Association of low body temperature and poor outcomes in patients admitted with worsening heart failure: a substudy of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial

Background: Lingering congestion portends poor outcomes in patients with heart failure (HF) and is a key target in their management. Studies have shown that physical exam has low yield in this setting and conventional methods for more precise assessment and monitoring of volume status (e.g., body weight, natriuretic peptides, and chest radiography) have significant inherent shortcomings. Summary: Point of care ultrasonography (POCUS) is a noninvasive versatile bedside diagnostic tool that enhances the sensitivity of conventional physical examination to gauge congestion in these patients. It also aids in monitoring the efficacy of decongestive therapy and bears prognostic significance. In this narrative review, we discuss the role of focused sonographic assessment of the heart, venous system, and extravascular lung water/ascites (i.e., the pump, pipes, and the leaks) in objective assessment of fluid volume status. Key Messages: Since each of the discussed components of POCUS has its limitations, a combinational ultrasound evaluation guided by the main clinical features would be the key to reliable assessment and effective management of congestion in patients with HF.

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Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure

Clinical Research in Cardiology ◽

10.1007/s00392-020-01792-w ◽

2021 ◽

Author(s):

S. Sze ◽

P. Pellicori ◽

J. Zhang ◽

J. Weston ◽

I. B. Squire ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Clinical Frailty Scale ◽

Mineralocorticoid Receptor Antagonist ◽

Reduced Ejection Fraction ◽

Frail Patients ◽

History Of ◽

Poor Outcomes ◽

To Receive

Abstract Background Frailty is common in patients with chronic heart failure (CHF) and is associated with poor outcomes. The natural history of frail patients with CHF is unknown. Methods Frailty was assessed using the clinical frailty scale (CFS) in 467 consecutive patients with CHF (67% male, median age 76 years, median NT-proBNP 1156 ng/L) attending a routine follow-up visit. Those with CFS > 4 were classified as frail. We investigated the relation between frailty and treatments, hospitalisation and death in patients with CHF. Results 206 patients (44%) were frail. Of 291 patients with HF with reduced ejection fraction (HeFREF), those who were frail (N = 117; 40%) were less likely to receive optimal treatment, with many not receiving a renin–angiotensin–aldosterone system inhibitor (frail: 25% vs. non-frail: 4%), a beta-blocker (16% vs. 8%) or a mineralocorticoid receptor antagonist (50% vs 41%). By 1 year, there were 56 deaths and 322 hospitalisations, of which 25 (45%) and 198 (61%), respectively, were due to non-cardiovascular (non-CV) causes. Most deaths (N = 46, 82%) and hospitalisations (N = 215, 67%) occurred in frail patients. Amongst frail patients, 43% of deaths and 64% of hospitalisations were for non-CV causes; 58% of cardiovascular (CV) deaths were due to advancing HF. Among non-frail patients, 50% of deaths and 57% of hospitalisations were for non-CV causes; all CV deaths were due to advancing HF. Conclusion Frailty in patients with HeFREF is associated with sub-optimal medical treatment. Frail patients are more likely to die or be admitted to hospital, but whether frail or not, many events are non-CV. Graphical abstract

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Nutritional and Non-Nutritional Predictors of Low Spot Urinary Creatinine Concentration in Patients with Heart Failure

Nutrients ◽

10.3390/nu13113994 ◽

2021 ◽

Vol 13 (11) ◽

pp. 3994

Author(s):

Jolanta Malinowska-Borowska ◽

Aleksandra Kulik ◽

Marta Buczkowska ◽

Weronika Ostręga ◽

Apolonia Stefaniak ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Weight Loss ◽

Creatinine Concentration ◽

Urinary Creatinine ◽

Under Nutrition ◽

Patients With Heart Failure ◽

Poor Outcomes ◽

Biochemical Indices ◽

Appendicular Muscle Mass

Low spot urinary creatinine concentration (SUCR) is a marker of muscle wasting and clinical outcome. The risk factors for low SUCR in heart failure (HF) remain poorly understood. We explored the risk factors for low SUCR related to poor outcomes. In 721 HF patients (age: 52.3 ± 11 years, female: 14%, NYHA: 2.7 ± 0.7) SUCR and Dexa body composition scans were performed. BMI prior HF-onset, weight loss, and appendicular muscle mass were obtained. Each patient was classified as malnutrition or normal by GLIM criteria and three other biochemical indices (CONUT, PNI, and GRNI). Sarcopenia index (SI) as creatinine to cystatin C ratio was also calculated. Within 1 year, 80 (11.1%) patients died. In ROC curve we identified a SUCR value of 0.628 g/L as optimally discriminating surviving from dead. In low SUCR group more advanced HF, higher weight loss and catabolic components of weight trajectory (CCWT), more frequent under-nutrition by GLIM, and lower SI were observed. In multivariate analysis the independent predictors of low SUCR were SI, CCWT, and GNRI score. In conclusion: the risk of low SUCR was associated with a worse outcome. Low SUCR was associated with greater catabolism and sarcopenia but not with biochemical indices of malnutrition.

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Impact of Renal Disease on Natriuretic Peptide Testing for Diagnosing Decompensated Heart Failure and Predicting Mortality

Clinical Chemistry ◽

10.1373/clinchem.2006.084533 ◽

2007 ◽

Vol 53 (8) ◽

pp. 1511-1519 ◽

Cited By ~ 67

Author(s):

Christopher R deFilippi ◽

Stephen L Seliger ◽

Susan Maynard ◽

Robert H Christenson

Keyword(s):

Heart Failure ◽

Renal Function ◽

Natriuretic Peptide ◽

Estimated Glomerular Filtration Rate ◽

Area Under The Curve ◽

Decompensated Heart Failure ◽

Multivariate Regression Analysis ◽

Poor Outcomes ◽

One Year ◽

Roc Area

Abstract Background: Concomitant occurrence of kidney disease (KD) and heart failure (HF) is common and associated with poor outcomes. Natriuretic peptide studies have typically excluded many individuals with KD. We compared the accuracy of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) for diagnosing decompensated HF and predicting mortality across the spectrum of renal function. Methods: BNP and NT-proBNP were prospectively measured in a cohort of 831 dyspnea patients. KD was defined as an estimated glomerular filtration rate <60 mL · min−1 · (1.73 m2)−1. The accuracy and predictive value of each test for diagnosing decompensated HF and predicting all-cause 1-year mortality were assessed by ROC area under the curve (AUC) and multivariate regression analysis. Results: Among the 831 dyspnea patients, 393 (47%) had KD. The diagnostic accuracies of BNP and NT-proBNP in detecting decompensated HF were similar to each other in patients without KD (AUC 0.75 vs 0.74, respectively; P = 0.60) and in patients with KD (AUC 0.68 vs 0.66; P = 0.10). One-year mortality rates were 36.3% and 19.0% in those with and without KD, respectively (P <0.001). Progressively higher BNP and NT-proBNP concentrations remained predictive of increased mortality in KD patients. Compared with the lowest quartile, quartile 4 of BNP had an adjusted hazards ratio (HR) of 2.6 (95% CI 1.4–4.8; P = 0.004 for trend) and NT-proBNP quartile 4 had an HR of 4.5 (95% CI 2.0–10.2; P <0.001 for trend). Only NT-proBNP remained a predictor of death after adjustment for clinical confounders and the other natriuretic peptide marker. Conclusions: NT-proBNP and BNP are equivalent predictors of decompensated HF across a spectrum of renal function, but NT-proBNP is a superior predictor of mortality.

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Abstract 303: Inpatient Sleep Interruptions Among Patients With Congestive Heart Failure

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.303 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Evan Claggett ◽

Rachel H Krallman ◽

Delaney Feldeisen ◽

Daniel G Montgomery ◽

Kim Eagle ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Electronic Health Record ◽

Sample Size ◽

Health Record ◽

Post Discharge ◽

Electronic Health Record Data ◽

Care Clinic ◽

Electronic Health ◽

Poor Outcomes

Background: The effects of sleep deprivation are vast, ranging from increased stress responses, to lowered immunity and delayed wound healing. However, sleep disruptions are common in the inpatient setting. This study sought to quantify the number and frequency of inpatient sleep disturbances and analyze post-discharge outcomes (emergency department visit, readmission, death) among congestive heart failure (CHF) patients. Methods: Data were collected retrospectively from 30 randomly selected patients admitted for CHF and referred to a cardiac transitional care clinic from 2014 to 2017. Each night over the course of the hospitalization was broken into 12 one-hour intervals (1900-0659 hours), and the electronic health record was examined for 20 variables indicative of sleep disruption (e.g. vitals taken, medications dispensed, wound care) (Figure 1). Demographics and outcomes were compared between high (above median) and low (below median) groups for average number of nightly interval interruptions and average longest uninterrupted sleep interval (LUSI). Results: On average, patients had a length of admission of 5.4 nights, a LUSI of 2.9 hours (range: 1-4), and 6.3 disruptions between 1900-0659 hours (range: 3-8). The readmission rates for the total population were 23% at 30 days and 63% at 180 days. No significant differences were seen in demographics or outcomes up to 180 days post-discharge when comparing high and low patient groups in either average nightly interval interruptions or average LUSI. Conclusion: Although no differences were seen between groups, the majority of patients had poor outcomes (23% were readmitted at 30 days; 63% at 180 days) as well as poor sleep during their admission. The lack of sleep across the entire patient population may be contributing to the poor outcomes observed. Many of the variables reviewed (e.g. vitals taken, medications dispensed, etc.) had potentially elective timing, which suggests actionable changes to the inpatient process may be possible to improve sleep quantity and quality. This was an exploratory pilot study to determine the ability to use electronic health record data for this purpose. As such, the sample size was too small to detect differences. A larger sample size is needed to better understand the extent to which sleep disruptions impact patient outcomes.

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Risk Factors for Poor Outcomes in Children Hospitalized With Acute Decompensated Heart Failure

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2018.01.1006 ◽

2018 ◽

Vol 37 (4) ◽

pp. S391

Author(s):

B. Hong ◽

J. Friedland-Little ◽

E. Albers ◽

N. Jorgensen ◽

R. Mazor ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Poor Outcomes

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Calf muscle pump function as a predictor of all-cause mortality

Vascular Medicine ◽

10.1177/1358863x20953212 ◽

2020 ◽

Vol 25 (6) ◽

pp. 519-526

Author(s):

Meghana Halkar ◽

Jose Medina Inojosa ◽

David Liedl ◽

Waldemar Wysokinski ◽

Damon E Houghton ◽

...

Keyword(s):

Heart Failure ◽

Charlson Comorbidity Index ◽

Negative Impact ◽

Calf Muscle ◽

Study Objective ◽

Muscle Pump ◽

Calf Muscle Pump ◽

Comorbidity Index ◽

Predominantly Female ◽

Poor Outcomes

Calf muscle pump (CMP) promotes venous return from the lower extremity and contributes to preload and cardiac output. Impaired CMP function may reflect a measure of frailty or cumulative disease burden or may impede cardiac function. The study objective was to test the hypothesis that impaired CMP negatively impacts survival. Consecutive adult patients who underwent venous strain gauge plethysmography at the Mayo Clinic Gonda Vascular Laboratory (January 1, 1998 – December 31, 2011) were assessed for overall survival. Patients with venous incompetence, venous obstruction or unilateral calf pump dysfunction were excluded. Risk of mortality was assessed with Cox proportional hazard ratios and after adjusting for Charlson Comorbidity Index variables. Over the study period, 2728 patients were included in the analysis. Compared to patients with normal CMP, those with impaired CMP were older ( p < 0.001), predominantly female ( p = 0.01) and had higher mean Charlson scores ( p < 0.001). Patients with impaired CMP had a higher mortality rate at 5 (8.9% vs 2.4%), 10 (17.5% vs 5.9%), and 15 years (22.8% vs 8.3%) compared to those with normal CMP ( p < 0.001 for each comparison). Of patients with heart failure, those with impaired CMP had worse survival at each 5-year increment compared to those with normal CMP ( p < 0.05 at each increment). In conclusion, impaired CMP appears to be an independent predictor of poor outcomes after adjusting for variables within the Charlson Comorbidity Index. The association between impaired CMP, heart failure, and mortality may represent a negative impact on circulatory function or a surrogate measure of frailty.

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Temperature-Induced Changes in Reperfused Stroke: Inflammatory and Thrombolytic Biomarkers

Journal of Clinical Medicine ◽

10.3390/jcm9072108 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2108

Author(s):

Paulo Ávila-Gómez ◽

Pablo Hervella ◽

Andrés Da Silva-Candal ◽

María Pérez-Mato ◽

Manuel Rodríguez-Yáñez ◽

...

Keyword(s):

Body Temperature ◽

Clot Lysis ◽

Necrosis Factor Alpha ◽

Poor Outcome ◽

Tnf Α ◽

Influence Of Temperature On ◽

Factor Alpha ◽

Higher Temperature ◽

Poor Outcomes ◽

Induced Changes

Although hyperthermia is associated with poor outcomes in ischaemic stroke (IS), some studies indicate that high body temperature may benefit reperfusion therapies. We assessed the association of temperature with effective reperfusion (defined as a reduction of ≥8 points in the National Institute of Health Stroke Scale (NIHSS) within the first 24 h) and poor outcome (modified Rankin Scale (mRS) > 2) in 875 retrospectively-included IS patients. We also studied the influence of temperature on thrombolytic (cellular fibronectin (cFn); matrix metalloproteinase 9 (MMP-9)) and inflammatory biomarkers (tumour necrosis factor-alpha (TNF-α), interleukin 6 (IL-6)) and their relationship with effective reperfusion. Our results showed that a higher temperature at 24 but not 6 h after stroke was associated with failed reperfusion (OR: 0.373, p = 0.001), poor outcome (OR: 2.190, p = 0.005) and higher IL-6 levels (OR: 0.958, p < 0.0001). Temperature at 6 h was associated with higher MMP-9 levels (R = 0.697; p < 0.0001) and effective reperfusion, although this last association disappeared after adjusting for confounding factors (OR: 1.178, p = 0.166). Our results suggest that body temperature > 37.5 °C at 24 h, but not at 6 h after stroke, is correlated with reperfusion failure, poor clinical outcome, and infarct size. Mild hyperthermia (36.5–37.5 °C) in the first 6 h window might benefit drug reperfusion therapies by promoting clot lysis.

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