Study Shows Acute Heart Failure Treatment Unchanged Despite 20 Years of Efforts

Reprieve Cardiovascular (‘Reprieve’), a company focused on advancing the treatment of acute decompensated heart failure (ADHF), recently announced significant insights from the TREAT-AHF study published in JACC: Heart Failure. 

Heart failure (HF) stands as a major cause of hospital admissions in the United States. Decongestion, which is critical in managing HF inpatients, involves removing excess fluid from the body. However, contemporary methods and outcomes of decongestion, including the associated weight loss, are not adequately documented. Nearly two decades ago, the Acute Decompensated Heart Failure National Registry (ADHERE) highlighted inpatient HF treatment patterns and decongestion results in a nationwide database encompassing 275 community and academic medical centers.

The TREAT-AHF study, a modern registry, examines a broad cohort of 262,673 HF patients from 2015 to 2022. Findings showed that changes in inpatient body weight were akin to those reported in ADHERE, with 20% of HF patients discharged weighing more than at admission, signaling challenges in effectively removing excess fluid. The study revealed substantial variations in weight loss due to diuretic use, influenced by patient characteristics and clinical practices. The median hospital stay length was found to be 5.8 days, underscoring the variability and unpredictability in decongestion treatment duration, which creates resource and scheduling challenges for all stakeholders involved.

Dr. Alexander Sandhu from Stanford University, emphasizing the importance of decongestion therapy, noted that there has been little evolution in diuretic management since prior studies. He advocates for innovative strategies to enhance decongestion for hospitalized HF patients.

Additional research presented at the American College of Cardiology 2024 sessions focused on guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). The study discovered that GDMT usage among diverse community-based health systems was lower than in national quality improvement registries, where participation is voluntary. A significant number of patients were taken off GDMT before discharge, despite previous inpatient administration, due to factors like hypotension, hyperkalemia, and worsening renal function, with many cases having no clear clinical explanation. This highlights an urgent need for novel strategies to ensure comprehensive GDMT use during acute HF hospitalizations.

Dr. Andrew Ambrosy from The Permanente Medical Group stressed that the underuse and discontinuation of GDMT during hospitalization lead to poorer care quality and patient outcomes. He called for the development of in-hospital management strategies that facilitate both clinical decongestion and the sustained administration of GDMT.

Reprieve Cardiovascular is partnering with leading heart failure researchers and Truveta, which offers extensive and timely electronic health record data from over 30 health systems, to enhance the understanding and treatment of ADHF. Truveta Data, covering over 100 million de-identified patients from across the U.S., has been instrumental in the TREAT-AHF analysis.

Mark Pacyna, CEO of Reprieve Cardiovascular, emphasized the company's commitment to understanding the ADHF patient journey. He noted that clinical evidence shows little change in heart failure decongestion management over the past 20 years, despite clear opportunities for improvement. Pacyna highlighted the necessity of sustained partnerships among hospital systems, healthcare providers, and industry partners to enhance patient care.

Acute decompensated heart failure (ADHF) is marked by the sudden or gradual onset of symptoms such as difficulty breathing, swelling in the legs or feet, and fatigue, often necessitating unplanned medical visits or hospitalization. ADHF, driven by a rapid increase in fluid volume, accounts for a significant number of hospital admissions globally, with recurring hospitalizations leading to higher patient morbidity and mortality.

Reprieve Cardiovascular, a privately held company based in Milford, Massachusetts, is dedicated to developing pioneering therapies to improve the lives of over 25 million heart failure patients worldwide. The company aims to bring intelligence to decongestion management, enhancing fluid removal safety for every heart failure patient. In 2022, Reprieve launched the FASTR Trial to compare its decongestive therapy system to optimal diuretic therapy for ADHF treatment.

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