What do Spanish registries report about worsening events in chronic heart failure? Needs and challenges

ABSTRACT

Introduction

Worsening heart failure (HF) is associated with a high risk of death and rehospitalization. Despite that, real world evidence about the impact of worsening HF on clinical practice is scarce.

Areas covered

A narrative review about registries addressing recent worsening HF events in Spain, with special emphasis on patients recently hospitalized for HF was performed.

Expert opinion

Worsening HF can be defined as situations where the patient’s HF deteriorates to the extent that it necessitates initiation or intensification of diuretic treatment (mainly intravenous). The events can occur at the outpatient level, generally in the day hospital, in the emergency department or even hospitalization. Early identification of worsening HF events is essential to establish appropriate treatment as soon as possible. In this context, robust clinical benefits have been reported for renin-angiotensin system inhibitors, sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors, and vericiguat. In Spain, several registries of patients with HF have been developed, some of them including patients recently hospitalized for HF, but not with recent worsening HF events. Therefore, registries addressing recent worsening events would be desirable. Using a practical approach, this review analyzes the importance of worsening HF events, with special emphasis on Spanish data.

GRAPHICAL ABSTRACT

AA: aldosterone antagonists; ARNI: angiotensin II and neprilysin antagonists (dual inhibition of angiotensin II and neprilysin); BB: beta-blockers; HF: heart failure; ACEI: angiotensin-converting enzyme inhibitor; SGLT2i: sodium-glucose cotransporter 2 inhibitor.

KEYWORDS:

• Worsening heart failure
• SGLT2 inhibitors
• heart failure with reduced ejection fraction
• registry
• sacubitril-valsartan
• vericiguat

Acknowledgement

Writing and Editorial assistance was provided by Content Ed Net (Madrid, Spain).

Article highlights

• Worsening HF episodes are not only associated with a higher risk of death and rehospitalization, but also they represent a real inflection point in the evolution of HF disease.

• Worsening HF should not be limited to HF hospitalization, but to other clinical situations, including outpatients needing intravenous diuretics, or an increase in the requirements for diuretics use.

• To reduce HF burden, the early identification of these patients, as well as the prompt initiation or optimization of HF disease modifying therapies are mandatory.

• In Spain, several registries of patients with HF have been developed, some of them including patients recently hospitalized for HF, but not with recent worsening HF events.

• Therefore, specific registries addressing recent worsening events would be desirable, as they would allow the identification of gaps and areas of improvement in the management of this population.

Declaration of Interest

JL Bonilla Palomas has received support from Novartis, Bayer, Rovi, Pfizer, Boehringer Ingelheim, Lilly and AstraZeneca for research projects, lectures, and/or participation in advisory boards. JI Morgado García de Polavieja has received support from Bayer, Rovi, Pfizer, Boehringer Ingelheim, Lilly, AstraZeneca and Novartis for lectures and/or participation in advisory boards. D Rangel-Sousa has received grants from Novartis, Vifor, Janssen, Bayer, Rovi, Boehringer-Ingelheim Astra-Zeneca, Astellas, Medtronic and Abbott for research projects, lectures, and participation in advisory boards. F Torres Calvo has received support from Bayer, Rovi, Pfizer, Boehringer Ingelheim, Lilly, NOVONORDIK, CLS Vifor, AstraZeneca and Novartis for lectures and/or participation in advisory boards. C Ortiz Cortés has received support from Novartis, Bayer, Rovi, Boehringer Ingelheim, Lilly, AstraZeneca and Vifor for research projects, lectures and/or participation in advisory boards. J López Aguilera has received support from Novartis, Bayer, Pfizer, NOVONORDISK, Boehringer Ingelheim, Lilly, CLS Vifor, Rovi and AstraZeneca for lectures and/or participation in advisory boards. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Writing and Editorial assistance for this paper was funded by Bayer Hispania SL.