Detailed Assessment of the “I Need Help” Criteria in Patients With Heart Failure: Insights From the HELP-HF Registry

Author:

Pagnesi Matteo1ORCID,Ghiraldin Daniele1,Vizzardi Enrico1ORCID,Chiarito Mauro23ORCID,Stolfo Davide4ORCID,Baldetti Luca5ORCID,Adamo Marianna1ORCID,Lombardi Carlo Mario1,Inciardi Riccardo Maria1,Tomasoni Daniela1ORCID,Loiacono Ferdinando2ORCID,Maccallini Marta23ORCID,Villaschi Alessandro23ORCID,Gasparini Gaia23,Montella Marco23,Contessi Stefano4ORCID,Cocianni Daniele4,Perotto Maria4ORCID,Barone Giuseppe5,Sartori Samantha6ORCID,Davison Beth A.7,Merlo Marco4,Cappelletti Alberto Maria5,Sinagra Gianfranco4ORCID,Pini Daniela2,Metra Marco1ORCID

Affiliation:

1. Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M. Pagnesi, D.G., E.V., M.A., C.M.L., R.M.I., D.T., M. Metra).

2. Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy (M.C., F.L., M. Maccallini, A.V., G.G., M. Montella, D.P.).

3. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., M. Maccallini, A.V., G.G., M. Montella).

4. Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Italy (D.S., S.C., D.C., M. Perotto, M. Merlo, G.S.).

5. Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.B., A.M.C.).

6. Icahn School of Medicine at Mount Sinai, New York, NY (S.S.).

7. Momentum Research Inc, Durham, NC (B.A.D.).

Abstract

BACKGROUND: The “I Need Help” markers have been proposed to identify patients with advanced heart failure (HF). We evaluated the prognostic impact of these markers on clinical outcomes in a real-world, contemporary, multicenter HF population. METHODS: We included consecutive patients with HF and at least 1 high-risk “I Need Help” marker from 4 centers. The impact of the cumulative number of “I Need Help” criteria and that of each individual “I Need Help” criterion was evaluated. The primary end point was the composite of all-cause mortality or first HF hospitalization. RESULTS: Among 1149 patients enrolled, the majority had 2 (30.9%) or 3 (22.6%) “I Need Help” criteria. A higher cumulative number of “I Need Help” criteria was independently associated with a higher risk of the primary end point (adjusted hazard ratio for each criterion increase, 1.19 [95% CI, 1.11–1.27]; P <0.001), and patients with >5 criteria had the worst prognosis. Need of inotropes, persistently high New York Heart Association classes III and IV or natriuretic peptides, end-organ dysfunction, >1 HF hospitalization in the last year, persisting fluid overload or escalating diuretics, and low blood pressure were the individual criteria independently associated with a higher risk of the primary end point. CONCLUSIONS: In our HF population, a higher number of “I Need Help” criteria was associated with a worse prognosis. The individual criteria with an independent impact on mortality or HF hospitalization were need of inotropes, New York Heart Association class or natriuretic peptides, end-organ dysfunction, multiple HF hospitalizations, persisting edema or escalating diuretics, and low blood pressure.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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