scholarly journals Door-to-Furosemide time effects on in-hospital mortality and length of stay in acute heart failure patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K.V Viriyanukulvong ◽  
A.H Han-Gla ◽  
J.P Phannajit ◽  
A.A Ariyachaipanich
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Early Treatment ◽  
Hospital Death ◽  
Single Center ◽  
Hospital Outcomes ◽  
Baseline Serum ◽  
Funding Sources ◽  
Patient Arrival

Abstract Background Acute heart failure (AHF) is a common cause of hospitalization and mortality. Time-to-therapy concept may help improve in-hospital outcomes. Objective To evaluate In-hospital outcomes after receiving early versus delayed furosemide injection among AHF patients. Method Retrospective single-center cohort study included patients who were admitted with AHF through ED during 1 July 2017 to 31 Dec 2019. Door-to-furosemide (D2F) time was defined as the time from patient arrival at the ED to the first intravenous furosemide injection within 24 hours. Patients with a D2F time ≤60 min were classified as the early treatment group. Primary outcome was in-hospital mortality and secondary outcomes were in-hospital morbidities. Adjusted odd ratio and the 95% confidence interval (CI) were represented using multiple logistic regression adjusted for age, sex, weight, furosemide dose, and baseline serum creatinine. Results Among 820 enrolled AHF patients, the median D2F time was 80.5 min (interquartile range: 42 to 187 min). of those 324 (39%) patients were categorized into early D2F time group. The rate of total in-hospital death was 4.9% and did not differ between groups (3.1% vs. 6%, early vs delayed D2F group; p=0.067). In multivariate analysis, early treatment is not significantly associated with lower in-hospital mortality (odd ratio: 0.57; 95% CI: 0.27–1.23; p=0.152) as well as secondary endpoints. Conclusions In this small single-center study, early treatment with furosemide was uncommon. Less than half of admitted patients were received furosemide within 1 hour. In-hospital mortality was double in delayed group but was not statistically significant. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Effects of levosimendan in patients with acute heart failure and cardiorenal syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Ribeiro Da Silva ◽  
G Santos Silva ◽  
D Caeiro ◽  
M Passos Silva ◽  
C Guerreiro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Natriuretic Peptides ◽  
Angiotensin Receptor Blockers ◽  
Cardiorenal Syndrome ◽  
Baseline Serum ◽  
Beneficial Effects ◽  
Funding Sources ◽  
Tertiary Center ◽  
Short Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiorenal syndrome (CRS) is common in patients with acute heart failure (AHF) and is associated with poor prognosis. Levosimendan (LVS) is an inodilator used in AHF and has beneficial effects on renal function (RF). However, its effects on RF in CRS patients are not established. Purpose To evaluate whether LVS could improve RF in AHF patients with or without CRS. Methods Retrospective study that included patients with AHF treated with LVS in a cardiac intensive care unit of a tertiary center, between January 2015 and June 2018. Baseline serum creatinine (SCr) was recorded and SCr and glomerular filtration rate (GFR) were accessed before and within 5 days after LSV use. CRS was defined as an increase in SCr > 0,3 mg/dL over baseline (before LVS use). RF improvement was defined as a decrease in SCr after LVS use. We evaluate outcomes at 1-year. Results 61 patients were included, 84% males, mean age 65 years, ejection fraction ≤40% in 87%. INTERMACS 4 and hemodynamic profile C were the most frequent presentation. LSV was administered in 24h, without bolus, in most patients. CRS was present in 44,3% of patients. Basal characteristics were similar between CRS and no-CRS patients, including prevalence of chronic kidney disease, baseline SCr or natriuretic peptides (p> 0,05 for all). CRS patients had a significant improvement in RF after LVS use (SCr 2,08 to 1,65 mg/dL, p< 0,001 and GFR 40,4 to 54,6 mL/min/m2, p< 0,001), while no-CRS patients had no significant improvement in RF (SCr 1,33 to 1,32 mg/dL and GFR 64,1 to 64,5 mL/min/m2, p> 0,05 for all). Also, there was a significant decrease in natriuretic peptides after LVS in CRS patients (NT-proBNP 13527,5 to 10708,8 pg/mL, p= 0,006), without significant differences in no-CRS patients. It is noteworthy that at discharge, CRS patients were more likely to titrate HF optimal medical therapy (OMT) compared with no-CRS patients (p= 0,039). There was a lower tendency to suspend angiotensin-converting enzyme (ACE-I) and angiotensin receptor blockers (ARB) in CRS patients (p= 0,05). At discharge CRS patients received more furosemide than at admission (77,2 mg/day to 97,1 mg/day, p= 0,019) compared with no-CRS patients (89,6 mg/day to 97,0 mg/day, p= 0,469), receiving similar doses at discharge. In CRS patients, RF improvement was associated with a decrease in intra-hospital mortality (p= 0,043) and a tendency to decrease 30-day mortality (p= 0,060), but without differences in one-year mortality. Conclusion In CRS patients, LVS improved RF and NT-proBNP, allowed to titrate OMT and decreased the need to suspend ACE-I or ARB and was associated to a decrease in short-term mortality.

scholarly journals Impact of acute kidney injury on in-hospital outcomes among patients hospitalized with acute heart failure: a propensity score matched analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Shetty ◽  
H Malik ◽  
A Abbas ◽  
Y Ying ◽  
W Aronow ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Kidney Injury ◽  
Matched Cohort ◽  
Hospital Outcomes ◽  
Increased Risk ◽  
The Impact

Abstract Background Acute kidney injury (AKI) is frequently present in patients admitted for acute heart failure (AHF). Several studies have evaluated the mortality risk and have concluded poor prognosis in any patient with AKI admitted for AHF. For the most part, the additional morbidity and mortality burden in AHF patients with AKI has been attributed to the concomitant comorbidities, and/or interventions. Purpose We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes in patients presenting with acute heart failure (AHF). We identified isolated AKI patients after excluding other concomitant diagnoses and procedures, which may contribute to an increased risk of mortality and morbidity. Methods Data from the National Inpatient Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF and the concomitant secondary diagnosis of AKI. Propensity score matching was performed on 30 baseline variables to identify a matched cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital procedures and complications. Results Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching a matched cohort of 356,940 patients was identified. In this matched group, the AKI group had significantly higher in-hospital mortality (3.8% vs 1.7%, p<0.001). Complications such as sepsis and cardiac arrest were higher in the AKI group. Similarly, in-hospital procedures including CABG, mechanical ventilation and IABP were performed more in the AKI group. AHF patients with AKI had longer in-hospital stay of ∼1.7 days. Conclusions In a propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital mortality was >2-fold in the AKI group. Healthcare utilization and burden of complications were higher in the AKI group. Funding Acknowledgement Type of funding source: None

scholarly journals Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Selcuk ◽  
M Keskin ◽  
T Cinar ◽  
N Gunay ◽  
S Dogan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Troponin I ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Previous History ◽  
Hospital Death ◽  
Funding Sources ◽  
Elevated Glucose ◽  
Artery Disease

Abstract Introduction The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95% CI: 0.76–0.97). Conclusion The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Factors Associated with Intra-hospital Mortality of Peripartum Cardiomyopathy Patients in Northcentral Nigeria

2021 ◽  
pp. 1-10
Author(s):  
Ogunmodede James Ayodele ◽  
Kolo Philip Manma ◽  
Dele-Ojo Bolade Folashade ◽  
Ogunmodede Adebusola Jane ◽  
Yusuf Idris Abiola ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Serum Sodium ◽  
Survival Curve ◽  
Severe Heart Failure ◽  
Peripartum Cardiomyopathy ◽  
Hospital Death ◽  
Hospital Outcomes ◽  
Targeted Interventions ◽  
Factors Associated

Aims:  We studied the patient characteristics, intra-hospital outcomes and factors associated with intra-hospital mortality in patients admitted for Peripartum Cardiomyopathy (PPCM) in our centre using data from the Ilorin Heart failure Registry. Study design: Prospective Observational Methodology: All the 22 confirmed PPCM patients admitted between January 1, 2016 and December 31, 2019 were recruited and followed up for intra-hospital outcomes. The primary outcome was all-cause intra-hospital mortality. Results: Intra-hospital death occurred in four out of 22 patients (18.2%). The mean age of all patients was 28.4 ± 4.8 years and it was similar in both survivors and patients who died (P=0.960). Majority of patients (14, 63.7%) presented in New York Heart Association Class IV. Mean duration of hospital stay was 11 + 5.7days which was similar between patients who died and those who survived hospital admission (9.0 ± 2.8 vs 11.4 ± 6.1, P=0.457). Median ECG heart rate was 120 (116-123) bpm which was similar between both groups. Factors associated with mortality were biochem ical parameters serum sodium and eGFR which were significantly lower among those who died (125.0 ± 4.1 vs 133.7 ± 2.5mmol/L, P=<0.001; 41.0 ± 18.8 vs 81.9 ± 11.03 mls/min/1.73m2, P<0.001) and the Ejection fraction (EF) and Fractional Shortening (FS) which were also significantly lower in the patients who died 24.0 ± 8.2% vs 37.9 ± 6.2%, P=0.002; 11.0 ± 4.3% vs 18.4 ± 3.8, P=0.003 respectively. Other echocardiographic parameters were similar between the two groups of patients.  A Kaplan-Meier survival curve was drawn to show the time to outcome. Conclusion: Majority of PPCM patients present in clinically severe heart failure and the intra-hospital mortality is high. The importance of serum sodium, eGFR, EF and FS as factors associated with mortality indicates patient sub-groups requiring greater attention and targeted interventions.

scholarly journals Clinical characteristics and outcomes of patients admitted with acute heart failure: insights from a single-center heart failure registry in South India

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Aashiq Ahamed Shukkoor ◽  
Nimmy Elizabeth George ◽  
Shanmugasundaram Radhakrishnan ◽  
Sivakumar Velusamy ◽  
Rajendiran Gopalan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Heart Failure ◽  
South India ◽  
Univariate Analysis ◽  
North India ◽  
Study Cohort ◽  
Hospital Outcomes

Abstract Background The epidemiology of HF in India is largely unexplored. Current resources are based on a few hospital-based and a community-based registry from North India. Thus, we present the data from a single hospital-based registry in South India. Patients admitted with acute heart failure over a period of 1 year were enrolled in the registry and were characterized based on their ejection fraction (EF) measured by echocardiogram. The clinical profile of the patients was assessed, including their in-hospital outcomes. One-way ANOVA and univariate analysis were performed for comparison between three EF-based groups and for the assessment of in-hospital outcomes. Results A total of 449 patients were enrolled in the registry, of which 296, 90, and 63 patients were categorized as, HFrEF, HFmrEF, and HFpEF, respectively. The prevalence of HFrEF was higher (65.99%). The mean age (SD) of the study cohort was 59.9±13.3. The majority of the patients presented with acute denovo HF (67%) and were more likely to be males (65.9%). The majority of patients presented with warm and wet clinical phenotype (86.4%). In hospital mortality was higher in HFmrEF (3.3%). Conclusion Patients with HFrEF had high adherence to guideline-directed medical therapy (GDMT). HFrEF patients were also likely to have longer hospital stay along with a worsening of renal function. The in-hospital mortality was comparable between the EF-based groups. Additionally, the association of clinical phenotypes with outcome highlighted that patients in warm and wet phenotype had a longer length of hospital stay, whereas the mortality and worsening renal function rates were found to be significantly higher in the cold and wet group.

scholarly journals Is oxygen therapy beneficial for normoxemic patients with acute heart failure? A propensity score matched study

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Yue Yu ◽  
Ren-Qi Yao ◽  
Yu-Feng Zhang ◽  
Su-Yu Wang ◽  
Wang Xi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Linear Regression ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Oxygen Therapy ◽  
Ambient Air ◽  
Supplemental Oxygen ◽  
Research Database ◽  
Icu Mortality

Abstract Background The clinical efficiency of routine oxygen therapy is uncertain in patients with acute heart failure (AHF) who do not have hypoxemia. The aim of this study was to investigate the association between oxygen therapy and clinical outcomes in normoxemic patients hospitalized with AHF using real-world data. Methods Normoxemic patients diagnosed with AHF on ICU admission from the electronic ICU (eICU) Collaborative Research Database were included in the current study, in which the study population was divided into the oxygen therapy group and the ambient-air group. Propensity score matching (PSM) was applied to create a balanced covariate distribution between patients receiving supplemental oxygen and those exposed to ambient air. Linear regression and logistic regression models were performed to assess the associations between oxygen therapy and length of stay (LOS), and all-cause in-hospital as well as ICU mortality rates, respectively. A series of sensitivity and subgroup analyses were conducted to further validate the robustness of our findings. Results A total of 2922 normoxemic patients with AHF were finally included in the analysis. Overall, 42.1% (1230/2922) patients were exposed to oxygen therapy, and 57.9% (1692/2922) patients did not receive oxygen therapy (defined as the ambient-air group). After PSM analysis, 1122 pairs of patients were matched: each patient receiving oxygen therapy was matched with a patient without receiving supplemental oxygen. The multivariable logistic model showed that there was no significant interaction between the ambient air and oxygen group for all-cause in-hospital mortality [odds ratio (OR) 1.30; 95% confidence interval (CI) 0.92–1.82; P = 0.138] or ICU mortality (OR 1.39; 95% CI 0.83–2.32; P = 0.206) in the post-PSM cohorts. In addition, linear regression analysis revealed that oxygen therapy was associated with prolonged ICU LOS (OR 1.11; 95% CI 1.06–1.15; P <  0.001) and hospital LOS (OR 1.06; 95% CI 1.01–1.10; P = 0.009) after PSM. Furthermore, the absence of an effect of supplemental oxygen on mortality was consistent in all subgroups. Conclusion Routine use of supplemental oxygen in AHF patients without hypoxemia was not found to reduce all-cause in-hospital mortality or ICU mortality.

scholarly journals Determinants of In-Hospital Mortality in Elderly Patients Aged 80 Years or above with Acute Heart Failure: A Retrospective Cohort Study at a Single Rural Hospital

2021 ◽  
Vol 10 (7) ◽  
pp. 1468
Author(s):  
Yusuke Watanabe ◽  
Kazuko Tajiri ◽  
Hiroyuki Nagata ◽  
Masayuki Kojima
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Stepwise Regression ◽  
Stepwise Regression Analysis ◽  
Antibiotic Administration ◽  
Very Elderly ◽  
Survivor Group

Heart failure is one of the leading causes of mortality worldwide. Several predictive risk scores and factors associated with in-hospital mortality have been reported for acute heart failure. However, only a few studies have examined the predictors in elderly patients. This study investigated determinants of in-hospital mortality in elderly patients with acute heart failure, aged 80 years or above, by evaluating the serum sodium, blood urea nitrogen, age and serum albumin, systolic blood pressure and natriuretic peptide levels (SOB-ASAP) score. We reviewed the medical records of 106 consecutive patients retrospectively and classified them into the survivor group (n = 83) and the non-survivor group (n = 23) based on the in-hospital mortality. Patient characteristics at admission and during hospitalization were compared between the two groups. Multivariate stepwise regression analysis was used to evaluate the in-hospital mortality. The SOB-ASAP score was significantly better in the survivor group than in the non-survivor group. Multivariate stepwise regression analysis revealed that a poor SOB-ASAP score, oral phosphodiesterase 3 inhibitor use, and requirement of early intravenous antibiotic administration were associated with in-hospital mortality in very elderly patients with acute heart failure. Severe clinical status might predict outcomes in very elderly patients.

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