Identification of Stage D Heart Failure Patients: Clinical Assessment Versus ESC Heart Failure Association Criteria

Background: Reducing 30 day readmission rates for patients with heart failure (HF) has been a recent focus of lowering health care expenditures. Hemodynamic profiles (HP) have been associated with clinical outcomes in chronic systolic HF. The relationship of HP to outcomes in acute decompensated diastolic HF (DHF) has not been defined. Methods: This case-control study of 1892 DHF patients discharged alive from an academic hospital between 2002-2012 with left ventricular function greater or equal to 45% were categorized into 4 groups: Profile A, no evidence of congestion and hypoperfusion (dry-warm); Profile B, congestion with adequate perfusion (wet-warm); Profile C, congestion with hypoperfusion (wet-cold); and Profile L, hypoperfusion without congestion (dry-cold). All cause readmissions at 30 days and 1 year and mortality at 30 days and 1 year were examined. Statistical analysis using multivariable Cox Proportional hazard model was performed adjusting for demographic, clinical, care and hospital characteristics. Results: Of the 1892 patients, 1196 (63%) were females; mean age was 68 (±14) years. There were 724(38%), 1000 (53%), 88(5%) and 80 (4%) patients in the hemodynamic profiles A, B, C and L respectively. Profiles B and C were associated with an increased risk for 30-day all-cause HF readmission compared to profiles A and L: Hazard ratio (HR) [1.38 (95% C.I 1.17-1.61)], [1.39 (95% C.I 1.18-1.62)] for B and C profiles respectively. Profiles C and L were associated with increased mortality at 1 year: HR [1.46 (95% CI 1.06-1.89)] and [1.31 (95% CI 1.01-1.64)] for A and L profiles respectively (Table). Conclusions: Clinical assessment of HP can help identify DHF patients at increased risk of readmission and mortality, similar to systolic heart failure patients.

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Longer Duration of Milrinone Associated with Higher Risk for Right Ventricular Failure Following Left Ventricular Assist Device Implantation in Stage D Heart Failure Patients

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2019.07.131 ◽

2019 ◽

Vol 25 (8) ◽

pp. S47

Author(s):

Mina M. Benjamin ◽

Zhuping Garacci ◽

Sakthi Sundarajan ◽

Asim Mohammed

Keyword(s):

Heart Failure ◽

Left Ventricular ◽

Right Ventricular Failure ◽

Ventricular Failure ◽

Assist Device ◽

Ventricular Assist ◽

Heart Failure Patients ◽

Device Implantation ◽

Left Ventricular Assist ◽

Stage D

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Guiding decongestion treatment in chronic heart failure patients. Clinical assessment or serial laboratory evaluation?

European Heart Journal ◽

10.1093/eurheartj/eht307.p647 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P647-P647 ◽

Cited By ~ 1

Author(s):

A. Karavidas ◽

K. Konstantinou ◽

M. Nikolaou ◽

V. Matzaraki ◽

N. Papoutsidakis ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Clinical Assessment ◽

Laboratory Evaluation ◽

Heart Failure Patients

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Identification and outcomes in Stage D heart failure patients

Journal of Cardiac Failure ◽

10.1016/s1071-9164(03)00160-x ◽

2003 ◽

Vol 9 (5) ◽

pp. S85

Author(s):

Edward C Chao ◽

Wafaa A Elatre ◽

Bonita L Huiskes ◽

J.Thomas Heywood

Keyword(s):

Heart Failure ◽

Heart Failure Patients ◽

Stage D

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2007 Katharine A. Lembright Award and Lecture—Stage D Heart Failure: Quality-of-Life Outcomes After Transplantation and Mechanical Support

Circulation ◽

10.1161/circ.116.suppl_16.ii_d ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Kathleen Grady

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Psychological Distress ◽

Heart Transplantation ◽

Functional Disability ◽

Left Ventricular ◽

Heart Failure Patients ◽

Improved Outcomes ◽

Stage D

Approximately 5 million individuals have heart failure in the United States. The 1-year mortality rate for patients with New York Heart Association class IV heart failure is 50%. Treatment options for patients with refractory symptoms and stage D heart failure include heart transplantation and mechanical circulatory support devices. Improved outcomes have been demonstrated in these advanced heart failure patients who undergo surgical therapies. Prolongation of life is relevant only if quality of life (QOL) is improved. Improvement in QOL outcomes has been demonstrated before and after heart transplantation, including improved outcomes when bridged to transplantation with left ventricular assist devices (LVADs). While listed for transplantation, worse QOL is significantly related to more symptoms, psychological distress, and functional disability. Patients who are bridged to heart transplantation with an LVAD report significantly improved QOL and decreased symptoms from before to early after LVAD implantation, as well as fairly good and stable QOL outcomes through 1 year after implantation. At 1 year after transplantation, better QOL is significantly related to less psychological distress, functional disability, and symptom distress; older age; and fewer complications. At 5 to 10 years after heart transplantation, QOL is positive and stable. Improved QOL is significantly related to biopsychosocial variables, including less depression, more positive emotions, more social support, and less fatigue. Thus, for stage D heart failure patients, heart transplantation conveys significant short-and long-term QOL benefit, including in those patients who are bridged to transplantation with an LVAD.

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