worsening heart failure (solid black line). The heart failure syndrome is characterized by acute changes in status typically requiring a hospitalization (A). In-hospital worsening heart failure (B, dotted gray line) represents a more complicated and costly hospitalization associated with worse long-term outcomes.