Heart Rate During the Post-Discharge Home Visit Predicts Mortality in Patients With Heart Failure

Abstract Background Multiparametric remote monitoring of patients with heart failure (HF) has the potential to mitigate the health risks of lockdowns for COVID-19. Aims To compare health care use, physiological variables, and HF decompensations during one month before and during the first month of the first French national lockdown for COVID-19 among patients undergoing remote monitoring. Methods Transmitted vital parameters and data from cardiac implantable electronic devices were analyzed in 51 patients. Medical contact was defined as the sum of visits and days of hospitalization. Results The lockdown was associated with a marked decrease in cardiology medical contact (118 days before vs 26 days during, -77%, p = 0.003) and overall medical contact (180 days before vs 79 days during, -58%, p = 0.005). Patient adherence with remote monitoring was 84±21% before and 87±19% during lockdown. The lockdown was not associated with significant changes in various parameters, including physical activity (2±1 to 2±1 h/day), weight (83±16 to 83±16 kg), systolic blood pressure (121±19 to 121±18 mmHg), heart rate (68±10 to 67±10 bpm), heart rate variability (89±44 to 78±46 ms, p = 0.05), atrial fibrillation burden (84±146 vs 86±146 h/month), or thoracic impedance (66±8 to 66±9 Ω). Seven cases of HF decompensations were observed before lockdown, all but one of which required hospitalization, versus six during lockdown, all but one of which were managed remotely. Conclusions The lockdown restrictions caused a marked decrease in health care use but no significant change in the clinical status of HF patients under multiparametric remote monitoring. lay summary The first French COVID-19 lockdown had a huge detrimental impact on conventional health care use (-78% in cardiology medical contact). However the lockdown had little impact over the short-term, if any, on vital parameters and the clinical status of patients with heart failure who were adherent to multiparametric remote monitoring. This remote monitoring strategy allowed early identification and home management of most of the heart failure decompensations during the lockdown.

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Heart Rate–Induced Myocardial Ca 2+ Retention and Left Ventricular Volume Loss in Patients With Heart Failure With Preserved Ejection Fraction

Journal of the American Heart Association ◽

10.1161/jaha.120.017215 ◽

2020 ◽

Vol 9 (17) ◽

Author(s):

Daniel N. Silverman ◽

Mehdi Rambod ◽

Daniel L. Lustgarten ◽

Robert Lobel ◽

Martin M. LeWinter ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Ejection Fraction ◽

Sinus Rhythm ◽

Left Ventricular ◽

Atrial Pacing ◽

Preserved Ejection Fraction ◽

Volume Loss ◽

Heart Rates ◽

Patients With Heart Failure

Background Increases in heart rate are thought to result in incomplete left ventricular (LV) relaxation and elevated filling pressures in patients with heart failure with preserved ejection fraction (HFpEF). Experimental studies in isolated human myocardium have suggested that incomplete relaxation is a result of cellular Ca 2+ overload caused by increased myocardial Na + levels. We tested these heart rate paradigms in patients with HFpEF and referent controls without hypertension. Methods and Results In 22 fully sedated and instrumented patients (12 controls and 10 patients with HFpEF) in sinus rhythm with a preserved ejection fraction (≥50%) we assessed left‐sided filling pressures and volumes in sinus rhythm and with atrial pacing (95 beats per minute and 125 beats per minute) before atrial fibrillation ablation. Coronary sinus blood samples and flow measurements were also obtained. Seven women and 15 men were studied (aged 59±10 years, ejection fraction 61%±4%). Patients with HFpEF had a history of hypertension, dyspnea on exertion, concentric LV remodeling and a dilated left atrium, whereas controls did not. Pacing at 125 beats per minute lowered the mean LV end‐diastolic pressure in both groups (controls −4.3±4.1 mm Hg versus patients with HFpEF −8.5±6.0 mm Hg, P =0.08). Pacing also reduced LV end‐diastolic volumes. The volume loss was about twice as much in the HFpEF group (controls −15%±14% versus patients with HFpEF −32%±11%, P =0.009). Coronary venous [Ca 2+ ] increased after pacing at 125 beats per minute in patients with HFpEF but not in controls. [Na + ] did not change. Conclusions Higher resting heart rates are associated with lower filling pressures in patients with and without HFpEF. Incomplete relaxation and LV filling at high heart rates lead to a reduction in LV volumes that is more pronounced in patients with HFpEF and may be associated with myocardial Ca 2+ retention.

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090 Prognostication in patients with heart failure and intermediate peak oxygen consumption values can be more accurately assessed by heart rate recovery

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(11)70092-1 ◽

2011 ◽

Vol 3 (1) ◽

pp. 29

Author(s):

Ahmed Ben Driss ◽

Jean-Yves Tabet ◽

Philippe Meurin ◽

Nathalie Renaud ◽

Hélène Weber ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Oxygen Consumption ◽

Heart Rate Recovery ◽

Peak Oxygen Consumption ◽

Consumption Values ◽

Patients With Heart Failure

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Abstract 13303: Cardio-ankle Vascular Index Predicts New Onset Stroke in Patients With Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.13303 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Yu Hotsuki ◽

Akiomi YOSHIHISA ◽

Yu Sato ◽

Yasuhiro Ichijo ◽

Koichiro Watanabe ◽

...

Keyword(s):

Heart Failure ◽

Regression Tree ◽

Left Ventricular ◽

Classification And Regression Tree ◽

Left Ventricular Ejection ◽

Chronic Obstructive ◽

Post Discharge ◽

Ventricular Ejection Fraction ◽

Patients With Heart Failure ◽

New Onset

Aim: We aimed to evaluate the implication of cardio-ankle vascular index (CAVI) to predict new onset stroke in patients with heart failure (HF). Methods and Results: This was a prospective observational study, which recruited clinical data of a total of 898 patients hospitalized for HF. According to the survival classification and regression tree analysis, the accurate cut-off value of CAVI in predicting post-discharge stroke was 9.6. We divided patients into two groups: the high CAVI group (CAVI > 9.6, n = 230, 25.6%) and the low CAVI group (CAVI ≤ 9.6, n = 668, 74.4%). We compared the patients’ characteristics and occurrence of new onset stroke. The high CAVI group was older (73.5 vs. 66.0 years old, P < 0.001) and had a higher prevalence of male sex (74.3% vs. 62.0%, P = 0.001) and prior stroke (23.5% vs. 17.5%, P = 0.047). The high CAVI group showed higher levels of B-type natriuretic peptide (246.0 vs. 165.1 pg/mL, P < 0.001) and lower levels of estimated glomerular filtration rate (51.6 vs. 61.8 mL/kg/1.73 m2, P < 0.001). In contrast, left ventricular ejection fraction, and prevalence of other co-morbidities such as hypertension, diabetes mellitus, dyslipidemia, chronic obstructive pulmonary disease was comparable between the two groups. The Kaplan-Meier analysis demonstrated that rate of new onset stroke was higher in the high CAVI group than in the low CAVI group ( Figure , log-rank P = 0.001). After adjusting for potential confounding factors, high CAVI was an independent predictor of new onset stroke (hazard ratio 2.359, 95% confidence interval 1.223-4.513, P=0.010). Conclusions: CAVI independently predicts new onset stroke in patients with HF.

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Revisiting the clinical evidence of heart rate target in patients with heart failure treated with beta-blockers

10.5152/anatoljcardiol.2021.90 ◽

2021 ◽

Vol 25 (11) ◽

pp. 762-773

Author(s):

Xue Geng ◽

◽

Jidong Zhang ◽

Yanan Zhang ◽

Haijuan Hu ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Clinical Evidence ◽

Beta Blockers ◽

Patients With Heart Failure

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High-Sensitive Troponin I and Re-Hospitalization in Patients With Decompensated Congestive Heart Failure

ACTA MEDICA IRANICA ◽

10.18502/acta.v57i2.1766 ◽

2019 ◽

Author(s):

Shokoufeh Hajsadeghi ◽

Yaghoub Bagheri ◽

Mohammad Hossein Ghafouri ◽

Scott Reza Jafarian Kerman ◽

Morteza Hassanzadeh

Keyword(s):

Heart Failure ◽

Troponin I ◽

Decompensated Heart Failure ◽

Left Ventricular ◽

Hospitalized Patients ◽

Post Discharge ◽

Shock Delivery ◽

Coronary Syndrome ◽

Patients With Heart Failure

Abstract- Patients with heart failure (HF) are frequently admitted for episodes of decompensation. Cardiac troponins are easily accessible biomarkers role of which for risk stratification of re-hospitalization among HF patients is less certain. We aimed to evaluate high-sensitive cardiac troponin I (hs-cTnI) levels among re-hospitalized patients with decompensated heart failure (D-HF). Consecutive subjects admitted with D-HF to 2 hospitals in Tehran, during the year 2014 were recruited. Excluded ones were patients with a suspected acute coronary syndrome or myocarditis/pericarditis, those with cardiopulmonary resuscitation/DC shock delivery, or major complications during or after hospitalization. Along with echocardiography parameters, level of hs-cTnI was checked at the first hour of hospitalization and 3 months after discharge. The patients were then categorized according to having or not having re-hospitalization during 3 months post discharge. A total of 97 patients were finally recruited. Among re-hospitalized patients, Left ventricular (LV) ejection fraction was significantly lower (38±14 % vs. 50 ± 12%; P=0.001), and LV end-systolic dimension was significantly higher (44±9 mm vs. 38±11 mm; P=0.012) compared to the other group. Moreover, levels of hs-cTnI were significantly higher among the re-hospitalized patients, both at initial visit (0.66±0.43 ng/ml vs 0.51±0.14 ng/ml, respectively; P=0.017) and at 3 months (0.59±0.48 ng/ml vs 0.48±0.23 ng/ml, respectively; P=0.030). This prospective study demonstrated that levels of hs-cTnI (both at the base and at follow up) are higher among patients who readmitted during 3 months of hospitalization for D-HF.

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