Intense optimization of oral therapy rapidly restores respiratory function in worsening heart failure patients

IF 3.7 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

ESC Heart Failure Pub Date : 2025-07-28 DOI:10.1002/ehf2.15373

Hajer Yaakoubi, Lotfi Boukadida, Marwa Toumia, Anaïs Caillard, Houda Ben Soltane, Rahma Jaballah, Imen Trabelsi, Randa Dhaoui, Asma Zorgati, Hamdi Boubaker, Meriem Khrouf, Zied Mezgar, Houda Ben Salah, Alexandre Mebazaa, Benjamin Deniau, Semir Nouira, Riadh Boukef

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Abstract

Aims

Breathlessness is the primary symptom of decompensated heart failure (HF), but the prevalence and evolution of persistent respiratory distress post-hospitalization remain unclear.

Methods and results

The Longitudinal Observational Study for mIddle Term Follow-up Patients Admitted for Acute Dyspnea in TunIsia (SIDI) study is a prospective and multicentre study on HF patients with preserved ejection fraction admitted for acute dyspnoea. Patients were followed for 6 months. The primary endpoint was to assess the incidence of persistent respiratory distress and factors linked to respiratory recovery at Day 90. The secondary endpoint was rehospitalization and/or death at Day 90 and 180. Among 231 patients, 140 had SpO₂ and respiratory rate data at Day 90. Persistent respiratory distress was observed in 97 (69%). Multivariable analysis found no association between respiratory recovery and sex, diabetes, hypertension, kidney disease or NT-proBNP levels. However, intensive follow-up (n = 54) with oral neuroendocrine inhibition significantly improved respiratory parameters at Day 90 (adjusted HR: 5.70 [95% CI 2.13–18.28], P = 0.0001) compared with standard follow-up (n = 86) and reduced rehospitalization and/or death at Day 90 and 180.

Conclusions

Persistent respiratory distress is frequent in the months following HF hospitalization. Optimized guideline-directed therapy and close follow-up improve respiratory recovery. SpO₂ and respiratory rate monitoring should be integrated into HF management.

Abstract Image

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激烈的优化口服治疗迅速恢复呼吸功能恶化心衰患者。

目的：呼吸困难是失代偿性心力衰竭（HF）的主要症状，但住院后持续呼吸窘迫的患病率和演变尚不清楚。方法和结果：突尼斯急性呼吸困难中期随访患者纵向观察研究（SIDI）研究是一项前瞻性多中心研究，研究对象是因急性呼吸困难入院的保留射血分数的HF患者。随访6个月。主要终点是评估第90天持续呼吸窘迫的发生率和与呼吸恢复相关的因素。次要终点是第90天和180天的再住院和/或死亡。在231例患者中，140例患者在第90天有SpO2和呼吸率数据。97例（69%）出现持续呼吸窘迫。多变量分析发现，呼吸恢复与性别、糖尿病、高血压、肾病或NT-proBNP水平无关联。然而，与标准随访（n = 86）相比，口服神经内分泌抑制的强化随访（n = 54）在第90天显著改善了呼吸参数（调整后HR: 5.70 [95% CI 2.13-18.28], P = 0.0001），并减少了第90天和180天的再住院和/或死亡。结论：持续性呼吸窘迫在HF住院后的几个月内是常见的。优化的指导治疗和密切随访可改善呼吸恢复。应将SpO2和呼吸频率监测纳入心衰管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.