Inpatient Management of Heart Failure: Are We Shooting at the Right Target?
Authors: G. Michael Felker, David J. Whellan
Journal: Annals of Internal Medicine (2016)

Editorials7 February 2017Inpatient Management of Heart Failure: Are We Shooting at the Right Target?G. Michael Felker, MD, MHS and David J. Whellan, MD, MHSG. Michael Felker, MD, MHSFrom Duke University Medical Center, Durham, North Carolina, and Sidney Kimmel Medical College, Philadelphia, Pennsylvania. and David J. Whellan, MD, MHSFrom Duke University Medical Center, Durham, North Carolina, and Sidney Kimmel Medical College, Philadelphia, Pennsylvania.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2667 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient management of patients with heart failure (HF) is under duress. For years, the focus has been on quickly treating patients and discharging them in order to reduce or control the cost of care. A target of reducing length of stay to 5 days was identified (1). More recently, as reimbursements started to penalize early readmissions, the focus of care of patients with HF turned from "early discharge" (rushing to get patients out of the hospital) to "effective discharge." This shift in focus highlights the need for a reliable target for providers to aim at that could signal that patients ...References1. Bueno H, Ross JS, Wang Y, Chen J, Vidán MT, Normand SL, et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993–2006. JAMA. 2010;303:2141-7. [PMID: 20516414] doi:10.1001/jama.2010.748 CrossrefMedlineGoogle Scholar2. Bergethon KE, Ju C, DeVore AD, Hardy NC, Fonarow GC, Yancy CW, et al. Trends in 30-day readmission rates for patients hospitalized with heart failure: findings from the Get With The Guidelines-Heart Failure registry. Circ Heart Fail. 2016;9:e002594. doi:10.1161/CIRCHEARTFAILURE.115.002594 CrossrefMedlineGoogle Scholar3. McQuade CN, Mizus M, Wald JW, Goldberg L, Jessup M, Umscheid CA. Brain-type natriuretic peptide and amino-terminal pro–brain-type natriuretic peptide discharge thresholds for acute decompensated heart failure. A systematic review. Ann Intern Med. 2017;166:180-90. doi:10.7326/M16-1468 LinkGoogle Scholar4. Troughton R, Felker GM, Januzzi JL. Natriuretic peptide-guided heart failure management. Eur Heart J. 2014;35:16-24. [PMID: 24216390] doi:10.1093/eurheartj/eht463 CrossrefMedlineGoogle Scholar5. Troughton RW, Frampton CM, Brunner-La Rocca HP, Pfisterer M, Eurlings LW, Erntell H, et al. Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis. Eur Heart J. 2014;35:1559-67. [PMID: 24603309] doi:10.1093/eurheartj/ehu090 CrossrefMedlineGoogle Scholar6. Carubelli V, Lombardi C, Lazzarini V, Bonadei I, Castrini AI, Gorga E, et al. N-terminal pro-B-type natriuretic peptide-guided therapy in patients hospitalized for acute heart failure. J Cardiovasc Med (Hagerstown). 2016;17:828-39. [PMID: 27322401] doi:10.2459/JCM.0000000000000419 CrossrefMedlineGoogle Scholar7. Stienen S, Salah K, Moons AH, Bakx AL, van Pol PE, Schroeder-Tanka JM, et al. Rationale and design of PRIMA II: a multicenter, randomized clinical trial to study the impact of in-hospital guidance for acute decompensated heart failure treatment by a predefined NT-PRoBNP target on the reduction of readmIssion and Mortality rAtes. Am Heart J. 2014;168:30-6. [PMID: 24952857] doi:10.1016/j.ahj.2014.04.008 CrossrefMedlineGoogle Scholar8. Steinen S. Can NT-proBNP-guided therapy during hospital admission for acute decompensated heart failure reduce mortality and readmissions? An international, multicenter, randomized clinical trial (PRIMA II). J Card Fail. 2016;22:939-40. doi:10.1016/j.cardfail.2016.09.011 CrossrefGoogle Scholar9. DeBusk RF, Miller NH, Parker KM, Bandura A, Kraemer HC, Cher DJ, et al. Care management for low-risk patients with heart failure: a randomized, controlled trial. Ann Intern Med. 2004;141:606-13. [PMID: 15492340]. doi:10.7326/0003-4819-141-8-200410190-00008 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Duke University Medical Center, Durham, North Carolina, and Sidney Kimmel Medical College, Philadelphia, Pennsylvania.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2667.Corresponding Author: David J. Whellan, MD, MHS, Jefferson Heart Institute, 1015 Chestnut Street, Suite 317, Philadelphia, PA 19107; e-mail, david.[email protected]edu.Current Author Addresses: Dr. Felker: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705.Dr. Whellan: Jefferson Heart Institute, 1015 Chestnut Street, Suite 317, Philadelphia, PA 19107.This article was published at Annals.org on 29 November 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBrain-Type Natriuretic Peptide and Amino-Terminal Pro–Brain-Type Natriuretic Peptide Discharge Thresholds for Acute Decompensated Heart Failure Casey N. McQuade , Marisa Mizus , Joyce W. Wald , Lee Goldberg , Mariell Jessup , and Craig A. Umscheid Metrics Cited byTrends in Characteristics and Outcomes in Primary Heart Failure Hospitalizations Among Older Population in the United States, 2004 to 2018Trends of Clinical Outcomes and Health Care Resource Use in Heart Failure in the United States 7 February 2017Volume 166, Issue 3Page: 223-224KeywordsBrain natriuretic peptidesClinical trialsHeart failureHospitalizationsInpatientsLength of stayMortalityN terminal pro brain natriuretic peptidesNatriuretic peptidesVasodilators ePublished: 29 November 2016 Issue Published: 7 February 2017 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...