scholarly journals Effects of levosimendan in patients with acute heart failure and cardiorenal syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Ribeiro Da Silva ◽  
G Santos Silva ◽  
D Caeiro ◽  
M Passos Silva ◽  
C Guerreiro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Natriuretic Peptides ◽  
Angiotensin Receptor Blockers ◽  
Cardiorenal Syndrome ◽  
Baseline Serum ◽  
Beneficial Effects ◽  
Funding Sources ◽  
Tertiary Center ◽  
Short Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiorenal syndrome (CRS) is common in patients with acute heart failure (AHF) and is associated with poor prognosis. Levosimendan (LVS) is an inodilator used in AHF and has beneficial effects on renal function (RF). However, its effects on RF in CRS patients are not established. Purpose To evaluate whether LVS could improve RF in AHF patients with or without CRS. Methods Retrospective study that included patients with AHF treated with LVS in a cardiac intensive care unit of a tertiary center, between January 2015 and June 2018. Baseline serum creatinine (SCr) was recorded and SCr and glomerular filtration rate (GFR) were accessed before and within 5 days after LSV use. CRS was defined as an increase in SCr > 0,3 mg/dL over baseline (before LVS use). RF improvement was defined as a decrease in SCr after LVS use. We evaluate outcomes at 1-year. Results 61 patients were included, 84% males, mean age 65 years, ejection fraction ≤40% in 87%. INTERMACS 4 and hemodynamic profile C were the most frequent presentation. LSV was administered in 24h, without bolus, in most patients. CRS was present in 44,3% of patients. Basal characteristics were similar between CRS and no-CRS patients, including prevalence of chronic kidney disease, baseline SCr or natriuretic peptides (p> 0,05 for all). CRS patients had a significant improvement in RF after LVS use (SCr 2,08 to 1,65 mg/dL, p< 0,001 and GFR 40,4 to 54,6 mL/min/m2, p< 0,001), while no-CRS patients had no significant improvement in RF (SCr 1,33 to 1,32 mg/dL and GFR 64,1 to 64,5 mL/min/m2, p> 0,05 for all). Also, there was a significant decrease in natriuretic peptides after LVS in CRS patients (NT-proBNP 13527,5 to 10708,8 pg/mL, p= 0,006), without significant differences in no-CRS patients. It is noteworthy that at discharge, CRS patients were more likely to titrate HF optimal medical therapy (OMT) compared with no-CRS patients (p= 0,039). There was a lower tendency to suspend angiotensin-converting enzyme (ACE-I) and angiotensin receptor blockers (ARB) in CRS patients (p= 0,05). At discharge CRS patients received more furosemide than at admission (77,2 mg/day to 97,1 mg/day, p= 0,019) compared with no-CRS patients (89,6 mg/day to 97,0 mg/day, p= 0,469), receiving similar doses at discharge. In CRS patients, RF improvement was associated with a decrease in intra-hospital mortality (p= 0,043) and a tendency to decrease 30-day mortality (p= 0,060), but without differences in one-year mortality. Conclusion In CRS patients, LVS improved RF and NT-proBNP, allowed to titrate OMT and decreased the need to suspend ACE-I or ARB and was associated to a decrease in short-term mortality.

scholarly journals Door-to-Furosemide time effects on in-hospital mortality and length of stay in acute heart failure patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K.V Viriyanukulvong ◽  
A.H Han-Gla ◽  
J.P Phannajit ◽  
A.A Ariyachaipanich
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Early Treatment ◽  
Hospital Death ◽  
Single Center ◽  
Hospital Outcomes ◽  
Baseline Serum ◽  
Funding Sources ◽  
Patient Arrival

Abstract Background Acute heart failure (AHF) is a common cause of hospitalization and mortality. Time-to-therapy concept may help improve in-hospital outcomes. Objective To evaluate In-hospital outcomes after receiving early versus delayed furosemide injection among AHF patients. Method Retrospective single-center cohort study included patients who were admitted with AHF through ED during 1 July 2017 to 31 Dec 2019. Door-to-furosemide (D2F) time was defined as the time from patient arrival at the ED to the first intravenous furosemide injection within 24 hours. Patients with a D2F time ≤60 min were classified as the early treatment group. Primary outcome was in-hospital mortality and secondary outcomes were in-hospital morbidities. Adjusted odd ratio and the 95% confidence interval (CI) were represented using multiple logistic regression adjusted for age, sex, weight, furosemide dose, and baseline serum creatinine. Results Among 820 enrolled AHF patients, the median D2F time was 80.5 min (interquartile range: 42 to 187 min). of those 324 (39%) patients were categorized into early D2F time group. The rate of total in-hospital death was 4.9% and did not differ between groups (3.1% vs. 6%, early vs delayed D2F group; p=0.067). In multivariate analysis, early treatment is not significantly associated with lower in-hospital mortality (odd ratio: 0.57; 95% CI: 0.27–1.23; p=0.152) as well as secondary endpoints. Conclusions In this small single-center study, early treatment with furosemide was uncommon. Less than half of admitted patients were received furosemide within 1 hour. In-hospital mortality was double in delayed group but was not statistically significant. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Synergistic Impact of Systolic Blood Pressure and Perfusion Status on Mortality in Acute Heart Failure

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
Xavier Rossello ◽  
Héctor Bueno ◽  
Víctor Gil ◽  
Javier Jacob ◽  
Francisco Javier Martín-Sánchez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Physical Examination ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
Positive Association ◽  
Prognostic Impact ◽  
Inverse Association ◽  
Logistic Regression Models ◽  
Short Term Mortality

Background: Physical examination remains the cornerstone in the assessment of acute heart failure. There is a lack of adequately powered studies assessing the combined impact of both systolic blood pressure (SBP) and hypoperfusion on short-term mortality. Methods: Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in 3 time periods between 2011 and 2016. Logistic regression models were used to assess the association of 30-day mortality with SBP (<90, 90–109, 110–129, and ≥130 mm Hg) and with manifestations of hypoperfusion (cold skin, cutaneous pallor, delayed capillary refill, livedo reticularis, and mental confusion) at admission. Results: Among 10 979 patients, 1143 died within the first 30 days (10.2%). There was an inverse association between 30-day mortality and initial SBP (35.4%, 18.9%, 12.4%, and 7.5% for SBP<90, SBP 90–109, SBP 110–129, and SBP≥130 mm Hg, respectively; P <0.001) and a positive association with hypoperfusion (8.0%, 14.8%, and 27.6% for those with none, 1, ≥2 signs/symptoms of hypoperfusion, respectively; P <0.001). After adjustment for 11 risk factors, the prognostic impact of hypoperfusion on 30-day mortality varied across SBP categories: SBP≥130 mm Hg (odds ratio [OR]=1.03 [95% CI, 0.77–1.36] and OR=1.18 [95% CI, 0.86–1.62] for 1 and ≥2 compared with 0 manifestations of hypoperfusion), SBP 110 to 129 mm Hg (OR=1.23 [95% CI, 0.86–1.77] and OR=2.18 [95% CI, 1.44–3.31], respectively), SBP 90 to 109 mm Hg (OR=1.29 [95% CI, 0.79–2.10] and OR=2.24 [95% CI, 1.36–3.66], respectively), and SBP<90 mm Hg (OR=1.34 [95% CI, 0.45–4.01] and OR=3.22 [95% CI, 1.30–7.97], respectively); P -for-interaction =0.043. Conclusions: Hypoperfusion confers an incremental risk of 30-day all-cause mortality not only in patients with low SBP but also in normotensive patients. On admission, physical examination plays a major role in determining prognosis in patients with acute heart failure.

scholarly journals Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation

Heart ◽  
2019 ◽  
Vol 106 (4) ◽  
pp. 292-298 ◽  
Author(s):  
Min-Soo Ahn ◽  
Byung Su Yoo ◽  
Junghan Yoon ◽  
Seung-Hwan Lee ◽  
Jang Young Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Heart Failure ◽  
Guideline Adherence ◽  
Angiotensin Receptor Blockers ◽  
Poor Adherence ◽  
Good Adherence ◽  
Reduced Ejection Fraction ◽  
End Point ◽  
Receptor Blockers

ObjectivesThis study evaluated the relationship between guideline adherence for recommended therapy on discharge and relevant 60-day and 1-year clinical outcomes in patients with acute heart failure (HF) with reduced ejection fraction and atrial fibrillation (AF).MethodsOf 5625 acute patients with HF in the Korean Acute Heart Failure registry, 986 patients with HF and documented AF were analysed. Guideline adherence scores were calculated for the prescription of ACE inhibitors, angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists and anticoagulants.ResultsIn patients with HF with AF, there was a significant trend of reduced 60-day and 1-year mortality rates and the composite end point with guideline adherence. According to the Cox proportion hazard model, poor adherence was associated with a significantly higher risk of 60-day mortality (HR 4.75; 95% CI 1.77 to 12.74) and the composite end point (HR 2.36; 95% CI 1.33 to 4.18) compared with good adherence. Furthermore, poor adherence was associated with a significantly higher risk of 1-year mortality compared with moderate (HR 1.64; 95% CI 1.15 to 2.33) and good adherence (HR 2.34; 95% CI 1.39 to 3.97) and with a higher risk of the 1-year composite end point compared with good adherence (HR 1.58; 95% CI 1.07 to 2.33).ConclusionBetter adherence to guidelines was associated with better 60-day and 1-year prognoses in patients with HF with AF.

scholarly journals Cardiorenal syndrome in acute heart failure: A vicious cycle?

2014 ◽  
Vol 33 (3) ◽  
pp. 139-146
Author(s):  
Francisca Caetano ◽  
Sérgio Barra ◽  
Ana Faustino ◽  
Ana Botelho ◽  
Paula Mota ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Cardiorenal Syndrome ◽  
Vicious Cycle

Biomarkers in acute heart failure

2015 ◽  
Author(s):  
Rajiv Choudhary ◽  
Kevin Shah ◽  
Alan Maisel
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Natriuretic Peptides ◽  
Health Care Systems ◽  
Medical Problem ◽  
National Health Care ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Acute Dyspnoea ◽  
Care Systems ◽  
Neutrophil Gelatinase

Acute heart failure continues to be a worldwide medical problem, associated with frequent readmissions, high mortality, and a profound economic impact on national health care systems. In the past decade, biomarkers have shifted the way in which acute heart failure is managed by the cardiologist. The search for the ideal biomarker to aid in the diagnosis, prognosis, and treatment of acute heart failure is ongoing. The natriuretic peptides have proved extremely useful in determining whether acute dyspnoea has a cardiac aetiology. In addition, recent trials have demonstrated the use of natriuretic peptides in inpatient and outpatient prognosis, as well as in titrating medications in outpatients with chronic heart failure to prevent acute heart failure hospitalizations. Other emerging acute heart failure biomarkers include mid-regional pro-adrenomedullin, mid-regional proatrial natriuretic peptide, troponin, ST2, and neutrophil gelatinase-associated lipocalin.

Angiopoietin-Like Protein 7 and Short-Term Mortality in Acute Heart Failure

2020 ◽  
Vol 10 (2) ◽  
pp. 116-124 ◽  
Author(s):  
Chongyu Zhang ◽  
Xin He ◽  
Jingjing Zhao ◽  
Yalin Cao ◽  
Jian Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Inflammatory Responses ◽  
Statistical Significance ◽  
Serum Levels ◽  
Enzyme Linked Immunosorbent Assay ◽  
Short Term ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Short Term Mortality

Introduction: Angiopoietin-like protein 7 (ANGPTL7) is involved in extracellular matrix expression and inflammatory responses. However, the prognostic utility of ANGPTL7 among patients with acute heart failure (AHF) remains unclear. Objective: To evaluate the association between ANGPTL7 and short-term mortality due to AHF. Methods and Results: Patients with AHF were prospectively studied. Serum levels of ANGPTL7 were measured by an enzyme-linked immunosorbent assay. Associations between 30- and 90-day mortality and tertiles of ANGPTL7 were assessed by multivariate logistic regression models. The study comprised 142 patients. Median patient age was 68 years, and 69.7% were male. There were 20 deaths within 30 days and 37 deaths within 90 days. Crude rates of 30-day mortality in low, intermediate, and high tertiles of ANGPTL7 were 4.6, 14.6, and 22.9%, respectively. Crude rates of 90-day mortality of corresponding tertiles were 15.2, 25.0, and 37.5%. After adjusting for potential confounders, including NT-proBNP, the high tertile of ANGPTL7 was associated with a significantly increased risk of both 30-day mortality (odds ratio [OR]: 6.77, 95% confidence interval [CI]: 1.41–32.61, p = 0.017) and 90-day mortality (OR: 3.78, 95% CI: 1.38–10.36, p = 0.010) compared with the low tertile of ANGPTL7. Although mortality risk tended to be higher in the intermediate tertile than the low tertile, it did not reach statistical significance (OR: 3.75, 95% CI: 0.73–19.14, p = 0.113 for 30-day mortality; OR: 1.88, 95% CI: 0.66–5.34, p = 0.236 for 90-day mortality). Conclusions: Serum level of ANGPTL7 was independently associated with short-term mortality among patients with AHF.

Sign in / Sign up

Export Citation Format

Share Document