Abstract
AIMS: Breathlessness is the primary symptom of decompensated heart failure (HF), but the prevalence and evolution of persistent respiratory distress post-hospitalization remain unclear. METHODS AND RESULTS: The Longitudinal Observational Study for mIddle Term Follow-up Patients Admitted for Acute Dyspnea in TunIsia (SIDI) study is a prospective and multicentre study on HF patients with preserved ejection fraction admitted for acute dyspnoea. Patients were followed for 6 months. The primary endpoint was to assess the incidence of persistent respiratory distress and factors linked to respiratory recovery at Day 90. The secondary endpoint was rehospitalization and/or death at Day 90 and 180. Among 231 patients, 140 had SpO(2) and respiratory rate data at Day 90. Persistent respiratory distress was observed in 97 (69%). Multivariable analysis found no association between respiratory recovery and sex, diabetes, hypertension, kidney disease or NT-proBNP levels. However, intensive follow-up (n = 54) with oral neuroendocrine inhibition significantly improved respiratory parameters at Day 90 (adjusted HR: 5.70 [95% CI 2.13-18.28], P = 0.0001) compared with standard follow-up (n = 86) and reduced rehospitalization and/or death at Day 90 and 180. CONCLUSIONS: Persistent respiratory distress is frequent in the months following HF hospitalization. Optimized guideline-directed therapy and close follow-up improve respiratory recovery. SpO(2) and respiratory rate monitoring should be integrated into HF management.