Prevalence of left bundle branch block and CRT treatment in a large regional unselected ECG database

Abstract Introduction Heart failure is a clinical syndrome in which signs and symptoms are due to functional and/or structural abnormalities of the heart which prevent the necessary supply of oxygenated blood or do so at the expense of high filling pressures. It has a prevalence of 1–2% in the western world and increasing prevalence with increasing age. While the prognosis for coronary heart disease has improved significantly, the same does not apply for heart failure, perhaps because some effective treatment methods have not been sufficiently implemented in health care. One effective but underutilized heart failure treatment is the cardiac resynchronisation therapy (CRT), that coordinates the contraction of the left and right ventricles via a pacemaker (PM). CRT treatment is an evidence based treatment recommended by among other the ESC guidelines for heart failure. Clinical studies have suggested decreases in mortality, hospitalization, morbidity and improvements in quality of life for heart failure patients receiving a CRT. Purpose To find a new clinical pathway to improve CRT implementation and to evaluate if it might be optimized through ECG-based surveillance and thus improving prognosis. Methods In a population of approximately 2.5 million people in our region we investigated the University Hospital's ECG database between 2000 and 2018. During which time 432 108 adult patients with 1 482 489 ECG's presented to the hospital. We searched and found 5 511 unique patients with the following ECG criteria: QRS ≥150 ms at any time, LBBB and Non pace. According to the Pacemaker Registry we excluded 771 patients that had previously received a PM/CRT. We also identified patients with diagnosis of heart failure by using the ICD-10 codes (I42.0 and I50). Results Our final cohort consists of 4 740 patients. The median age was 75 (19–112) years, 34.5% were female and 14.9% were subsequently implanted with a CRT (60% with CRT-D). The median time to CRT implantation from the first ECG with LBBB was 244 (IQR 994) days. Of the 4 740 patients 20.6% had a previous hospitalistion for heart failure with a median delay from the hospitalisation to CRT implantation of 5 (IQR 5.4) years. Conclusions Our observational data from a large real-life regional ECG database show there is a considerable number of heart failure patients that could benefit from CRT treatment. Using an existing ECG database could be useful in finding patients with indication for CRT implantation. This could possibly influence morbidity and mortality in a regional heart failure population by minimizing the delay of CRT treatment. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Karolinska University Hospital Research Fund

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Underlying causes of under-utilization of cardiac resynchronization therapy in real-world heart failure settings

European Heart Journal ◽

10.1093/eurheartj/ehab724.0935 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

E Choha ◽

J Henrysson ◽

E Thunstrom ◽

M Fu ◽

C Basic

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Cardiac Resynchronization Therapy ◽

Real World ◽

Angiotensin Receptor Blockers ◽

Real Life ◽

University Hospital ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Underlying Causes

Abstract Background Despite well-established effectiveness of cardiac resynchronization therapy (CRT) in patients with heart failure (HF), it remained significantly under-utilized. The underlying causes are still not well described. Aim To investigate how many patients with HF were eligible for CRT and determine underlying causes why CRT was abstained for these patients in real life settings. Methods Retrospective review of medical data was carried out in all patients hospitalized for newly diagnosed HF from January 1, 2016 to December 31, 2019. Patients were identified from the local university hospital register with three afiliations by use of international classification of disease (ICD)-10 codes I50.0-I50.9. Medical journals, including electrocardiograms and echocardiograms, were reviewed. The indication for CRT was evaluated three months after mineralocorticoid receptor antagonists (MRA) were initiated as addition to angiotensin converting enzyme inhibitor /angiotensin-receptor blockers and beta-blocker treatment according to European guidelines for heart failure from 2016. Follow-up was minimum one year and up to two years after HF diagnosis. Results In 3456 patients with HF, 642 (18.6%) were patients hospitalized for new onset of HF with ejection fraction (EF) <40%. Out of those, 104 (16.2%) patients were excluded because of incomplete medical record as a result of referral to primary care. Finally, 538 were included in this study. Overall, 163 patients (30.3%) met CRT criteria with 22.5%, 2.6%, 1.9% complying with recommendation IA, IIA, IIB respectively, and 3.9% had more than 50% right ventricular pacing. Only 52 (9.7%) of patients received CRT with mean age 69.3±11.5 years, and 69.2% men and EF 31.9% ± 7.6. In all these patients with HF eligible for CRT, no difference was found in baseline data including hypertension, ischemic heart disease, atrial fibrillation, valvular heart disease, diabetes mellitus, stroke, cancer and renal failure nor medical treatment between those received CRT and those without CRT. Among underlying causes of under-utilization of CRT, 24.3% were due to multiple concomitant comorbidities, 4.5% due to patient's own wish, 12.5% due to other reasons such as socioeconomic problems and 58.6% with unknown reasons. Mortality rates were 20.7% in patients without treatment with CRT compared with 7.7% in those who received CRT (p=0.037). Conclusion In this real world HF cohort, 1/3 patients were eligible for CRT treatment. However only 1/3 received CRT and 58.6% had no contraindication but did not receive CRT, which emphasize urgent need for structured implementation methods for device treatment in patients with HF. FUNDunding Acknowledgement Type of funding sources: None.

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To analyze the effect of introduction of post-discharge follow-up phone calls and weekly educational group sessions policy for heart failure patients by Hahnemann University Hospital on its 30-day re-hospitalization rates for these patients

10.17918/etd-3620 ◽

2021 ◽

Author(s):

Dheeraj Goyal

Keyword(s):

Heart Failure ◽

University Hospital ◽

Post Discharge ◽

Heart Failure Patients ◽

Educational Group ◽

Phone Calls ◽

Hospitalization Rates ◽

Group Sessions

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Study on Heart Failure Patients Admitted in National Institute of Cardiovascular Diseases

Cardiovascular Journal ◽

10.3329/cardio.v13i2.52971 ◽

2021 ◽

Vol 13 (2) ◽

pp. 172-176

Author(s):

Nur Alam ◽

Abdullah Al Shafi Majumder

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Heart Disease ◽

Cardiovascular Diseases ◽

Epidemiological Studies ◽

Clinical Syndrome ◽

Cross Sectional ◽

Common Cause ◽

Heart Failure Patients ◽

Coronary Syndrome

Background: Heart failure is a complex clinical syndrome that arises secondary to abnormalities of cardiac structure and/or function (inherited or acquired) that impair the ability of the left ventricle to fill or eject blood. There is a paucity of data on characteristics of the patients of heart failure admitted in hospitals in terms of demographic and etiological information. So, this study aimed to see the disease burden of heart failure patients and the age and sex specific prevalence of heart failure among patients admitted into NICVD and to identify the etiological pattern of diseases leading to heart failure with associated comorbid factors. Methods: It was a cross sectional study carried out at National Institute of Cardiovascular Diseases (NICVD) Dhaka Bangladesh and was conducted from January 2015 to December 2015. Total 400 heart failure patients were taken. Results: The mean age of the patients were 54 ± 14 years ranging from 16 to 95 years with a high preponderance of male. Most the patient population was in the age group of 51- 60 years (29.5%). 79% of the cases were male & 21% female by gender specification. Ischaemic cardiomyopathy (ICM) was found to be the common cause of heart failure (n=153, 40.75%) followed by Acute coronary syndrome (32.5%) and Valvular heart disease (18.25%). The patients with heart failure having acute coronary syndrome (n=107) had hypertension (46.8%) as the most prevalent major risk factor. In the present study only 11% patient had heart failure with preserved ejection fraction. Mortality rate of the study population were 6.3%. Conclusion: In this study, the most common cause of heart failure is ischaemic heart disease. So, patients of acute and chronic ischemic heart disease patients should be treated and follow up with care. Clinical and epidemiological studies are needed to explore further. Cardiovasc. j. 2021; 13(2): 172-176

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Prognostic value of signs and symptoms in heart failure patients using remote telemonitoring

Journal of Telemedicine and Telecare ◽

10.1177/1357633x211039404 ◽

2021 ◽

pp. 1357633X2110394

Author(s):

Arno Joachim Gingele ◽

Lloyd Brandts ◽

Kjeld Vossen ◽

Christian Knackstedt ◽

Josiane Boyne ◽

...

Keyword(s):

Heart Failure ◽

At Risk ◽

Adverse Events ◽

Confidence Interval ◽

Odds Ratio ◽

Hospital Admissions ◽

Early Recognition ◽

Signs And Symptoms ◽

Clinical Deterioration ◽

Heart Failure Patients

Introduction Heart failure is a serious burden on health care systems due to frequent hospital admissions. Early recognition of outpatients at risk for clinical deterioration could prevent hospitalization. Still, the role of signs and symptoms in monitoring heart failure patients is not clear. The heart failure coach is a web-based telemonitoring application consisting of a 9-item questionnaire assessment of heart failure signs and symptoms and developed to identify outpatients at risk for clinical deterioration. If deterioration was suspected, patients were contacted by a heart failure nurse for further evaluation. Methods Heart failure coach questionnaires completed between 2015 and 2018 were collected from 287 patients, completing 18,176 questionnaires. Adverse events were defined as all-cause mortality, heart failure- or cardiac-related hospital admission or emergency cardiac care visits within 30 days after completion of each questionnaire. Multilevel logistic regression analyses were performed to assess the association between the heart failure coach questionnaire items and the odds of an adverse event. Results No association between dyspnea and adverse events was observed (odds ratio 1.02, 95% confidence interval 0.79–1.30). Peripheral edema (odds ratio 2.21, 95% confidence interval 1.58–3.11), persistent chest pain (odds 2.06, 95% confidence interval 1.19–3.58), anxiety about heart failure (odds ratio 2.12, 95% confidence interval 1.44–3.13), and extensive struggle to perform daily activities (odds ratio 2.23, 95% confidence interval 1.38–3.62) were significantly associated with adverse outcome. Discussion Regular assessment of more than the classical signs and symptoms may be helpful to identify heart failure patients at risk for clinical deterioration and should be an integrated part of heart failure telemonitoring programs.

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Chronic heart failure

Oxford Handbook of Cardiac Nursing ◽

10.1093/med/9780198832447.003.0010 ◽

2020 ◽

pp. 217-240

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Mortality Rate ◽

Adult Population ◽

Age Groups ◽

Severe Heart Failure ◽

Signs And Symptoms ◽

Developed Countries ◽

Clinical Syndrome ◽

The Uk

Heart failure is a complex clinical syndrome of signs and symptoms that suggest the ability of the heart to pump effectively has been impaired. It is distinguished by dyspnoea, effort intolerance, fluid retention, and poor survival. The prevalence of heart failure is around 1–2% in the adult population in developed countries, and 920 000 people in the UK have heart failure. The incidence of heart failure has decreased; however, the number of people newly diagnosed with heart failure has increased. This is thought to be largely due to an ageing population, improvement in the management and survival of people with ischaemic heart disease, and effective treatment of heart failure. The condition can occur in all age groups; however, the incidence and prevalence steeply increase with age. The average age at first diagnosis is typically 77yrs. Chronic heart failure (CHF) has a poor prognosis, the mortality rate for CHF being worse than for many cancers. It is estimated that 70% of those hospitalized for the first time with severe heart failure will die within 5yrs. However, this has been improving, with 6mth mortality rate ↓ from 26% in 1995, 15% in 2009, to 8.9% in 2016. This chapter will outline the aetiology, pathophysiology, and management of CHF, including considerations for palliative care.

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Retrospective application of Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure criteria for the remote management of patients with cardiac resynchronisation therapy

Journal of Telemedicine and Telecare ◽

10.1177/1357633x16647633 ◽

2016 ◽

Vol 23 (4) ◽

pp. 470-475

Author(s):

Francesco MA Brasca ◽

Jessica Franzetti ◽

Valeria Rella ◽

Gabriella Malfatto ◽

Roberto Brambilla ◽

...

Keyword(s):

Heart Failure ◽

Remote Monitoring ◽

Area Under The Curve ◽

Cardiac Resynchronisation Therapy ◽

Failure Criteria ◽

Heart Failure Patients ◽

Patients With Heart Failure ◽

Cardiac Resynchronisation ◽

Acute Decompensation ◽

Resynchronisation Therapy

Aim The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure (PARTNERS HF) trial elaborated a multiparametric model for prediction of acute decompensation in advanced heart failure patients, based on periodical in office data download from cardiac resynchronisation devices. In this study, we evaluated the ability of the PARTNERS HF criteria to detect initial decompensation in a population of moderate heart failure patients under remote monitoring. Methods We retrospectively applied the PARTNERS HF criteria to 1860 transmissions from 104 patients (median follow up 21 months; range 1–67 months), who were enrolled in our programme of telemedicine after cardiac resynchronisation therapy. We tested the ability of a score based on these criteria to predict any acute clinical decompensation occurring in the 15 days following a transmission. Results In 441 cases, acute heart failure was diagnosed after the index transmission. The area under the curve (AUC) of the score for the diagnosis of acute decompensation was 0.752 (confidence interval (CI) 95% 0.728–0.777). The best score cut-off was consistent with the results of PARTNERS HF: with a score ≥2, sensitivity was 75% and specificity 68%. The odds ratio for events was 6.24 (CI 95% 4.90–7.95; p < 0.001). Conclusions When retrospectively applied to remote monitoring transmissions and arranged in a score, PARTNERS HF criteria could identify HF patients who subsequently developed acute decompensation. These results warrant prospective studies applying PARTNERS HF criteria to remote monitoring.

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