Negative impact of socioeconomic deprivation on clinical outcomes after cryoablation for atrial fibrillation: 18-month study

Abstract Background Lower socioeconomic status has also been shown to associate with higher incidence of atrial fibrillation (AF), increased mortality and morbidity. However, the impact of socioeconomic deprivation on clinical outcomes post AF cryoablation has yet to be investigated. Aim To assess the impact of socioeconomic deprivation (as categorised by Scottish Index of Multiple Deprivation, SIMD) on the medical management and clinical outcomes of patients with AF post cryoablation. Methods A retrospective study of paroxysmal or persistent AF patients after cryoablation. Parameters included basic demographics, weight, past medical history (hypertension, heart failure, diabetes, stroke, myocardial infarction, sleep apnoea) and alcohol misuse. Medical treatment post ablation (Beta blocker, calcium channel blocker, flecainide, amiodarone, dronaderone, sotolol, anticoagulant use) were also recorded. Socioeconomic deprivation index, as per SIMD was recorded (1 – most deprived and 10 – least deprived), and accordingly placed into quintile (SIMD 1–2,3–4,5–6,7–8, 9–10). Follow-up for 18 months. Clinical outcome assessed was rate of readmission for symptomatic AF, rate of heart failure admission, stroke, bleeding diathesis and all-cause mortality. Results 383 patients were identified: 78 from the lowest quintile (SIMD 1–2), 68 (SIMD 3–4), 64 (SIMD 5–6), 62 (SIMD 7–8), and 111 from the highest quintile (SIMD 9–10). No statistical difference exists between age, gender or weight. Lowest socioeconomic quintile has higher incidence of heart failure (p=0.006) and hypertension (p=0.005) but other past medical history was no different. No difference in incidence of alcohol misuse. Medicine prescription was not different. Echo features: left ventricular function, atrial size and valvular dysfunction were not different between all groups. 18 months follow-up demonstrated that both readmission for symptomatic documented AF and recurrence of symptoms at 18 months were higher among patients of lowest socioeconomic quintile (Keplan Meier plot, p=0.014 and p=0.006 respectively). Stepwise multiple regression analysis also confirmed multiple socioeconomic deprivation as an independent predictor for more adverse clinical outcome (p=0.02). Risk of symptom recurrence at 18 months in patients from the least deprived background is less than one third as compared to the ones from the most deprived background (Odd-ratio 0.32 (0.17 - 0.59)) Risk of readmission for AF in patients from the wealthiest socioeconomic group is also less than a third as compared to those of most deprived social group (Odd-ratio 0.31 (95% CI 0.15–0.61)). Other clinical outcomes including risk of admissions for heart failure, stroke, bleeding diathesis and all-cause mortality was not statistically different across all groups. Summary After cryoablation, patients from the lowest socioeconomic group are more likely to experience symptoms recurrence and readmission for symptomatic AF FUNDunding Acknowledgement Type of funding sources: None.

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Socioeconomic deprivation and 1 year clinical outcomes after cryablation for atrial fibrillation

EP Europace ◽

10.1093/europace/euab116.189 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

Y Lau ◽

O Cimpeanu ◽

GE Marshall ◽

GJ Padfield ◽

GA Wright ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcomes ◽

Alcohol Misuse ◽

Socioeconomic Deprivation ◽

Socioeconomic Group ◽

Bleeding Diathesis ◽

Lower Socioeconomic ◽

All Cause Mortality ◽

The Impact

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Socioeconomic deprivation has previously been demonstrated to result in worse heart failure and myocardial infarction outcomes. Published studies shown lower socioeconomic group to associate with higher prevalence of atrial fibrillation (AF), increased mortality and morbidity. However, the impact of socioeconomic deprivation on clinical outcomes post AF cryoablation has yet to be investigated. AIM To assess the impact of socioeconomic deprivation (as categorised by Scottish Index of Multiple Deprivation, SIMD) on the medical management and clinical outcomes of patients with AF treated by cryoablation. METHODS A retrospective study of paroxysmal or persistent AF patients after cryoablation. The parameters included basic demographics, weight, past medical history (inclusive of hypertension, heart failure, diabetes, stroke or transient ischaemic attacks, prior myocardial infarction, obstructive sleep apnoea) and alcohol misuse. Medical treatment post AF ablation (Beta blocker, non-dihydropyridine calcium channel blocker, flecainide, amiodarone, dronaderone, sotolol, anticoagulant use) were also recorded. Individual’s socioeconomic deprivation index, as described SIMD was also recorded (1 – most deprived and 10 – least deprived), and accordingly placed into quintile (SIMD 1-2,3-4,5-6,7-8, 9-10). Follow-up for 12 months. Clinical outcome assessed was rate of readmission for symptomatic documented AF, rate of heart failure admission, stroke, bleeding diathesis and all-cause mortality. RESULTS 312 patients were identified: 65 from the lowest quintile (SIMD 1-2), 57 from SIMD 3-4, 54 from SIMD 5-6, 52 from SIMD 7-8, and 84 from the highest quintile (SIMD 9-10). No statistical difference exists between age, gender or weight. Lowest socioeconomic quintile has higher incidence of heart failure (p =0.018) but other past medical history was no different. No difference in incidence of alcohol misuse. Prescription rate/rhythm control agents and anticoagulant use post ablation was not statistically different between all groups. 12 months follow-up demonstrated readmission for symptomatic documented AF was statistically higher among patients of lowest socioeconomic quintile (Keplan Meier plot, p = 0.001). Stepwise multiple regression analysis also confirmed multiple socioeconomic deprivation as an independent predictor for more adverse clinical outcome (p = 0.02). Risk of readmission for AF in patients from the wealthiest socioeconomic group is almost a quarter as compared to those of most deprived social group (Odd-ratio 0.273 (95% CI 0.122 – 0.607)). Other clinical outcomes including risk of admissions for heart failure, stroke, bleeding diathesis and all-cause mortality was not statistically different across all groups. Summary After cryoablation for AF, patients from the lower socioeconomic group are still more likely to experience readmission for symptomatic AF at 12-month, despite similar post-procedure pharmaceutical agents utilised.

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P5472Social economic deprivation and adverse clinical outcomes after acute coronary syndrome

European Heart Journal ◽

10.1093/eurheartj/ehz746.0426 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y C Lau ◽

J Latter ◽

A Jong ◽

R Weir

Keyword(s):

Clinical Outcome ◽

Secondary Prevention ◽

Clinical Outcomes ◽

Statistical Difference ◽

Independent Predictor ◽

Composite Endpoint ◽

Socioeconomic Deprivation ◽

Angiotensin Ii Receptor Blocker ◽

The Impact

Abstract Background NHS was created in 1948 to redress the healthcare inequality through provision of universal healthcare service in the UK. However even of late, significant health inequality persists. Socioeconomic deprivation is known to result in increased overall morbidity and mortality. Aim To assess the impact of socioeconomic deprivation (as categorised by Scottish Index of Multiple Deprivation, SIMD) on the medical management and clinical outcomes of patients with ACS (NSTEMI/STEMI) who were treated with PCI Methods A retrospective study of NSTEMI/NSTEMI patients after inpatient treatment with coronary angiogram and PCI. The parameters include basic demographics, risk factors, LV EF on echocardiogram, lipid profile and discharge medication. Individual's socioeconomic deprivation index, as described SIMD was also recorded (1 – most deprived and 10 – least deprived), and accordingly placed into quintile (SIMD 1–2, 3–4, 5–6,7 –8, 9–10). Follow-up for 24 months. Clinical outcome assessed was composite endpoint event of MACE. Results 357 from the lowest quintile (SIMD 1–2), 319 from SIMD 3–4, 191 from SIMD 5–6, 120 from SIMD 7–8, and 99 from the highest quintile (SIMD 9–10) were included. No statistical difference exists between age or gender. No difference in past medical history (inclusive of hypertension, diabetes, dyslipidemia, family history. No difference in incidence of nicotine use. Prescription of aspirin, P2Y12 inhibitors (clopidogrel, ticagrelor or prasugrel) as well as secondary prevention medications (such as ace inhibitor/angiotensin II receptor blocker, beta blocker, statin and GTN) were good and not statistically different between all groups. No statistical difference exists between all groups relating to pre-discharge LV ejection fraction on echocardiogram or random cholesterol level check on admission. 24 months follow-up demonstrated composite endpoint of MACE was statistically higher among patients of lowest socioeconomic quintile (Kaplan Meier plot, p<0.001). Step-wise multiple regression analysis also confirmed multiple socioeconomic deprivation as an independent predictor for more adverse clinical outcomes (p<0.001, R2=14.5%). Patients from the least deprived quintile possess survival advantage almost 14-folds as compared to those of most deprived group (Odd-ratio 13.8 (95% CI: 39.4–48.5)). Summary After an ACS event, despite initial coronary intervention and subsequent optimal prescription of prognostically beneficial secondary prevention medications, patients from the lower socioeconomic group (as described by SIMD) are still more likely to experience readmission for cardiovascular death, non-fatal myocardial infarction and non-fatal stroke. Socioeconomic deprivation has been shown to be an independent predictor of adverse clinical outcome for those who survived initial ACS. Acknowledgement/Funding None

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Impact of Acute Hemoglobin Falls in Heart Failure Patients: A Population Study

Journal of Clinical Medicine ◽

10.3390/jcm9061869 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1869

Author(s):

Cristina Lopez ◽

Jose Luis Holgado ◽

Antonio Fernandez ◽

Inmaculada Sauri ◽

Ruth Uso ◽

...

Keyword(s):

Heart Failure ◽

Kidney Injury ◽

First Episode ◽

Heart Failure Patients ◽

Risk Of Mortality ◽

All Cause Mortality ◽

The Impact ◽

Worse Prognosis ◽

Significant Mortality

Aims: This study assessed the impact of acute hemoglobin (Hb) falls in heart failure (HF) patients. Methods: HF patients with repeated Hb values over time were included. Falls in Hb greater than 30% were considered to represent an acute episode of anemia and the risk of hospitalization and all-cause mortality after the first episode was assessed. Results: In total, 45,437 HF patients (54.9% female, mean age 74.3 years) during a follow-up average of 2.9 years were analyzed. A total of 2892 (6.4%) patients had one episode of Hb falls, 139 (0.3%) had more than one episode, and 342 (0.8%) had concomitant acute kidney injury (AKI). Acute heart failure occurred in 4673 (10.3%) patients, representing 3.6/100 HF patients/year. The risk of hospitalization increased with one episode (Hazard Ratio = 1.30, 95% confidence interval (CI) 1.19–1.43), two or more episodes (HR = 1.59, 95% CI 1.14–2.23, and concurrent AKI (HR = 1.61, 95% CI 1.27–2.03). A total of 10,490 patients have died, representing 8.1/100 HF patients/year. The risk of mortality was HR = 2.20 (95% CI 2.06–2.35) for one episode, HR = 3.14 (95% CI 2.48–3.97) for two or more episodes, and HR = 3.20 (95% CI 2.73–3.75) with AKI. In the two or more episodes and AKI groups, Hb levels at the baseline were significantly lower (10.2–11.4 g/dL) than in the no episodes group (12.8 g/dL), and a higher and significant mortality in these subgroups was observed. Conclusions: Hb falls in heart failure patients identified those with a worse prognosis requiring a more careful evaluation and follow-up.

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Renal Function during Hospitalization and Outcome in Chinese Patients with Acute Decompensated Heart Failure

10.21203/rs.3.rs-1098724/v1 ◽

2021 ◽

Author(s):

Hao-Wei Lee ◽

Chin-Chou Huang ◽

Chih-Yu Yang ◽

Hsin-Bang Leu ◽

Po-Hsun Huang ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Clinical Outcomes ◽

Acute Decompensated Heart Failure ◽

Significant Risk ◽

Decompensated Heart Failure ◽

Chinese Patients ◽

Cox Regression Analysis ◽

The Impact

Abstract It is well known that the heart and kidney have a bi-directional correlation, in which organ dysfunction results in maladaptive changes in the other. We aimed to investigate the impact of renal function and its decline during hospitalization on clinical outcomes in patients with acute decompensated heart failure (ADHF). A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four-variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF), defined as eGFR decline between admission (eGFRadmission) and pre-discharge (eGFRpredischarge), occurred in 41 patients. Clinical outcomes during the follow-up period were defined as 4P-major adverse cardiovascular events (4P-MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization. During an average follow-up period of 2.6±3.2 years, 66 patients experienced 4P-MACE. Cox regression analysis revealed that impaired eGFRpredischarge, but not eGFRadmission or WRF, was significantly correlated with the development of 4P-MACE (HR, 2.003; 95% CI, 1.072–3.744; P=0.029). In conclusion, impaired renal function before discharge, but not WRF, is a significant risk factor for poor outcomes in patients with ADHF.

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Long-term impact of baseline anaemia on clinical outcomes following percutaneous coronary intervention in stable angina

Open Heart ◽

10.1136/openhrt-2020-001319 ◽

2020 ◽

Vol 7 (2) ◽

pp. e001319

Author(s):

Line Davidsen ◽

Kristian Hay Kragholm ◽

Mette Aldahl ◽

Christoffer Polcwiartek ◽

Christian Torp-Pedersen ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Clinical Outcomes ◽

Stable Angina ◽

Coronary Intervention ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

All Cause Mortality ◽

The Impact

BackgroundIn patients with stable angina (SA), the clinical benefits of percutaneous coronary intervention (PCI) reside almost exclusively within the realm of symptomatic improvement rather than improvement in hard clinical endpoints. The benefits of PCI should always be balanced against its potential short-term and long-term risks. Common among these risks is the presence of anaemia and its interaction with poor clinical outcomes and increased morbidity; this study aims to elucidate the impact of anaemia on long-term clinical outcomes of this patient group.MethodsFrom Danish national registries, we identified patients with SA treated with PCI who had a haemoglobin measurement maximum of 90 days prior to PCI procedure. Anaemia was defined as haemoglobin <130 and <120 g/L in men and women, respectively. Follow-up was up to 3 years after PCI, and Cox regression was used to estimate HRs with 95% CIs of hospitalisation due to bleeding, acute coronary syndrome (ACS) and all-cause mortality in patients with anaemia compared with patients without anaemia.ResultsOf 2837 included patients, 14.6% had anaemia prior to PCI. During follow-up, 93 patients (3.3%) had a bleeding episode, which was higher in patients with anaemia (5.8%) compared with patients without anaemia (2.8%). A total of 213 patients (7.5%) developed ACS, which was higher in patients with anaemia (10.6%) compared with patients without anaemia (7.0%). Furthermore, 185 patients (6.5%) died, with a mortality rate of 18.1% in patients with anaemia compared with 4.5% in patients without anaemia. In multivariable analyses, anaemia was associated with a significantly increased risk of bleeding (HR 1.69; 95% CI 1.04 to 2.73; P 0.033), ACS (HR 1.47; 95% CI 1.04 to 2.10; P 0.031) and all-cause mortality (HR 2.41; 95% CI 1.73 to 3.30; P <0.001).ConclusionAnaemia in patients with SA was significantly associated with bleeding, ACS and all-cause mortality following PCI.

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The Added Value of In-Hospital Tracking of the Efficacy of Decongestion Therapy and Prognostic Value of a Wearable Thoracic Impedance Sensor in Acutely Decompensated Heart Failure With Volume Overload: Prospective Cohort Study (Preprint)

10.2196/preprints.12141 ◽

2018 ◽

Author(s):

Christophe J P Smeets ◽

Seulki Lee ◽

Willemijn Groenendaal ◽

Gabriel Squillace ◽

Julie Vranken ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcomes ◽

Fluid Balance ◽

Volume Overload ◽

Decompensated Heart Failure ◽

Added Value ◽

Thoracic Impedance ◽

Fluid Status ◽

All Cause Mortality

BACKGROUND Incomplete relief of congestion in acute decompensated heart failure (HF) is related to poor outcomes. However, congestion can be difficult to evaluate, stressing the urgent need for new objective approaches. Due to its inverse correlation with tissue hydration, continuous bioimpedance monitoring might be an effective method for serial fluid status assessments. OBJECTIVE This study aimed to determine whether in-hospital bioimpedance monitoring can be used to track fluid changes (ie, the efficacy of decongestion therapy) and the relationships between bioimpedance changes and HF hospitalization and all-cause mortality. METHODS A wearable bioimpedance monitoring device was used for thoracic impedance measurements. Thirty-six patients with signs of acute decompensated HF and volume overload were included. Changes in the resistance at 80 kHz (R80kHz) were analyzed, with fluid balance (fluid in/out) used as a reference. Patients were divided into two groups depending on the change in R80kHz during hospitalization: increase in R80kHz or decrease in R80kHz. Clinical outcomes in terms of HF rehospitalization and all-cause mortality were studied at 30 days and 1 year of follow-up. RESULTS During hospitalization, R80kHz increased for 24 patients, and decreased for 12 patients. For the total study sample, a moderate negative correlation was found between changes in fluid balance (in/out) and relative changes in R80kHz during hospitalization (rs=-0.51, P<.001). Clinical outcomes at both 30 days and 1 year of follow-up were significantly better for patients with an increase in R80kHz. At 1 year of follow-up, 88% (21/24) of patients with an increase in R80kHz were free from all-cause mortality, compared with 50% (6/12) of patients with a decrease in R80kHz (P=.01); 75% (18/24) and 25% (3/12) were free from all-cause mortality and HF hospitalization, respectively (P=.01). A decrease in R80kHz resulted in a significant hazard ratio of 4.96 (95% CI 1.82-14.37, P=.003) on the composite endpoint. CONCLUSIONS The wearable bioimpedance device was able to track changes in fluid status during hospitalization and is a convenient method to assess the efficacy of decongestion therapy during hospitalization. Patients who do not show an improvement in thoracic impedance tend to have worse clinical outcomes, indicating the potential use of thoracic impedance as a prognostic parameter.

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Atrial Fibrillation in Patients With Cardiomyopathy: Prevalence and Clinical Outcomes From Real‐World Data

Journal of the American Heart Association ◽

10.1161/jaha.121.021970 ◽

2021 ◽

Author(s):

Benjamin J. R. Buckley ◽

Stephanie L. Harrison ◽

Dhiraj Gupta ◽

Elnara Fazio‐Eynullayeva ◽

Paula Underhill ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Clinical Outcomes ◽

Restrictive Cardiomyopathy ◽

The United States ◽

Research Network ◽

Real World Data ◽

All Cause Mortality ◽

Incident Heart Failure ◽

The Impact

Background Cardiomyopathy is a common cause of atrial fibrillation (AF) and may also present as a complication of AF. However, there is a scarcity of evidence of clinical outcomes for people with cardiomyopathy and concomittant AF. The aim of the present study was therefore to characterize the prevalence of AF in major subtypes of cardiomyopathy and investigate the impact on important clinical outcomes. Methods and Results A retrospective cohort study was conducted using electronic medical records from a global federated health research network, with data primarily from the United States. The TriNetX network was searched on January 17, 2021, including records from 2002 to 2020, which included at least 1 year of follow‐up data. Patients were included based on a diagnosis of hypertrophic, dilated, or restrictive cardiomyopathy and concomitant AF. Patients with cardiomyopathy and AF were propensity‐score matched for age, sex, race, and comorbidities with patients who had a cardiomyopathy only. The outcomes were 1‐year mortality, hospitalization, incident heart failure, and incident stroke. Of 634 885 patients with cardiomyopathy, there were 14 675 (2.3%) patients with hypertrophic, 90 117 (7.0%) with restrictive, and 37 685 (5.9%) with dilated cardiomyopathy with concomitant AF. AF was associated with significantly higher odds of all‐cause mortality (odds ratio [95% CI]) for patients with hypertrophic (1.26 [1.13–1.40]) and dilated (1.36 [1.27–1.46]), but not restrictive (0.98 [0.94–1.02]), cardiomyopathy. Odds of hospitalization, incident heart failure, and incident stroke were significantly higher in all cardiomyopathy subtypes with concomitant AF. Among patients with AF, catheter ablation was associated with significantly lower odds of all‐cause mortality at 12 months across all cardiomyopathy subtypes. Conclusions Findings of the present study suggest AF may be highly prevalent in patients with cardiomyopathy and associated with worsened prognosis. Subsequent research is needed to determine the usefulness of screening and multisdisciplinary treatment of AF in this population.

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Abstract 15114: Paradoxical Association of Ventricular Tachyarrhythmias and All-Cause Mortality in Patients With Renal Impairment: a MADIT-CRT Substudy

Circulation ◽

10.1161/circ.130.suppl_2.15114 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Usama Daimee ◽

Arthur Moss ◽

Ilan Goldenberg ◽

Martin Ruwald ◽

Wojciech Zareba ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Renal Dysfunction ◽

Lower Risk ◽

Ventricular Tachyarrhythmias ◽

Heart Failure Patients ◽

Mild Heart Failure ◽

All Cause Mortality ◽

The Impact

Background: The risk of ventricular tachyarrhythmias (VTAs) in mild heart failure patients with renal dysfunction receiving cardiac resynchronization therapy plus an implantable cardioverter-defibrillator (CRT-ICD) or an ICD alone is not well understood. Hypothesis: We assessed the hypothesis that baseline renal function affects risk of VTAs and all-cause mortality as well as benefit derived from CRT-ICD during in-trial follow-up. Methods: We evaluated the impact of renal function in 1274 patients with mild heart failure and left-bundle branch block enrolled in MADIT-CRT. Patients with BUN>70 mg/dl or creatinine>3.0 mg/dl were excluded from the trial. Two subgroups were created based on the estimated glomerular filtration rate (GFR): GFR<60 and GFR≥60 ml/min/1.73 m2. Patients were studied over 3.3 years of follow-up for endpoints of ventricular tachycardia ≥200 beats per minute or ventricular fibrillation (fast VT/VF) and all-cause mortality. Results: The 413 patients with GFR<60 ml/min/1.73 m2 (mean 48.1±8.3) experienced lower risk of fast VT/VF (HR: 0.63, 95% CI: 0.44-0.90, p=0.012) but increased risk of death (HR: 2.43, 95% CI: 1.67-3.57, p<0.001), relative to those in the GFR≥60 group (mean 79.6±16.0) [Figure]. For both, CRT-ICD relative to ICD-only treatment was associated with lower likelihood of fast VT/VF (GFR<60: HR=0.46, 95% CI: 0.24-0.86, p=0.016; GFR≥60: HR=0.54, 95% CI: 0.38-0.76, p<0.001) without a significant effect on death (GFR<60: HR=0.62, 95% CI: 0.38-1.04, p=0.065; GFR≥60: HR=0.78, 95% CI: 0.45-1.36, p=0.379). There was no significant treatment interaction for the endpoints (p>0.10). Conclusion: In conclusion, in mild heart failure patients, moderate renal dysfunction is associated with lower risk of VTAs but greater risk of all-cause mortality relative to mildly impaired-to-normal renal function. In both groups, similar benefit from CRT-ICD was found in reducing risk of VTAs.

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Impact of Platelet-to-Lymphocyte Ratio on Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction

Angiology ◽

10.1177/0003319716657258 ◽

2016 ◽

Vol 68 (4) ◽

pp. 346-353 ◽

Cited By ~ 13

Author(s):

Xi-Peng Sun ◽

Jing Li ◽

Wei-Wei Zhu ◽

Dong-Bao Li ◽

Hui Chen ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Ischemic Stroke ◽

Clinical Outcomes ◽

St Segment Elevation ◽

Recurrent Myocardial Infarction ◽

St Segment ◽

All Cause Mortality ◽

Infarction Heart

We investigated the association between platelet-to-lymphocyte ratio (PLR) and clinical outcomes (including all-cause mortality, recurrent myocardial infarction, heart failure, serious cardiac arrhythmias and ischemic stroke) in patients with ST-segment elevation myocardial infarction (STEMI). Based on PLR quartiles, 5886 patients with STEMI were categorized into 4 groups: <98.8 (n = 1470), 98.8 to 125.9 (n = 1474), 126.0 to 163.3 (n = 1478), >163.3 (n = 1464), respectively. We used Cox proportional hazards models to examine the relation between PLR and clinical outcomes. Mean duration of follow-up was 81.6 months, and 948 patients (16.1%) died during follow-up. The lowest mortality occurred in the lowest PLR quartile group ( P = 0.006), with an adjusted hazard ratio of 1.18 (95% confidence interval [CI], 1.04-1.55), 1.31 (95% CI, 1.18-1.64), and 1.59 (95% CI, 1.33-1.94) in patients with PLR of 98.8 to 125.9, 126.0 to 163.3, >163.3, respectively. Higher levels of PLR were also associated with recurrent myocardial infarction ( Ptrend = .023), heart failure ( Ptrend = .018), and ischemic stroke ( Ptrend = .043). In conclusion, a higher PLR was associated with recurrent myocardial infarction, heart failure, ischemic stroke, and all-cause mortality in patients with STEMI.

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P6335The impact of patient's adherence to maintenance of euvolaemia on all-cause mortality and heart failure re-hospitalization: insights from the Optimize Heart Failure Care Program

European Heart Journal ◽

10.1093/eurheartj/ehz746.0932 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y Lopatin ◽

A Grebennikova ◽

Z Pagava ◽

S Berkinbayev ◽

M Glezer ◽

...

Keyword(s):

Heart Failure ◽

Weight Control ◽

Fluid Intake ◽

Self Care ◽

Care Program ◽

Poor Adherence ◽

Heart Failure Care ◽

All Cause Mortality ◽

The Impact

Abstract Background Four recommended self-care behaviors (low salt diet, avoidance of excessive fluid intake, weight control, and flexible diuretic regimen) play an important role in the management of heart failure (HF) patients. However, little is known about the impact of patients' adherence to these self-care behaviors on prognosis and rate of HF re-hospitalizations. The aim of our study was to analyze the impact of HF patients' adherence to maintenance of euvolaemia on all-cause mortality and HF re-hospitalizations. Methods The analysis included data from the international prospective multicenter Optimize Heart Failure Care Program which was collected over 12 months from 628 patients (mean age 62.6±12.3 years, 70% male) hospitalized with decompensated HF, NYHA II-IV (mean 2.7±0.6), mean left ventricular ejection fraction 33.8±9.4%. The underlying etiology of HF was ischemic in 64% of cases. Before discharge from the hospital all HF patients were educated in self-care skills to maintain the euvolaemia. To assess patients' adherence to low salt diet, avoidance of excessive fluid intake, weight control and flexible diuretic regimen, an indirect method (patient-reported compliance, which was measured using a special questionnaire) was used. Three types of adherence were determined: good (patients always maintained euvolaemia), moderate (patients sometimes maintained euvolaemia) and poor adherence (patients did not maintain euvolaemia). Results After discharge from the hospital the overall adherence rates were 66.4% for low sodium diet, 58% for fluid intake, 69.9% for weight control, and 87.2% for the flexible diuretic regimen. However, the adherence to diet and the flexible diuretic regimen significantly decreased (p<0.01) by the 12 months of follow-up. Good, moderate and poor adherence to maintain euvolaemia were noted in 40%, 31.5% and 28.5% patients, respectively. After 12 months of follow-up all-cause mortality and rate of HF re-hospitalizations and were significantly lower in the group of good patients' adherence in comparison with moderate and poor patients' adherence (HR 0.72, 95% CI 0.61–0.84, p<0.0001) (Figure). Conclusion Less than half of HF patients demonstrated good adherence to the guideline-recommended control of euvolaemia. The rates of all-cause mortality and HF re-hospitalizations in the group of good patient's adherence were significantly lower compared with the groups of moderate and poor adherence to maintenance of euvolaemia. Constant efforts to promote the maintenance of euvolaemia in HF patients are needed.

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