scholarly journals Mortality trends in an ambulatory multidisciplinary heart failure unit from 2001 to 2018

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giosafat Spitaleri ◽  
Josep Lupón ◽  
Mar Domingo ◽  
Evelyn Santiago-Vacas ◽  
Pau Codina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Linear Regression ◽  
Cardiovascular Mortality ◽  
Clinical Characteristics ◽  
Real Life ◽  
Cardiovascular Death ◽  
Progressive Decrease ◽  
Mortality Trends ◽  
Heart Failure Unit ◽  
Ambulatory Patients

AbstractTo assess mortality trends at 1 and 3 years from 2001 to 2018 in a real-life cohort of HF outpatients from different etiologies with depressed and preserved LVEF. A total of 2368 consecutive patients with HF (mean age 66.4 ± 12.9 years, 71% men, 15.4% with preserved LVEF) admitted to a HF clinic from August 2001 to September 2018 were included in the study. Patients were divided into five quintiles (Q) according to the period of admission. Trends for all-cause and cardiovascular mortality from Q1 to Q5 were assessed by linear regression. Patients with LVEF < 50% had a progressive decrease in the rates of all-cause and cardiovascular death at 1 year (12.1% in Q1 to 6.5% in Q5, p = 0.003; and 8.4% in Q1 to 3.8% in Q5, p = 0.007, respectively) and 3 years (30.5% in Q1 to 17.0% in Q5, p = 0.003; and 23.9% in Q1 to 9.8% in Q5, p = 0.003, respectively). These trends remained significant after adjusting for clinical characteristics and risk. No significant trend in mortality was observed in patients with LVEF ≥ 50%. In a cohort of real-life ambulatory patients with HF, mortality progressively declined in patients with LVEF < 50%, but the same trend was not observed in patients with preserved LVEF.

scholarly journals Differences in long-term all-cause and cardiovascular mortality according to heart failure aetiology in ambulatory patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Spitaleri ◽  
G Cediel ◽  
E Santiago-Vacas ◽  
P Codina ◽  
M Domingo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Mortality ◽  
Lower Risk ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Real Life ◽  
Cardiovascular Death ◽  
Number Of Patients

Abstract Background Heart failure (HF) is the final stage of many cardiac disorders. Mortality in heart HF remains challenging despite improvement in outcomes proved in clinical trials in HF with reduced ejection fraction and it can be influenced by the aetiology of HF. Purpose To assess differences in long-term mortality (up to 18 years) in a real-life cohort of HF outpatients according to the aetiology of HF. Methods Consecutive patients with HF admitted at the HF Clinic from August 2001 to September 2019 were included. Follow-up was closed at 30.9.2020. HF aetiology was divided into ischemic heart disease (IHD), dilated cardiomyopathy (CM) –including non-compaction CM–, hypertensive CM, alcohol-derived CM, drug-derived CM, valvular disease, hypertrophic CM and others. For the present analysis, this latter group was excluded due to the big heterogeneity and limited number of patients in each subtype of aetiology. All-cause death and cardiovascular death were the primary end-points. Fine & Gray method for competing risk was used for cardiovascular mortality analysis. Results Out of 2387 patients included (age 66.5±12.5 years, 71.3% men, LVEF 35.4%±14.2, mainly in NYHA class II [65.5%] and III [26.5%]), 1317 deaths were recorded (731 from cardiovascular cause) during a maximum follow-up of 18 years (median 4.1 years [IQR 2–7.8] for the total cohort, 5.3 years [IQR 2.6–9.7] for survivors). Figure 1 shows Cox regression multivariable analysis for all-cause death and cardiovascular mortality. Considering IHD aetiology as reference, only dilated CM showed significantly lower risk of all-cause death, and only drug-induced CM showed higher risk of all-cause death. However, when cardiovascular mortality was considered almost all aetiologies showed significant lower risk of cardiovascular death than IHD. Figure 2 shows adjusted survival curves (A) and adjusted incidence curves of cardiovascular death (B) based on HF aetiology. Conclusions After adjusting for multiple prognostic factors among the studied HF aetiologies, dilated CM and drug-related CM showed the lowest and the highest risk of all-cause death, respectively. Patients with IHD showed the highest adjusted risk of cardiovascular death. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals High venous to arterial CO2 gap is related to cardiovascular death in cardiogenic shock

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
T Lopez-Sobrino ◽  
A Gazquez Toscano ◽  
M Soler Selva ◽  
N Romeu Mirabete ◽  
M Parellada Vendrell ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Partial Pressure ◽  
Cardiovascular Mortality ◽  
Tertiary Hospital ◽  
Cardiovascular Death ◽  
Progressive Decrease ◽  
Central Venous ◽  
Funding Sources ◽  
Central Venous Saturation

Abstract Funding Acknowledgements Type of funding sources: None. Background Venous to arterial CO2 gap (CO2gap) is calculated by subtracting partial pressure of arterial CO2 to central venous partial pressure of CO2 (ScvCO2). This marker has been studied in septic shock and indicates hypoperfusion when exceeds 6mmHg. Its kinetics and applicability in cardiogenic shock (CS) are unclear, being mixed/central venous saturation and lactate more commonly used. Purpose The objective of the study is to describe CO2gap kinetics in patients with CS. Secondary objective is to analyze if CO2gap is as marker of prognosis in CS. Methods Prospective observational study that included patients admitted for CS in the Acute Cardiovascular Care Unit of a tertiary hospital. Gasometric samples were obtained at admission, 6, 12, 24 and 48 hours from the onset of shock. In-hospital mortality was registered. Results We included 40 patients with CS during 1 year. Most patients were male (80%), average age was 68 years. There was a high incidence of cardiac arrest (58%), most frequent cause of CS was STEMI (45%), in-hospital mortality was 45%, most cases from non-cardiovascular causes (61%). Refractory shock was frequent (28%). Average lactate peak was 6.02 mmol / L. CO2gap kinetics consisted in a peak at admission (8.8mmHg), a valley 6h (7.7mmHg), new peak at 12h (8.5mmHg) and progressive decrease at at 24 (6.8mmHg) and 48h (5.7 mmHg). Significantly, higher CO2gap values at admission (10.97mmHg vs 8.16mmHg, p = 0.007) was predictor of cardiovascular mortality. Lactate values at 6, 12 and 48 hours were also predictors of cardiovascular mortality, as well as ScvO2 at admission. Conclusions Patients with CS present with high CO2gap values during first hours of admission. The kinetics of this marker consists in two peaks at admission and 12 hours from CS onset, a valley at 6 hours and a progressive decrease at 24 and 48 hours. Its determination at admission is associated with cardiovascular mortality. We suggest the potential benefit of combining this marker, along with lactate and ScvO2 values, to guide management of patients with CS. Abstract Figure. CO2 gap and cardiovascular mortality

scholarly journals Five-Year Outcomes of Heart Failure with Preserved Ejection Fraction

2020 ◽  
Vol 14 (1) ◽  
pp. 18-26
Author(s):  
Cristina Macía-Rodríguez ◽  
Emilio Páez-Guillán ◽  
Vanesa Alende-Castro ◽  
Alba García-Villafranca ◽  
Lara Maria Mateo-Mosquera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Clinical Characteristics ◽  
Hypertensive Heart Disease ◽  
Preserved Ejection Fraction ◽  
Related Factors ◽  
Factors Associated ◽  
Heart Failure Unit ◽  
High Level

Objective: The aim of this study was to describe the clinical characteristics of patients that have had a heart failure with preserved ejection fraction (HF-pEF) and to identify the factors associated with 5-year mortality and readmission. Methods: A prospective cohort study was conducted of patients followed by the Heart Failure Unit of the Internal Medicine Department. Clinical characteristics and outcomes were collected. Univariate and multivariate analyses were performed in order to identify factors associated with 5-year mortality and readmission. Results: A total of 209 patients with HF-pEF were followed, 59.3% of these were women, with a mean age 79 years. The main etiology was hypertensive heart disease and a high level of comorbidity (chronic renal failure, hypertension and atrial fibrillation) was observed. The 5-year mortality was 55.5%; the related variables were anemia (hazard ratio [HR]=1.7; 95% confidence interval [CI]: 1.2-2.5), in patients being treated with statins (HR=0.7; 95%CI 0.5-0.9) and spironolactone (HR= 1.6; 95% CI: 1.1-2.3); 24.5% of patients had >2 admission in 5 years, with the main related factors being atrial fibrillation (HR=2.7; 95%CI: 1.4-5.5), anemia (HR=1.9; 95%CI:1.0-3.3) and were being treated with spironolactone (HR=2.1; 95%CI:1.2-3.7). Conclusion: Patients with HF-pEF are old and present a high level of comorbidity. Furthermore, they have a high 5-year mortality and readmission rate. The only factor associated with lower mortality was the treatment with statins. The use of spironolactone was associated with a higher mortality risk.

scholarly journals Clinical characteristics and management of hospitalized and ambulatory patients with heart failure–results from ESC heart failure long‐term registry–Egyptian cohort

2015 ◽  
Vol 2 (3) ◽  
pp. 159-167 ◽  
Author(s):  
Mahmoud Hassanein ◽  
Magdy Abdelhamid ◽  
Bassem Ibrahim ◽  
Ahmed Elshazly ◽  
Mohamed Wafaie Aboleineen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Characteristics ◽  
Patients With Heart Failure ◽  
Ambulatory Patients

scholarly journals The impact of the coronavirus disease and Tele-Heart Failure Clinic on cardiovascular mortality and heart failure hospitalization in ambulatory patients with heart failure

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249043
Author(s):  
Sarinya Puwanant ◽  
Supanee Sinphurmsukskul ◽  
Laddawan Krailak ◽  
Pavinee Nakaviroj ◽  
Noppawan Boonbumrong ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Mortality ◽  
Cardiovascular Death ◽  
Clinic Visit ◽  
Readmission Rates ◽  
Reduced Ejection Fraction ◽  
Face To Face ◽  
Heart Failure Clinic ◽  
Patients With Heart Failure ◽  
The Impact

Background We sought to investigate the impact of the COVID-19 pandemic and the Tele-HF Clinic (Tele-HFC) program on cardiovascular death, heart failure (HF) rehospitalization, and heart transplantation rates in a cohort of ambulatory HF patients during and after the peak of the pandemic. Methods Using the HF clinic database, we compared data of patients with HF before, during, and after the peak of the pandemic (January 1 to March 17 [pre-COVID], March 17 to May 31 [peak-COVID], and June 1 to October 1 [post-COVID]). During peak-COVID, all patients were managed by Tele-HFC or hospitalization. After June 1, patients chose either a face-to-face clinic visit or a continuous tele-clinic visit. Results Cardiovascular death and medical titration rates were similar in peak-COVID compared with all other periods. HF readmission rates were significantly lower in peak-COVID (8.7% vs. 2.5%, p<0.001) and slightly increased (3.5%) post-COVID. Heart transplant rates were substantially increased in post-COVID (4.5% vs. peak-COVID [0%], p = 0.002). After June 1, 38% of patients continued with the Tele-HFC program. Patients managed by the Tele-HFC program for <6 months were less likely to have HF with reduced ejection fraction (73% vs. 54%, p = 0.005) and stage-D HF (33% vs. 14%, p = 0.001), and more likely to achieve the target neurohormonal blockade dose (p<0.01), compared with the ≥6-month Tele-HFC group. Conclusions HF rehospitalization and transplant rates significantly declined during the pandemic in ambulatory care of HF. However, reduction in these rates did not affect subsequent 5-month hospitalization and cardiovascular mortality in the setting of Tele-HFC program and continuum of advanced HF therapies.

scholarly journals Wearable Cardioverter-Defibrillator Used as a Telemonitoring System in a Real-Life Heart Failure Unit Setting

2021 ◽  
Vol 10 (22) ◽  
pp. 5435
Author(s):  
Christian Blockhaus ◽  
Stephan List ◽  
Hans-Peter Waibler ◽  
Jan-Erik Gülker ◽  
Heinrich Klues ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Real Life ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Specific Patient ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator ◽  
Heart Failure Unit

Background: In patients with reduced left ventricular ejection fraction (LVEF) who are at risk of sudden cardiac death, a wearable cardioverter-defibrillator (WCD) is recommended as a bridge to the recovery of LVEF or as a bridge to the implantation of a device. In addition to its function to detect and treat malignant arrhythmia, WCD can be used via an online platform as a telemonitoring system to supervise patients’ physical activity, compliance, and heart rate. Methods: We retrospectively analyzed 173 patients with regard to compliance and heart rate after discharge. Results: Mean WCD wearing time was 59.75 ± 35.6 days; the daily wearing time was 21.19 ± 4.65 h. We found significant differences concerning the patients’ compliance. Men showed less compliance than women, and younger patients showed less compliance than patients who were older. Furthermore, we analyzed the heart rate from discharge until the end of WCD prescription and found a significant decrease from discharge to 4, 8, or 12 weeks. Conclusion: WCD can be used as a telemonitoring system to help the involved heart failure unit or physicians attend to and adjust the medical therapy. Furthermore, specific patient groups should be educated more intensively with respect to compliance.

Plasmin-α2-antiplasmin Complex in Patients with Atrial Fibrillation

1999 ◽  
Vol 82 (07) ◽  
pp. 100-103 ◽  
Author(s):  
William Feinberg ◽  
Elizabeth Macy ◽  
Elaine Cornell ◽  
Sarah Nightingale ◽  
Lesly Pearce ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Linear Regression ◽  
Clinical Characteristics ◽  
Stroke Risk ◽  
Left Ventricular ◽  
Recent Onset ◽  
Poor Left Ventricular Function ◽  
Fractional Shortening

SummaryPlasmin-α2-antiplasmin complex (PAP) is an index of recent fibrinolytic activity. We examined PAP levels in patients with atrial fibrillation (AF) to determine whether these levels are correlated with clinical characteristics associated with stroke risk. We obtained blood for measurement of PAP in a non-random sample of 586 patients with AF on entering the Stroke Prevention in Atrial Fibrillation III Study. PAP levels were measured with an ELISA assay. PAP values were transformed with a natural logarithm (PAPln) prior to all analyses. Older age, female gender, recent congestive heart failure, decreasing fractional shortening, recent onset of AF, and coronary artery disease were each univariately associated with higher levels of PAP (all p <0.05, two-sample t-test, simple linear regression). Older age, recent congestive heart failure, decreasing fractional shortening, and recent onset of AF were independently associated with higher PAP levels by multivariate analysis (linear regression). Among patients receiving warfarin, PAP levels were not correlated with INR levels (linear regression, p = 0.60). Patients classified as high-risk for thromboembolism by our risk stratification criteria (systolic blood pressure >160 mm Hg, prior thromboembolism, recent congestive heart failure, poor left ventricular function, and women over age 75) had higher PAP levels than low-risk patients (antilog mean PAPln 5.6 vs 4.9, p <0.001, two-sample t-test). PAP levels in patients with AF are associated with clinical characteristics predictive of thromboembolism. Elevated PAP levels are particularly associated with poor left ventricular function and are not affected by anticoagulation. PAP levels may be a marker of stroke risk in patients with AF.Presented in part at the American Heart Association 22nd annual Joint Conference on Stroke and the Cerebral Circulation, Anaheim, CA, February, 1997.

284 Non-cardiovascular mortality in patients assisted in a multidisciplinary Heart Failure Unit

2007 ◽  
Vol 6 (1) ◽  
pp. 59-60
Author(s):  
A URRUTIA ◽  
J LUPON ◽  
B GONZALEZ ◽  
D MAS ◽  
M DOMINGO ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Mortality ◽  
Heart Failure Unit

scholarly journals Place and causes of acute cardiovascular mortality during the COVID-19 pandemic

Heart ◽  
2020 ◽  
Vol 107 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Jianhua Wu ◽  
Mamas A Mamas ◽  
Mohamed O Mohamed ◽  
Chun Shing Kwok ◽  
Chris Roebuck ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Retrospective Cohort ◽  
Cardiovascular Death ◽  
Care Homes ◽  
Adult Age ◽  
Coronary Syndrome ◽  
Seeking Help ◽  
At Home

ObjectiveTo describe the place and causes of acute cardiovascular death during the COVID-19 pandemic.MethodsRetrospective cohort of adult (age ≥18 years) acute cardiovascular deaths (n=5 87 225) in England and Wales, from 1 January 2014 to 30 June 2020. The exposure was the COVID-19 pandemic (from onset of the first COVID-19 death in England, 2 March 2020). The main outcome was acute cardiovascular events directly contributing to death.ResultsAfter 2 March 2020, there were 28 969 acute cardiovascular deaths of which 5.1% related to COVID-19, and an excess acute cardiovascular mortality of 2085 (+8%). Deaths in the community accounted for nearly half of all deaths during this period. Death at home had the greatest excess acute cardiovascular deaths (2279, +35%), followed by deaths at care homes and hospices (1095, +32%) and in hospital (50, +0%). The most frequent cause of acute cardiovascular death during this period was stroke (10 318, 35.6%), followed by acute coronary syndrome (ACS) (7 098, 24.5%), heart failure (6 770, 23.4%), pulmonary embolism (2 689, 9.3%) and cardiac arrest (1 328, 4.6%). The greatest cause of excess cardiovascular death in care homes and hospices was stroke (715, +39%), compared with ACS (768, +41%) at home and cardiogenic shock (55, +15%) in hospital.Conclusions and relevanceThe COVID-19 pandemic has resulted in an inflation in acute cardiovascular deaths, nearly half of which occurred in the community and most did not relate to COVID-19 infection suggesting there were delays to seeking help or likely the result of undiagnosed COVID-19.

Sign in / Sign up

Export Citation Format

Share Document