Utility of patient-reported perception of symptom change in patients with acute decompensated heart failure in predicting post-discharge clinical outcomes: insights from KCHF registry

AIMS: The relief of the symptoms is one of the major purposes in the treatment for acute decompensated heart failure. The aim of this study is to investigate the relationship between patient-reported perception of symptom change of heart failure during hospitalization and subsequent prognosis in patients with acute decompensated heart failure (ADHF). METHODS AND RESULTS: Among 4056 consecutive patients hospitalized due to ADHF from a multicentre cohort study in Japan (Kyoto Congestive Heart Failure study), the study population consisted of 3567 patients who assessed their perception of symptom change during index hospitalization by themselves on 7-point Likert scale. We classified them the study patients into 4 groups: marked improvement group (N = 1602; 44.9%), moderate improvement group (N = 1659; 46.5%), minimal improvement group (N = 240; 6.7%), and no improvement group (N = 66; 1.9%). Primary outcome measures were a composite of all-cause death or HF hospitalization. The cumulative 1-year incidence of the primary outcome was higher in the no, minimal, and moderate improvement groups than in the marked improvement group (56%, 45%, 36%, vs. 29%, log-rank P < 0.001). After adjustment, the hazard ratios of the no, minimal, and moderate improvement groups relative to the marked improvement group were 1.66, 95% confidence interval [CI]: 1.14-2.42; 1.26, 95% CI: 1.01-1.57; 1.08, 95% CI: 0.95-1.21, respectively, for the primary outcome. CONCLUSION: The patient-reported perception of symptom change at discharge was correlated with a composite of all-cause death or HF hospitalization at 1 year after discharge in patients admitted to the hospital for ADHF.