Guideline-based and personalized treatment approach to reduce hospitalizations and mortality for high risk advanced chronic systolic heart failure

Abstract The aim of our research was to evaluate mortality and rehospitalizations rates in patients with high risk subtype of heart failure (advanced HF) during 12 months of intensive monitoring after discharge on the basis of guidelines recommendations and personalized approach in treatment with frequent outpatient monitoring to reveal subcompensation/worsening of HF. Methods High risk advanced subtype of systolic HF was determined based on at least two hospitalizations during last year, severely reduced EF<30%, right and left atria hypertension echo patterns, pseudonormal/restrictive diastolic dysfunction, frequent outpatient deterioration of euvolemic state. Patients were randomized into two groups: 143 patients who underwent personalized intensive outpatient monitoring with care and 71 patients who underwent standard monitoring with regular guideline based treatment Intensive monitoring in ambulatory settings included frequent attending protocol of clinical evaluation (from OPTIMIZE -HF multicenter study), body mass, heart rate, GFR controls and additional echo evaluation of pressures in right and left atria at every outpatient visit, lung ultrasound with detection of B-lines. Results Cumulative number of CV and HF deaths was 11% (16 out of 143 in intensive monitoring group) and 36% (26 out of 71 patients) in standard monitoring group. Kaplan-Meier curve showed survival benefit in patients with personalized monitoring and treatment compared to those who were on standard care (Picture 1). Conclusions A strong trend towards decline in mortality and rehospitalizations, when personalized outpatient monitoring was implemented was observed (P<0,001) at 12 months in patients with advanced systolic heart failure. Kaplan-Meier survival curves groups Funding Acknowledgement Type of funding source: None

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Abstract 17262: Outcomes following High Risk Surgery provided as an Alternative to Transplant in patients with End-stage Heart Disease

Circulation ◽

10.1161/circ.130.suppl_2.17262 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Hiroyuki Kawajiri ◽

Lisa Garrard ◽

Cedric Manlhiot ◽

Heather Ross ◽

Diego Delgado ◽

...

Keyword(s):

Heart Failure ◽

High Risk ◽

Hospital Mortality ◽

Left Ventricular ◽

Senior Author ◽

Conventional Surgery ◽

Severe Left Ventricular Dysfunction ◽

Kaplan Meier ◽

End Stage ◽

Type Of Surgery

Background: Heart transplant (Tx) and ventricular assist device (VAD) have become established treatments for end stage heart failure; however, both treatments still have unsolved problems. Patients referred for Tx or VAD are often found to have cardiac lesions amenable to surgical intervention. We examined the results of conventional surgery in patients with severe left ventricular dysfunction to explore the possibility of high risk surgery as an alternative option. Methods: We reviewed our institutional database and identified all surgical patients referred to our senior author with severe LV dysfunction (EF<20%). We then selected patients who were initially referred for consideration of Tx or VAD, but were instead offered conventional surgery. All patients underwent evaluation for Tx candidacy and thus were prospectively stratified into Tx eligible (Tx-E) or Tx non-eligible (Tx-NE) groups. We compared outcomes stratified by Tx eligibility as well as by type of surgery. Results: A total of 133 patients were enrolled. 68 patients were Tx-E, and 65 were Tx-NE. Tx-E patients were younger than Tx-NE (57±8 vs 70±8 year-old, p<0.01). Isolated CABG was performed in 77 patients, while 56 had other procedures. In-hospital mortality was 8.8% in Tx-E, and 15.4% in Tx-NE (p=0.29). Kaplan-Meier analysis demonstrated that survival in Tx-E was comparable to ISHLT Tx data, while survival in Tx-NE was comparable to INTERMACS DT data (Figure1). When stratified by type of surgery, in-hospital mortality was lower for isolated CABG (6.5% vs 19.6%, p=0.03). Isolated CABG seemed to have comparable survival to ISHLT Tx and INTERMACS DT by Kaplan-Meier analysis (Figure2). Conclusion: The mortality and morbidity in patients undergoing alternative surgeries appears to be similar to the contemporary results of Tx and VAD destination therapy. Particularly if the pathology of heart failure is graftable coronary artery disease, isolated CABG may be a good option for highly selected patients.

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CARDIAC DEVICE DATA ANALYTICS AIDS IN IDENTIFICATION OF PATIENTS AT HIGH RISK FOR DECOMPENSATED SYSTOLIC HEART FAILURE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)31114-3 ◽

2019 ◽

Vol 73 (9) ◽

pp. 506

Author(s):

Rohit Mehta ◽

Terri Cooper ◽

Elizabeth Davenport ◽

Seema Gupta ◽

J. Jason Sims ◽

...

Keyword(s):

Heart Failure ◽

High Risk ◽

Data Analytics ◽

Systolic Heart Failure ◽

Cardiac Device

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Prognostic value of estimated plasma volume in patients with chronic systolic heart failure

Journal of Investigative Medicine ◽

10.1136/jim-2020-001538 ◽

2020 ◽

pp. jim-2020-001538

Author(s):

Yuyao Lin ◽

Yanbo Xue ◽

Jing Liu ◽

Xiqiang Wang ◽

Linyan Wei ◽

...

Keyword(s):

Heart Failure ◽

Plasma Volume ◽

Prognostic Value ◽

Primary Outcome ◽

Systolic Heart Failure ◽

Area Under The Curve ◽

Characteristic Analysis ◽

Kaplan Meier ◽

All Cause Mortality ◽

Cox Analysis

Assessing congestion is challenging but important to patients with chronic heart failure (CHF). However, there are limited data regarding the association between estimated plasma volume status (ePVS) determined using hemoglobin/hematocrit data and outcomes in patients with stable CHF. We prospectively analyzed 231 patients; the median follow-up period was 35.6 months. We calculated ePVS at admission using the Duarte and Strauss formula, derived from hemoglobin and hematocrit ratios and divided patients into three groups. The primary outcome was a composite of all-cause mortality or heart failure rehospitalization. Among 274 patients (61.98 years of age, 2.3% male), the mean ePVS was 3.98±0.90 dL/g. The third ePVS tertile had a higher proportion of primary outcome (71.4%) than the first or second tertile (48.1% and 59.7%, respectively; p=0.013). On multivariable Cox analysis, after adjusting for potential confounders, higher ePVS remained significantly associated with increased rate of primary outcome (adjusted HR 1.567, 95% CI 1.267 to 1.936; p<0.001). Kaplan-Meier survival analyses showed that the occurrence of primary outcome, all-cause mortality and rehospitalization increased progressively from first to third tertiles (p=0.006, 0.014 and 0.001; respectively). In receiver operating characteristic analysis, the area under the curve of ePVS for primary outcome was 0.645. ePVS determined using hemoglobin and hematocrit was independently associated with clinical outcomes for patients with stable CHF. Our study thus further strengthens the evidence that ePVS has important prognostic value in patients with stable CHF.Trial registration number ChiCTR-ONC-14004463.

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