The importance of changes in prognostic markers during the management of HFrEF: Reassessment better predicts the outcomes than the initial evaluation

Purpose Risk scores in HFrEF are based on an analysis of prognostic markers at one point during the follow-up regardless of the patient's treatment evolution. However, patient's management and therapy response will change their prognosis. Objectives To appreciate the impact of therapy optimization on usual prognostic markers in patients with HFrEF and to compare the prognostic value of these markers before and after therapy optimization. Methods All patients hospitalized at our institution from 1st May 2011 to 30th April 2015 with LVEF  Results Among the 328 patients included at M0, 81% were men, mean age was 57 years, 42% had ischemic HF, 39% were in NYHA class I or II, mean duration of HF was 6,5 ± 10,1 years, average BNP was 584 pg/mL (IQR 211-777) and LVEF was 28 ± 7%. The exposure to HF therapy was significantly higher at M6 when compared with M0. Primary outcome occurred in 20% of the patients at 1 year and in 35% at 3 years with an all-cause mortality of 2,6% and 10,4% respectively. During follow-up, there were significant changes on prognostic markers: 86% NYHA class I-II at M6 versus 39% at M0 (P  Conclusion Assessment of usual markers after therapy optimization better predicts prognosis than the same markers collected 6 months earlier.