scholarly journals Impact of comorbidity on the predictive value of cystatin-C in patients admitted for acute decompensated heart failure: insights from a prospective study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kayama ◽  
T Yamada ◽  
T Watanabe ◽  
T Morita ◽  
Y Furukawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cystatin C ◽  
Charlson Comorbidity Index ◽  
Prognostic Value ◽  
Roc Analysis ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Heart Failure Patients ◽  
Comorbidity Index ◽  
The Impact

Abstract Background Comorbidities are strongly associated with poor clinical outcome in heart failure patients. The Age-adjusted Charlson comorbidity index (ACCI), which is well-known widely used comorbidity index, recently has been used as a robust prognostic model in heart failure patients. On the other hand, Cystatin C, as a novel and important biomarker of renal function, has been recently reported as a useful long-term risk stratification score in heart failure patients. However, there is no information available on the impact of comorbidities on the prognostic value of cystatin-C in patients admitted for acute decompensated heart failure (ADHF). Methods We prospectively studied 458 consecutive ADHF patients with survival discharge. Patients with hemodialysis were excluded. Echocardiography and venous blood sampling were performed just before discharge and serum cystatin-C level was measured. Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI). ACCI was commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age. The endpoint was all-cause death (ACD). Results During a follow-up period of 2.8±1.5 years, 132 patients had ACD. At multivariate Cox analysis, ACCI (p=0.0015) and cystatin-C level (p=0.0145) were significantly and independently associated with ACD. Patients with high ACCI (≥6: determined by ROC analysis) had a significantly greater risk of ACD (37.2% vs 17.8%, p<0.0001, HR 2.45 [1.61–3.70]). In the subgroup of higher ACCI, patients with higher cystatin-C level (≥1.56: determined by ROC analysis) had a significantly higher risk of ACD (50.3% vs 23.4%). Furthermore, in the subgroup of lower ACCI, patients with higher cystatin-C level had also significantly higher risk of ACD (34.2% vs 12.1%). Conclusions The prognostic value of cystatin-C is not affected by comorbidities and cystatin-C provide prognostic information even in patients admitted for ADHF, irrespective of comorbid burden. All-cause death-free rate in ADHF pts Funding Acknowledgement Type of funding source: None

The impact of admission cystatin C levels on in-hospital and three-year mortality rates in acute decompensated heart failure

2018 ◽  
Vol 29 (5) ◽  
pp. 305-309 ◽  
Author(s):  
Hatice Selcuk ◽  
Mehmet Timur Selcuk ◽  
Orhan Maden ◽  
Kevser Gülcihan Balci ◽  
Mustafa Mücahit Balci ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cystatin C ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Mortality Rates ◽  
The Impact

P794Long-term prognostic value of the combination of AHEAD score and wasting syndrome in patients admitted for acute decompensated heart failure with reduced or preserved LV ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Yamada ◽  
T Morita ◽  
Y Furukawa ◽  
S Tamaki ◽  
M Kawasaki ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Prognostic Value ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Hemoglobin E ◽  
Heart Failure Patients ◽  
Wasting Syndrome ◽  
Ahead Score

Abstract Background Comorbidities are associated with poor clinical outcome in heart failure patients (pts). AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been related to clinical outcomes in acute decompensated heart failure (ADHF) pts. On the other hand, heart failure is one of a number of disorders associated with the development of wasting syndrome. Previous studies have reported reduced mortality rates in heart failure patients with increased body mass index (BMI), so-called, obesity paradox. We sought to investigate the prognostic value of the combination of AHEAD score and the cachectic state in ADHF pts, relating to reduced or preserved LVEF (HFrEF or HFpEF). Methods and results We studied 303 pts admitted for ADHF and discharged with survival (HFrEF (LVEF <50%); n=163, HFpEF (LVEF ≥50%; n=140). We evaluated AHEAD score (range 0–5, atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus) and wasting syndrome was defined as BMI <20 kg/m2 and serum albumin level (Alb) <3.2 g/dl at the discharge. During a follow-up period of 5.1±4.2 years, 121 pts died. At multivariate Cox analysis, AHEAD score and wasting syndrome was significantly and independently associated with the total mortality, in pts with not only HFrEF but also HFpEF. Pts with both high AHEAD score (≥3: AUC 0.625 [0.542–0.709] in HFrEF and ≥3: AUC 0.611 [0514–0.708] in HFpEF, by ROC curve analysis) and wasting syndrome had a higher risk of mortality than those with either and none of them in HFrEF (71% vs 51% vs 40%, p<0.0001, respectively) and HFpEF (78% vs 33% vs 24%, p<0.0001, respectively). Conclusion The combination of AHEAD score and wasting syndrome would be useful for stratifying patients at risk for the mortality in ADHF pts, regardless of HFrEF or HFpEF.

scholarly journals Effects of a multidisciplinary heart failure program in short term readmissions of heart failure patients, preliminary results

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Gorriz Magana ◽  
M.J Espinosa Pascual ◽  
R Abad Romero ◽  
R Olsen Rodriguez ◽  
D Nieto Ibanez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Short Term ◽  
Ventricular Ejection Fraction ◽  
Heart Failure Patients ◽  
Basic Characteristics ◽  
The Impact

Abstract Background Unexpected readmissions are frequent among heart failure patients, due to their natural history that implies multiple readmissions, with high costs and clinical relevance. Purpose We aimed to assess the impact of a Multidisciplinary Heart Failure Program (MHFP) on the readmission-free period after an episode of acute decompensated heart failure (ADHF). Methods We carried out an analytical and observational study including all patients admitted to our Universitary Hospital, which covers 220,000 individuals, with an episode of heart failure when there was not a Multidisciplinary Heart Failure Program (January 2013 to December 2013). Once the MHFP was established, we compared non-MHFP patients with every patient admitted during February 2019 and February 2020 in terms of clinical data, imaging technique findings and short-term readmissions. Results The rate of readmission during this period was a 24.8% in non-MHFP and 17.2% in MHFP (p=0.15). However, we could find differences in median time to readmission due to ADHF, that was 1.74 months (CI 95%, 0.12–3.35) in non-MHFP, compared to 5.125 months (CI 95%, 4.15–6.09) in MHFP (p=0.002) (see Graph 1). There were also no significant differences in terms of basic characteristics between the MHFP and the non-MHFP patients (age, gender, left ventricular ejection fraction, left bundle branch block, hypertension). It is remarkable that establishing a MHFP has lengthened the readmission-free period. The rate of decompensation in the first and sixth month was respectively in the non–MHFP 9% and 21%; and in the MHFP 2% and 10%. Conclusion According to our results, the implantation of this Multidisciplinary Heart Failure Program has shown a reduction in the time to ADHF readmission compared with a cohort of similar pts some years before, which is clinically relevant. Graph 1 Funding Acknowledgement Type of funding source: None

P5406Impact of the albumin level on the prognostic value of diuretic response in patients admitted for acute decompensated heart failure: a prospective study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Yamamoto ◽  
T Yamada ◽  
T Morita ◽  
Y Furukawa ◽  
S Tamaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Value ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Albumin Level ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diuretic Response ◽  
Cox Analysis ◽  
The Impact

Abstract Background The reduced diuretic response (DR) has been shown to be associated with poor clinical outcome in patients with acute decompensated heart failure (ADHF). In addition, hypoalbuminemia, which is related to DR, has been also reported to predict poor prognosis in ADHF patients. However, there is no information available on the impact of albumin level on the prognostic value of DR in patients with ADHF. Methods We prospectively studied 296 consecutive patients who were admitted for ADHF and survived to discharge. The patients were divided into 2 groups according to the presence or absence of hypoalbuminemia at the admission, defined as the serum level of albumin at admission <3.5g/dl, and DR was defined as weight loss per 40mg intravenous dose and 80mg oral dose of furosemide up to day 4. The endpoint was a composite of all-cause mortality and unplanned hospitalization for worsening heart failure. Results There were 144 patients with hypoalbuminemia and 152 patients without hypoalbuminemia. During a mean follow-up period of 2.2±1.5 years, 88 patients with hypoalbuminemia and 53 patients without hypoalbuminemia reached the endpoint. In group with hypoalbuminemia, DR was significantly smaller in patients with than without the endpoint (0.85 [0.50–1.50] vs 1.60 [0.76–2.70] kg/40mg furosemide, p=0.003), while there was no significant difference in DR between them in group without hypoalbuminemia (1.17 [0.59–1.66] vs 1.07 [0.75–1.88] kg/40mg furosemide, p=0.381). At multivariate Cox analysis, in group with hypoalbuminemia, DR was significantly associated with the endpoint, independently of age, left ventricular ejection fraction, and serum creatinine and plasma BNP levels. On the other hand, in group without hypoalbuminemia, DR showed no significant association with the endpoint at univariate Cox analysis. Kaplan-Meier analysis showed that patients with poor DR (≤1.08 kg/40mg furosemide: median value) had a significantly higher risk of the endpoint in group with hypoalbuminemia, but not in group without hypoalbuminemia (Figure). Figure 1 Conclusion Our results suggested that prognostic value of DR in ADHF patients is affected by the presence or absence of hypoalbuminemia.

HAND-GRIP STRENGTH IN ACUTE DECOMPENSATED HEART FAILURE PATIENTS: ACCURACY AS A PREDICTOR OF MALNUTRITION AND PROGNOSTIC VALUE

Nutrition ◽  
2021 ◽  
pp. 111352
Author(s):  
Suena Medeiros Parahiba ◽  
Stefanny Ronchi Spillere ◽  
Priccila Zuchinali ◽  
Gabriela dos Reis Padilha ◽  
Melina Borba Duarte ◽  
...  
Keyword(s):  
Heart Failure ◽  
Grip Strength ◽  
Prognostic Value ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Hand Grip Strength ◽  
Heart Failure Patients ◽  
Hand Grip

Abstract 12984: Long-term Prognostic Value of the Serial Change of Acute Hemodynamic Index During Hospitalization in Patients Admitted for Acute Decompensated Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takahisa Yamada ◽  
Tetsuya Watanabe ◽  
Takashi Morita ◽  
Yoshio Furukawa ◽  
Shunsuke Tamaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Death ◽  
Prognostic Value ◽  
Roc Analysis ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Cox Regression Analysis ◽  
Serial Change

Backgrounds: Controlled heart rate (HR) and increased pulse pressure (PP) are related to better outcomes in stable heart failure. Hemodynamic response to stress evaluated by an acute hemodynamics index (AHI), the product of HR and PP, has been reported to be associated with poor outcomes in patients admitted for acute decompensated heart failure (ADHF). However, there is no information available on the long-term prognostic value of the serial change of AHI during hospitalization in patients admitted for ADHF. Methods and Results: We studied 259 patients admitted for ADHF and discharged with survival. We measured AHI (HR x PP/1000) at admission and discharge. AHI significantly decreased from admission to discharge (6.98±3.04 to 3.81±1.21 bpm·mmHg, p<0.0001). During a mean follow-up period of 5.0±3.2 yrs, 53 patients had cardiac death. The change [ad-dis] of AHI from admission to discharge (AHI[ad-dis]) was significantly less in patients with than without cardiac death (1.98±2.17 vs 3.47±2.87 bpm·mmHg, p=0.0005). Multivariate Cox regression analysis revealed that AHI[ad-dis], but not PP[ad-dis], was significantly associated with cardiac death, independently of prior heart failure hospitalization, body mass index, estimated glomerular filtration rate, hemoglobin level and left ventricular end-diastolic dimension. ROC analysis revealed that AUC in AHI[ad-dis](0.668[0.588-0.749]) was greater than that in PP[ad-dis](0.637[0.572-0.717]). Patients with less AHI[ad-dis] (≤1.79 bpm·mmHg by ROC analysis) had a significantly higher risk of cardiac death than those with greater AHI[ad-dis] (adjusted hazard ratio: 3.19[1.77 to 5.76], 30% vs 13%, p<0.0001). Conclusions: Cardiac death was frequently observed in ADHF patients who had less degree of the decrease in AHI during hospitalization. The change of AHI during hospitalization would be a simple and useful marker for risk stratification in patients admitted for ADHF.

Comparative prognostic impact of ACCI and AHEAD risk score in heart failure with reduced, mid-range and preserved left ventricular ejection fraction admitted for acute decompensated heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kayama ◽  
T Yamada ◽  
T Watanabe ◽  
T Morita ◽  
Y Furukawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Risk Score ◽  
Prognostic Value ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Comorbidity Index ◽  
Independent Association ◽  
Cox Analysis ◽  
Ahead Score

Abstract Background Comorbidities are strongly associated with poor clinical outcome in heart failure patients (pts). The Age-adjusted Charlson comorbidity index (ACCI), which is well-known widely used comorbidity index, recently has been used as a robust prognostic model in heart failure pts. On the other hand, AHEAD risk score has been recently reported as a useful long-term risk stratification score in acute decompensated heart failure (ADHF) pts. Recently, a new group of heart failure pts with mid-range ejection fraction (HFmrEF) has been defined, separated from reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). We sought to compare the prognostic value of ACCI and AHEAD score in ADHF pts, relating to HFrEF, HFmrEF and HFpEF. Methods We prospectively studied 410 consecutive ADHF pts (HFrEF [n=143], HFmrEF [n=99] and HFpEF [n=168]) with survival discharge. ACCI contains 19 issues which was weighted according to their potential influence on mortality. AHEAD risk score is a simple index, which is range 0–5; atrial fibrillation, hemoglobin &lt;13 mg/dL for men and 12 mg/dL for women, age &gt;70 years, creatinine &gt;130 μmol/L, and diabetes mellitus. The endpoint of this study was all cause death (ACD). Results During a follow-up period of 2.4±1.4 years, 119 pts had ACD (42, 29 and 48 pts in HFrEF, HFmrEF and HFpEF, respectively). At univariate Cox analysis, ACCI and AHEAD risk score were significantly associated with ACD in each subgroup. At multivariate Cox analysis, in HFrEF pts, ACCI, but not AHEAD risk score, showed the significant and independent association with ACD. In HFmrEF, both ACCI and AHEAD risk score was significantly and independently associated with ACD and ROC analysis showed AUC of ACCI was greater than that of AHEAD risk score (0.778 [0.683–0.855] vs 0.637 [0.572–0.764], p=0.07). On the other hand, in HFpEF pts, AHEAD risk score, but not ACCI, showed the significant and independent association ACD. Conclusion ACCI provides more prognostic value in HFrEF pts, and AHEAD risk score has more prognostic value in HFpEF pts. In HFmrEF pts, both ACCI and AHEAD score might have prognostic values, although ACCI tends to be more associated with ACD than AHEAD score. Funding Acknowledgement Type of funding source: None

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