Clinical risk factors for mortality in an analysis of 1375 patients admitted for COVID treatment

AbstractThe goal of the present work was to examine clinical risk factors for mortality in 1375 COVID + patients admitted to a hospital in Suffolk County, NY. Data were collated by the hospital epidemiological service for patients admitted from 3/7/2020 to 9/1/2020. Time until final discharge or death was the outcome. Cox proportional hazards models were used to estimate time until death among admitted patients. In total, all cases had resolved leading to 207 deaths. Length of stay was significantly longer in those who died as compared to those who did not (p = 0.007). Of patients who had been discharged, 54 were readmitted and nine subsequently died. Multivariable-adjusted Cox proportional hazards regression revealed that in addition to older age, male sex, and a history of chronic heart failure, chronic obstructive pulmonary disease, and diabetes, that a history of premorbid depression was a risk factors for COVID-19 mortality (aHR = 2.42 [1.38–4.23] P = 0.002), and that this association remained after adjusting for age and for neuropsychiatric conditions as well as medical comorbidities including cardiovascular disease and pulmonary conditions. Sex-stratified analyses revealed that associations between mortality and depression was strongest in males (aHR = 4.45 [2.04–9.72], P < 0.001), and that the association between heart failure and mortality was strongest in participants aged < 65 years old (aHR = 30.50 [9.17–101.48], P < 0.001). While an increasing number of studies have identified several comorbid medical conditions including chronic heart failure and age of patient as risk factors for mortality in COVID + patients, this study confirmed several prior reports and also noted that a history of depression is an independent risk factor for COVID-19 mortality.

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Predictors of hospitalizations for heart failure decompensation in patients with comorbid occupational chronic obstructive pulmonary disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.0949 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L.A Shpagina ◽

O.S Kotova ◽

I.S Shpagin ◽

G.V Kuznetsova ◽

N.V Kamneva ◽

...

Keyword(s):

Heart Failure ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Chronic Obstructive ◽

Length Of Service ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Patients With Heart Failure ◽

Occupational Copd ◽

Heart Failure Decompensation

Abstract Background Heart failure decompensation requiring hospitalization is an important event, associated with mortality and investigating its predictors is topical problem. Chronic obstructive pulmonary disease (COPD) is a common comorbidity for heart failure. Both conditions share common molecular mechanisms such as systemic inflammation. COPD is heterogeneous and subpopulations with different inflammation patterns may interact with heart failure in different manner. Airway inflammation in occupational COPD may differs from COPD in tobacco smokers. Additionally cardiotoxicity of industrial chemicals influence heart failure features. Despite this biological plausibility, heart failure and occupational COPD comorbidity is not studied enough. Purpose To reveal predictors of hospitalizations for heart failure decompensation in patients with heart failure and occupational COPD comorbidity. Methods Occupational COPD patients (n=115) were investigated in a prospective cohort observational study. Comparison group – 115 tobacco smokers with COPD. Control group – 115 healthy persons. Controls were selected by propensity score matching, covariates were COPD duration, age and gender. Then COPD groups were stratified according to heart failure. Working conditions, echocardiography, spirometry, pulsoxymetry, 6-mitute walking test were done. Molecular markers of tissue damage – chemokine ligand 18 (CCL 18), lactate dehydrogenase, cardiac troponin T, N-terminal pro-B-type natriuretic peptide (NT pro-BNP), protein S100 beta, von Willebrand factor were measured in serum by ELISA. Follow up after initial assessment was 12 month. Predictors were determined by Cox proportional hazards regression with ROC analysis. Results Heart failure rate in occupational COPD patients were higher – 54.8% versus 36.5% in tobacco smokers with COPD, p<0.05. Heart failure with preserved ejection fraction was predominant – 40.9%. Prevalence of biventricular heart failure was 38.3%, isolated right heart failure – 13%, left heart failure – 2.6%. Cumulative hospitalization rate in occupational COPD with heart failure group was higher than in comparison group, 17.5% and 9.5% respectively, p=0.01. In Cox proportional hazards regression model predictors of hospitalizations for heart failure decompensation during 12 months in this group were length of service (HR 1.22, 95% CI: 1.03–2.5), aromatic hydrocarbons concentration at workplaces air (HR 1.4, 95% CI: 1.15–1.96), serum protein S100 beta (HR 1.10, 95% CI: 1.02–1.87), SaO2 (HR 1.2, 95% CI: 1.06–2.13). Area under the ROC curve was 0.82. Conclusion Length of service, aromatic hydrocarbons concentration at workplaces air, serum protein S100 beta, SaO2 are considered to be independent risk factors of heart failure decompensation required hospitalization in patients with heart failure and occupational COPD comorbidity. Funding Acknowledgement Type of funding source: None

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P1666Do beta-blockers increase the risk for hospitalizations in heart failure with preserved ejection fraction? A secondary analysis of beta-blocker use in the TOPCAT trial

European Heart Journal ◽

10.1093/eurheartj/ehz748.0424 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D N Silverman ◽

T B Plante ◽

M I Infeld ◽

S P Juraschek ◽

G Dougherty ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Beta Blocker ◽

Proportional Hazards ◽

Beta Blockers ◽

Secondary Analysis ◽

Cox Proportional Hazards ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Reduced Ejection Fraction

Abstract Background The use of beta-blockers for treatment of heart failure (HF) with a reduced ejection fraction (EF) is unequivocally beneficial, but their role in the treatment of preserved EF (HFpEF) remains unclear. Purpose In a contemporary HFpEF cohort, we sought to assess the association of HF hospitalizations and the use of beta-blockers in patients with an EF above and below 50%. Methods The TOPCAT trial tested spironolactone vs. placebo among patients with HFpEF, including some with mild reductions in EF between 45–50%. The primary outcome was a composite of cardiovascular (CV) mortality, aborted cardiac arrest, or HF hospitalizations. Medication use, including beta-blockers, was reported at each visit and hospitalization. In the 1,761 participants from the Americas, we compared the association of beta-blocker use (vs. no use) and HF hospitalization or CV mortality using Cox proportional hazards models adjusted for baseline demographics, history of myocardial infarction, atrial fibrillation, chronic obstructive pulmonary disease, asthma, and hypertension. The analyses were repeated in the EF strata ≥50% and <50%. Results Among patients included in the current analysis (mean age 72 years, 50% female, 78% white), 1,496/1,761 (85%) received beta-blockers and 1,566/1,761 (89%) had an EF ≥50%. HF hospitalizations and CV mortality occurred in 399/1,761 (23%) and 223/1,761 (13%) of participants, respectively. Beta-blocker use was associated with an increase in risk of HF hospitalization among patients with preserved EF ≥50% [HR 1.56, (95% CI 1.09–2.24), p=0.01] and was associated with a reduction in risk of hospitalization in patients with an EF <50% [HR 0.42, (95% CI 0.18- 0.99), p<0.05]. We found a significant interaction for EF threshold and beta-blocker use on incident HF hospitalizations (p=0.01). There were no differences in CV mortality. Figure 1. Kaplan Meier incidence plots Conclusions Beta-blocker use was associated with an increase in HF hospitalizations in patients with HFpEF (EF≥50%) but did not affect CV mortality. Further research is needed to confirm these findings and elucidate causality.

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Comorbidity of chronic heart failure and chronic obstructive pulmonary disease: features of pathogenesis, clinic and diagnostics

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2018-6-62-68 ◽

2018 ◽

Vol 17 (6) ◽

pp. 62-68 ◽

Cited By ~ 1

Author(s):

R. E. Tokmachev ◽

M. S. Mukhortova ◽

A. V. Budnevsky ◽

E. V. Tokmachev ◽

E. S. Ovsyannikov

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Chronic Obstructive Pulmonary Disease ◽

Chronic Heart Failure ◽

Pulmonary Disease ◽

Research Methods ◽

Clinical Symptoms ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Common Risk Factors

This article discusses the epidemiology of chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD). CHF and COPD are characterized by high prevalence and high mortality, especially when they are combined. The article analyzes the general mechanisms of formation of these diseases: the relationship of COPD with cardiovascular diseases is explained by common risk factors, including smoking, physical inactivity, improper feeding and genetic predisposition. The leading role in the pathogenesis of pathologies is played by the activation and maintenance of systemic inflammation. Article presents the features of the clinical picture and the direction of the diagnostics in case of suspected combined pathology, the possibilities of modern laboratory and instrumental research methods. Diagnostics of comorbidity of CHF and COPD may be difficult, given the above common risk factors, some common pathogenesis mechanisms and similar clinical symptoms. However the caution regarding the comorbidity of the studied conditions, as well as a thorough clinical examination and the appointment of the necessary additional research methods, can reduce the number of diagnostic mistakes and improve the prognosis in such patients.

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Clinical determinants and prognostic impact of osteoporosis in patients with chronic heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.3418 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Katano ◽

T Yano ◽

T Tsukada ◽

H Kouzu ◽

S Honma ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Chronic Heart Failure ◽

Adverse Events ◽

Gait Speed ◽

Loop Diuretics ◽

Clinical Risk Factors ◽

Funding Source ◽

Prognostic Impact ◽

Clinical Risk

Abstract Background Despite accumulating evidence of a close association between orthopedic fractures and chronic heart failure (CHF), the clinical risk factors of osteoporosis, defined as reduction in bone mineral densities (BMDs), in CHF patients have not been systematically analyzed. In addition, the impact of osteoporosis on prognosis of CHF remains unclear. Aims We aimed to clarify the prevalence, clinical risk factors, and prognostic impact of osteoporosis in CHF patients. Methods We retrospectively examined 303 CHF patients (75 years, [interquartile range (IQR), 66–82 years]; 41% female). BMDs at the lumber spine, femoral neck, and total femur were measured by dual-energy X-ray absorptiometry (DEXA), and osteoporosis was diagnosed when BMD at any of the three sites was less than 70% of Young Adult Mean. Results The prevalence of osteoporosis in the CHF patients was 40%. Patients with osteoporosis were older (79 [IQR, 74–86] vs. 72 [IQR, 62–80] years), included a large percentage of females, had slower gait speed and had lower body mass index (BMI). Loop diuretics and warfarin were used more frequently and direct oral anticoagulants (DOACs) were used less frequently in patients with osteoporosis than in patients without osteoporosis. Multivariate logistic regression analysis indicated that sex (odds ratio [OR] 5.07, 95% Confidence Interval [CI] 2.68–9.61, p<0.01), BMI (OR, 0.83; 95% CI, 0.75–0.91; p<0.01), gait speed (OR, 0.80; 95% CI, 0.70–0.92; p<0.01), loop diuretics use (OR, 2.52; 95% CI, 1.20–5.27; p=0.01) and no DOACs use (OR, 0.43; 95% CI, 0.19–0.96; p=0.04) were independently associated with osteoporosis. During the mean follow-up period of 290±254 days, 92 patients (30.4%) had adverse events. When patients with osteoporosis were divided into subgroups according to the number of sites with BMD of an osteoporosis level, Kaplan-Meier survival curves showed that the rate of adverse events (death and cardiovascular events) was higher in patients with osteoporotic BMD at two or more sites than in patients without osteoporosis (51% vs. 23%, p=0.03) (Figure). In multivariate Cox regression analyses, osteoporotic BMD at two or more sites was an independent predictor of adverse events after adjustment for age, sex, and NT-proBNP level (Hazard ratio, 1.74; 95% CI, 1.01–2.99; p=0.04). Conclusion The risk of osteoporosis may be increased in users of loop diuretics and may be decreased in users of DOACs in CHF patients. Extent of osteoporosis is a novel predictor of adverse events in CHF patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Japan Society for the Promotion of Science KAKENHI

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Increased One-Year Recurrent Ischemic Stroke after First-Ever Ischemic Stroke in Males with Benign Prostatic Hyperplasia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17155360 ◽

2020 ◽

Vol 17 (15) ◽

pp. 5360 ◽

Cited By ~ 1

Author(s):

Chun-Gu Cheng ◽

Hsin Chu ◽

Jiunn-Tay Lee ◽

Wu-Chien Chien ◽

Chun-An Cheng

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Benign Prostatic Hyperplasia ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Prostatic Hyperplasia ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Increased Risk ◽

One Year

(1) Background: Patients with benign prostatic hyperplasia (BPH) were questioned about quality of life and sleep. Most BPH patients were treated with alpha-1 adrenergic receptor antagonists, which could improve cerebral blood flow for 1–2 months. Patients with ischemic stroke (IS) could experience cerebral autoregulation impairment for six months. The relationship between BPH and recurrent IS remains unclear. The aim of this study was to determine the risk of one-year recurrent IS conferred by BPH. (2) Methods: We used data from the Taiwanese National Health Insurance Database to identify newly diagnosed IS cases entered from 1 January 2008 to 31 December 2008. Patients were followed until the recurrent IS event or 365 days after the first hospitalization. The risk factors associated with one-year recurrent IS were assessed using Cox proportional hazards regression. (3) Results: Patients with BPH had a higher risk of recurrent IS (12.11% versus 8.15%) (adjusted hazard ratio (HR): 1.352; 95% confidence interval (CI): 1.028–1.78, p = 0.031). Other risk factors included hyperlipidemia (adjusted HR: 1.338; 95% CI: 1.022–1.751, p = 0.034), coronary artery disease (adjusted HR: 1.487; 95% CI: 1.128–1.961, p = 0.005), chronic obstructive pulmonary disease (adjusted HR: 1.499; 95% CI: 1.075–2.091, p = 0.017), and chronic kidney disease (adjusted HR: 1.523; 95% CI: 1.033–2.244, p = 0.033). (4) Conclusion: Patients with BPH who had these risk factors had an increased risk of one-year recurrent IS. The modification of risk factors may prevent recurrent IS.

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Clinical Risk Factors and Prognostic Impact of Osteoporosis in Patients With Chronic Heart Failure

Circulation Journal ◽

10.1253/circj.cj-20-0593 ◽

2020 ◽

Vol 84 (12) ◽

pp. 2224-2234

Author(s):

Satoshi Katano ◽

Toshiyuki Yano ◽

Takanori Tsukada ◽

Hidemichi Kouzu ◽

Suguru Honma ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Chronic Heart Failure ◽

Clinical Risk Factors ◽

Prognostic Impact ◽

Clinical Risk

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Features of the clinic and diagnosis of chronic heart failure in patients with chronic obstructive pulmonary disease

Kardiologiia ◽

10.18087/cardio.2486 ◽

2019 ◽

Vol 59 (2S) ◽

pp. 47-55

Author(s):

N. A. Karoli ◽

A. V. Borodkin ◽

A. P. Rebrov

Keyword(s):

Heart Failure ◽

Chronic Obstructive Pulmonary Disease ◽

Chronic Heart Failure ◽

Pulmonary Disease ◽

High Sensitivity ◽

Chronic Obstructive ◽

Diagnostic Features ◽

Obstructive Pulmonary Disease ◽

Galectin 3 ◽

History Of

Aim.To elucidate clinical and diagnostic features of chronic heart failure (CHF) in patients with chronic obstructive pulmonary disease (COPD).Materials and methods.The study included 239 patients with COPD and 42 patients with CHF without COPD. The first subgroup consisted of 60 patients with a history of myocardial infarction (MI) and the second subgroup consisted of 79 patients without a history of MI. A general clinical examination, EchoCG, measurements of N-terminal pro B-type natriuretic peptide (NT-proBNP), galectin 3, and high-sensitivity C-reactive protein (hsCRP) were performed for all patients.Results.The risk group for excluding HF as a cause of progressive dyspnea in COPD patients consisted of patients with the bronchitic phenotype who belonged to GOLD groups C and D with frequent exacerbations, increased hsCRP, reduced oxygen saturation, and impaired exercise tolerance. Patients with a history of MI constituted a special group of risk. Measuring specific biomarkers, primarily BNP or NT-proBNP, is recommended to confirm the presence/absence of CHF and to evaluate CHF severity in patients with these risk factors.Conclusion.A combination of COPD and CHF produces a number of clinical and, specifically, diagnostic problems, which have not been completely solved so far.

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