scholarly journals Trends in the medical therapy of patients who discharge from hospital after decompensated heart failure

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
C Mantis ◽  
I Vasiliadis ◽  
A Anadiotis ◽  
E Ioannidis ◽  
S Patsilinakos
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Medical Therapy ◽  
Cardiac Glycosides ◽  
Enzyme Inhibitor ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Angiotensin Ii Receptor Blocker ◽  
Aldosterone Antagonists ◽  
Discharge From Hospital

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute heart failure is one of the most common causes of cardiovascular hospitalization. An important factor in the prevention of re-admissions is the optimal medical therapy of heart failure patients. Purpose To evaluate medication in patients after hospitalization for acute decompensated heart failure. Methods We studied consecutive patients who admitted and discharged from two tertiary hospitals due to decompensated heart failure from June 2019 to December 2020. Their medication was recorded at the time of discharge and one month later. Results Overall, 730 patients (61% men), with mean age of 77 ± 12 years, were studied. At discharge, the vast majority of the patients (94%) received diuretic, while 45% of them received either angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) or sacubitril/valsartan (20%, 12% and 13%, respectively). 74% of the patients received b-blockers, half of the patients (51%) received aldosterone antagonists, 12% Sodium-glucose Cotransporter-2 inhibitors (SGLT2i) , 6% cardiac glycosides, and only 3% ibavradine. In one month of reassessment, the corresponding percentages were: 90% diuretics, 25% ACEI, 16% ARB, 18% sacubitril/valsartan, 78% b-blockers, 53% aldosterone antagonists, 14% SGLT2i, 4% cardiac glycosides and 3% ibavradine. Despite the low dosing regimens at discharge, after one month, the majority of the patients already receiving ACEI, ARB,  sacubitril/valsartan and beta-blockers were up-titrated, while a dose reduction was noticed on diuretics in almost all patients. Conclusion There are still considerable margins to improve management of the optimal medical treatment of patients who discharge from hospital after acute heart failure.

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 13918: Prognostic Value of Plasma Ngal in the 12-month All-cause Mortality of Acute Heart Failure or Acute Decompensated Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hao T Phan
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Prognostic Value ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Plasma Ngal ◽  
Kaplan Meier ◽  
All Cause Mortality

Introduction: The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Renal dysfunction is common in patients with AHF or ADHF and is associated with significant early and late morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is an early predictor of acute kidney injury and adverse events in various diseases; however, in AHF or ADHF patients, its significance remains poorly understood. This study was aimed to evaluate the 12 month prognostic value of plasma NGAL in AHF or ADHF patients Hypothesis: plasma NGAL has value in prognosis of 12-month all-cause mortality of Acute Heart Failure or Acute Decompensated Heart Failure Methods: This was a prospective cohort study Results: there were 46 all-cause mortality cases (rate 33.1%) 12 months follow up after discharge. There were 11 cases (rate 7.9%) lost to follow-up; mean age 66.12 ± 15.77, men accounted for 50.4%. The optimal cut-off of NGAL for 12-month all-cause mortality prognosis was > 383.74 ng/ml, AUC 0.632 (95% CI 0.53-0.74, p = 0.011), sensitivity 58.7 %, specificity 68.29 %, positive predictive value 50.9%, negative predictive value 74.7%. Kaplan-Meier analysis revealed that the high plasma NGAL (≥ 400 ng/ml) group exhibited a worse prognosis than the low plasma NGAL (< 400 ng/ml) group in 12-month all-cause death (Hazard Ratio 2.56; 95%CI 1.35-4.84, P=0.0039. Independent predictors of 12-month all-cause-mortality were identified using multivarable Cox proportional-hazards regression models with backward-stepwise selection method consisted of two variables: level of NGAL, mechanical ventialtion at admission. Conclusions: Plasma NGAL and mechanical ventilation at admission were independent predictors of 12-month all-cause mortality in patients with AHF or ADHF. The survival probability 12-month follow-up of high level NGAL (≥ 400 ng/ml) groups were lower than that of low level NGAL (<400 ng/ml,), difference was statistically significant χ2 = 8.31; p = 0.0047 by Kaplan-Meier curves.

Medical Therapy for Acute Decompensated Heart Failure: What Recent Clinical Trials Have Taught Us About Diuretics and Vasodilators

2011 ◽  
Vol 9 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Catherine Marti ◽  
Robert Cole ◽  
Andreas Kalogeropoulos ◽  
Vasiliki Georgiopoulou ◽  
Javed Butler
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Medical Therapy ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure

scholarly journals Association of an increase in serum albumin levels with positive 1-year outcomes in acute decompensated heart failure: A cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243818
Author(s):  
Takao Kato ◽  
Hidenori Yaku ◽  
Takeshi Morimoto ◽  
Yasutaka Inuzuka ◽  
Yodo Tamaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Serum Albumin ◽  
Acute Heart Failure ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Primary Outcome Measure ◽  
Favorable Effect

Background Despite the prognostic importance of hypoalbuminemia, the prognostic implication of a change in albumin levels has not been fully investigated during hospitalization in patients with acute decompensated heart failure (ADHF). Methods Using the data from the Kyoto Congestive Heart Failure registry on 3160 patients who were discharged alive for acute heart failure hospitalization and in whom the change in albumin levels was calculated at discharge, we evaluated the association with an increase in serum albumin levels from admission to discharge and clinical outcomes by a multivariable Cox hazard model. The primary outcome measure was a composite of all-cause death or hospitalization for heart failure. Findings Patients with increased albumin levels (N = 1083, 34.3%) were younger and less often had smaller body mass index and renal dysfunction than those with no increase in albumin levels (N = 2077, 65.7%). Median follow-up was 475 days with a 96% 1-year follow-up rate. Relative to the group with no increase in albumin levels, the lower risk of the increased albumin group remained significant for the primary outcome measure (hazard ratio: 0.78, 95% confidence interval: 0.69–0.90: P = 0.0004) after adjusting for confounders including baseline albumin levels. When stratified by the quartiles of baseline albumin levels, the favorable effect of increased albumin was more pronounced in the lower quartiles of albumin levels, but without a significant interaction effect (interaction P = 0.49). Conclusions Independent of baseline albumin levels, an increase in albumin during index hospitalization was associated with a lower 1-year risk for a composite of all-cause death and hospitalization in patients with acute heart failure.

Abstract 2416: Progressive Improvement in Cardiac Performance produced by Continuous Aortic Flow Augmentation in Patients Hospitalized with Acute Decompensated Heart Failure: Results from the MOMENTUM Trial

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Michael R Zile ◽  
Paolo Colombo ◽  
Mandeep Mehra ◽  
Barry Greenberg ◽  
Scott Brown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Medical Therapy ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Cardiac Performance ◽  
Aortic Flow ◽  
Stroke Work ◽  
Pulmonary Capillary ◽  
Vasodilator Treatment ◽  
The Relationship

Previous studies indicate that superimposing continuous aortic flow augmentation (CAFA) on pulsatile aortic flow yields vasodilation, unloading, and improved cardiac performance. Whether improvement in indices of cardiac performance are dependent or independent of changes in hemodynamic load has not been examined. Multi-center Trial of Orqis® Medical Cancion® System for Enhanced Treatment of heart failure (HF) Unresponsive to Medical Therapy (MOMENTUM) is a randomized trial comparing CAFA plus medical therapy (n = 109) vs. medical therapy alone (n = 59) in patients hospitalized with HF inadequately responsive to therapy. Entry required reduced LVEF and cardiac index, elevated pulmonary capillary wedge pressure (PCWP), and either impaired renal function or high diuretic requirement, despite IV inotrope or vasodilator treatment. CAFA was achieved for up to 96 hrs using an arterial-to-arterial circuit (flow up to 1.5 L/min). Changes in cardiac performance were assessed using the relationship between stroke work (stroke volume x [Mean blood pressure-PCWP] x 0.00133, kg*cm) and PCWP. Figure shows hemodynamic effects (mean ± SEM) at baseline (B) and at hours post-B time. CAFA progressively improves LV performance (↑ Stroke Work and ↓ PCWP, p < 0.05 for both) resulting in an upward-leftward shift in the Starling function curve. In contrast, medical therapy alone resulted in no change in cardiac performance (↓ Stroke Work and ↓ PCWP, p < 0.05 for both), no shift in Starling curve. CAFA treatment, independent of changes in both preload and afterload, increased stroke work and decreased PCWP by progressively improving cardiac performance.

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