Identification of Patient Phenotypes Associated With Elevated Aldosterone Levels

Post-discharge mortality and re-hospitalization for acute heart failure (AHF) affects 15%
and 30% of patients respectively, within 90 days. With over 1 million annual
hospitalizations and a financial cost exceeding 20 billion dollars, AHF is a major public
health burden. Yet no AHF therapy to date definitively reduces morbidity and mortality, and
in stark contrast to heart attack patients, highly rated evidence in guidelines do not
exist. Although AHF is a syndrome and not one disease, typical treatment of patients
hospitalized with AHF suggests otherwise. Despite substantial differences among AHF
patients, therapy is largely uniform; patients receive medicine to help get rid of excess
volume and little else. Although decades of empirical use support the symptomatic benefits
of traditional therapies, outcomes remain extremely poor. As opposed to the
"one-size-fits-all‟ approach used unsuccessfully to date in clinical trials, identification
of specific AHF patient sub-groups is critical, so that tailored therapies can be developed
and tested. Preliminary data suggests that the neurohormone aldosterone may be detrimental
in AHF patients. Furthermore, this hormone level appears to rise during hospitalization.
The investigators therefore propose to identify specific AHF patient phenotypes associated
with high serum aldosterone levels to subsequently address the hypothesis that early
aldosterone blockade continued throughout hospitalization will decrease re-hospitalization
and mortality. Specifically, the investigators hypothesize that AHF patients with elevated
serum aldosterone levels have a distinct phenotype compared to those with lower or normal
aldosterone levels. Specifically, they will be older, have a lower systolic blood pressure,
lower EF, worse renal function, higher BNP, and previous hospitalization for HF.