Timing of hemoconcentration during treatment of acute decompensated heart failure and subsequent survival: Importance of sustained decongestion

Jeffrey M. Testani, Meredith A. Brisco, Jennifer Chen, Brian D. McCauley, Chirag R. Parikh, W. H.Wilson Tang

Research output: Contribution to journalArticle

Abstract

Objectives This study sought to determine if the timing of hemoconcentration influences associated survival. Background Indicating a reduction in intravascular volume, hemoconcentration during the treatment of decompensated heart failure has been associated with reduced mortality. However, it is unclear if this survival advantage stems from the improved intravascular volume or if healthier patients are simply more responsive to diuretics. Rapid diuresis early in the hospitalization should similarly identify diuretic responsiveness, but hemoconcentration this early would not indicate euvolemia if extravascular fluid has not yet equilibrated. Methods Consecutive admissions at a single center with a primary discharge diagnosis of heart failure were reviewed (N = 845). Hemoconcentration was defined as an increase in both hemoglobin and hematocrit levels, then further dichotomized into early or late hemoconcentration by using the midway point of the hospitalization. Results Hemoconcentration occurred in 422 (49.9%) patients (41.5% early and 58.5% late). Patients with late versus early hemoconcentration had similar baseline characteristics, cumulative in-hospital loop diuretic administered, and worsening of renal function. However, patients with late hemoconcentration versus early hemoconcentration had higher average daily loop diuretic doses (p = 0.001), greater weight loss (p < 0.001), later transition to oral diuretics (p = 0.03), and shorter length of stay (p < 0.001). Late hemoconcentration conferred a significant survival advantage (hazard ratio: 0.74 [95% confidence interval: 0.59 to 0.93]; p = 0.009), whereas early hemoconcentration offered no significant mortality benefit (hazard ratio: 1.0 [95% confidence interval: 0.80 to 1.3]; p = 0.93) over no hemoconcentration. Conclusions Only hemoconcentration occurring late in the hospitalization was associated with improved survival. These results provide further support for the importance of achieving sustained decongestion during treatment of decompensated heart failure.

Original languageEnglish (US)
Pages (from-to)516-524
Number of pages9
JournalJournal of the American College of Cardiology
Volume62
Issue number6
DOIs
StatePublished - Aug 6 2013

Keywords

  • decompensated heart failure
  • hemoconcentration
  • mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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