P3514Gender differences in prognosis for total mortality among patients with ADHF: results of four-year follow-up

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Polyakov ◽  
I Fomin
Keyword(s):  
Mortality Rate ◽  
Acute Decompensated Heart Failure ◽  
Clinical Signs ◽  
Regression Tree ◽  
Total Mortality ◽  
High Sensitivity ◽  
Decompensated Heart Failure ◽  
Mortality Rates ◽  
Average Observation ◽  
Clinical Conditions

Abstract Aim To obtain information on the effect of various predictors on the prognosis of a patient with acute decompensated heart failure (ADHF). Methods We investigated a sample of patients (n=719) hospitalized due to ADHF for 4 years (average observation duration was 2.3 years). 27 predictors were included in the model (clinical conditions and clinical signs of ADHF). We used regression tree method with CHAID algorithm with 10-fold cross-validation to determine the most important predictors of the prognosis. Results The most significant predictor for total mortality at the first branching was the gender of the patient. Mortality rate was 65.0% among males vs 47.9% among females (p<0.001). In the subgroup of males, the next most significant predictor for the prognosis was the level of systolic blood pressure (SBP): mortality rates was 79.6% with SBP ≤125 mm Hg vs. 57.2% with SBP >125 mm Hg (p=0.001). In the subgroup of males with SBP >125 mm Hg mortality rates differed depending on the presence of X-ray signs of congestion; when present, the total mortality was 65.7% vs. 47.8 in the absence (p=0.01). In the subgroup of females, the first most significant predictor of prognosis was diabetes mellitus (DM): mortality rates was 60.1% with DM vs. 41.2% without DM (p<0.001). The worst prognosis was found among those who are over 78 years old (55.8%) compared with younger (32.4%, p=0.001) for females with DM. The model has high sensitivity (74.9%) but low specificity (50.3%). In the ROC analysis, AUC was 0.673 (95% CI: 0.634–0.712). Regression tree for total mortality rate Conclusion The 4-year survival rate for patients with ADHF varies by gender. Among men, the most important predictors of prognosis were the level of SBP and the presence of congestion in the lungs at the hospital admission. Among women, DM and age had the greatest influence on the prognosis.

Outcomes of de novo and acute decompensated heart failure patients according to ejection fraction

Heart ◽  
2017 ◽  
Vol 104 (6) ◽  
pp. 525-532 ◽  
Author(s):  
Ki Hong Choi ◽  
Ga Yeon Lee ◽  
Jin-Oh Choi ◽  
Eun-Seok Jeon ◽  
Hae-Young Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mortality Rate ◽  
Ejection Fraction ◽  
De Novo ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
First Year ◽  
Preserved Ejection Fraction ◽  
University Hospitals ◽  
Reduced Ejection Fraction

ObjectiveThere are conflicting results among previous studies regarding the prognosis of heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF). This study aimed to compare the outcomes of patients with de novo acute heart failure (AHF) or acute decompensated HF (ADHF) according to HFpEF (EF≥50%), or HFrEF (EF<40%) and to define the prognosis of patients with HF with mid-range EF (HFmrEF, 40≤EF<50%).MethodsBetween March 2011 and February 2014, 5625 consecutive patients with AHF were recruited from 10 university hospitals. A total of 5414 (96.2%) patients with EF data were enrolled, which consisted of 2867 (53.0%) patients with de novo and 2547 (47.0%) with ADHF. Each of the enrolled group was stratified by EF.ResultsIn de novo, all-cause death rates were not significantly different between HFpEF and HFrEF (HFpEF vs HFrEF, 206/744 (27.7%) vs 438/1631 (26.9%), HRadj 1.15, 95% CI 0.96 to 1.38, p=0.14). However, among patients with ADHF, HFrEF had a significantly higher mortality rate compared with HFpEF (HFpEF vs HFrEF, 245/613 (40.0%) vs 694/1551 (44.7%), HRadj 1.25, 95% CI 1.06 to 1.47, p=0.007). Also, in ADHF, HFmrEF was associated with a significantly lower mortality rate within 1 year compared with HFrEF (HFmrEF vs HFrEF, 88/383 (23.0%) vs 430/1551 (27.7%), HRadj 1.31, 95% CI 1.03 to 1.65, p=0.03), but a significantly higher mortality rate after 1 year compared with HFpEF (HFmrEF vs HFpEF, 83/295 (28.1%) vs 101/469 (21.5%), HRadj 0.70, 95% CI 0.52 to 0.96, p=0.02).ConclusionsHFpEF may indicate a better prognosis compared with HFrEF in ADHF, but not in de novo AHF. For patients with ADHF, the prognosis associated with HFmrEF was similar to that of HFpEF within the first year following hospitalisation and similar to HFrEF 1  year after hospitalisation.

Mortality rates are going down in clinical use of inotropics. Temporal trends for prognosis in acute decompensated heart failure (1992/1999–2005/ 2006)

2014 ◽  
Vol 175 (3) ◽  
pp. 584-586 ◽  
Author(s):  
Juliano N. Cardoso ◽  
André Grossi ◽  
Carlos H. Del Carlo ◽  
Cristina Martins dos Reis ◽  
Milena Curiati ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Temporal Trends ◽  
Decompensated Heart Failure ◽  
Mortality Rates ◽  
Clinical Use

scholarly journals Biomarkers In Acute Heart Failure — Cardiac And Kidney

2015 ◽  
Vol 1 (2) ◽  
pp. 107 ◽  
Author(s):  
A Mark Richards ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Test Performance ◽  
Acute Decompensated Heart Failure ◽  
Unmet Need ◽  
Kidney Injury ◽  
High Sensitivity ◽  
Decompensated Heart Failure ◽  
Predictive Values

Natriuretic peptides (NP) are well-validated aids in the diagnosis of acute decompensated heart failure (ADHF). In acute presentations, both brain natriuretic peptide (BNP) and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) offer high sensitivity (>90 %) and negative predictive values (>95 %) for ruling out ADHF at thresholds of 100 and 300 pg/ml, respectively. Plasma NP rise with age. For added rule-in performance age-adjusted thresholds (450 pg/ml for under 50 years, 900 pg/ml for 50—75 years and 1,800 pg/ml for those >75 years) can be applied to NT-proBNP results. Test performance (specificity and accuracy but not sensitivity) is clearly reduced by renal dysfunction and atrial fibrillation. Obesity offsets the threshold downwards (to ~50 pg/ml for BNP), but overall discrimination is preserved. Reliable markers for impending acute kidney injury in ADHF constitute an unmet need, with candidates, such as kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin, failing to perform sufficiently well, and new possibilities, including the cell cycle markers insulin growth factor binding protein 7 and tissue inhibitor of metalloproteinases type 2, remain the subject of research.

Estimations of Ocean Mortality Rates for Pacific Salmon (Oncorhynchus)

1962 ◽  
Vol 19 (4) ◽  
pp. 561-589 ◽  
Author(s):  
Robert R. Parker
Keyword(s):  
Mortality Rate ◽  
Sockeye Salmon ◽  
Pacific Salmon ◽  
Pink Salmon ◽  
Total Mortality ◽  
Mortality Rates ◽  
Mortality Factor ◽  
Sampling Errors ◽  
Instantaneous Rate ◽  
Factor C

A conceptual model representing natural marine mortality rates of Pacific salmon is developed. Ocean mortality rate (q) is taken as the base to which coastal mortality rates of juveniles (c) and of adults (k) are additive factors. The effect of marking is taken as a multiplicative factor (m) of the instantaneous rate (i) where i = q + c + k. Together with time these values are incorporated into the balanced equation[Formula: see text]where N0 denotes the population entering the sea and R1, R2, R3 denote the returns at succeeding times of maturity. The locus of c + k = f(q) is used to graphically depict all possible combinations of c + k and q within the limits [q, c + k = 0]. Intersections of loci are taken as estimates of values of q and c + k which satisfy two sets of data. Available data for sockeye salmon (O. nerka) from Cultus Lake, Chilko Lake and Hooknose Creek, British Columbia, Karluk River and Bare Lake, Alaska, and Dalnee River, Kamchatka, pink salmon (O. gorbuscha) and chum salmon (O. keta) from Hooknose Creek, chinook salmon (O. tshawytscha) from the coast of Southeast Alaska and coho (O. kisutch) from the Eel River, California, are utilized. It is concluded that ocean mortality is relatively constant, of the order of magnitude q = 0. 32 or S = 73% annually. A juvenile coastal mortality factor (c) apparently exists and is characteristic of the species and race through the media of size of migrants, time spent in the costal area, and geography. An adult coastal factor (k) may exist but is of negligible influence on the total mortality rate. While the data utilized collectively may be considered as extensive, serious defects in sampling errors and undefined variability were encountered. It is doubted that mortality rates can be more accurately defined from any repetition of experiments used, hence a more direct approach is indicated for solution of this problem.

scholarly journals Acute decompensated heart failure: a study of nursing care

2020 ◽  
Vol 15 (3) ◽  
pp. 1-12
Author(s):  
Nicholas Woolfe Loftus ◽  
Tracey Bowden
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Pulmonary Oedema ◽  
Acute Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Clinical Signs ◽  
Decompensated Heart Failure ◽  
Medical Attention ◽  
Acute Decompensation ◽  
Care Study

This care study focuses on the initial acute phase of care for a patient with acutely decompensated heart failure. Heart failure is a syndrome characterised by clinical signs, such as pulmonary oedema, and symptoms, such as dyspnoea. Acute heart failure develops rapidly and requires urgent medical attention, unlike the slower insidious onset of chronic heart failure. Acute heart failure can be either new or acute decompensation of chronic heart failure. The patient presented with cardiogenic pulmonary oedema because of acute decompensation of his chronic heart failure. He agreed to medical management, which included continuous positive airway pressure, intra-arterial cannulation and a furosemide infusion. This treatment proved largely effective, but it may have been better if his furosemide infusion had been stopped sooner. The implications for practice are explored in this care study.

Abstract P159: No Gender Difference in All-Cause Mortality Rates in a Cohort of Heart Failure With Preserved Ejection Fraction in the US Veteran Population

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Katherine E Kurgansky ◽  
David Gagnon ◽  
Kelly Cho ◽  
J M Gaziano ◽  
Jacob Joseph ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mortality Rate ◽  
Ejection Fraction ◽  
Rate Ratio ◽  
Total Mortality ◽  
Mortality Rates ◽  
Failure Diagnosis ◽  
Preserved Ejection Fraction ◽  
Heart Failure Diagnosis

Introduction: Heart failure with preserved ejection fraction (HFpEF) affects about 5% of people 65 or older, with a higher prevalence in women. Previous studies suggest that women with HFpEF may live longer than men. Further understanding of mortality outcomes by gender could be useful in implementing gender-specific treatment strategies to improve outcomes in HFpEF patients. Hypothesis: We assessed the hypothesis that women have a lower rate of total mortality than males in a US Veteran HFpEF cohort. Methods: We used a validated algorithm to curate a HFpEF cohort using ICD9 codes, laboratory values, medications, and ejection fraction values from the national Veterans Affairs database. This algorithm had 88% sensitivity and 96% specificity. We examined crude and adjusted mortality rates by gender, beginning at the time of heart failure diagnosis with follow-up through 2016. The adjusted mortality rate was directly standardized to the population of veterans with heart failure (n= 626,179) according to distribution of age, race, cardiovascular disease (CVD), and chronic kidney disease (CKD). Crude and standardized rate ratios were calculated from the mortality rates. Results: Our HFpEF cohort (n= 74,937) included 72,267 men and 2,670 women. Mean age was 72.5 (11.2) in men and 69.1 (14.3) in women at the time of heart failure diagnosis. Males were 85.2% white, 33.7% had CVD, and 27.1% had CKD, whereas females were 82.5% white, 28.7% had CVD, and 20.5% had CKD. During a mean follow up of 4.8 (3.7) years, 52,703 deaths occurred in men and 1,614 deaths occurred in women.The crude mortality rate was significantly lower for females (109.7/1000 person-years) compared to males (153.5/1000 person-years). Corresponding crude incidence rate ratio (95% CI) for total mortality comparing females to males was 0.71 (0.69-0.74; p<.0001). However, after standardizing, there was no significant difference in total mortality rates between men (170.0/1000 person-years) and women (173.4/1000 person-years). The standardized mortality rate ratio was 1.02 (95% CI: 0.84-1.23; p=0.8397). Conclusions: In conclusion, our data do not show any difference in total mortality rate between men and women following the diagnosis of HFpEF.

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