Prognostic impact of the updated 2018 HFA-ESC definition of advanced heart failure: results from the HELP-HF registry

Abstract

Aims: The Heart Failure Association of the European Society of Cardiology (HFA-ESC) proposed a definition of advanced heart failure (HF) that has not been validated, yet. We assessed its prognostic impact in a consecutive series of patients with high-risk HF.

Methods and results: The HELP-HF registry enrolled consecutive patients with HF and at least one high-risk 'I NEED HELP' marker, evaluated at four Italian centres between 1^st January 2020 and 30^th November 2021. Patients meeting the HFA-ESC advanced HF definition were compared to patients not meeting this definition. The primary endpoint was the composite of all-cause mortality or first HF hospitalization. Out of 4753 patients with HF screened, 1149 (24.3%) patients with at least one high-risk 'I NEED HELP' marker were included (mean age 75.1 ± 11.5 years, 67.3% male, median left ventricular ejection fraction [LVEF] 35% [interquartile range 25%-50%]). Among them, 193 (16.8%) patients met the HFA-ESC advanced HF definition. As compared to others, these patients were younger, had lower LVEF, higher natriuretic peptides and a worse clinical profile. The 1-year rate of the primary endpoint was 69.3% in patients with advanced HF according to the HFA-ESC definition versus 41.8% in the others (hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.82-2.74, p < 0.001). The prognostic impact of the HFA-ESC advanced HF definition was confirmed after multivariable adjustment for relevant covariates (adjusted HR 1.98, 95% CI 1.57-2.50, p < 0.001).

Conclusions: The HFA-ESC advanced HF definition had a strong prognostic impact in a contemporary, real-world, multicentre high-risk cohort of patients with HF.

Keywords: Advanced heart failure; European Society Of Cardiology; Heart Failure Association; Heart failure; Hospitalization; Mortality.

Figure 1

Primary composite endpoint and all‐cause mortality at 1 year in patients with versus without advanced heart failure (HF) definition according to the 2018 Heart Failure Association of the European Society of Cardiology (HFA‐ESC) criteria. The figure shows Kaplan–Meier curves for 1‐year primary composite endpoint of all‐cause mortality or HF hospitalization (A) and Kaplan–Meier curves for 1‐year all‐cause mortality (B) in patients with versus without advanced HF definition according to the 2018 HFA‐ESC criteria (i.e. meeting vs. not meeting all four 2018 HFA‐ESC criteria).