Recognizing Worsening Chronic Heart Failure as an Entity and an End Point in Clinical Trials

Heart failure has been considered a progressive and often fatal condition. However, clinical trials conducted during the last 2 decades among outpatients with heart failure and reduced ejection fraction have shown that the negative trajectory of this syndrome can be altered with effective therapies, improving the annual mortality risk from approximately 20% to approximately 5% to 8%.¹ The same success has not been demonstrated for patients with heart failure and preserved ejection fraction as well as for patients hospitalized for worsening symptoms, irrespective of ejection fraction. Patients hospitalized for heart failure are at a particularly high risk for adverse outcomes after discharge.