692 A novel prognostic index including comorbidities for stable heart failure validated in different clinical settings

Abstract Background Prognostic models developed in general cohorts with a mixture of heart failure (HF) phenotypes, though more widely applicable, are also likely to yield larger prediction errors in settings where the HF phenotypes have substantially different baseline mortality rates or different predictor-outcome associations. This study sought to use individual participant data meta-analysis to develop an HF phenotype stratified model for predicting 1-year mortality in patients admitted with acute HF. Methods Four prospective European cohorts were used to develop an HF phenotype stratified model. Cox model with two rounds of backward elimination was used to derive the prognostic index. Weibull model was used to obtain the baseline hazard functions. The internal-external cross-validation (IECV) approach was used to evaluate the generalizability of the developed model in terms of discrimination and calibration. Results 3577 acute HF patients were included, of which 2368 were classified as having HF with reduced ejection fraction (EF) (HFrEF; EF < 40%), 588 as having HF with midrange EF (HFmrEF; EF 40–49%), and 621 as having HF with preserved EF (HFpEF; EF ≥ 50%). A total of 11 readily available variables built up the prognostic index. For four of these predictor variables, namely systolic blood pressure, serum creatinine, myocardial infarction, and diabetes, the effect differed across the three HF phenotypes. With a weighted IECV-adjusted AUC of 0.79 (0.74–0.83) for HFrEF, 0.74 (0.70–0.79) for HFmrEF, and 0.74 (0.71–0.77) for HFpEF, the model showed excellent discrimination. Moreover, there was a good agreement between the average observed and predicted 1-year mortality risks, especially after recalibration of the baseline mortality risks. Conclusions Our HF phenotype stratified model showed excellent generalizability across four European cohorts and may provide a useful tool in HF phenotype-specific clinical decision-making.

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Family Caregiving for Individuals With Heart Failure: A Scientific Statement From the American Heart Association

Circulation ◽

10.1161/cir.0000000000000768 ◽

2020 ◽

Vol 141 (22) ◽

Cited By ~ 1

Author(s):

Lisa Kitko ◽

Colleen K. McIlvennan ◽

Julie T. Bidwell ◽

J. Nicholas Dionne-Odom ◽

Shannon M. Dunlay ◽

...

Keyword(s):

Heart Failure ◽

Family Caregiving ◽

Heart Association ◽

Well Being ◽

Clinical Settings ◽

Financial Health ◽

Future Directions ◽

Scientific Statement ◽

The Relationship ◽

Health And Well Being

Many individuals living with heart failure (HF) rely on unpaid support from their partners, family members, friends, or neighbors as caregivers to help manage their chronic disease. Given the advancements in treatments and devices for patients with HF, caregiving responsibilities have expanded in recent decades to include more intensive care for increasingly precarious patients with HF—tasks that would previously have been undertaken by healthcare professionals in clinical settings. The specific tasks of caregivers of patients with HF vary widely based on the patient’s symptoms and comorbidities, the relationship between patient and caregiver, and the complexity of the treatment regimen. Effects of caregiving on the caregiver and patient range from physical and psychological to financial. Therefore, it is critically important to understand the needs of caregivers to support the increasingly complex medical care they provide to patients living with HF. This scientific statement synthesizes the evidence pertaining to caregiving of adult individuals with HF in order to (1) characterize the HF caregiving role and how it changes with illness trajectory; (2) describe the financial, health, and well-being implications of caregiving in HF; (3) evaluate HF caregiving interventions to support caregiver and patient outcomes; (4) summarize existing policies and resources that support HF caregivers; and (5) identify knowledge gaps and future directions for providers, investigators, health systems, and policymakers.

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Usefulness of Seattle Heart Failure Model in Heart Failure Patients with Reduced Ejection Fraction in the Clinical Settings

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2015.08.155 ◽

2015 ◽

Vol 21 (10) ◽

pp. S171

Author(s):

Kotaro Miyaji ◽

Sandeep Shakkya ◽

Naoki Hayakawa ◽

Hiroki Suzuki ◽

Satoshi Kodera ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Clinical Settings ◽

Failure Model ◽

Reduced Ejection Fraction ◽

Heart Failure Patients ◽

Heart Failure Model

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The effectiveness of CRT on improvement of survival of heart failure patients in real life clinical settings

Acta Cardiologica ◽

10.1080/00015385.2017.1291179 ◽

2017 ◽

Vol 72 (2) ◽

pp. 180-187

Author(s):

Marek Hudak ◽

Michal Kerekanic ◽

Silvia Misikova ◽

Erika Komanova ◽

Alexander Boho ◽

...

Keyword(s):

Heart Failure ◽

Real Life ◽

Clinical Settings ◽

Heart Failure Patients

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Should all acutely ill medical patients be treated with antithrombotic drugs?

Thrombosis and Haemostasis ◽

10.1160/th12-11-0860 ◽

2013 ◽

Vol 109 (04) ◽

pp. 589-595 ◽

Cited By ~ 13

Author(s):

Ludovica Perri ◽

Lorenzo Loffredo ◽

Francesco Violi

Keyword(s):

Heart Failure ◽

Venous Thrombosis ◽

Observational Studies ◽

Risk Profile ◽

Medical Illness ◽

Clinical Settings ◽

Medical Patients ◽

Antithrombotic Drugs ◽

Thrombotic Risk ◽

Acute Infections

SummaryAfter reports from observational studies suggesting an association between acutely ill medical patients and venous thromboembolism (VTE), interventional trials with anticoagulants drugs have demonstrated a significant reduction of VTE during and immediately after hospitalisation. Although several guidelines suggest the clinical relevance of reducing this outcome, there is a low tendency to use anticoagulants in patients hospitalised for acute medical illness. We speculated that such underuse may be dependent on a low perception that patients included in the trials are actually at risk of thromboembolism. Therefore, the aim of this study was to analyse the clinical settings included in the interventional trials and their relationship with thrombotic risk. Analysis of interventional trials revealed that the majority of patients included in the trials (about 80%) were affected by heart failure, acute respiratory syndrome or infections. Among these three illnesses, literature data shows an association with venous thrombosis only in patients with acute infections; this finding was, however, supported only by retrospective study. On the contrary, there is scarce or no evidence that heart failure and acute respiratory syndrome are associated with venous thrombosis. These data underscore the need of better defining the thrombotic risk profile of acutely ill medical patients included in interventional trials with anticoagulants.

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Rare Cause for Sudden Right Heart Failure

The Scientific World JOURNAL ◽

10.1100/tsw.2010.190 ◽

2010 ◽

Vol 10 ◽

pp. 1996-1998 ◽

Cited By ~ 1

Author(s):

Amir M. Nia ◽

Natig Gassanov ◽

Matthias Schmidt ◽

Ferdinand Kuhn-Régnier ◽

Erland Erdmann ◽

...

Keyword(s):

Heart Failure ◽

Malignant Tumors ◽

Right Heart Failure ◽

Decompensated Heart Failure ◽

Clinical Settings ◽

Right Heart ◽

Large Tumor ◽

Multiple Metastases ◽

The Right ◽

Time Point

Right heart failure occurs daily in clinical settings, but an underlying cardiac malignant tumor is very uncommon. We report a case of a 48-year-old man presenting only with palpitations and decompensated heart failure. Echocardiographic imaging revealed a large tumor of the right ventricle. Shortly after a putatively successful surgical approach, the patient was admitted again with heart failure symptoms. On reassessment, a complete relapse with multiple metastases could be seen. Generally, cardiac malignant tumors are diagnosed at a time-point when therapeutic options are very limited or even postmortem. Broad echocardiographic screening in patients with unspecific symptoms might be helpful to detect cardiac malignant tumors at early stages.

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Tachycardia-related cardiomyopathy: a review of the literature

Italian Journal of Medicine ◽

10.4081/itjm.2010.92 ◽

2013 ◽

pp. 92-98

Author(s):

Maurizio Ongari ◽

Giuseppe Boriani

Keyword(s):

Heart Failure ◽

Rate Control ◽

Ventricular Dysfunction ◽

Myocardial Dysfunction ◽

Subsequent Development ◽

Left Ventricular ◽

Clinical Settings ◽

Supraventricular Tachyarrhythmia ◽

Ventricular Response ◽

Supraventricular Tachyarrhythmias

A fast heart rate or an irregular ventricular rhythm can produce various degrees of functional impairment and structural remodeling of the ventricle referred to as tachycardiarelated cardiomyopathy or tachycardiomyopathy. This form of myocardial dysfunction can be caused by supraventricular or ventricular tachyarrhythmias that are incessant and associated with ventricular rates higher than 120 bpm. It can be reversed with pharmacological or nonpharmacological rate control or arrhythmia reversion. The prevalence of ventricular and supraventricular tachyarrhythmias is high among patients with heart failure. Consequently, in clinical settings, it may be difficult to determine whether a patient with severe ventricular dysfunction and supraventricular tachyarrhythmia associated with a rapid ventricular response is suffering from tachycardiomyopathy or from heart failure complicated by the subsequent development of a supraventricular tachyarrhythmia (e.g. atrial fibrillation). This typical ‘‘chicken-or-the-egg’’ dilemma can be resolved by treating the arrhythmia (pharmacological or nonpharmacological rate and/or rhythm control) and closely monitoring the evolution of the left ventricular dysfunction. Proper management of tachycardiomyopathy requires appropriate decision making, use of both pharmacological and nonpharmacological treatment approaches, and close follow-up. The purpose of this review article is to examine currently available data (experimental and clinical) on this complex clinical entity and on rate-control therapy.

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Abstract 17672: Interaction of Global Coronary Vasomotor Dysfunction and Early Revascularization on Adverse Cardiovascular Outcomes

Circulation ◽

10.1161/circ.130.suppl_2.17672 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Viviany R Taqueti ◽

Rory Hachamovitch ◽

Venkatesh Murthy ◽

Masanao Naya ◽

Courtney Foster ◽

...

Keyword(s):

Heart Failure ◽

Coronary Angiography ◽

Prognostic Index ◽

Cardiovascular Death ◽

Left Ventricular ◽

Cardiovascular Outcomes ◽

Vasomotor Function ◽

Flow Reserve ◽

Early Revascularization ◽

Vasomotor Dysfunction

Background: Coronary vasomotor dysfunction identifies patients at risk for cardiac death. We sought to determine the association between global coronary flow reserve (CFR, an integrated measure of coronary vasomotor function) and adverse cardiovascular events, in patients referred for coronary angiography with or without subsequent revascularization. Methods and Results: Consecutive patients (n=329) without prior coronary artery bypass surgery (CABG), heart failure, or left ventricular (LV) systolic dysfunction referred for invasive coronary angiography after stress testing with myocardial perfusion positron emission tomography (PET) were followed (median 3.1 years) for cardiovascular death and heart failure admission. Extent and severity of coronary angiographic stenosis was estimated using the CAD prognostic index (CADPI) and CFR measured noninvasively by PET. A subset of patients (n=193) underwent early revascularization, defined as CABG and/or percutaneous coronary intervention (PCI) within 90 days after PET. After adjusting for clinical risk score, LV ejection fraction, LV ischemia, CADPI, and time-dependent early revascularization with CABG and/or PCI, CFR remained independently associated with events (hazard ratio for unit decrease in CFR, 2.02; 95% CI 1.20-3.40, p=0.008). In adjusted analysis, there was a significant interaction (p=0.04) between CFR and early revascularization by CABG, such that patients with impaired CFR who underwent CABG (n=39), but not PCI (n=154), experienced event rates comparable to those with preserved CFR, independently of revascularization. Conclusions: CFR associated with adverse cardiovascular outcomes independently of angiographic severity, and modified the effect of early revascularization. Diffuse atherosclerosis and microvascular dysfunction may contribute to the pathophysiology of cardiovascular death and heart failure, and impact upon the outcomes of revascularization.

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