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

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.