AT THE ESC CONGRESS 2015
LONDON (FRONTLINE MEDICAL NEWS) – Hepatic dysfunction, which is beginning to be appreciated as an important complication of patients with acute heart failure, boosted the relative rate of death in patients with acute heart failure by 57% in an analysis of more than 5,000 patients followed for a year in a registry maintained by the European Society of Cardiology (ESC).
The registry data also showed that at entry into the registry the acute heart failure patients had an 8% prevalence of hepatic dysfunction.
These observations on the prevalence and impact of liver dysfunction in acute heart failure patients highlight a new recognition that acute heart failure can trigger morbidity and mortality through its hepatic effects in a manner similar to the better-appreciated effect that acute heart failure has on renal and pulmonary function, Dr. Alexandre Mebazaa said at the annual congress of the European Society of Cardiology.
“Everybody knows about the kidney, but not many know about the liver,” said Dr. Mebazaa in an interview. Recent studies on mechanisms of organ damage during acute heart failure episodes indicates that the liver, kidneys, and lungs are all damaged by fluid congestion in these organs, he said. “Fluid overload leads to organ dysfunction,” and this complication seems relatively resistant to the diuretic treatment that acute heart failure patients typically receive when they are hospitalized for decompensation episodes. “New approaches are needed to remove fluid from the organs. Diuretics remove fluid from the blood, but not from the organs,” said Dr. Mebazaa, a professor of anesthesiology and critical care medicine at Lariboisière Hospital in Paris.
The data Dr. Mebazaa reported at the congress were the first 1-year follow-up data from the ESC’s Heart Failure Long-Term Registry , begun in 2012 and involving centers from more than 30 countries in Europe as well as in North Africa and the Middle East. The panel of ESC members who oversee this registry “selected centers dedicated to the database,” he said.
The registry followed 5,039 patients with acute heart failure for at least 1 year, as well as 7,401 patients diagnosed with chronic heart failure. Another striking, though not surprising finding of the 1-year follow-up data was the disparity in mortality and hospitalization rates between these two subgroups.
After 1 year, the mortality rate was 24% among the acute heart failure patients, compared with 6% among the chronic heart failure patients. Dr. Mebazaa called the acute heart failure mortality rate “terrible.”
Hospitalization rates in the two subgroups over the 1-year follow-up ran to 19% among the acute heart failure patients ands 10% for chronic heart failure patients. The combined rate of death or hospitalization over 1 year was 36% in the acute heart failure patients and 15% in those with chronic heart failure.
These data “show that we really need new treatments for acute heart failure to reduce rehospitalizations and deaths,” Dr. Mebazaa said.
A multivariate adjusted analysis identified several baseline factors that significantly linked with mortality among the acute heart-failure patients during the 1-year follow-up. In addition to hepatic dysfunction linking with a 57% increased rate of death other factors included age, which linked with a 24% increased rate for every 5 years of older age; New York Heart Association class III or IV severity, which linked with 50% higher mortality; renal dysfunction, which linked with a 52% higher mortality rate; and aortic stenosis, linked with a 54% increased mortality rate.
The finding that hepatic dysfunction was an independent mortality risk in acute heart failure confirmed a finding that Dr. Mebazaa and his associates reported in 2013 in a post hoc analysis of 1,134 patients with acute heart failure who had been enrolled in a drug-intervention trial ( Eur Heart J. 2013 Sep 15;34:742-9 ). The registry results confirm for the first time that finding in an independent and much larger group of patients, Dr. Mebazaa said.
On Twitter @mitchelzoler