. 2024 Jul 10;40(2):371–384. doi: 10.1093/ndt/gfae156

Table 6:

Heart failure hospitalization definitions.

Source	Heart failure hospitalization definition
SCTI and the United States FDA (2017)	A Heart Failure Hospitalization is defined as an event that meets ALL of the following criteria:1) The patient is admitted to the hospital with a *primary diagnosis* of HF2) The patient's length of stay in hospital extends for at least 24 hours (or a change in calendar date if the hospital admission and discharge times are unavailable)3) The patient exhibits documented new or worsening symptoms due to HF on presentation, including at least ONE of the following:a. Dyspnoea (dyspnoea with exertion, dyspnoea at rest, orthopnea, PND)b. Decreased exercise tolerancec. Fatigued. Other symptoms of worsened end-organ perfusion or volume overload (must be specified and described by the protocol)4) The patient has objective evidence of new or worsening HF, consisting of at least TWO physical examination findings OR one physical examination finding and at least ONE laboratory criterion, including:a. Physical examination findings considered to be due to heart failure, including new or worsened:i. Peripheral oedemaii. Increasing abdominal distention or ascites (in the absence of primary hepatic disease)iii. Pulmonary rales/crackles/crepitationsiv. Increased JVP and/or hepatojugular refluxv. S₃ gallopvi. Clinically significant or rapid weight gain thought to be related to fluid retentionb. Laboratory evidence of new or worsening HF, if obtained within 24 hours of presentation, including:i. Increased BNP/N-terminal pro-BNP (NT-proBNP) concentrations consistent with decompensation of heart failure (such as BNP >500 pg/ml or NT-proBNP >2000 pg/ml). In patients with chronically elevated natriuretic peptides, a significant increase should be noted above baseline.ii. Radiological evidence of pulmonary congestioniii. Non-invasive diagnostic evidence of clinically significant elevated left- or right-sided ventricular filling pressure or low cardiac output. For example, echocardiographic criteria could include: septal or lateral E/e’ >15 or >12, respectively; D-dominant pulmonary venous inflow pattern; plethoric inferior vena cava with minimal collapse on inspiration; or decreased left ventricular outflow tract minute stroke distance (time velocity integral)ORiv. Invasive diagnostic evidence with right heart catheterization showing a pulmonary capillary wedge pressure (pulmonary artery occlusion pressure) ≥18 mmHg, central venous pressure ≥12 mmHg, or a cardiac index <2.2 l/min/m²Note: All results from diagnostic tests should be reported, if available, even if they do not meet the above criteria, because they provide important information for the adjudication of these events.5) The patient receives at least ONE of the following treatments specifically for HF:a. Significant augmentation in oral diuretic therapy (e.g. doubling of loop diuretic dose, initiation of maintenance loop diuretic therapy, initiation of combination diuretic therapy)b. Initiation of intravenous diuretic (even a single dose) or vasoactive agent (e.g. inotrope, vasopressor, vasodilator)c. Mechanical or surgical intervention, including:i. Mechanical circulatory support (e.g. intra-aortic balloon pump, ventricular assist device, extracorporeal membrane oxygenation, total artificial heart)ii. Mechanical fluid removal (e.g. ultrafiltration, hemofiltration, dialysis)General Considerations (HF Hospitalization)Combination diuretic therapy could include (1) a thiazide-type diuretic (e.g. hydrochlorothiazide, metolazone, chlorothiazide) plus a loop diuretic; or (2) mineralocorticoid receptor antagonist (MRA) (e.g. spironolactone or eplerenone) plus a loop diuretic.
Heart Failure Collaboratory and Academic Research Consortium (2020)^a	Heart failure hospitalizationA sub-category of cardiovascular hospitalization.An admission to the hospital where patient length of stay extends for at least 24 h or as measured by a change in calendar date, and:i. The patient is admitted to the hospital with a primary diagnosis of HF.ii. The patient exhibits documented new or worsening symptoms due to HF on presentation, including at least one of the following: dyspnoea (dyspnoea with exertion, dyspnoea at rest, orthopnoea, PND); decreased exercise tolerance; fatigue; or other symptoms of worsened end-organ perfusion or volume overload that must be specified and described by the trial protocol.iii. The patient has objective evidence of new or worsening HF, consisting of at least two physical examination findings or one physical examination finding and one laboratory or invasively measured criterion, including:a. Physical examination findings considered to be due to HF include new or worsened: peripheral oedema; increasing abdominal distention or ascites (in the absence of primary hepatic disease); pulmonary rales/crackles/crepitations; increased JVP and/or hepatojugular reflux; S3 gallop; clinically significant or rapid weight gain thought to be related to fluid retention.b. Laboratory evidence of new or worsening HF, if obtained within 24 h of presentation, include:increased BNP/N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations consistent with decompensation of HF (in patients with chronically elevated natriuretic peptides, a significant increase should be noted above baseline); radiological, ultrasonographic, or implantable monitor evidence of pulmonary congestion; non-invasive or implantable diagnostic evidence of clinically significant elevated left- or right-sided ventricular filling pressure, or low cardiac output.c. Invasive evidence of new or worsening HF including right heart catheterization showing elevated pulmonary capillary wedge pressure (pulmonary artery occlusion pressure), elevated central venouspressure, depressed cardiac index, or left heart catheterization showing elevated left ventricular end diastolic pressure consistent with decompensation of HF.iv. The patient receives at least one of the following treatments specifically for HF:a. Significant augmentation in oral diuretic therapy (at least a doubling of loop diuretic dose, initiation of maintenance loop diuretic therapy, initiation of combination diuretic therapy).b. Initiation of intravenous diuretic (even a single dose).c. Initiation of an intravenous vasoactive agent (catecholamine, phosphodiesterase-3 inhibitor, other vasopressor, vasodilator).d. Mechanical or surgical intervention, including mechanical circulatory support (intra-aortic balloon pump, temporary, or durable ventricular assist device including both percutaneous and surgically placed devices, extracorporeal membrane oxygenation, or total artificial heart).e. Mechanical fluid removal (ultrafiltration, haemofiltration, haemodialysis).v. However, in cases where documentation of the above criteria may not be obtained, the following definition of a HF hospitalization may be used: If agreed by consensus of a clinical events committee, events of symptomatic HF that include at least one worsening symptom, as well as either one physical examination finding or one laboratory finding or invasively measured criterion, in addition to at least one intravenous or mechanical treatment specific for HF, may be considered HF hospitalizations, with or without supporting documentation.vi. Events that do not meet the criteria for any of the preceding definitions may be collected and analysed according to a pre-specified plan.

Source

Heart failure hospitalization definition

SCTI and the United States FDA (2017)

A Heart Failure Hospitalization is defined as an event that meets ALL of the following criteria:1) The patient is admitted to the hospital with a primary diagnosis of HF2) The patient's length of stay in hospital extends for at least 24 hours (or a change in calendar date if the hospital admission and discharge times are unavailable)3) The patient exhibits documented new or worsening symptoms due to HF on presentation, including at least ONE of the following:a. Dyspnoea (dyspnoea with exertion, dyspnoea at rest, orthopnea, PND)b. Decreased exercise tolerancec. Fatigued. Other symptoms of worsened end-organ perfusion or volume overload (must be specified and described by the protocol)4) The patient has objective evidence of new or worsening HF, consisting of at least TWO physical examination findings OR one physical examination finding and at least ONE laboratory criterion, including:a. Physical examination findings considered to be due to heart failure, including new or worsened:i. Peripheral oedemaii. Increasing abdominal distention or ascites (in the absence of primary hepatic disease)iii. Pulmonary rales/crackles/crepitationsiv. Increased JVP and/or hepatojugular refluxv. S₃ gallopvi. Clinically significant or rapid weight gain thought to be related to fluid retentionb. Laboratory evidence of new or worsening HF, if obtained within 24 hours of presentation, including:i. Increased BNP/N-terminal pro-BNP (NT-proBNP) concentrations consistent with decompensation of heart failure (such as BNP >500 pg/ml or NT-proBNP >2000 pg/ml). In patients with chronically elevated natriuretic peptides, a significant increase should be noted above baseline.ii. Radiological evidence of pulmonary congestioniii. Non-invasive diagnostic evidence of clinically significant elevated left- or right-sided ventricular filling pressure or low cardiac output. For example, echocardiographic criteria could include: septal or lateral E/e’ >15 or >12, respectively; D-dominant pulmonary venous inflow pattern; plethoric inferior vena cava with minimal collapse on inspiration; or decreased left ventricular outflow tract minute stroke distance (time velocity integral)ORiv. Invasive diagnostic evidence with right heart catheterization showing a pulmonary capillary wedge pressure (pulmonary artery occlusion pressure) ≥18 mmHg, central venous pressure ≥12 mmHg, or a cardiac index <2.2 l/min/m²Note: All results from diagnostic tests should be reported, if available, even if they do not meet the above criteria, because they provide important information for the adjudication of these events.5) The patient receives at least ONE of the following treatments specifically for HF:a. Significant augmentation in oral diuretic therapy (e.g. doubling of loop diuretic dose, initiation of maintenance loop diuretic therapy, initiation of combination diuretic therapy)b. Initiation of intravenous diuretic (even a single dose) or vasoactive agent (e.g. inotrope, vasopressor, vasodilator)c. Mechanical or surgical intervention, including:i. Mechanical circulatory support (e.g. intra-aortic balloon pump, ventricular assist device, extracorporeal membrane oxygenation, total artificial heart)ii. Mechanical fluid removal (e.g. ultrafiltration, hemofiltration, dialysis)General Considerations (HF Hospitalization)Combination diuretic therapy could include (1) a thiazide-type diuretic (e.g. hydrochlorothiazide, metolazone, chlorothiazide) plus a loop diuretic; or (2) mineralocorticoid receptor antagonist (MRA) (e.g. spironolactone or eplerenone) plus a loop diuretic.

Heart Failure Collaboratory and Academic Research Consortium (2020)^a

Heart failure hospitalizationA sub-category of cardiovascular hospitalization.An admission to the hospital where patient length of stay extends for at least 24 h or as measured by a change in calendar date, and:i. The patient is admitted to the hospital with a primary diagnosis of HF.ii. The patient exhibits documented new or worsening symptoms due to HF on presentation, including at least one of the following: dyspnoea (dyspnoea with exertion, dyspnoea at rest, orthopnoea, PND); decreased exercise tolerance; fatigue; or other symptoms of worsened end-organ perfusion or volume overload that must be specified and described by the trial protocol.iii. The patient has objective evidence of new or worsening HF, consisting of at least two physical examination findings or one physical examination finding and one laboratory or invasively measured criterion, including:a. Physical examination findings considered to be due to HF include new or worsened: peripheral oedema; increasing abdominal distention or ascites (in the absence of primary hepatic disease); pulmonary rales/crackles/crepitations; increased JVP and/or hepatojugular reflux; S3 gallop; clinically significant or rapid weight gain thought to be related to fluid retention.b. Laboratory evidence of new or worsening HF, if obtained within 24 h of presentation, include:increased BNP/N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations consistent with decompensation of HF (in patients with chronically elevated natriuretic peptides, a significant increase should be noted above baseline); radiological, ultrasonographic, or implantable monitor evidence of pulmonary congestion; non-invasive or implantable diagnostic evidence of clinically significant elevated left- or right-sided ventricular filling pressure, or low cardiac output.c. Invasive evidence of new or worsening HF including right heart catheterization showing elevated pulmonary capillary wedge pressure (pulmonary artery occlusion pressure), elevated central venouspressure, depressed cardiac index, or left heart catheterization showing elevated left ventricular end diastolic pressure consistent with decompensation of HF.iv. The patient receives at least one of the following treatments specifically for HF:a. Significant augmentation in oral diuretic therapy (at least a doubling of loop diuretic dose, initiation of maintenance loop diuretic therapy, initiation of combination diuretic therapy).b. Initiation of intravenous diuretic (even a single dose).c. Initiation of an intravenous vasoactive agent (catecholamine, phosphodiesterase-3 inhibitor, other vasopressor, vasodilator).d. Mechanical or surgical intervention, including mechanical circulatory support (intra-aortic balloon pump, temporary, or durable ventricular assist device including both percutaneous and surgically placed devices, extracorporeal membrane oxygenation, or total artificial heart).e. Mechanical fluid removal (ultrafiltration, haemofiltration, haemodialysis).v. However, in cases where documentation of the above criteria may not be obtained, the following definition of a HF hospitalization may be used: If agreed by consensus of a clinical events committee, events of symptomatic HF that include at least one worsening symptom, as well as either one physical examination finding or one laboratory finding or invasively measured criterion, in addition to at least one intravenous or mechanical treatment specific for HF, may be considered HF hospitalizations, with or without supporting documentation.vi. Events that do not meet the criteria for any of the preceding definitions may be collected and analysed according to a pre-specified plan.

^aAlso includes definitions for worsening heart failure in the setting of acute heart failure, worsening heart failure in the setting of a non-heart failure hospitalization, and worsening heart failure events without hospitalization.