Some asymptomatic heart failure (HF) patients may benefit from a more proactive treatment plan, according to new research published in the American Journal of Cardiology.
Various studies have highlighted the advantages of treating HF with reduced ejection fraction (HFrEF) and even HF with mid-range ejection fraction (HFmrEF) as soon as patients begin to show symptoms. It remains unclear, however, how much time should be spent treating patients at the absolute earliest stages of HF.
The study’s authors evaluated data from 153 consecutive HFmrEF and HFrEF patients who were all in New York Heart Association (NYHA) functional class I. All patients were treated at a single facility from January 2016 to December 2017 and had no history of hospitalization due to HF prior to their initial visit. Patients had a mean age of 74 years old and a mean LVEF of 40.9%. Patients were excluded from the analysis if they had severe valvular heart disease, severe pulmonary hypertension, uncontrolled arrhythmia or hypertension, severe chronic obstructive pulmonary disease, anemia, advanced chronic kidney injury or thyroid disease.
After one year, the group reported, clinical disease progression was identified in 17.8% of patients. While 4.6% of patients died from HF or sudden cardiac death, 8.5% were hospitalized for HF. All-cause mortality after one year was 5.9%.
A baseline QRS duration of ≥120 ms and a mitral regurgitation grade higher than one were both found to be “significant predictors” of clinical disease progression. Tracking these numbers closely when patients are evaluated could make a big impact on their health—and even save their life.
The presence of atrial fibrillation or atrial flutter, the authors added, is not independently associated with a greater risk of disease progression.
“By focusing exclusively on stable HF patients in NYHA functional class I, our study sheds light on a strongly under-represented group of patients in clinical trials, and provides practical insight for the management of these patients,” wrote lead author Alexander Marschall, MD, a cardiologist at Central Defense Hospital in Madrid, Spain, and colleagues. “We demonstrate that supposedly stable HF patients, despite the absence of symptoms, are in need of a more proactive therapeutic approach in order to avoid clinical deterioration. Therefore, the identification of those patients who are at highest risk of progression is key to improve outcomes.”
Read the full study here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.