Clinical Heart and Vascular Center

Prognosis in Heart Failure and Shock

Jennifer Thibodeau
Jennifer Thibodeau, M.D., M.S.C.S.

By Jennifer Thibodeau, M.D., M.S.C.S.
Associate Professor of Internal Medicine
Medical Director, Heart Failure

Advances in the management of patients with heart failure (HF) have led to improved survival and quality of life for patients living with this condition. Accurate prognostic stratification of patients with HF is critical because it can inform and guide thera­peutic decision-making, guide referral to device implantation, or provide for more tailored or personalized therapy. I had the privilege of mod­erating an electronic poster session highlighting innovative research in prognosticating patients with HF, titled “Prognosis in Heart Failure and Shock.” This session showcased six research find­ings that identified higher-risk HF patients.

Dr. Ana Carolina Alba from Toronto General Hospital demonstrated that late gadolinium en­hancement was associated with increased risk of death or advanced HF therapies in patients with non-ischemic cardiomyopathy. Dr. Masahiro Seo from Osaka General Medical Center found that a lower serum cholinesterase level, which reflects various factors such as hepatic function, inflam­mation, and nutritional status, was associated with increased mortality for patients with HF with preserved ejection fraction (HFpEF), HF with mid-range ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF). Dr. Bethany Doran from the University of Colorado used latent class analysis to identify important clustering vari­ables and to define distinct phenotypic profiles in HFrEF patients enrolled in the HF-ACTION study. She identified four different HFrEF phenotypes that had distinct clinical, functional, and prog­nostic characteristics and suggested that this classification provided opportunity for targeted intervention among these patient cohorts.

Dr. Sergio Ramalho from Brigham and Women’s Hospital found that clinician-reported pulmonary disease was independently associ­ated with greater risk of HF hospitalization and all-cause hospitalization, but not mortality, in patients with HFpEF. Pulmonary disease was not associated with prominent differences in cardiac structure and function, suggesting a role of extracardiac factors in mediating the observed risks. Dr. Manju Bengaluru Jayanna from the University of Iowa Hospital and Clinics found that among end-stage renal disease patients on dialysis who are hospitalized for decompensated HF, comorbidity burden increased but in-hospital mortality and length of stay decreased signifi­cantly from 2001-2014. 

Accurate prognostic stratification of patients with HF is critical because it can inform and guide therapeutic decision-making, guide referral to device implantation, or provide for more tailored or personalized therapy

Jennifer Thibodeau, M.D., M.S.C.S.

Finally, Dr. Abdullah Sarkar from the Univer­sity of Miami found that patients who undergo orthopedic surgery are at a high risk of develop­ing decompensated HF postoperatively. This risk is dependent on the type of orthopedic surgery, with spinal surgery at highest risk. These data suggest that management of HF patients undergoing orthopedic surgery might need to be intensified to decrease risk of decompensa­tion following surgery. This session highlighted the potential for identifying different prognostic risk factors that could guide a personalized management strat­egy for HF patients.