Detailed Assessment of the "I Need Help" Criteria in Patients With Heart Failure: Insights From the HELP-HF Registry.

Background: The "I Need Help" markers have been proposed to identify patients with advanced heart failure (HF). We evaluated the prognostic impact of these markers on clinical outcomes in a real-world, contemporary, multicenter HF population.
Methods: We included consecutive patients with HF and at least 1 high-risk "I Need Help" marker from 4 centers. The impact of the cumulative number of "I Need Help" criteria and that of each individual "I Need Help" criterion was evaluated. The primary end point was the composite of all-cause mortality or first HF hospitalization.
Results: Among 1149 patients enrolled, the majority had 2 (30.9%) or 3 (22.6%) "I Need Help" criteria. A higher cumulative number of "I Need Help" criteria was independently associated with a higher risk of the primary end point (adjusted hazard ratio for each criterion increase, 1.19 [95% CI, 1.11-1.27]; P <0.001), and patients with >5 criteria had the worst prognosis. Need of inotropes, persistently high New York Heart Association classes III and IV or natriuretic peptides, end-organ dysfunction, >1 HF hospitalization in the last year, persisting fluid overload or escalating diuretics, and low blood pressure were the individual criteria independently associated with a higher risk of the primary end point.
Conclusions: In our HF population, a higher number of "I Need Help" criteria was associated with a worse prognosis. The individual criteria with an independent impact on mortality or HF hospitalization were need of inotropes, New York Heart Association class or natriuretic peptides, end-organ dysfunction, multiple HF hospitalizations, persisting edema or escalating diuretics, and low blood pressure.
Competing Interests: Disclosures Dr Pagnesi reports personal fees from Abbott Laboratories, AstraZeneca, Boehringer Ingelheim, and Vifor Pharma, all outside the submitted work. Dr Stolfo reports personal fees from Novartis, Merck, GlaxoSmithKline, and Acceleron, all outside the submitted work. Dr Adamo reports speaker fees from Abbott Vascular and Medtronic. Dr Merlo reports personal fees for congresses from Novartis, Vifor Pharma, and Pfizer and unrestricted research grant from Pfizer, all outside the submitted work. Dr Sinagra reports consulting fees from Novartis, Impulse Dynamics, and Biotronik and speaker fees and honoraria from Novartis, Bayer, AstraZeneca, Boston Scientific, Vifor Pharma, Menarini, and Akcea Therapeutics, all outside the submitted work. Dr Metra reports personal consulting honoraria of minimal amount from Abbott, Amgen, Bayer, Edwards Therapeutics, LivaNova, and Vifor Pharma for participation to advisory board meetings and executive committees of clinical trials. The other authors report no conflicts.