scholarly journals Prognostic role of myocardial work in patients with heart failure and reduced ejection fraction treated by sacubitril/valsartan

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Galli ◽  
Y Bouali ◽  
A Gallard ◽  
A Hubert ◽  
C Leclercq ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Multivariable Analysis ◽  
Rank Test ◽  
P Value ◽  
Reduced Ejection Fraction ◽  
Funding Sources ◽  
Increase Risk ◽  
Echocardiographic Examination ◽  
Constructive Work

Abstract Funding Acknowledgements Type of funding sources: None. Background the non-invasive assessment of myocardial work (MW) by pressure-strain loops analysis (PSL) is a relative new tool for the evaluation of myocardial performance. Sacubitril/Valsartan is a treatment for heart failure with reduced ejection fraction (HFrEF) which has a spectacular effect on the reduction of cardiovascular events (MACEs). Purposes of this study were to evaluate 1) the short and medium term effect of Sacubitril/Valsartan treatment on MW parameters; 2) the prognostic value of MW in this specific group of patients. Methods 79 patients with HFrEF (mean age: 66 ± 12 years; LV ejection fraction: 28 ± 9%) were prospectively included in the study and treated with Sacubitril/Valsartan. Echocardiographic examination was performed at baseline, and after 6- and 12-month of therapy with Sacubitril/Valsartan. Results Sacubitril/Valsartan significantly increased myocardial constructive work (CW) (1023 ± 449 vs 1424 ± 484 mmHg%, p < 0.0001) and myocardial work efficiency (WE) [87 (78-90) vs 90 (86-95), p < 0.0001]. During FU (2.6 ± 0.9 years), MACEs occurred in 13 (16%) patients. After correction for LV size, LVEF and WE, global myocardial constructive work (CW) was the only predictor of MACEs [HR 0.99 (0.99-1.00), p = 0.05]. (Table 1). A CW < 910 mmHg (AUC = 0.81, p < 0.0001, Figure 1, left panel) identified patients at particularly increase risk of MACEs [HR 11.09 (1.45-98.94), p = 0.002, log-rank test p < 0.0001] (Figure 2, Right panel). Conclusions in patients with HFrEF who receive a comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy, Sacubitril/Valsartan induces a significant improvement of myocardial CW and WE. In this population, the estimation of CW before the initiation of Sacubitril/Valsartan therapy allows the prediction of MACEs. Univariable analysis Multivariable analysis HR (95% CI) p-value HR (95% CI) p-value Age, per year 0.99 (0.95-1.04) 0.81 Ischemic cardiomyopathy 1.07 (0.36-3.21) 0.89 LVEDVi*, per ml/m2 1.01 (1.00-1.03) 0.03 LVESVi, per ml/m2 1.01 (1.00-1.03) 0.009 1.01 (0.99-1.02) 0.35 LVEF, per % 0.91 (0.85-0.98) 0.01 1.02 (0.93-1.12) 0.71 CW, per mmHg% 0.99 (0.99-1.00) 0.002 0.99 (0.99-1.00) 0.04 WE, per mmHg% 0.91 (0.86-0.96) 0.001 0.95 (0.88-1.02) 0.16 Predictors of MACEs at univariable and multivariable analysis Abstract Figure 1 A and B

Prognostic role of myocardial work in patients with heart failure and reduced ejection fraction treated by sacubitril/valsartan

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Galli ◽  
Y Bouali ◽  
C Laurin ◽  
A Gallard ◽  
A Hubert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Rank Test ◽  
Reduced Ejection Fraction ◽  
Non Invasive ◽  
Patients With Heart Failure ◽  
Increase Risk ◽  
Echocardiographic Examination ◽  
Constructive Work

Abstract Background The non-invasive assessment of myocardial work (MW) by pressure-strain loops analysis (PSL) is a relative new tool for the evaluation of myocardial performance. Sacubitril/Valsartan is a treatment for heart failure with reduced ejection fraction (HFrEF) which has a spectacular effect on the reduction of cardiovascular events (MACEs). Purposes of this study were to evaluate 1) the short and medium term effect of Sacubitril/Valsartan treatment on MW parameters; 2) the prognostic value of MW in this specific group of patients. Methods 79 patients with HFrEF (mean age: 66±12 years; LV ejection fraction: 28±9%) were prospectively included in the study and treated with Sacubitril/Valsartan. Echocardiographic examination was performed at baseline, and after 6- and 12-month of therapy with Sacubitril/Valsartan. Results Sacubitril/Valsartan significantly increased global myocardial constructive work (CW) (1023±449 vs 1424±484 mmHg%, p<0.0001) and myocardial work efficiency (WE) [87 (78–90) vs 90 (86–95), p<0.0001]. During FU (2.6±0.9 years), MACEs occurred in 13 (16%) patients. After correction for LV size, LVEF and WE, CW was the only predictor of MACEs (Table 1). A CW<910 mmHg (AUC=0.81, p<0.0001, Figure 1A) identified patients at particularly increase risk of MACEs [HR 11.09 (1.45–98.94), p=0.002, log-rank test p<0.0001] (Figure 1 B). Conclusions In patients with HFrEF who receive a comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy, Sacubitril/Valsartan induces a significant improvement of myocardial CW and WE. In this population, the estimation of CW before the initiation of Sacubitril/Valsartan therapy allows the prediction of MACEs. Funding Acknowledgement Type of funding source: None

Abstract 16539: Heart Failure With Mid-Range or Improved Ejection Fraction Improves Cardiovascular Outcomes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Matthew Cefalu ◽  
Jasneet Devgun ◽  
Samuel Kennedy ◽  
Jeremy Slivnick ◽  
Zachary Garrett ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Multivariable Analysis ◽  
Cardiovascular Outcomes ◽  
Rank Test ◽  
Prior History ◽  
Reduced Ejection Fraction ◽  
Log Rank Test ◽  
History Of ◽  
The Ohio State University

Heart failure with improved ejection fraction (HFiEF) is a unique and developing clinical entity among the heart failure (HF) spectrum. Prior studies suggest the characteristics, therapy, and prognosis of HFiEF are distinctive from HF with reduced ejection fraction (HFrEF) or mid-range ejection fraction (HFmrEF). We hypothesized that patients diagnosed with acute HF who later progressed to HFiEF would have improved cardiovascular outcomes compared to HFrEF. Our retrospective study included 295 adult patients with no prior history of HF at The Ohio State University diagnosed with acute HF. We defined HFrEF as a persistent ejection fraction < 40%, HFmrEF as persistent ejection fraction 40-49%, and HFiEF as improvement from baseline ejection fraction by > 5%. Nearly 74% of patients were found to have HFiEF while 12% and 14% were classified as HFrEF and HFmrEF respectively. Using a log-rank test, the time to first cardiovascular rehospitalization was significantly longer in HFiEF compared to HFrEF or HFmrEF (p=0.0192, Figure 1). Multivariable analysis, controlled for age and gender, indicated HFiEF had a trend towards significance as an independent predictor for time to cardiovascular hospitalization (p=0.053). Notably amyloid HF, valvular HF, and ischemic HF were all significant independent predictors. Survival analysis demonstrated that HFmrEF had significantly longer survival on log-rank test compared to HFrEF (p=0.0367). Multivariable analysis shows significantly lower hazard of mortality for those with HFmrEF (HR 0.57, 95% CI [0.36-0.92], p=0.017). Our exciting data indicates the progression to HFiEF after the diagnosis of acute HF is associated with reduced cardiovascular rehospitalization, and HFmrEF is associated with increased survival. These data have implications in patient surveillance and risk stratification as well as defining the natural history of HFiEF and HFmrEF as unique entities.

scholarly journals 412 Sacubitril/valsartan promotes cardiac reverse remodeling and preserves renal function in a real-world heart failure and reduced ejection fraction (HFrEF) population

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M V Polito ◽  
A Rispoli ◽  
V Vitulano ◽  
F D"auria ◽  
A Silverio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Real World ◽  
Cardiac Death ◽  
Nyha Class ◽  
P Value ◽  
Composite Outcome ◽  
Reduced Ejection Fraction ◽  
Echocardiographic Parameters

Abstract Funding Acknowledgements none Aims. To evaluate the effects of Sacubitril/Valsartan (S/V) on clinical, laboratory and echocardiographic parameters and outcomes in a real-world population with heart failure with reduced ejection fraction (HFrEF). Methods and results. Prospective study enrolling consecutive patients with HFrEF treated with S/V.The primary outcome was HF rehospitalization;secondary outcomes were all-cause death, cardiac death and the composite of cardiac death and HF rehospitalization at 12 months follow up.The clinical outcome was compared with a retrospective cohort of 90 HFrEF patients treated with standard medical therapy by using propensity score weighting. At 6 months follow-up, changes in symptoms, echocardiographic parameters, eGFR and furosemide dose were also evaluated. The study population consisted of 90 patients (66.1 ± 11.7 years). At 6 months FU, a significant improvement in NYHA class, LVEF (from 31.0% to 34.0%; p = 0.001), LVESV (from 115.0 to 101.0 mL; p = 0.033) and sPAP (from 31.0 to 25.0 mmHg; p = 0.024) was observed. Moreover, S/V did not affect negatively eGFR and was associated with a significantly lower dose of furosemide prescribed. The propensity score weighting adjusted regression analysis showed a significantly lower risk for HF rehospitalization (HR, 0.131; 95% CI, 0.034-0.503; p = 0.003) and the composite outcome (HR, 0.162; 95% CI, 0.053-0.492; p = 0.001) among patients treated with S/V as compared to the standard therapy group. Conclusions In this real-world HFrEF population, S/V reduced HF rehospitalization and cardiac death at 1 year. Moreover, S/V improved significantly NYHA class, LVEF, LVESV and sPAP at 6 months, preserving renal function and reducing the need of furosemide. Table Study outcomes Unadjusted model HR 95% CI p-value HF rehospitalization 0.273 0.101-0.740 0.011 Cardiac death 0.443 0.137-1.440 0.176 Composite outcome 0.331 0.155-0.710 0.005 All-cause death 0.666 0.272-1.628 0.372 Adjusted model HR 95% CI p-value HF rehospitalization 0.131 0.034-0.503 0.003 Cardiac death 0.259 0.047-1.415 0.119 Composite outcome 0.162 0.053-0.492 0.001 All-cause death 0.713 0.201-2.529 0.601 Adjusted and unadjusted HR for the study outcomes. Abstract 412 Figure.

scholarly journals 164 Effect of cardiac contractility modulation therapy on myocardial work in patients with heart failure with reduced ejection fraction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Daniele Masarone ◽  
Stefano De Vivo ◽  
Vittoria Errigo ◽  
Antonio D’ Onofrio ◽  
Giuliano D’Alterio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Contractility Modulation ◽  
Reduced Ejection Fraction ◽  
Constructive Work ◽  
Global Work ◽  
The Impact

Abstract Aims Cardiac contractility modulation therapy (CCMT) has been shown to reduce hospitalizations and to improve quality of life in heart failure patients with reduced ejection fraction (HFrEF) who remain symptomatic despite disease-modifying therapies. Strain imaging derived myocardial work (MW) is an emerging tool for evaluating left ventricular mechanics by incorporating systolic deformation and afterload burden in the analysis. To evaluate prospectively the impact of CCMT in HFrEF patients on MW derived parameters in relation to standard echocardiographic indices. Methods and results We recruited 12 HFrEF patients with indications to CCMT according to current clinical practice. A comprehensive echo-Doppler evaluation, including speckle tracking derived assessment of global longitudinal strain (GLS), was performed before and after three months from the CCM device implantation. Parameters of MW such as global work index (GWI), global constructive work (GCW) global wasted work (GWW), and global work efficiency (GWE) were calculated according to standardized procedures. Median values (interquartile range) were compared for all those parameters from baseline and 3-month follow-up with Wilcoxon Rank Sum test for continuous variables. At three months from CCM implant an improvement of LVEF [from 32% (27–34) to 36% (29–39), P &lt; 0.05], GLS [from 7.4% (6.2–11.2) to 9.9% (7.5–9.4), P &lt; 0.05], GWI [from 461 mmHg (372–613) to 589 mmHg (413–696), P &lt; 0.05], GCW [from 800 mmHg (620–930) to 970 mmHg (644–1009), P = 0.236], and GWE [from 73% (65–78) to 85% (78–87), P &lt; 0.05] was observed, with a consistent reduction of GWW [from 161 mmHg (148–227) to 125 mmHg (101–188), P &lt; 0.05]. We also found a positive correlation between the magnitude of LVEF improvement and the baseline values of GCW (r = 0.727, P = 0.011). Conclusions At 3 months, CCMT significantly improves standard and advanced left ventricular systolic function indices. This improvement is due to the increase of constructive work and a reduction of wasted work. In addition, the increase of left ventricular ejection fraction can be predicted by the global constructive work levels at baseline.

scholarly journals Prognostic Nutritional Index as the Predictor of Long-Term Mortality among HFrEF Patients with ICD

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
G Cinier ◽  
MI Hayiroglu ◽  
L Pay ◽  
AC Yumurtas ◽  
O Tezen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mortality Rate ◽  
Multivariable Analysis ◽  
Prognostic Nutritional Index ◽  
Rank Test ◽  
Reduced Ejection Fraction ◽  
Logistic Regression Models ◽  
Nutritional Index ◽  
Long Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background The benefit of implantable cardiac defibrillator (ICD) in patients with heart failure and reduced ejection fraction (HFrEF) could be limited in a particular group of patients. Low prognostic nutritional index (PNI) indicates malnutrition and pro-inflammatory condition. We sought to investigate the value of PNI in predicting long-term mortality among HFrEF patients with ICD. Methods Electronic database was searched for identifying patients with HFrEF who were implanted ICD in our institution between 2009 and 2019. Demographic and clinical characteristics of included patients were recorded. PNI was calculated according to the formula: 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (per mm3). Patients were divided into the quartiles according to PNI values. Differences between the groups were analysed by the log-rank test. A forward Cox proportional regression model was used for multivariable analysis. Results One thousand and hundred patients were included to the study. The underlying heart failure etiology was ischemic and non-ischemic in 77.3% and 22.7% of patients respectively. Mortality rate in Q1 (5.1%) was considered as the reference. In the unadjusted model the mortality rate was 9.5% [hazard ratio (HR) 1.76, 95% confidence interval (95% CI) (0.92 – 3.38)] in Q2, 10.2% (HR 1.88, 95% CI 0.99 – 3.58) in Q3 and 39.6% (HR 8.12, 95% CI 4.65 – 14.17) in Q4. The same trend was consistent in the age- and sex-adjusted, comorbidities-adjusted and covariates-adjusted models. Conclusion Among patients who were implanted ICD secondary to HFrEF, lower PNI value predicted all-cause mortality during long-term follow up. This is the first study demonstrating the value of PNI in this population. Table 1Admission Prognostic Nutritional Index (n = 1100)Q1 (n = 275)Q2 (n = 275)Q3 (n = 275)Q4 (n = 275)Long-term mortalityNumber of deaths142628109Mortality, %5.19.510.239.6Mortality, HR (%95 CI)Model 1: unadjusted1[Reference]1.76 (0.92 - 3.38)1.88 (0.99 - 3.58)8.12 (4.65 - 14.17)Model 2: adjusted for age, sex1[Reference]1.70 (0.90 - 3.48)1.79 (0.94 - 3.42)7.76 (4.42 - 13.61)Model 3: adjusted for comorbiditesa1[Reference]1.85 (0.96 - 3.55)1.89 (0.99 - 3.60)9.02 (4.34 - 14.12)Model 4: adjusted for covariatesb1[Reference]1.66 (0.88 - 3.21)1.60 (0.80 - 3.05)6.45 (3.61 - 12.5)Cox proportional analysis and logistic regression models for the long-term mortality by the prognostic nutritional indexAbstract Figure 1

scholarly journals The association of ischaemic stroke in patients with heart failure without atrial flutter/fibrillation

Heart ◽  
2019 ◽  
Vol 106 (8) ◽  
pp. 616-623 ◽  
Author(s):  
Yen-Lien Chou ◽  
Jun-Ting Liou ◽  
Cheng-Chung Cheng ◽  
Min-Chien Tsai ◽  
Wei-Shiang Lin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischaemic Stroke ◽  
Atrial Flutter ◽  
Regression Models ◽  
Propensity Scores ◽  
Multivariable Analysis ◽  
Population Based ◽  
Rank Test ◽  
P Value ◽  
Kaplan Meier

PurposeThis study evaluated the association between ischaemic stroke (IS) and heart failure (HF) in the absence of atrial fibrillation (AF) or atrial flutter (AFL) using a population-based nation-wide cohort database.MethodNewly diagnosed patients with HF without previous stroke and acute myocardial infarction (AMI) were enrolled. Based on the propensity scores matching age, sex and all comorbidities, our studies comprised 12 179 patients with HF and 12 179 patients without HF. Cox proportion hazard regression models and competing-risk regression models were used to evaluate the risk of IS among patients with HF without AF or AFL.ResultsIn the multivariable analysis, older age (adjusted HR (95% CI)=1.05 (1.04 to 1.05)), male sex (adjusted HR (95% CI)=1.36 (1.24 to 1.50)), diabetes (adjusted HR (95% CI)=2.22 (1.97 to 2.49)) and hypertension (adjusted HR (95% CI)=1.60 (1.41 to 1.82)) were markedly associated with IS in patients with HF. The HF group had a markedly higher risk of IS than did the non-HF group (subdistribution HR (SHR)=1.51, 95% CI: 1.37 to 1.66) and AMI (SHR=3.40, 95% CI: 2.71 to 4.28). Additionally, according to the Kaplan-Meier analysis, patients with HF were at a significantly higher risk of cumulative incidence of IS and AMI than did patients with non-HF (p value of log-rank test <0.001).ConclusionThis study indicated that HF is a strong independent risk factor for IS, even in the absence of AF or AFL. Clinical physicians should investigate IS through routine screening and careful monitoring of patients with HF.

scholarly journals P1818 Baseline clinical, echocardiographic and laboratory characteristics of HFrEF patients who were started with sacubitryl+ walsartan in different clinical status: long-term stabile vs after acute heart f

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Wisniowska-Smialek ◽  
A Karabinowska ◽  
K Holcman ◽  
E Dziewiecka ◽  
A Lesniak-Sobelga ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Systolic Function ◽  
Nyha Class ◽  
Clinical Status ◽  
Left Ventricular ◽  
P Value ◽  
Reduced Ejection Fraction ◽  
Heart Failure Exacerbation ◽  
Short Time

Abstract Background According to the latest approach new class ARNI with sacubitryl-valsartan may be ordered in clinically stable heart failure patients with reduced ejection fraction ( HFrEF) or short time after acute heart failure exacerbation. Methods: Since July 2016 till February 2019 we started ARNI in 50 HFrEF patients; 33 (66%) were clinically stabile during at least 3 months and 17 (34%) were short time after HF exacerbation. Results: There were no differences in age (63 vs 58) and BMI between groups. Clinically stabile patients presented significantly lower NYHA class (2 ± 0,5 vs 3 ± 0,7) and lower NT-proBNP level (1948 pg/ml vs 5570 pg/ml) in comparison to those after HF decompensation. There were no differences in left ventricular end-diastolic diameter (LVEDD), volume (LVEDV) and ejection fraction (EF) between both groups. Patients after HF decompensation had greater left and right atrium area(LAA, RAA respectively), higher estimated pulmonary artery pressure (PASP) and reduced right ventricular systolic function expressed with TAPSE (tricuspid annular plane systolic excursion) in comparison to stabile patients. Patients from both groups presented similar physical activity tolerance estimated with 6-minute walking test ( 6- MWT): 369 m vs 402 m (tbl). Conclusions: Clinical, echocardiographic and laboratory differences were observed between groups of HFrEF patients with different clinical status when ARNI was administrated. Parameter Stabile n = 33 After HF decompensation n= 17 p- value BMI [kg/m2] 25(23-36) 25(21-26) 0,72 Age [years] 63 (39-68) 58 (42-67) 0,81 NYHA 2 ± 0,5 3 ± 0,7 0,001 NT-proBNP [pg/ml] 1948(601-2933) 5570(4147-8021) P&lt; 0,001 6 MWT dystans [m] 369(327-432) 402(240-480) 0,32 FW [%] 23 (18-28) 19(15-26) 0,17 LVEDD [mm] 69(59-76) 64(63-71) 0,32 LVEDvol [ml] 242(153-324) 225(178-235) 0,29 TAPSE [mm] 19(14-21) 14(13-16) 0,02 LAA [cm2] 28(24-34) 36(27-39) 0,032 RAA [cm2] 19(16-30) 26(23-32) 0,046 PASP [mmHg] 31(23-43) 43(38-55) 0,046

scholarly journals Sodium-glucose co-transporter-2 inhibitors improve cardiovascular outcomes in heart failure with reduced ejection fraction regardless of ischemic etiology

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Patoulias ◽  
A Boulmpou ◽  
C Tsavousoglou ◽  
M Toumpourleka ◽  
F Siskos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Composite Endpoint ◽  
Cardiovascular Death ◽  
Cardiovascular Outcomes ◽  
Composite Outcome ◽  
Reduced Ejection Fraction ◽  
Funding Sources ◽  
Diabetes Status ◽  
Primary Composite Outcome

Abstract Background Coronary artery disease remains the main underlying cause of heart failure (HF), despite the progress in prevention, diagnosis and treatment. Sodium-glucose co-transporter-2 inhibitors have been shown to improve surrogate cardiovascular outcomes in patients with HF with reduced ejection fraction (HFrEF), regardless of diabetes status. Purpose We sought to determine the effect of SGLT-2 inhibitors on the primary composite endpoint (cardiovascular death or hospitalization for HF) across the two hallmark trials in the HFrEF population (EMPEROR Reduced and DAPA-HF), according to ischemic or non-ischemic etiology of HF. Methods We pooled data from EMPEROR reduced and DAPA-HF trials in a total of 8,474 patients with HFrEF, performing a sub-analysis according to the presence of ischemic cardiomyopathy as the underlying cause of HFrEF. Results Treatment with SGLT-2 inhibitors resulted in a significant decrease in the risk for the primary composite outcome in patients with HFrEF of ischemic etiology, equal to 18% (RR=0.82, 95% CI: 0.73–0.92, I2=0%). In patients with HFrEF of non-ischemic etiology, SGLT-2 inhibitors produced a significant decrease in the risk for the primary composite outcome equal to 18% (RR=0.72, 95% CI: 0.63–0.82, I2=0%). Despite the greater effect in patients with non-ischemic HFrEF, no subgroup difference was detected (p=0.16). Generated results are summarized in Figure 1. Conclusions SGLT-2 inhibitors improve surrogate cardiovascular outcomes both in patients with ischemic and non-ischemic HFrEF. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure

2020 ◽  
Vol 8 ◽  
pp. 205031212094009
Author(s):  
Kamal Waheeb Alghalayini
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Hospital Admission ◽  
Clinical Pathway ◽  
Hospital Admissions ◽  
Medical Condition ◽  
P Value ◽  
Reduced Ejection Fraction ◽  
Heart Failure Clinic ◽  
Infusion Protocol

Introduction: It is proposed that access to administering intravenous furosemide outside the hospital can contribute to lowering hospital admissions for heart failure. This study aims to evaluate the effect of outpatient furosemide infusion protocol in preventing hospitalization for patients with decompensating heart failure. This constitutes designing a viable clinical pathway in hospitals using a multidisciplinary heart failure program. Methods: A prospective interventional study testing the effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure was conducted on 150 decompensating heart failure patients requiring hospital admission. Only 105 patients met the criteria and subsequently enrolled in the study. Each patient was administered intravenous furosemide infusion one or more times according to the protocol and depending on their symptoms of decompensation. Patients were referred for admission at any point once there is no improvement of their medical condition, or referred to heart failure clinic when clinical picture improved as observed by the treating team. Results: In total, 14 of 105 patients who received intravenous furosemide infusion did not respond to diuretic infusion protocol and required hospital admission while 91 patients responded to same protocol and did not require admission, P value was statistically significant in three laboratory test measures of potassium (<0.001), urea (0.004), and creatinine (0.008). Heart failure with reduced ejection fraction was observed in 70 (76.9%) responders with a mean ejection fraction of 23% and in 9 (64.3%) non-responders with mean ejection fraction of 19.9%. Conclusion: Outpatient intravenous furosemide infusion protocol is effective in preventing hospitalization for decompensating heart failure and a viable clinical pathway for heart failure programs.

Characteristics and management of heart failure: a retrospective single center study in Cambodia

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
YOUHOK Lim
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Public Hospital ◽  
Beta Blockers ◽  
P Value ◽  
Total N ◽  
Reduced Ejection Fraction ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background The most common etiologies of cardiovascular disease (CVD) in Cambodia included heart failure (HF) (52.9%), angina pectoris (11.6%), and acute myocardial infarction (4.11%). Purpose The goal of this study is to describe characteristics, clinical features, evaluation and treatment of patients with HF admitted to one public hospital in Cambodia. Methods This retrospective study included all patients age ≥18 years who were admitted with the diagnosis of HF to the Intensive Care Unit of one public hospital from 1st January 2017 to 31st December 2018. Out of 140 cases, 20 were excluded because they did not meet the inclusion criteria. Characteristics, evaluation, and treatment of the 120 remaining patients were analyzed. Results HF with reduced Ejection Fraction (HFrEF) was present in 15%, with mid-range EF (HFmrEF) in 13.3%, and preserved EF (HFpEF) in 71.7% of patients. Hypertension was more prevalent in HFpEF (89.5%, P &lt;0.001) (table 1). Diabetes was more common in HFpEF and HFmrEF (52.3% and 43.7%, P = 0.316) (table 1). Coronary artery disease was more prevalent in HFrEF (72.2%, P = 0.015) (table 1). Global wall hypokinesia was more common in HFrEF group (72.2%, P &lt;0.001) (figure 1). Patients with HFrEF who were given ACEi/ARB (44.4%, P = 0.324) was lower than those with HFpEF (55.8%, P = 0.324). Oral beta-blockers were commonly used in HFrEF (44.4%, P &lt;0.175). Spironolactone was prescribed more in HFmrEF (56.2%, P &lt;0.001) patients than in those with HFrEF (44.4%, P &lt;0.001). Conclusions HFpEF was the most common types of HF in this population, and was associated with hypertension and diabetes. HFrEF was least common and was associated with CAD. Prevention and treatment of hypertension and diabetes is essential to reduce the incidence of HFpEF while greater use of guideline recommended drugs is needed in HFrEF. TABLE 1: Characteristics of HF Patients Clinical characteristics Total (n = 120) HFrEF (n = 18) HFmrEF (n = 16) HFpEF (n = 86) p value Age (years) 58.8 ± 15.2 57.2 ± 16.3 57.3 ± 16.3 61.8 ± 12.9 0.274 Women, n (%) 57 (47.5) 10 (55.5) 4 (25.0) 43 (50.0) 0.14 Men, n (%) 63 (52.5) 8 (44.4) 12 (75.0) 43 (50.0) 0.14 Hypertension, n (%) 95 (79.2) 7 (38.9) 11 (68.7) 77 (89.5) &lt;0.001 Diabetes, n (%) 58 (48.3) 6 (33.3) 7 (43.7) 45 (52.3) 0.316 CAD, n (%) 55 (45.8) 13 (72.2) 9 (56.2) 32 (37.2) 0.015 Values are shown as n (%) or mean ± SD. HFrEF, heart failure with reduced ejection fraction; HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; CAD, coronary artery disease. Abstract FIGURE 1: Proportion of HF and LVWM

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