Impact of Early Initiation of Inotropic Agents on Long-term Outcomes in Acute Heart Failure Syndromes: Role of PDEIII Inhibitors

Abstract Background The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. Purpose The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (HRD) (admission- discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes. Methods We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentric, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission. Results The mean age of the study population was 72±12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one-year all-cause mortality (Relative risk (RR)= 1.182, confidence interval (CI) 95% 1.024–1.366, p=0.022) in SR. In AF patients discharge HR was associated with one-year all-cause mortality (RR= 1.276, CI 95% 1.115–1.459, p≤0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction (Figure 1) Effect of post-discharge heart rate Conclusions In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients Acknowledgement/Funding Heart Failure Program of the Red de Investigaciόn Cardiovascular del Instituto de Salud Carlos III, Madrid, Spain (RD12/0042) and the Fondo Europeo de

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Acute heart failure congestion and perfusion status – impact of the clinical classification on in‐hospital and long‐term outcomes; insights from the ESC‐EORP‐HFA Heart Failure Long‐Term Registry

European Journal of Heart Failure ◽

10.1002/ejhf.1492 ◽

2019 ◽

Vol 21 (11) ◽

pp. 1338-1352 ◽

Cited By ~ 30

Author(s):

Ovidiu Chioncel ◽

Alexandre Mebazaa ◽

Aldo P. Maggioni ◽

Veli‐Pekka Harjola ◽

Giuseppe Rosano ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Clinical Classification ◽

Long Term Outcomes

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Cardiology consultation in oncology practice: a 5-year survey

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa118 ◽

2020 ◽

Vol 50 (12) ◽

pp. 1419-1425

Author(s):

Kazuko Tajiri ◽

Ikuo Sekine ◽

Hiroyuki Naito ◽

Momoko Murata ◽

Siqi Li ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Venous Thromboembolism ◽

Cancer Treatment ◽

Multidisciplinary Approach ◽

Long Term Outcomes ◽

Oncology Practice ◽

The University

Abstract Objective Onco-cardiology services are expanding rapidly in Japan. To provide a better service, it is important to consider the needs of oncologists. However, little is known regarding specific needs for which oncologists should consult cardiologists to manage cardiovascular problems of their patients. We analysed cardiology consultations sought by oncologists to evaluate the role of cardiologists in cancer treatment. Method We retrospectively investigated consecutive 2064 cardiology consultations of cancer patients in the University of Tsukuba Hospital, Tsukuba, Japan, between January 2014 and December 2018. Results The most common timing of cardiology consultation was before the commencement of cancer treatment (n = 1355; 65.7%), followed by after the commencement of cancer treatment (n = 686; 33.2%). Among the 361 consultations before the administration of anticancer drugs, 235 (65.1%) were for anthracycline-based regimens. There were 506 (24.5%) consultations for the management of cardiovascular emergencies developing after the commencement of cancer treatment; venous thromboembolism was the most frequent (n = 125; 24.7%), followed by atrial fibrillation (n = 110; 21.7%) and heart failure (n = 74; 14.6%). There were marked differences in the types of cardiovascular emergencies depending on the type of cancer. Conclusions This survey revealed the various cardiovascular problems for which oncologists sought interventions by cardiologists. A multidisciplinary approach in an onco-cardiology service is essential to achieve optimal long-term outcomes.

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Complement activation products in acute heart failure: Potential role in pathophysiology, responses to treatment and impacts on long-term survival

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617694674 ◽

2017 ◽

Vol 7 (4) ◽

pp. 348-357 ◽

Cited By ~ 4

Author(s):

Marten Trendelenburg ◽

Fabio Stallone ◽

Kateryna Pershyna ◽

Timo Eisenhut ◽

Raphael Twerenbold ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Complement Activation ◽

Subgroup Analysis ◽

Potential Role ◽

Control Group ◽

Term Survival ◽

Activation Products

Background: Previous studies have indicated a correlation between heart failure, inflammation and poorer outcome. However, the pathogenesis and role of inflammation in acute heart failure (AHF) is incompletely studied and understood. The aim of our study was to explore the potential role of innate immunity – quantified by complement activation products (CAPs) – in pathophysiology, responses to treatment and impacts on long-term survival in AHF. Methods: In a prospective study enrolling 179 unselected patients with AHF, plasma concentrations of C4d, C3a and sC5b-9 were measured in a blinded fashion on the first day of hospitalisation and prior to discharge. The final diagnosis, including the AHF phenotype, was adjudicated by two independent cardiologists. Long-term follow-up was obtained. Findings in AHF were compared to that obtained in 75 healthy blood donors (control group). Results: Overall, concentrations of all three CAPs were significantly higher in patients with AHF than in healthy controls (all p < 0.001). In an age-adjusted subgroup analysis, significant differences could be confirmed for concentrations of C4d and sC5b-9, and these parameters further increased after 6 days of in-hospital treatment ( p < 0.001). In contrast, C3a levels in AHF patients did not differ from those of the control group in the age-adjusted subgroup analysis and remained constant during hospitalisation. Concentrations of C4d, C3a and sC5b-9 were significantly higher when AHF was triggered by an infection as compared to other triggers ( p < 0.001). In addition, CAP levels significantly correlated with each other ( r = 0.64–0.76), but did not predict death within 2 years. Conclusions: Activation of complement with increased plasma levels of C4d and sC5b-9 at admission and increasing levels during AHF treatment seems to be associated with AHF, particularly when AHF was triggered by an infection. However, CAPs do not have a prognostic value in AHF.

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