BURDEN OF ATRIAL FIBRILLATION OR ATRIAL FLUTTER IN DIASTOLIC HEART FAILURE HOSPITALIZATIONS: INSIGHT FROM 2017 NATIONAL INPATIENT SAMPLE

Background: The CHADS-VASC score does not incorporate renal dysfunction in stroke risk assessment in patients with atrial fibrillation and the prevalence of atrial fibrillation, atrial flutter, and cerebrovascular accidents (CVA) in patients with concurrent CHF and CKD is not well investigated. Objective: Evaluate the prevalence of history of stroke, atrial fibrillation, atrial flutter in patients with CHF and CKD. Methods: Data from the single institution Get With The Guidelines- Heart Failure (GWG-HF) cohort of 2938 consecutive inpatients with known GFR was utilized. CHADS-VASC score was calculated from the GWG-HF variables. Chronic kidney disease (CKD) was defined as GFR <60 ml/min. Results: An overwhelming majority (95%) of GWG-HF patients had elevated >1 CHADS-VASC score, which was also significantly more common in patients with CKD (97.6% vs. 91.7% in patients without CKD, p<0.0001). Average CHADS-VASC score was also significantly increased in patients with CKD (4+/-1.3 vs. 3.3+/-1.4, p<0.0001). Furthermore, CKD was associated with increased prevalence of atrial fibrillation and/or flutter (45.6% vs. 35.3%, p<0.0001) and stroke history (17.5% vs. 12.3%, p=0.002). When stroke and TIA histories were removed from the CHADS-VASC score ("CHAD-VASC score"), the remaining variables were strongly predictive of stroke or TIA (14.2% vs. 3.8%, p<0.0001). In multivariate logistic regression analysis, both CHAD-VASC score (OR 2.6, 95%CI 1.3-5.4, p=0.009) and CKD (OR 1.5, 95%CI 1.2-1.8, p=0.001) were associated significantly increased odds of prior stroke or TIA. Conclusions: In patients admitted with heart failure, CKD is associated with increased prevalence of atrial fibrillation or atrial flutter as well as increased prevalence of CVA/TIA. Further prospective studies are warranted to examine whether CKD history should be included in stroke risk assessment in patients with atrial fibrillation or atrial flutter, in conjunction with existing risk assessment frameworks.

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Abstract 17140: Impact of Atrial Fibrillation on the Outcomes of Heart Failure With Preserved Ejection Fraction- A National Inpatient Sample Based Study

Circulation ◽

10.1161/circ.142.suppl_3.17140 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Tauseef Akhtar ◽

Parth V Desai ◽

Jayakumar Sreenivasan ◽

Poonam Bhayan ◽

Roshini Syed ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Heart Transplantation ◽

Embolic Stroke ◽

Preserved Ejection Fraction ◽

National Inpatient Sample ◽

Hepatic Congestion

Introduction: Atrial fibrillation (AF) adversely affect the outcomes in the patients of heart failure (HF) with reduced ejection fraction, however there are limited data exploring such an association in HF with preserved ejection fraction (HFpEF). Hypothesis: AF is associated with worse outcomes in HFpEF. Methods: We included all the patients with the primary diagnosis of HFpEF from the national inpatient sample (NIS) database (2012-2014) using ICD-9 codes. Exposure of interest was AF. Primary outcome was in-hospital mortality and secondary outcomes were rates of sudden cardiac arrest (SCA), syncope, cardiogenic shock, embolic stroke, acute myocardial infarction (AMI), acute kidney injury (AKI), passive hepatic congestion, ventricular fibrillation (V fib) and flutter, ventricular assist device (VAD), AICD, cardiac resynchronization therapy (CRT), intra-aortic balloon placement (IABP) placement and heart transplantation. Hospitalization cost was also studied. Results: Our study cohorts included 26,51,970 patients of HFpEF with AF and 37,44,101 patients of HFpEF without AF. AF cohort had more numbers of older patients and less female representation. In-hospital mortality was more in AF cohort. Similarly, the odds of SCA, cardiogenic shock, embolic stroke, passive hepatic congestion, Vfib and flutter, AICD and CRT placement were higher in AF cohort. The odds of syncope, AMI and AKI were lower in AF cohort as compared to non-AF cohort. While the odds of heart transplantation and VAD and IABP use remained comparable between the study cohorts, AF cohort incurred greater of cost of hospitalization. Conclusion: AF in HFpEF patients is associated with increased in-hospital mortality and cardiogenic shock and should be aggressively treated for improved outcomes.

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246 Evaluation of therapeutic effect for diastolic heart failure by ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity in patients with atrial fibrillation

European Journal of Echocardiography ◽

10.1016/s1525-2167(06)60096-6 ◽

2006 ◽

Vol 7 ◽

pp. S25-S25

Author(s):

T WATANABE ◽

M IWAITAKANO ◽

H YAOITA ◽

Y MARUYAMA

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Therapeutic Effect ◽

Diastolic Heart Failure ◽

Mitral Annular Velocity

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Comparison between ivabradine and low-dose digoxin in the therapy of diastolic heart failure with preserved left ventricular systolic function

Clinics and Practice ◽

10.4081/cp.2013.e29 ◽

2013 ◽

Vol 3 (2) ◽

pp. 29 ◽

Cited By ~ 9

Author(s):

Giuseppe Cocco ◽

Paul Jerie

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Rate ◽

Low Dose ◽

Systolic Function ◽

Diastolic Heart Failure ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Coronary Patients

Multicenter trials have demonstrated that in patients with sinus rhythm ivabradine is effective in the therapy of ischemic heart disease and of impaired left ventricular systolic function. Ivabradine is ineffective in atrial fibrillation. Many patients with symptomatic heart failure have diastolic dysfunction with preserved left ventricular systolic function, and many have asymptomatic paroxysmal atrial fibrillation. Ivabradine is not indicated in these conditions, but it happens that it is <em>erroneously</em> used. Digoxin is now considered an outdated and potentially dangerous drug and while effective in the mentioned conditions, is rarely used. The aim of the study was to compare the therapeutic effects of ivabradine in diastolic heart failure with preserved left ventricular systolic function. Patients were assigned to ivabradine or digoxin according to a randomization cross-over design. Data were single-blind analyzed. The analysis was performed using an intention-to-treat method. Forty-two coronary patients were selected. In spite of maximally tolerated therapy with renin-antagonists, diuretics and ?-blockers, they had congestive diastolic heart failure with preserved systolic function. Both ivabradine and digoxin had positive effects on dyspnea, Nterminal natriuretic peptide, heart rate, duration of 6-min. walk-test and signs of diastolic dysfunction, but digoxin was high-statistically more effective. Side-effects were irrelevant. Data were obtained in a single-center and from 42 patients with ischemic etiology of heart failure. The number of patients is small and does not allow assessing mortality. In coronary patients with symptomatic diastolic heart failure with preserved systolic function low-dose digoxin was significantly more effective than ivabradine and is much cheaper. One should be more critical about ivabradine and low-dose digoxin in diastolic heart failure. To avoid possible negative effects on the cardiac function and a severe reduction of the cardiac output the resting heart rate should not be decreased to <65 beats/min.

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The Effect of Echocardiography Based on Lipid Nano Contrast Agent on Cardiology Patients with Heart Failure and Atrial Fibrillation

Journal of Nanoscience and Nanotechnology ◽

10.1166/jnn.2021.18687 ◽

2021 ◽

Vol 21 (2) ◽

pp. 852-858

Author(s):

Lizhong Wang ◽

Jianing Xi ◽

Qian Cao ◽

Yaowen Jia ◽

Zhenying Zhang ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Contrast Agent ◽

Stress Echocardiography ◽

Clinical Symptoms ◽

Diastolic Heart Failure ◽

Significant Difference ◽

Patients With Heart Failure ◽

Before And After ◽

Conventional Echocardiography

This paper discusses the effect and evaluation of echocardiography based on lipid nano contrast agent on patients with heart failure and atrial fibrillation in cardiology department, providing reference for clinical diagnosis and treatment. Fifty two patients with diastolic heart failure diagnosed by echocardiography were selected for routine echocardiographic examination after optimizing the drug treatment scheme, and then the patients underwent treadmill exercise test and stress echocardiography evaluation. The results of conventional echocardiography and stress echocardiography after treatment were compared with those before treatment, and the clinical parameters and biochemical indexes before and after treatment were compared. Results after treatment, the clinical symptoms of the patients improved, the level of NT proBNP in the N-terminal forebrain decreased significantly, and the exercise tolerance increased significantly. Compared with the conventional echocardiography before and after treatment, the left ratio and e′ value of stress echocardiography after treatment increased significantly, while E/e′ decreased significantly. There was no significant difference in the indexes of general echocardiography before and after treatment. After treatment, positively correlated with the ratio of peak a to peak E. The results show that the sensitivity of stress echocardiography to evaluate ischemic diastolic heart failure has been improved, and some indexes have clinical significance. Compared with conventional echocardiography, it can effectively evaluate the therapeutic effect of drugs.

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762 Ischaemic heart failure predisposes to simultaneous occurrence of atrial fibrillation and atrial flutter

EP Europace ◽

10.1016/s1099-5129(05)80507-0 ◽

2005 ◽

Vol 7 ◽

pp. 172-172

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Atrial Flutter ◽

Simultaneous Occurrence

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854Predictors of ventricular tachyarrhythmia in patients with implantable cardioverter-defibrillator and non-ischaemic systolic heart failure

EP Europace ◽

10.1093/europace/euaa162.106 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

E Jedrzejczyk-Patej ◽

M Mazurek ◽

M Lazar ◽

P Pruszkowska-Skrzep ◽

T Podolecki ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ventricular Arrhythmia ◽

Implantable Cardioverter Defibrillator ◽

Atrial Flutter ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Urban Region ◽

Ventricular Ejection Fraction ◽

Cardioverter Defibrillator

Abstract Funding Acknowledgements none OnBehalf none Background The benefit of an implantable cardioverter-defibrillator (ICD) in patients with ischaemic heart failure (HF) has been well proven but the benefit of ICD in subjects with non-ischaemic systolic HF is less well-established. Consequently, there is very limited evidence which patients with non-ischaemic HF would benefit most from receiving an ICD. Aim To determine the incidence and predictors of ventricular arrhythmia in patients with ICD and non-ischaemic systolic HF. Methods Study population consisted of 420 consecutive patients with ICD and non-ischaemic systolic HF monitored remotely (on a daily basis) between 2010 and 2017 in tertiary care university hospital, in a densely inhabited, urban region of Poland. Sixty-six percentage of patients had cardiac resynchronization therapy with defibrillator (CRT-D). Results During the median follow-up of 1645 days (range: 507-3515) sustained ventricular arrhythmia occurred in 100 patients (23.8%). Of those, ventricular fibrillation (VF), ventricular tachycardia (VT) or VT/VF (combined) occurred in 10 (10.0%), 77 (77.0%) and 13 (13.0%) patients, respectively. Patients with versus without ventricular arrhythmia did differ with respect to baseline variables such as: left ventricular end diastolic diameter (LVEDD) - median of 67 mm [49-82] vs 62 mm [46-78]; post-inflammatory HF (17 vs 9.7%, P = 0.045); atrial fibrillation/atrial flutter - AF/AFL (57 vs. 38.1%, P = 0.0009); supraventricular arrhythmia (SVT) - any supraventricular arrythmia >100/min other than AF/AFL (27 vs. 15.9%, P = 0.01); and left ventricular ejection fraction - EF (25 vs. 28%, P = 0.01). No differences were observed for age, sex, NYHA class, mitral regurgitation, common comorbidities (including diabetes and chronic renal disease) or concomitant medications. On multivariable regression analysis, LVEDD (HR 1.05, 95% CI 1.004-1.09, P = 0.03), AF/AFL (HR 1.81, 95% CI 1.21-2.72, P = 0.004) and SVT (HR 1.91, 95% CI 1.21-3.01, P = 0.006) were identified as independent predictors of sustained ventricular arrhythmia in patients with ICD and non-ischaemic HF. All-cause mortality in patients with VT/VF was significantly higher than in subjects without sustained ventricular arrhythmias (33% vs. 20%, P = 0.03). Conclusions Ventricular arrhythmia occurred in 23.8% of patients with systolic non-ischaemic HF during 4.5 years of observation and was associated with significantly worse prognosis compared with subjects free of VT/VF. Left ventricular dimension, atrial fibrillation/atrial flutter and supraventricular tachycardia were identified as independent predictors for ventricular arrhythmia.

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