Adherence to Mediterranean Diet and All-Cause Mortality After an Episode of Acute Heart Failure

Introduction: The usefulness of serial measurement of BNP to reduce hospitalization or mortality in patients with HIV and heartfailure is unknown. Hypothesis: We sought to describe changes in B-type natriuretic peptide (BNP) and estimate the effect of HIV on BNP over a week of observation in an acute heart failure cohort of 40 HIV-infected adults (≥18 years) on antiretroviral therapy (ART) and 175 HIV-uninfected hospitalized patients in Uganda. Methods: We measured BNP using i-STAT BNP (Abbott point of care, Princeton, New Jersey) and compared changes by HIV serostatus, and evaluated BNP as a predictor of all-cause mortality at 30 days from hospitalization using multilevel mixed and competitive risk regression models respectively. Results: Overall HIV-infected participants had a higher mean BNP than HIV-uninfected counterparts. After initial declines in BNP in both groups between day 0 and day 3, BNP moderately increased among the HIV-infected on day 7 and continued to decline in the HIV-uninfected group. Each 1 pg/mL increase in baseline BNP from 400 pg/mL increased the risk of all-cause mortality within 30 days by 1% (adjusted standardized hazard ratio (aSHR) 1.01, 95%CI 1.01, 1.01). Other predictors of increased 30-day all-cause mortality included smoking (aSHR 1.99, 95%CI 1.04, 3.84), hypotension (aSHR 1.69, 95%CI 1.26, 2.26) and renal failure stage 3 (aSHR 2.06, 95%CI 1.34, 3.18), and renal failure stage 5 (aSHR 2.02, 95%CI 1.30, 3.13). We found a lower risk of 30-day all-cause mortality of 38% (95%CI 20%, 73%) for those receiving loop diuretics and 74% (95%CI 56%, 99%) for antiplatelet agents. Conclusions: Over a week of observation, HIV-infected people hospitalized with acute heart failure in Uganda have higher BNP levels than HIV-uninfected counterparts. Increases in BNP above the upper bound of the normal predicted heightened risk of all-cause mortality within 30 days of hospitalization.

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ANMCO POSITION PAPER: Role of intra-aortic balloon pump in patients with acute advanced heart failure and cardiogenic shock

European Heart Journal Supplements ◽

10.1093/eurheartj/suab074 ◽

2021 ◽

Vol 23 (Supplement_C) ◽

pp. C204-C220

Author(s):

Roberta Rossini ◽

Serafina Valente ◽

Furio Colivicchi ◽

Cesare Baldi ◽

Pasquale Caldarola ◽

...

Keyword(s):

Heart Failure ◽

Cardiogenic Shock ◽

Acute Heart Failure ◽

Advanced Heart Failure ◽

Position Paper ◽

Present Position ◽

Intra Aortic Balloon Pump ◽

All Cause Mortality ◽

Practical Recommendations

Abstract The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists, reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure.

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Blood Urea Nitrogen to Creatinine Ratio and Long-Term Mortality in Patients with Acute Heart Failure: A Prospective Cohort Study and Meta-Analysis

Cardiorenal Medicine ◽

10.1159/000509834 ◽

2020 ◽

Vol 10 (6) ◽

pp. 415-428

Author(s):

Xu Zhu ◽

Iokfai Cheang ◽

Shengen Liao ◽

Kai Wang ◽

Wenming Yao ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Acute Heart Failure ◽

Blood Urea Nitrogen ◽

Prospective Cohort ◽

Meta Analysis ◽

Bottom Quartile ◽

All Cause Mortality ◽

The Relationship

Objective: To further explore the relationship between the blood urea nitrogen to creatinine (BUN/Cr) ratio and the prognosis of patients with acute heart failure (AHF), a two-part study consisting of a prospective cohort study and meta-analysis were conducted. Methods: A total of 509 hospitalized patients with AHF were enrolled and followed up. Cox proportional hazards regression was used to analyze the relationship between the BUN/Cr ratio and the long-term prognosis of patients with AHF. Meta-analysis was also conducted regarding the topic by searching PubMed and Embase for relevant studies published up to October 2019. Results: During a median follow-up of 2.8 years, 197 (42.6%) deaths occurred. The cumulative survival rate of patients with a BUN/Cr ratio in the bottom quartile was significantly lower than in the other 3 groups (log-rank test: p = 0.003). In multivariate Cox regression models, the mortality rate of AHF patients with a BUN/Cr ratio in the bottom quartile was significantly higher than in the top quartile (adjusted HR 1.52; 95% CI 1.03–2.24). For the meta-analysis, we included 8 studies with 4,700 patients, consisting of 7 studies from the database and our cohort study. The pooled analysis showed that the highest BUN/Cr ratio category was associated with an 77% higher all-cause mortality than the lowest category (pooled HR 1.77; 95% CI 1.52–2.07). Conclusions: Elevated BUN/Cr ratio is associated with poor prognosis in patients with AFH and is an independent predictor of all-cause mortality.

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P6361Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?

European Heart Journal ◽

10.1093/eurheartj/ehz746.0957 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Vidal-Perez ◽

R Agra-Bermejo ◽

D Pascual-Figal ◽

F Gude Sampedro ◽

C Abou Jokh ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Rate ◽

Sinus Rhythm ◽

Acute Heart Failure ◽

Left Ventricular Ejection ◽

Long Term Outcomes ◽

All Cause Mortality ◽

One Year

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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Plasma volume status predicts prognosis in patients with acute heart failure syndromes

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617690889 ◽

2017 ◽

Vol 7 (4) ◽

pp. 330-338 ◽

Cited By ~ 22

Author(s):

Akiomi Yoshihisa ◽

Satoshi Abe ◽

Yu Sato ◽

Shunsuke Watanabe ◽

Tetsuro Yokokawa ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Plasma Volume ◽

Hazard Ratio ◽

Volume Status ◽

Cardiac Events ◽

All Cause Mortality ◽

Acute Heart Failure Syndromes ◽

Mortality Hazard Ratio ◽

Ideal Plasma

Background: The intravascular compartment is known as the plasma volume, and the extravascular compartment represents fluid within the interstitial space. Plasma volume expansion is a major symptom of heart failure. The aim of the current study was to investigate the impact of plasma volume status on the prognosis of acute heart failure syndromes. Methods and results: We analyzed 1115 patients with acute heart failure syndromes who were admitted to our hospital. These patients were divided into three groups based on their plasma volume status at admission: first tertile (plasma volume status <41.9%, n = 371), second tertile (41.9%⩽ plasma volume status <49.0%, n = 372), and third tertile (49.0%⩽ plasma volume status, n = 372). Plasma volume status was defined as follows: actual plasma volume = (1 − hematocrit) × [ a + ( b × body weight)] ( a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal plasma volume = c × body weight ( c=39 in males and c=40 in females); and plasma volume status = [(actual plasma volume − ideal plasma volume)/ideal plasma volume] × 100 (%). In the Kaplan–Meier analysis, all-cause mortality, cardiac mortality and cardiac events increased progressively from the first to third tertile ( p <0.001, respectively). In the Cox proportional hazard analysis, after adjusting for potential confounding factors, plasma volume status was an independent predictor of all-cause mortality (hazard ratio 1.429, p < 0.001), cardiac mortality (hazard ratio 1.416, p = 0.001) and cardiac events (hazard ratio 1.207, p = 0.004). Conclusion: Increased congestion is associated with increased morbidity and mortality in heart failure patients. Plasma volume status, which represents intravascular compartment and congestion, can identify poor prognosis in patients with acute heart failure syndromes.

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Relation of Acute Heart Failure Hospital Length of Stay to Subsequent Readmission and All-Cause Mortality

The American Journal of Cardiology ◽

10.1016/j.amjcard.2015.04.052 ◽

2015 ◽

Vol 116 (3) ◽

pp. 400-405 ◽

Cited By ~ 35

Author(s):

Kristi Reynolds ◽

Melissa G. Butler ◽

Teresa M. Kimes ◽

A. Gabriela Rosales ◽

Wing Chan ◽

...

Keyword(s):

Heart Failure ◽

Length Of Stay ◽

Acute Heart Failure ◽

Hospital Length ◽

Hospital Length Of Stay ◽

All Cause Mortality

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The impact of mineralocorticoid receptor antagonist use on all-cause mortality in acute heart failure patients

Annals of Clinical Cardiology ◽

10.4103/accj.accj_3_21 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Rajesh Rajan ◽

Ibrahim Al-Zakwani ◽

Mohammed Al-Jarallah ◽

Kadhim Sulaiman ◽

Raja Dashti ◽

...

Keyword(s):

Heart Failure ◽

Receptor Antagonist ◽

Acute Heart Failure ◽

Mineralocorticoid Receptor ◽

Mineralocorticoid Receptor Antagonist ◽

Heart Failure Patients ◽

All Cause Mortality ◽

The Impact

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Nutritional Status in Patients with Acute heart failure: A systematic review and meta-analysis with trial sequential analysis

10.1101/2021.01.09.21249490 ◽

2021 ◽

Author(s):

Jihane Belayachi ◽

Imane Katir ◽

Rhita Nechba Bennis ◽

Naoufel Madani ◽

Redouane Abouqal

Keyword(s):

Heart Failure ◽

Nutritional Status ◽

Quality Assessment ◽

Publication Bias ◽

Acute Heart Failure ◽

Sequential Analysis ◽

Meta Analysis ◽

Trial Sequential Analysis ◽

All Cause Mortality

AbstractA critical review of the prognosis impact of malnutrition in patients admitted with acute heart failure (AHF) has never been performed. We systematically reviewed the observational epidemiology literature to determine the all-cause mortality (ACM) in undernourished patients with acute heart failure or at risk of malnutrition through a meta-analysis of observational studies.A systemic search using PubMed, Scopus, and Web of Science was done for articles reporting an association between malnutrition and mortality in patient with acute heart failure published before December 2019. Original data from observational cohort studies in patients with acute heart failure at baseline, and with nutritional state evaluation at admission using screening, or assessment tools. The outcome of interest was mortality independent of the timeframe for follow up. The characteristics of the included study were collected. Data quality assessment using the Newcastle Ottawa Quality Assessment Scale. The hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were extracted. For the meta-analysis, a random-effects model was considered.Heterogeneity between studies was assessed using Cochran Q statistics and I2 statistics. Subgroup analyses were used to identify the source of heterogeneity. A sensitive analysis was performed to reflect the influence of the individual data set on the pooled HR. Publication bias was detected using the Doi plot and Luis Furuya-Kanamori asymmetry index (LFK index). The influence of potential publication bias on results was explored by using the trim-and-fill procedure. To assess the risks of random errors, trial sequential analysis (TSA) was performed.Seven studies were eligible for review and meta-analysis. There were 9053 participants and over 1536 events occurred. The prevalence of malnutrition varied from 33% to 78.8%. Mean follow-up varied between 189 and 951 days. ACM rates varied between 7% and 42.6%. Nutritional status is significantly associated with mortality in patients with AHF (Pooled HR=1.15;95%CI[1.08-1.23]). Considerable between-study heterogeneity was observed (I2=83%, P=0.001). Heterogeneity was partially explained by the different tools used to screen malnutrition risk, and follow-up durations used by the included studies. There was evidence of major publication bias regarding the risk of malnutrition-related to ACM. The obtained LFK index was 6.12 and suggests major asymmetry. The recalculated pooled HR that incorporates the hypothetical missing studies is 1.15; 95%CI (1.08-1.22). However, the accumulating number of participants and the required information size has not yet been achieved. Then, the trial sequential monitoring boundary is inconclusive.This first meta-analysis of the association between nutritional status in patients with acute heart failure and all-cause mortality indicated that malnutrition risk in a patient with acute heart failure was associated with increased all-cause mortality. The prognosis impact of malnutrition is real despite heterogeneity in tools and cut off for defining malnutrition and mean follow up duration. This review underlines the peremptory need for multicenter studies, for uniform guidelines for assessing nutritional status, and for reporting guidelines for prognostic studies in an acute cardiovascular setting. Better nutritional practice to improve patient care is emphasized in international and national health care guidelines.

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Prognostic Value of the Modified Model for End-Stage Liver Disease (MELD) Score Including albumin in acute heart failure

10.21203/rs.3.rs-120667/v1 ◽

2020 ◽

Author(s):

Shengen Liao ◽

Xinyi Lu ◽

Iokfai Cheang ◽

Xu Zhu ◽

Ting Yin ◽

...

Keyword(s):

Heart Failure ◽

Liver Disease ◽

Acute Heart Failure ◽

Prognostic Value ◽

Cox Regression ◽

International Normalized Ratio ◽

Meld Score ◽

End Stage Liver Disease ◽

All Cause Mortality ◽

End Stage

Abstract Background: Liver and renal function evaluated by the model for end-stage liver disease (MELD) score, the MELD excluding the international normalized ratio (MELD_XI) score and the MELD including sodium (MELD_sodium) score have been considered predictors of adverse events for patients with acute heart failure (AHF). However, the prognostic value of the MELD including albumin (MELD_albumin) score in patients with AHF has not been assessed. Methods: A total of 466 patients with AHF were prospectively evaluated. We compared the accuracy of the 4 MELD score formulas using the time-dependent receiver operating characteristic (ROC) curve and corresponding areas under the curve (AUC). Results: During a median follow-up period of 34 months, 196 deaths occurred. In the fully adjusted Cox regression model, standardized hazard ratios with 95% confidence interval expressing the risk of all-cause mortality were 1.22 (1.06–1.40), 1.20 (1.04–1.39), 1.21 (1.05-1.41) and 1.23 (1.06–1.42) for MELD, MELD_XI, MELD_albumin and MELD_sodium scores, respectively. The MELD_albumin score showed the best prognostic accuracy (AUC = 0.658) for the prediction of long-term all-cause mortality, followed by the MELD_sodium score (AUC = 0.590), the MELD score (AUC = 0.580), and the MELD_XI score (AUC = 0.544). Conclusions: The MELD_albumin score performs more accurately than the MELD score and the other modified MELD scores for predicting the risk of all-cause mortality in patients with acute heart failure.

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Association of Cyr61-cysteine-rich protein 61 and short-term mortality in patients with acute heart failure and coronary heart disease

Biomarkers in Medicine ◽

10.2217/bmm-2019-0111 ◽

2019 ◽

Vol 13 (18) ◽

pp. 1589-1597

Author(s):

Chen Liu ◽

Yalin Cao ◽

Xin He ◽

Chongyu Zhang ◽

Jian Liu ◽

...

Keyword(s):

Heart Failure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Acute Heart Failure ◽

Logistic Models ◽

Risk Scores ◽

Multivariate Logistic Regression Model ◽

Treatment Risk ◽

All Cause Mortality ◽

Short Term Mortality

Aim: The protein CCN1/CYR61 exerts critical functions in myocardial ischemic injury. We sought to investigate the prognostic value of CCN1 in patients with acute heart failure (AHF) and coronary heart disease (CAD). Methodology: We prospectively enrolled 113 patients with AHF and CAD. Patients were followed for all-cause mortality during a 30-day follow-up. Logistic models were used to estimate the association of CCN1 concentrations with 30-day mortality. Results: In multivariate logistic regression model, CCN1 was a significant predictor of 30-day mortality independent of current markers. Enhanced Feedback for Effective Cardiac Treatment risk score was recommended as one of the selected multivariable risk scores to predict outcome in AHF. CCN1 improved risk stratification for all-cause mortality when added to the Enhanced Feedback for Effective Cardiac Treatment risk scores at 30 days. Conclusion: We found CCN1 is independently associated with 30-day mortality in patients with AHF and CAD.

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