Elevated heart rate at 24–36h after admission and in-hospital mortality in acute in non-arrhythmic heart failure

Introduction: Heart failure is one of the leading cause of hospitalization and death worldwide having a major impact on the health care systems. Risk stratification of these patients helps to achieve a better clinical outcome with a reduction in morbidity and mortality. Methods: This was a single centre prospective observational study wherein patients with acute decompensated heart failure were enrolled. All enrolled patients underwent detailed clinical history including symptomatology, risk factors for cardiovascular diseases and family history were recorded. All these patients underwent routine haematological and biochemical testing along with documentation of cardiac biomarkers viz. Troponin T and N-terminal pro brain natriuretic peptide (NT pro-BNP). All these patients were then followed for one year. Outcomes in form of in-hospital mortality as well as adverse cardiac events (mortality, rehospitalisation) were documented. Results: A total of 264 patients were included with mean age of 67.6 ± 9.8 years. In-hospital mortality was reported in 28 patients (10.6%) while 27 (10.2%) patients died over a year of follow-up. Patients with an in-hospital mortality were older and higher NYHA class and heart rate, lower ejection fraction, systolic and diastolic blood pressure and higher cardiac troponins and NT-pro BNP levels. Multivariate logistic regression analysis revealed that heart rate, NYHA class, systolic blood pressures, NT pro-BNP and creatinine were independent predictors of mortality. Conclusions: Our study showed that acute heart failure has a substantial in-hospital as well as one year mortality rates. Use of biomarkers leads to a better risk stratification and hence an impact on outcomes.

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Association between High Cumulative Numbers of Elevated Heart Rate and Mortality in Neurological ICU patients: Retrospective Analysis of eICU Collaborative Research Database

10.21203/rs.2.9183/v1 ◽

2019 ◽

Author(s):

Dawei Zhou ◽

Zhimin Li ◽

Shaolan Zhang ◽

Jianxin Zhou ◽

Guangzhi Shi

Keyword(s):

Heart Rate ◽

Logistic Regression ◽

Hospital Mortality ◽

Collaborative Research ◽

Research Database ◽

Neurological Intensive Care Unit ◽

Increased Risk ◽

The Mean ◽

Apache Iv ◽

Elevated Heart Rate

Abstract Background Heart rate is routinely measured in Neurological intensive care unit(NICU), but its prognostic value remains debated. We sought to evaluate the association of high cumulative numbers of elevated Heart Rate (HcneHR) with mortality in NICU patients. Methods We used a large observational eICU Collaborative Research Database (eICU-CRD), where continous heart rate monitoring every 5 minute was available. We collected periodic heart rate, disease severity (APACHE IV score), NICU and hospital mortality and other information in 8347 patient admissions from the eICU-CRD. The cumulative numbers of Heart Rate (cneHR) were defined as >100 beats/min in first admittion 24 hours, and if cneHR ≥10,then was defined as higt cneHR(HcneHR). The primary outcome was NICU mortality. The other outcomes were hospital mortality, length of NICU stay and APACHE IV score. Multivariable logistic regression was used to assess for association for HcneHR and other covariance with NICU and hospiltal discharge status. Results The mean age of patients were 63 years, and the most frequent disease categories of NICU in eICU-CRD were postoperation (25%), stroke(19%), traumatic brain injury(14%). The mean APACHE IV score was 50. Overall NICU mortality of the cohort at discharge was 4%, and hospital mortality was 8%. The NICU mortality of HcneHR patients was 7%. Adjusted logistic regression for HcneHR showed a significantly increased risk of NICU death with odds ratio 1.61(confidence interval, 1.26-2.06; P <0 .001). Conclusions In adult neurocritically ill patients, we found a significant association for HcneHR with elevated mortality and several others important patient-centered outcomes.

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Effects of ivabradine on the prevention of intradialytic hypotension in a dialytic patient with heart failure with reduced ejection fraction

BMJ Case Reports ◽

10.1136/bcr-2021-246011 ◽

2021 ◽

Vol 14 (11) ◽

pp. e246011

Author(s):

Yusuke Nakano ◽

Hirohiko Ando ◽

Wataru Suzuki ◽

Tetsuya Amano

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Ejection Fraction ◽

Fluid Management ◽

Volume Control ◽

Intradialytic Hypotension ◽

Reduced Ejection Fraction ◽

Vasopressor Agent ◽

History Of ◽

Elevated Heart Rate

A 65-year-old man with a history of heart failure with reduced ejection fraction (HFrEF) and renal failure was admitted due to difficulty in fluid volume control during haemodialysis. He had frequent episodes of intradialytic hypotension (IDH) with presyncope during haemodialysis despite using a vasopressor agent. Before haemodialysis, his blood pressure was 130–150/60–70 mm Hg, and his heart rate was 80–100 beats/min. There were no specific causes of IDH. For refractory IDH, he was treated with oral ivabradine (2.5 mg two times per day), which resulted in reduced heart rate and decreased occurrence of IDH. This is the first report to describe a dialysis case with HFrEF presenting with an elevated heart rate and impaired fluid management as manifested by recurring IDH, which improved after ivabradine treatment. Ivabradine therapy may assist in increasing stroke volume by lowering the sinus heart rate, thus resulting in the prevention of IDH.

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