European Heart Journal Advance Access originally published online on May 2, 2009
European Heart Journal 2009 30(13):1666-1673; doi:10.1093/eurheartj/ehp144
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Weight changes after hospitalization for worsening heart failure and subsequent re-hospitalization and mortality in the EVEREST trial
1 Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 600, Chicago, IL 60611, USA
2 Tufts–New England Medical Center, Boston, MA, USA
3 Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
4 Institut National de la Santé et de la Recherche Médicale (INSERM), Nancy, France
5 Mayo Clinic, Rochester, MN, USA
6 Hospital Italiano, Buenos Aires, Argentina
7 Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
8 Otsuka Maryland Research Institute, Rockville, MD, USA
Received 5 November 2008; revised 4 February 2009; accepted 13 March 2009; online publish-ahead-of-print 2 May 2009.
* Corresponding author. Tel: +1 312 695 0051, Fax: +1 312 695 1434, Email: m-gheorghiade{at}northwestern.edu
Aims: Increases in body weight (BW) are important determinants for hospitalization in ambulatory patients with heart failure (HF), but have not yet been explored in patients hospitalized for worsening HF. We explore the relationship between change in BW after hospitalization for worsening HF and risk for repeat hospitalization and mortality in the EVEREST trial.
Methods and results: The EVEREST trial randomized 4133 patients hospitalized for worsening HF and low ejection fraction (
40%) to tolvaptan, a vasopressin antagonist, or placebo. Following discharge, BW was assessed at 1, 4, and 8 weeks, and every 8 weeks thereafter. A time-dependent Cox proportional Hazard model explored the relationship between change in BW at 60, 120, and 180 days from discharge and the risks of HF hospitalization, cardiovascular (CV) hospitalization, and all-cause mortality. For subjects re-hospitalized for heart failure at 60, 120, and 180 days after discharge, mean BW increase prior to the event was 1.96, 2.07, and 1.97 kg, respectively, compared with 0.74, 0.90, and 1.04 kg in patients without re-hospitalization (P < 0.001 all groups). A similar pattern was observed with CV hospitalization. However, increases in BW were not predictive of all-cause mortality.
Conclusion: Increases in BW after hospitalization for worsening HF was predictive of repeat hospitalization events, but not mortality in the post-discharge period.
Key Words: Heart failure hospitalizations • Body weight • Outcomes
Presented at the 2008 European Society of Cardiology Congress, and summarized by Dr Helmut Drexler in the highlight session ‘Heart failure and cardiomyopathies.’