Clinical Research
Heart Failure
Timing of Hemoconcentration During Treatment of Acute Decompensated Heart Failure and Subsequent Survival: Importance of Sustained Decongestion

https://doi.org/10.1016/j.jacc.2013.05.027Get rights and content
Under an Elsevier user license
open archive

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.

Key Words

decompensated heart failure
hemoconcentration
mortality

Abbreviations and Acronyms

ADHF
acute decompensated heart failure
BNP
B-type natriuretic peptide
CI
confidence interval
eGFR
estimated glomerular filtration rate
HC
hemoconcentration
Hct
hematocrit
Hgb
hemoglobin
HR
hazard ratio
IQR
interquartile range
OR
odds ratio
WRF
worsening renal function

Cited by (0)

This research was funded by grants from the National Institutes of Health (5T32HL007843-15, 1K23HL114868-01, and K24DK090203). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.