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. 2022 Mar 3;9(3):74.
doi: 10.3390/jcdd9030074.

Reduction of Hospitalization and Mortality by Echocardiography-Guided Treatment in Advanced Heart Failure

Hamayak Sisakian  1 , Syuzanna Shahnazaryan  1 , Sergey Pepoyan  1 , Armine Minasyan  2 , Gor Martirosyan  1 , Mariam Hovhannisyan  1 , Ashkhen Maghaqelyan  1 , Sona Melik-Stepanyan  2 , Armine Chopikyan  3 , Yury Lopatin  4
Affiliations

Reduction of Hospitalization and Mortality by Echocardiography-Guided Treatment in Advanced Heart Failure

Hamayak Sisakian et al. J Cardiovasc Dev Dis. .

Abstract

In advanced heart failure (AHF) clinical evaluation fails to detect subclinical HF deterioration in outpatient settings. The aim of the study was to determine whether the strategy of intensive outpatient echocardiographic monitoring, followed by treatment modification, reduces mortality and re-hospitalizations at 12 months. Methods: 214 patients with ejection fraction < 30% and >1 hospitalization during the last year underwent clinical evaluation and echocardiography at discharge and were divided into intensive (IMG; N = 143) or standard monitoring group (SMG; N = 71). In IMG, volemic status and left ventricular filling pressure were assessed 14, 30, 90, 180 and 365 days after discharge. HF treatment, particularly diuretic therapy, was temporarily intensified when HF deterioration signs and E/e’ > 15 were detected. In SMG, standard outpatient monitoring without obligatory echocardiography at outpatient visits was performed. Results: We observed lower hospitalization (absolute risk reduction [ARR]-0.343, CI-95%: 0.287−0.434, p < 0.05; number needed to treat [NNT]-2.91) and mortality (ARR-0.159, CI 95%: 0.127−0.224, p < 0.05; NNT-6.29) in IMG at 12 months. One-year survival was 88.8% in IMG and 71.8% in SMG (p < 0.05). Conclusion: In AHF, outpatient monitoring of volemic status and intracardiac filling pressures to individualize treatment may potentially reduce hospitalizations and mortality at 12 months follow-up. Echocardiography-guided outpatient therapy is feasible and clinically beneficial, providing evidence for the larger application of this approach.

Keywords: Tissue Doppler echocardiography; advanced heart failure; left ventricular filling pressure; mortality; outpatient monitoring; rehospitalizations.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Workflow chart of the present study.
Figure 2
Figure 2
Kaplan–Meier curve showing hospitalization rates in intensive monitoring group compared to standard monitoring (control) group during 12 months follow-up period. Y axis represents Cum Survival, X axis—follow-up period represented by months.
Figure 3
Figure 3
Kaplan–Meier curve showing survival rates in intensive and standard monitoring groups. Y axis represents Cum Survival, X axis—follow-up period represented by months.
See this image and copyright information in PMC

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