scholarly journals BIOIMPEDANCE SPECTROSCOPY MEASUREMENT OF ONGOING FLUID OVERLOAD POST-DISCHARGE FROM HOSPITALIZATION FOR DECOMPENSATED HEART FAILURE

2021 ◽  
Vol 77 (18) ◽  
pp. 798
Author(s):  
Anne Daleiden-Burns ◽  
Andrew J. Accardi ◽  
J. Thomas Heywood
Keyword(s):  
Heart Failure ◽  
Fluid Overload ◽  
Decompensated Heart Failure ◽  
Bioimpedance Spectroscopy ◽  
Post Discharge ◽  
Spectroscopy Measurement

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

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.

Abstract 13677: Usefulness of 2-year Iodine-123 Metaiodobenzylguanidine-based Risk Model for the Post-discharge Risk Stratification in Acute Decompensated Heart Failure Patients With Preserved Left Ventricular Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shunsuke Tamaki ◽  
Takahisa Yamada ◽  
Tetsuya Watanabe ◽  
Takashi Morita ◽  
Yoshio Furukawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Score ◽  
Mortality Risk ◽  
Risk Model ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Cardiac Mortality ◽  
Post Discharge ◽  
Patients With Heart Failure ◽  
Iodine 123

Background: A four-parameter risk model including cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging and readily available clinical parameters has been recently developed for the prediction of 2-year cardiac mortality risk in patients with chronic heart failure (CHF) using a Japanese CHF database consisting of 1322 patients. However, there is no information available on the usefulness of 2-year MIBG-based cardiac mortality risk score for the prediction of post-discharge prognosis in patients with heart failure with preserved LVEF (HFpEF) who are admitted with acute decompensated heart failure (ADHF). Methods and Results: Patients' data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT-HFpEF) study, which is a prospective multicenter observational registry for ADHF patients with LVEF ≥50% in Osaka. We studied 239 patients who survived to discharge. Cardiac MIBG imaging was performed just before discharge. The 2-year cardiac mortality risk score was calculated using four parameters, including age, LVEF, NYHA functional class, and the cardiac MIBG heart-to-mediastinum ratio on delayed image. The patients were stratified into three groups based on the 2-year cardiac mortality risk score: low- (<4%), intermediate- (4-12%), and high-risk (>12%) groups. The endpoint was all-cause death. During a follow-up period of 1.6±0.8 years, 33 patients had all-cause death. Multivariate Cox analysis showed that 2-year MIBG-based cardiac mortality risk score was an independent predictor of all-cause death (p=0.0009). There was significant difference in the rate of all-cause death among the three groups stratified by 2-year cardiac mortality risk score (Figure). Conclusions: In this multicenter study, the 2-year MIBG-based cardiac mortality risk score was shown to be useful for the prediction of post-discharge clinical outcome in HFpEF patients admitted for ADHF.

P773Initiation of sacubitril/valsartan and optimisation of evidence-based heart failure therapies after hospitalisation for acute decompensated heart failure: An analysis of the TRANSITION study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Wachter ◽  
D Pascual-Figal ◽  
J Belohlavek ◽  
E Straburzynska-Migaj ◽  
K K Witte ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Target Dose ◽  
Open Label ◽  
Post Discharge ◽  
Reduced Ejection Fraction ◽  
Disease Modifying ◽  
Transition Study

Abstract Background Optimisation of chronic heart failure (HF) therapy remains the key strategy to improve outcomes after hospitalisation for acute decompensated HF (ADHF) with reduced ejection fraction (HFrEF). Initiation and uptitration of disease-modifying therapies is challenging in this vulnerable patient population. We aimed to describe the patterns of treatment optimisation including sacubitril/valsartan (S/V) in the TRANSITION study. Methods TRANSITION (NCT02661217) was a randomised, open-label study comparing S/V initiation pre- vs. post-discharge (1–14 days) in patients admitted for ADHF after haemodynamic stabilisation. The primary endpoint was the proportion of patients achieving 97/103 mg S/V twice daily (bid) at 10 weeks post-randomisation. Up-titration of S/V was as per label. Information on dose of S/V and on the use of concomitant HF medication was collected at each study visit up to week 26. Results A total of 493 patients received at least one dose of S/V in the pre-discharge arm and 489 patients in the post-discharge arm. One month after randomisation, 45% of patients in the pre-d/c arm vs. 44% in the post-discharge arm used 24/26 mg bid starting dose and 42% vs. 40% were on 49/51 mg S/V bid, respectively. At week 10, 47% of patients had achieved the target dose in the pre-discharge arm vs. 51% in the post-discharge arm. At the end of the follow-up at 26 weeks, the proportion of patients on S/V target dose further increased to 53% in the pre-discharge and 61% in the post-discharge arm (Figure 1). At week 10, the mean dose of S/V was 132 mg in the pre-discharge arm and 136 mg in the post-discharge arm, and at week 26, it was 140 mg and 147 mg, respectively. Before hospital admission, 52% and 54% of the patients received a beta-blocker (BB) in the pre-discharge and post-discharge group, respectively, and 42% in both arms received a mineralcorticoid receptor antagonist (MRA). At time of discharge, 68% and 71%% of the patients received a BB and 68% and 65% an MRA, in the pre-discharge and post-discharge groups, respectively. These proportions remained stable to week 10 and week 26. Uptitration of sacubitril/valsartan Conclusions In the vulnerable post-ADHF population, initiation of S/V and up-titration to target dose was feasible within 10 weeks in half of the patients alongside with a 20% increase in the use of other disease-modifying medications that remained stable through the end of the 6-month follow-up. Acknowledgement/Funding The TRANSITION study was funded by Novartis

P762Usefulness of 2-year iodine-123 metaiodobenzylguanidine-based risk model for the post-discharge risk stratification in patients with acute decompensated heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Tamaki ◽  
T Yamada ◽  
T Morita ◽  
Y Furukawa ◽  
Y Iwasaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Score ◽  
Mortality Risk ◽  
Risk Group ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Risk Scores ◽  
Mibg Imaging ◽  
Cardiac Mortality ◽  
Post Discharge

Abstract Background A four-parameter risk model including cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging and readily available clinical parameters has been recently developed for the prediction of 2-year cardiac mortality risk in patients with chronic heart failure (CHF) using a Japanese CHF database consisting of 1322 patients. On the other hand, the Acute Decompensated Heart Failure National Registry (ADHERE) and Get With The Guidelines-Heart Failure (GWTG-HF) risk scores, simple tools to predict risk of in-hospital mortality, have been reported to be predictive of post-discharge outcome in patients with acute decompensated heart failure (ADHF). However, there is no information available on the usefulness of 2-year MIBG-based cardiac mortality risk score for the prediction of post-discharge prognosis in ADHF patients and its comparison with the ADHERE and GWTG-HF risk scores. Purpose We sought to validate the predictability of the 2-year MIBG-based cardiac mortality risk score for post-discharge clinical outcome in ADHF patients, and to compare its prognostic value with those of ADHERE and GWTG-HF risk scores. Methods We studied 297 consecutive patients who were admitted for ADHF, survived to discharge, and had definitive 2-year outcomes. Venous blood sampling was performed on admission, and echocardiography and cardiac MIBG imaging were performed just before discharge. In cardiac MIBG imaging, the cardiac MIBG heart-to-mediastinum ratio (HMR) was measured from the chest anterior view images obtained at 20 and 200 min after isotope injection. The 2-year cardiac mortality risk score was calculated using four parameters, including age, left ventricular ejection fraction, NYHA functional class, and HMR on delayed image. The patients were stratified into three groups based on the 2-year cardiac mortality risk score: low- (<4%), intermediate- (4–12%), and high-risk (>12%) groups. The ADHERE and GWTG-HF risk scores were also calculated from admission data as previously reported. The predictive ability of the scores was compared using receiver operating characteristic curve analysis. The endpoint was a composite of all-cause mortality and unplanned hospitalization for worsening heart failure. Results During a follow-up period, 110 patients reached the primary endpoint. There was significant difference in the rate of primary endpoint among the three groups stratified by 2-year cardiac mortality risk score (low-risk group: 18%, intermediate-risk group: 36%, high-risk group: 64%, Figure 1A). The 2-year cardiac mortality risk score demonstrated a greater area under the curve for the primary endpoint compared to the ADHERE and the GWTG-HF risk scores (Figure 1B). Figure 1 Conclusions The 2-year MIBG-based cardiac mortality risk score is also useful for the prediction of post-discharge clinical outcome in ADHF patients, and its prognostic value is superior to those of the ADHERE and the GWTG-HF risk scores.

scholarly journals Predictors of Post-Discharge 30-Day Hospital Readmission in Decompensated Heart Failure Patients

2019 ◽  
Author(s):  
Camila Sarteschi ◽  
Wayner Viera de Souza ◽  
Carolina Medeiros ◽  
Paulo Sergio Rodrigues Oliveira ◽  
Silvia Marinho Martins ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmission ◽  
Decompensated Heart Failure ◽  
Day Hospital ◽  
Post Discharge ◽  
Heart Failure Patients

scholarly journals P0229APPLICATION OF A RISK MITIGATION STRATEGY TO PREVENT EXCESS CARDIOVASCULAR RISK IN PULMONARY HYPERTENSION: LARIAT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
R James White ◽  
Murali Chakinala ◽  
Melanie Chin ◽  
Jeremy Feldman ◽  
Angie Goldsberry ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Fluid Overload ◽  
Risk Mitigation ◽  
Right Heart Failure ◽  
Decompensated Heart Failure ◽  
Double Blind ◽  
Increased Risk ◽  
Pulmonary Arterial

Abstract Background and Aims Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes (BEACON) was a multinational, randomized, double-blind, placebo-controlled Phase 3 trial that enrolled patients with type 2 diabetes (T2D) and stage 4 CKD. The BEACON trial was terminated due to a significant increase in the risk of heart failure occurring within the first four weeks of treatment with bardoxolone methyl. Post-hoc analyses identified a history of heart failure and elevated baseline serum concentrations of B-type natriuretic peptide (BNP) as risk factors for these events. A subsequent study, LARIAT (NCT02316821), was designed to evaluate the efficacy and safety of bardoxolone methyl in the treatment of patients with pulmonary arterial hypertension (PAH). Progressive right heart failure is the cause of death for most PAH patients, and PAH patients are at high risk for decompensated right heart failure. LARIAT was designed to mitigate the risk for heart failure, and here we present cardiovascular safety data from this trial. Method The LARIAT study was a 16-week double-blind, randomized, placebo-controlled, dose-ranging study that enrolled 208 patients with a confirmed diagnosis of PAH, most of whom had Group 1 Pulmonary Arterial Hypertension and were taking stable doses of at least one approved PAH therapy. Patients were randomized 3:1 to receive bardoxolone methyl or placebo at a starting dose of 2.5 mg, and subsequent doses of 5, 10, or 20mg. In addition to the dose-titration scheme, the initial protocol excluded patients with BNP &gt; 200 pg/mL (later amended to 400 pg/mL), acutely decompensated heart failure in the previous 30 days, or eGFR &lt; 45 mL/min/1.73 m2 at baseline. BNP and NT-proBNP were assessed serially throughout the study. In addition, 24-hour ambulatory blood pressure (ABPM) was monitored in a subset of the patients at baseline, Week 4, and Week 16. Results One fluid overload SAE was reported in a placebo patient but not in any bardoxolone methyl patients. Overall, only 2 (1.7%) bardoxolone methyl patients reported cardiovascular SAEs, neither of which were attributed to study drug. Moreover, there were no statistically significant increases in 24-hour ABPM blood pressure, weight, or NT-Pro BNP and BNP levels in bardoxolone methyl-treated patients. Thus, treatment with bardoxolone methyl did not appear to be associated with an increased risk for heart failure hospitalizations or fluid overload adverse events in the LARIAT study. Conclusion Despite the real risk for fluid retention and acutely decompensated heart failure in PAH patients, use of BNP &lt; 400 pg/ml and HF history can be used to safely select patients with PAH to receive bardoxolone methyl. There was no increased risk of heart failure or other signs of overt fluid overload; we did not observe subclinical measures of fluid retention (increases in blood pressure or weight). These data support the use of a risk-mitigation strategy in the continued development of bardoxolone methyl for patients at risk for decompensated heart failure.

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