Nesiritide Prolongs Hospital Length of Stay in Acute Decompensated Heart Failure with Preserved Ejection Fraction

Abstract Context.—In clinical trials, N-terminal pro-brain natriuretic peptide (NT-proBNP) testing has been shown to be valuable for diagnosis and triage of patients with acute decompensated heart failure. It is not yet clear what benefits might be expected from the initiation of NT-proBNP testing in an everyday clinical setting. Objective.—To determine the effects of NT-proBNP testing on hospital length of stay as well as on 60-day morbidity and mortality in patients with acute decompensated heart failure before and after the test was implemented in the clinical laboratory. Design.—We measured hospital length of stay and 60-day morbidity and mortality rates among patients with acute decompensated heart failure admitted before and after initiation of NT-proBNP testing in our hospital. Differences in demographics between preimplementation and postimplementation groups were compared with the χ2 test for categorical variables and the Wilcoxon rank sum test for continuous variables. Comparison between the hospital length of stay for each group was evaluated using the Mann-Whitney U test. Differences in rates of rehospitalization or death at 60 days following presentation were assessed using χ2 cross-tabulation. Results.—Patients in the postimplementation group had similar clinical features as those in the preimplementation group. The hospital length of stay for patients in the postimplementation study group decreased both with respect to mean (1.86-day reduction) and median (1.3-day reduction) hospital stay (both, P = .03). Additionally, significantly lower rates of death (6.6% absolute risk reduction, P = .01), rehospitalization (12.1% absolute risk reduction, P = .005), and the composite of the 2 rates (18.7% absolute risk reduction, P = .008) were found following initiation of NT-proBNP testing. Conclusions.—Implementation of NT-proBNP testing may result in significant reductions in hospital length of stay as well as improvements in rates of morbidity and mortality in patients with acute decompensated heart failure.

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Systolic blood pressure on admission in acute decompensated heart failure with preserved ejection fraction

ESC Heart Failure ◽

10.1002/ehf2.13420 ◽

2021 ◽

Author(s):

Akito Nakagawa ◽

Yoshio Yasumura ◽

Chikako Yoshida ◽

Takahiro Okumura ◽

Jun Tateishi ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Ejection Fraction ◽

Systolic Blood Pressure ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Preserved Ejection Fraction

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Impact of red blood cell distribution width on non-cardiac mortality in patients with acute decompensated heart failure with preserved ejection fraction

Journal of Cardiology ◽

10.1016/j.jjcc.2017.03.010 ◽

2017 ◽

Vol 70 (6) ◽

pp. 591-597 ◽

Cited By ~ 7

Author(s):

Ryo Imai ◽

Yusuke Uemura ◽

Takahiro Okumura ◽

Kenji Takemoto ◽

Tomohiro Uchikawa ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Blood Cell ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Cell Distribution ◽

Preserved Ejection Fraction ◽

Cardiac Mortality ◽

Distribution Width ◽

Red Blood Cell Distribution

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Outcomes of de novo and acute decompensated heart failure patients according to ejection fraction

Heart ◽

10.1136/heartjnl-2017-311813 ◽

2017 ◽

Vol 104 (6) ◽

pp. 525-532 ◽

Cited By ~ 23

Author(s):

Ki Hong Choi ◽

Ga Yeon Lee ◽

Jin-Oh Choi ◽

Eun-Seok Jeon ◽

Hae-Young Lee ◽

...

Keyword(s):

Heart Failure ◽

Mortality Rate ◽

Ejection Fraction ◽

De Novo ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

First Year ◽

Preserved Ejection Fraction ◽

University Hospitals ◽

Reduced Ejection Fraction

ObjectiveThere are conflicting results among previous studies regarding the prognosis of heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF). This study aimed to compare the outcomes of patients with de novo acute heart failure (AHF) or acute decompensated HF (ADHF) according to HFpEF (EF≥50%), or HFrEF (EF<40%) and to define the prognosis of patients with HF with mid-range EF (HFmrEF, 40≤EF<50%).MethodsBetween March 2011 and February 2014, 5625 consecutive patients with AHF were recruited from 10 university hospitals. A total of 5414 (96.2%) patients with EF data were enrolled, which consisted of 2867 (53.0%) patients with de novo and 2547 (47.0%) with ADHF. Each of the enrolled group was stratified by EF.ResultsIn de novo, all-cause death rates were not significantly different between HFpEF and HFrEF (HFpEF vs HFrEF, 206/744 (27.7%) vs 438/1631 (26.9%), HRadj 1.15, 95% CI 0.96 to 1.38, p=0.14). However, among patients with ADHF, HFrEF had a significantly higher mortality rate compared with HFpEF (HFpEF vs HFrEF, 245/613 (40.0%) vs 694/1551 (44.7%), HRadj 1.25, 95% CI 1.06 to 1.47, p=0.007). Also, in ADHF, HFmrEF was associated with a significantly lower mortality rate within 1 year compared with HFrEF (HFmrEF vs HFrEF, 88/383 (23.0%) vs 430/1551 (27.7%), HRadj 1.31, 95% CI 1.03 to 1.65, p=0.03), but a significantly higher mortality rate after 1 year compared with HFpEF (HFmrEF vs HFpEF, 83/295 (28.1%) vs 101/469 (21.5%), HRadj 0.70, 95% CI 0.52 to 0.96, p=0.02).ConclusionsHFpEF may indicate a better prognosis compared with HFrEF in ADHF, but not in de novo AHF. For patients with ADHF, the prognosis associated with HFmrEF was similar to that of HFpEF within the first year following hospitalisation and similar to HFrEF 1 year after hospitalisation.

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