Burden of acute heart failure (AHF)

Lasting underlying damage

  • Heart failure (HF) is a progressive condition punctuated by acute events that can lead to significantly
    poorer outcomes1
  • Hospitalization for AHF represents an important prognostic event
    • Each AHF event increases the risk of rehospitalization or death2-4
  • An AHF event is more than an exacerbation of symptoms1,2
  • AHF is a complex pathophysiologic process that triggers hemodynamic imbalances; leads to activation of neurohormones; and may cause damage to the heart, vasculature, and kidneys2
  • Even when the patient presenting symptoms is successfully stabilized, there may be rapidly occurring damage to the heart and kidneys, and higher risk of death after discharge2,4,5
  • No current treatments address the acute injury to the heart and kidneys resulting from the underlying pathological process6


  1. Okumura N, Jhund PS, Jianjian G, et al. [published online ahead of print April 20, 2016]. Circulation. doi: 10.1161/CIRCULATIONAHA.115.020729.
  2. Mann DL, Zipes DP, Libby P, Bonow RO, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Saunders; 2015.
  3. Bradley EH, Curry L, Horwitz LI, et al. Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circ Cardiovasc Qual Outcomes. 2013;6(4):444-450.
  4. Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA. 2003;290(19):2581-2587.
  5. Chang PP, Chambless LE, Shahar E, et al. Incidence and survival of hospitalized acute decompensated heart failure in four US communities (from the Atherosclerosis Risk in Communities Study). Am J Cardiol. 2014;113(3):504-510.
  6. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240-e327.
  7. Curtis LH, Greiner MA, Hammill BG, et al. Early and long-term outcomes of heart failure in elderly persons, 2001-2005. Arch Intern Med. 2008;168(22):2481-2488.
  8. Mebazaa A, Nieminen MS, Packer M, et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE randomized trial. JAMA. 2007;297(17):1883-1891.
  9. Loehr LR, Rosamond WD, Chang PP, Folsom AR, Chambless LE. Heart failure incidence and survival (from the Atherosclerosis Risk in Communities study). Am J Cardiol. 2008;101(7):1016-1022.
  10. Abraham WT, Fonarow GC, Albert NM, et al. Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment In Hospitalized Patients with Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol.2008;52(5):347-356.
  11. Lee DS, Austin PC, Stukel TA, et al. “Dose-dependent” impact of recurrent cardiac events on mortality in patients with heart failure. Am J Med. 2009;122(2):162-169.
  12. Weatherley BD, Milo-Cotter O, Felker GM, et al. Early worsening heart failure in patients admitted with acute heart failure – a new outcome measure associated with long-term prognosis? Fundam Clin Pharmacol. 2009;23(5):633-639.
  13. DeVore AD, Hammill BG, Sharma PP, et al. In-hospital worsening heart failure and associations with mortality, readmission, and healthcare utilization. J Am Heart Assoc. 2014;3(4). pii: e001088.
  14. Palmer JB, Friedman HS, Johnson KW, Navaratnam P, Gottlieb SS. Association of persistent and transient worsening renal function with mortality risk, readmissions risk, length of stay, and costs in patients hospitalized with acute heart failure. Clinicoecon Outcomes Res. 2015;19(7):357-367.
  15. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606-619.
  16. Pfuntner A, Wier LM, Stocks C. HCUP Statistical Brief #162: Most Frequent Conditions in U.S. Hospitals, 2011. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb162.pdf. Published September 2013. Accessed January 11, 2017.
  17. Agarwal SK, Wruck L, Quibrera M, et al. Temporal trends in hospitalization for acute decompensated heart failure in the United States, 1998–2011. Am J Epidemiol. 2016;183(5):462-470.
  18. Hauptman PJ, Swindle J, Burroughs TE, Schnitzler MA. Resource utilization in patients hospitalized with heart failure: insights from a contemporary national hospital database. Am Heart J. 2008;155(6):978-985.
  19. Dunlay SM, Redfield MM, Weston SA, et al. Hospitalizations after heart failure diagnosis: a community perspective. J Am Coll Cardiol. 2009;54(18):1695-1702.
  20. Dunlay SM, Shah ND, Shi Q, et al. Lifetime costs of medical care after heart failure diagnosis. Circ Cardiovasc Qual Outcomes. 2011;4(1):68-75.
  21. Centers for Medicare & Medicaid Services. Readmissions reduction program. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html. Updated April 18, 2016. Accessed December 1, 2016.
  22. Centers for Medicare & Medicaid Services. Hospital value-based purchasing program. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf. Published September 2015. Accessed December 1, 2016.
  23. Rau J. Half of nation’s hospitals fail again to escape Medicare’s readmission penalties. Kaiser Health News website. http://khn.org/news/half-of-nations-hospitals-fail-again-to-escape-medicares-readmission-penalties. Published August 3, 2015. Accessed February 13, 2017.