The Burden of Heart Failure

EVEN AFTER INCREASING THE DOSE, MANY HEART FAILURE PATIENTS EXPERIENCE REDUCED RESPONSIVENESS TO ORAL DIURETICS—RESULTING IN FLUID OVERLOAD1,2

EVEN AFTER INCREASING THE DOSE, MANY HEART FAILURE PATIENTS EXPERIENCE REDUCED RESPONSIVENESS TO ORAL DIURETICS—RESULTING IN FLUID OVERLOAD1,2

Often, a subacute presentation of worsening symptoms occurs over several days.2,3

In a clinical study of patients admitted to the hospital with heart failure, worsening of dyspnea and edema was noted on average 8 and 12 days prior to hospitalization, respectively.*4

When oral diuretics fail, clinicians often rely on giving IV diuretics—typically in the hospital, outpatient heart failure clinic, or infusion center.5,6

a hospital hallway

THE POTENTIAL IMPACT OF HEART FAILURE HOSPITALIZATIONS ON BOTH PATIENTS AND CAREGIVERS

The Burden on Patients

  • In patients with heart failure, studies have shown that each hospitalization is associated with poorer prognosis and significantly increases the risk of subsequent death7,8,9
  • A survey of patients with heart failure suggests that “home-time” is a priority10

THE BURDEN ON CAREGIVERS11

The caregiver’s own health can be negatively impacted by

  • Patient hospitalization
  • Lack of perceived control over management
  • Less social support

*N = 83 patients, of which 98% experienced dyspnea and 77% developed edema as a symptom associated with decompensation.

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References: 1. Vasko MR, Cartwright DB, Knochel JP, Nixon JV, Brater DC. Furosemide absorption altered in decompensated congestive heart failure. Ann Intern Med. 1985;102(3):314-318. doi:10.7326/0003-4819-102-3-314. 2. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145:e895-e1032. doi: 10.1161/CIR.0000000000001063. 3. Greene SJ, Mentz RJ, Felker GM. Outpatient worsening heart failure as a target for therapy. JAMA Cardiol. 2018 March 01;3(3):252-259. doi:10.1001/jamacardio.2017.5250. 4. Schiff GD, Fung S, Speroff T, McNutt RA. Decompensated heart failure: symptoms, patterns of onset, and contributing factors. Am J Med. 2003;114(8):625-630. doi:10.1016/s0002-9343(03)00132-3. 5. Sica DA, Muntendam P, Myers RL, et al. Subcutaneous furosemide in heart failure: pharmacokinetic characteristics of a newly buffered solution. JACC Basic Transl Sci. 2018;3(1):25-34. Published 2018 Feb 7. doi:10.1016/j.jacbts.2017.10.001. 6. Mullens W, Damman K, Harjola VP, et al. The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019;21(2):137-155. doi:10.1002/ejhf.1369. 7. Solomon SD, Dobson J, Pocock S, et al. Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circulation. 2007;116(13):1482-1487. doi:10.1161/CIRCULATIONAHA.107.696906. 8. Mills RM. The heart failure frequent flyer: an urban legend. Clin Cardiol. 2009;32(2):67-68. doi:10.1002/clc.20404. 9. Nieminen MS, Dickstein K, Fonseca C, et al. The patient perspective: quality of life in advanced heart failure with frequent hospitalisations. Int J Cardiol. 2015;191:256-264. doi:10.1016/j.ijcard.2015.04.235. 10. Greene SJ, O’Brien EC, Mentz RJ, et al. Home-time as a novel post-discharge outcome for patients hospitalized with heart failure. J Am Coll Cardiol. 2018 June 12;71(23):2643-2652. doi:10.1016/j.jacc.2018.03.517. 11. Hwang B, Fleischman KE, Howie-Esquivel J, et al. Caregiving for patients with heart failure: impact on patients’ families. Am J Critical Care. 2011;20(6):431-441.