Factors associated with successful return to work in young heart failure and ischaemic heart disease patients following index hospital admission

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
HV Thakkar ◽  
L Hollingsworth ◽  
JA Enright ◽  
S Sanderson ◽  
RJ Macfadyen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Return To Work ◽  
Decompensated Heart Failure ◽  
Individual Factors ◽  
P Value ◽  
Complex Interplay ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
Financial Benefits ◽  
The Individual

Abstract Funding Acknowledgements Type of funding sources: None. Background Factors influencing return to remunerated work following an acute cardiac illness are poorly defined. We wished to compare the factors in our cohorts following first presentation of acute coronary syndrome(ACS) and decompensated heart failure(HF). Methods Prospectively identified subjects, aged 18-65years, from a rehabilitation population for ACS and HF during 2018-2019 underwent a survey. Results Of 133cases meeting inclusion criteria, 84 completed the survey(41 HF, 80% male, mean age 55years; 43 ACS, 86% male, mean age 57years). Socio-economic indexes for Areas(SIEFA) index were similar for HF(900) & ACS(909) groups, which represents 11th and 14th percentile for Australia respectively. Cardiovascular risk factors were similar except hypercholesterolemia(37% v 60%; p = 0.029) was more common in ACS. Many subjects did not continue beyond Yr12, (54% HF v 30% ACS; p = 0.029). A majority of ACS cases returned to work as compared with HF(70% v 44%; p = 0.017)(Figure). On multivariate analysis, male gender[p = 0.031;OR 13.71 (1.28-147.36)]; access to financial benefits[p < 0.001;OR 22.75 (4.31-119.99)] and a desire to return to work [p = 0.014;OR 12.1 (1.67-87.82)] were associated with successful return to work (Table). Limitations Our study has small numbers so will be difficult to generalise to a wider population. We do show a signal towards the complex interplay of the social and individual factors in determining return to work. Further larger studies are required to tease out the differences between the individual factors to help predict return to work in the Australian context. Conclusion Successful return to work for patients with first presentation of ACS or HF could not be reliably predicted. Patients with ACS returned to work more often than HF. In HF patients who do n to return to work, recurrent symptoms, individual motivation, social support and access to financial benefits have a complex interplay. Predictors of return to work Predictor P value OR (95% CI) Diagnosis (heart failure) 0.095 0.29 (0.07, 1.24) Gender (male) 0.031 13.71 (1.28, 147.36) Access to benefit (none) <0.001 22.75 (4.31, 119.99) Desire to RTW (yes) 0.014 12.1 (1.67, 87.82) Abstract Figure. Rates of return to work in the 2 groups

scholarly journals Prognostic Significance of I-Month Postdischarge BNP in Identifying Patients at High Risk of Mortality and Readmission After Decompensated Heart Failure

2020 ◽  
Vol 1 (2) ◽  
pp. 59-66
Author(s):  
Vinod Kumar ◽  
Pravin K. Goel ◽  
Roopali Khanna ◽  
Aditya Kapoor ◽  
Kunal Mahajan
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Prognostic Significance ◽  
Decompensated Heart Failure ◽  
P Value ◽  
Coronary Syndrome ◽  
Risk Of Mortality ◽  
Acute Decompensation

Objective: The B-type natriuretic peptide (BNP) levels could predict future cardiovascular events in congestive heart failure patients. Most studies have correlated basal BNP levels to long-term outcomes. Limited data exist on the prognostic significance of 1-month postdischarge BNP levels after acute heart failure. Methods: Consecutive patients admitted for worsening heart failure were enrolled. BNP was measured at admission, predischarge and at 1-month following discharge. Patients were followed for 1 year for end points of death and rehospitalization. Results: A total of 150 patients (mean age 60.8 + 13.8 years) were included in the heart failure study. 81 (54%) patients had acute heart failure secondary to acute coronary syndrome, while the rest (46%) had acute decompensation of chronic heart failure irrespective of etiology. Mean ejection fraction was 28.6 + 8.9%. 14 patients expired during hospitalization. BNP at admission was an important predictor of in hospital mortality ( P value = .003). Following discharge, 7 events (3 deaths and 4 rehospitalizations) occurred over next 1 month. 1-month outcome was predicted by baseline BNP ( P value = .01) as well as discharge BNP value ( P value = .001). A total of 55 events (26 rehospitalization and 29 deaths) occurred at follow-up of 1 year. Age > 50years, ejection fraction at baseline and all time sequential BNP levels (at admission, discharge, as well as 1 month) were univariate predictors of death and rehospitalization at 1 year. The BNP at 1 month had best discriminative power and remained the lone significant predictor in the multivariate analysis ( P = < .001). Conclusions: 1-month postdischarge BNP level is a useful prognostic factor that predicts mortality and rehospitalization at 1-year follow-up, in patients admitted with heart failure, and helps in identifying patients who need more intensive drug treatment and closer follow-up.

Heart failure in Acute Coronary Syndrome: predictors and prognosis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Santos ◽  
H Santos ◽  
I Almeida ◽  
H Miranda ◽  
C Sa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Artery Bypass ◽  
Study Data ◽  
Multivessel Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
Previous Stroke ◽  
St Elevation

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Heart failure (HF) is a frequent complication of acute coronary syndromes (ACS). Therefore, it is important to access its impact on prognosis and identify patients (pts) with higher risk of HF. Objective To evaluate predictors and prognosis of HF in the setting of ACS. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Pts without data on cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without HF; GB - pts with HF during hospitalization. Results HF occurred in 4003 (15.6%) out of 25718 pts with ACS. GB was older (74 ± 12 vs 65 ± 13, p &lt; 0.001), had more females (36.3% vs 26.2%, p &lt; 0.001), had higher rates of arterial hypertension (78.4% vs 69.3%, p &lt; 0.001), dyslipidaemia (64.4% vs 61.1%. p &lt; 0.001), previous ACS (25.6% vs 19.7%, p &lt; 0.001,), previous HF (16.4% vs 4.1%, p &lt; 0.001), previous stroke (11.9% vs 6.4%, p &lt; 0.001), chronic kidney disease (CKD) (17.1% vs 5.5%, p &lt; 0.001), chronic obstructive pulmonary disease (COPD) (7.8% vs 3.8%, p &lt; 0.001) and longer times from first symptoms to admission (268min vs 238min, p &lt; 0.001). GA had higher rate of smokers (28.4% vs 16.2%, p &lt; 0.001) and higher rate of non-ST-elevation myocardial infarction (MI) (46.5% vs 43.0%, p &lt; 0.001). GB had higher rates of ST-elevation MI (STEMI) (49.2% vs 41.1%, p &lt; 0.001), namely anterior STEMI (58.1% vs 44.9%, p &lt; 0.001). GB had lower blood pressure (130 ± 32 vs 140 ± 28, p &lt; 0.001), higher heart rate (86 ± 23 vs 76 ± 18, p &lt; 0.001), Killip-Kimball class (KKC) ≥2 (63.2% vs 6.7%, p &lt; 0.001), atrial fibrillation (AF) (15.4% vs 5.7%, p &lt; 0.001), left bundle branch block (7.5% vs 3.1%, p &lt; 0.001) and were previously treated with diuretics (39.1% vs 22.1%, p &lt; 0.001), amiodarone (2.2% vs 1.4%, p &lt; 0.001) and digoxin (2.8% vs 0.7%, p &lt; 0.001). GB had higher rates of multivessel disease (66.0% vs 49.5%, p &lt; 0.001) and planned coronary artery bypass grafting (7.3% vs 6.0%, p &lt; 0.001), reduced left ventricle function (72.3% vs 33.4%, p &lt; 0.001) and needed more frequently mechanical ventilation (8.2% vs 0.9%, p &lt; 0.001), non-invasive ventilation (8.7% vs 0.5%, p &lt; 0.001) and provisory pacemaker (4.5% vs 1.0%, p &lt; 0.001). Logistic regression confirmed females (p &lt; 0.001, OR 1.42, CI 1.29-1.58), diabetes (p &lt; 0.001, OR 1.43, CI 1.30-1.58), previous ACS (p &lt; 0.001, OR 1.27, CI 1.10-1.47), previous stroke (p &lt; 0.001, OR 1.35, CI 1.16-1.57), CKD (p &lt; 0.001, OR 1.76, CI 1.50-2.05), COPD (p &lt; 0.001, OR 2.15, CI 1.82-2.54), previous usage of amiodarone (p = 0.041, OR 1.35, CI 1.01-1.81) and digoxin (p &lt; 0.001, OR 2.30, CI 1.70-3.16), and multivessel disease (p &lt; 0.001, OR 1.64, CI 1.67-2.32) were predictors of HF in the setting of ACS. Event-free survival was higher in GA than GB (79.5% vs 58.1%, OR 2.3, p &lt; 0.001, CI 2.09-2.56). Conclusion As expected, HF in the setting of ACS is associated with poorer prognosis. Several features may help predict the HF occurrence during hospitalizations, allowing an earlier treatment.

scholarly journals High-Sensitive Troponin I and Re-Hospitalization in Patients With Decompensated Congestive Heart Failure

2019 ◽  
Author(s):  
Shokoufeh Hajsadeghi ◽  
Yaghoub Bagheri ◽  
Mohammad Hossein Ghafouri ◽  
Scott Reza Jafarian Kerman ◽  
Morteza Hassanzadeh
Keyword(s):  
Heart Failure ◽  
Troponin I ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Hospitalized Patients ◽  
Post Discharge ◽  
Shock Delivery ◽  
Coronary Syndrome ◽  
Patients With Heart Failure

Abstract- Patients with heart failure (HF) are frequently admitted for episodes of decompensation. Cardiac troponins are easily accessible biomarkers role of which for risk stratification of re-hospitalization among HF patients is less certain. We aimed to evaluate high-sensitive cardiac troponin I (hs-cTnI) levels among re-hospitalized patients with decompensated heart failure (D-HF). Consecutive subjects admitted with D-HF to 2 hospitals in Tehran, during the year 2014 were recruited. Excluded ones were patients with a suspected acute coronary syndrome or myocarditis/pericarditis, those with cardiopulmonary resuscitation/DC shock delivery, or major complications during or after hospitalization. Along with echocardiography parameters, level of hs-cTnI was checked at the first hour of hospitalization and 3 months after discharge. The patients were then categorized according to having or not having re-hospitalization during 3 months post discharge. A total of 97 patients were finally recruited. Among re-hospitalized patients, Left ventricular (LV) ejection fraction was significantly lower (38±14 % vs. 50 ± 12%; P=0.001), and LV end-systolic dimension was significantly higher (44±9 mm vs. 38±11 mm; P=0.012) compared to the other group. Moreover, levels of hs-cTnI were significantly higher among the re-hospitalized patients, both at initial visit (0.66±0.43 ng/ml vs 0.51±0.14 ng/ml, respectively; P=0.017) and at 3 months (0.59±0.48 ng/ml vs 0.48±0.23 ng/ml, respectively; P=0.030). This prospective study demonstrated that levels of hs-cTnI (both at the base and at follow up) are higher among patients who readmitted during 3 months of hospitalization for D-HF.

Usefulness of the society for cardiovascular angiography and intervention classification for predicting in-hospital mortality in patients with acute decompensated heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Burgos ◽  
L Talavera ◽  
R Baro Vila ◽  
A Acosta ◽  
M Cabral ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Vasoactive Medication ◽  
Staging Classification

Abstract Introduction Recently a multidisciplinary group of the Society for Cardiovascular Angiography and Interventions (SCAI) derived a new classification schema for cardiogenic shock (CS), simple, clinically based and suitable for rapid assessment at the bedside but also arbitrary. Validation in different clinical datasets, specifically in patients with acute decompensated heart failure (ADHF), is necessary to establish the utility of this proposed classification schema. Purpose We aimed to evaluate the ability of a new SCAI CS staging classification to predict in-hospital mortality in patients with ADHF. Methods We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data of consecutive patients admitted with ADHF as a primary diagnosis between January 2015 and January 2019. We excluded patients who were hospitalized for an acute coronary syndrome. Patients were assigned to the modified SCAI Classification for CS: Stage A is “at risk” for CS, stage B is “beginning” shock, stage C is “classic”, stage D is “deteriorating”, and E is “extremis”, and in-hospital mortality was evaluated for each group. All-cause mortality was compared across SCAI stages using Kaplan-Meier analysis and log-rank test. Cox proportional hazards models were used to determine the association between SCAI stages and in-hospital mortality after adjusting for age, gender, left ventricular ejection fraction, use of vasoactive medication, mechanical circulatory assist devices, mechanical ventilation, percutaneous coronary intervention and cardiac surgery. Results Among 668 patients with a mean age of 74.9±12 years, 63.9% were male. In-hospital mortality was 11.2%. According to SCAI classification, the proportion of patients in stages A through E was 51.7%, 26.7%, 14.4%, 4.6% and 2.5%. The unadjusted mortality in each stages was: A 0.6%, B 4.5%, C 32.3%, D 61.3%, and E 88.2% (Log Rank P&lt;0.0001). After multivariable adjustment, each SCAI shock stage remained associated with increased in-hospital mortality (all P&lt;0.001 compared to stage A). Compared with SCAI shock stage A, adjusted hazard ratio (HR) values in SCAI shock stages B through E were 5.2, 31, 107, and 185, respectively (Figure). Conclusion In this large clinical cohort of patients with ADHF exclusively, the new SCAI CS staging classification was associated with in-hospital mortality. This finding supports the rationale of the classification in this setting, further prospective trials are needed to validate these findings. Adjusted in-hospital Mortality as a Func Funding Acknowledgement Type of funding source: None

P6471Pronostic impact of significant valvular disease in long-term survivors of out-of-hospital-cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Rodriguez ◽  
J Caro-Codon ◽  
J R Rey-Blas ◽  
S O Rosillo ◽  
O Gonzalez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Percutaneous Treatment ◽  
Valvular Disease ◽  
Temperature Management ◽  
P Value ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

Abstract Background There is scarce evidence about the prevalence and clinical relevance of moderate to severe valvular heart disease (VHD) in survivors of out of hospital cardiac arrest (OHCA). Purpose To determine whether VHD influence prognosis of OHCA survivors. Methods All consecutive patients admitted to the Acute Cardiac Care Unit after OHCA and surviving until hospital discharge were included. All patients received targeted-temperature management according to our local protocol. Univariate and multivariate Cox-proportional hazard models were employed. Results A total of 201 patients were included in the analysis. Mean age was 57.6±14.2 years and 168 (83.6%) were male. Eighteen patients (9.0%) had moderate or severe VHD during index admission (Table 1). Patients with VHD were less frequently of male sex, [11 (61.1%) vs 157 (85.8%), p=0.014], experienced less acute coronary syndrome-related arrhytmias [2 (11.1%) vs 85 (46.5%), p=0.005], and had a lower pH at hospital admission (6.9±1.6 vs 7.2±0.15, p=0.008). During a median follow-up of 40.3 (18.9–69.1) months, patients with VHD showed higher mortality [7 (38.9%) vs 28 (15.3%), p=0.004] and more heart failure-related admissions [7 (38.9%) vs 15 (8.2%), p<0.001]. Only five patients received surgical or percutaneous treatment for VHD during follow-up, with no deaths in this subgroup. Moderate or severe VHD proved to be an independent predictor of global cardiovascular events and specifically heart failure episodes (Figure 1). Table1 Variable With valvular disease Without valvular disease p value Age, mean±DS, years 63.5±13.2 57.0±14.1 0.066 Hypertension, n (%) 12 (66.7) 95 (51.9) 0.231 Diabetes, n (%) 5 (27.8) 24 (13.1) 0.149 Dyslipidaemia, n (%) 7 (38.9) 79 (43.2) 0.726 Smokin habit, n (%) 4 (22.2) 90 (49.2) 0.045 Witnessed cardiac arrest, n (%) 18 (100) 175 (95.6) 1.000 Time from CA to ROSC, mean±DS, minute 19.1±7.5 21.2±13.1 0.506 Shockable rhythm, n (%) 13 (72.2) 163 (89.1) 0.055 LVEF at hospital discharge (%) 42.8±12.1 46.9±14.6 0.254 Figure 1 Conclusion The presence of significant VHD in survivors after OHCA is a predictor of poor outcomes. Specific management of VHD may be specially relevant in this high-risk patients and guideline-oriented therapy, including surgery and percutaneous intervention should be encouraged when indicated.

Adverse cardiovascular outcome predicted by left atrial strain in acute decompensated heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Barki ◽  
M Losito ◽  
M Carrozzo ◽  
M.M Caracciolo ◽  
M Rovida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Atrial ◽  
Acute Decompensated Heart Failure ◽  
Significant Proportion ◽  
Decompensated Heart Failure ◽  
Primary Role ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
B Lines

Abstract Background A significant proportion of patients hospitalized for acute decompensated heart failure (ADHF) are readmitted to the hospital within 30 days, resulting in a major social and economic burden. Thus, risk stratification and identification of targets of therapy is of basic importance. Non-invasive imaging modality such as transthoracic echocardiography (TTE) represents a cornerstone tool to approach this clinical scenario for early recognition of high-risk patients. Purpose To define whether left atrial (LA) dynamics, evaluated by means of speckle tracking echocardiography (STE), may represent a predictor of cardiac events and early re-hospitalization in patients admitted to the emergency department (ED) for ADHF, in comparison with other non-invasive established prognostic index in heart failure (HF) such as NT-proBNP, B-lines at lung ultrasonography (LUS) and right ventricular (RV) to Pulmonary Circulation (PC) uncoupling evaluated through Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Arterial Systolic Pressure (PASP) ratio. Methods Seventy patients (mean age 75.6±11 years, 57% males) presenting with ADHF were prospectively enrolled within 24–48 hours from admission. In the acute phase and at pre-discharge the following variables have been collected: NT-proBNP, B-lines, TAPSE/PASP ratio, Left Atrial Volume indexed (LAVi) and global-peak atrial longitudinal strain (G-PALS). Results During a median follow-up of nine months we observed 18 events consisting of 7 deaths, 8 re-hospitalizations for ADHF, 1 re-hospitalization for acute coronary syndrome, 1 stroke and 1 mitral valve replacement. Multivariate Cox-regression analysis identified LAVi and GPALS at discharge, along with NT-proBNP, B-lines and TAPSE/PASP ratio, as independent predictors of major adverse CV events (LAVi: p=0.04; GPALS: p=0.05; NT-proBNP: p&lt;0.001; B-lines: p=0.03; TAPSE/PASP: p&lt;0.001) (Table 1). Conclusions Short-term re-hospitalization in ADHF is crucial and the identification of a higher risk through sensitive and potentially new hemodynamic phenotypes is of relevance. Our findings, although preliminary, may suggest a primary role of LA dynamics in this context. Funding Acknowledgement Type of funding source: None

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

2018 ◽  
Author(s):  
Glen Franklin ◽  
Amirreza Motameni ◽  
Johnson Walker
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Cardiac Arrhythmias ◽  
Acute Coronary Syndromes ◽  
Acute Decompensated Heart Failure ◽  
Management Strategies ◽  
Decompensated Heart Failure ◽  
Surgical Patient ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiac arrhythmias and events, such as acute coronary syndrome and acute decompensated heart failure, are becoming increasingly common with an aging population. Much is written regarding the evaluation and management of these conditions in the cardiac and vascular patient populations; however, there is less literature to discuss the management strategies in the critically ill noncardiac postoperative and polytrauma patients. Factors such as physiologic stress, electrolyte imbalances, neurologic derangement, infection, and massive fluid shifts create an environment that promotes cardiopulmonary instability. Appropriate recognition of cardiac arrhythmias, acute coronary syndromes, and heart failure coupled with accurate and timely intervention can reduce morbidity and mortality in these patients. This review discusses the assessment and management of cardiac tachy- and brady-arrhythmias, acute coronary syndromes, and acute decompensated heart failure in the surgical patient. This review contains 4 figures, 5 tables and 45 references Key Words: acute coronary syndrome, angina, arrhythmia, bradycardia, cardiac ischemia, dieresis, fluid overload, heart failure, infarction, tachycardia

P5451Catestatin and chronic heart failure patients with an acute decompensation event: clinical characteristics and 30-day all-cause mortality

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J A Borovac ◽  
D Glavas ◽  
Z Susilovic Grabovac ◽  
D Rusic ◽  
L Stanisic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Characteristics ◽  
Troponin I ◽  
High Sensitivity ◽  
Decompensated Heart Failure ◽  
Functional Class ◽  
P Value ◽  
Ckd Stage ◽  
All Cause Mortality ◽  
Acute Decompensation

Abstract Background Catestatin (CST) is a cardiovascular regulator with pleiotropic systemic functions that might affect the course of acutely decompensated heart failure (ADHF). Purpose To determine the association of serum CST with the 30-day all-cause mortality and to compare clinical and laboratory parameters between ADHF patients within the lowest vs. highest quartile of CST concentration. Methods Eighty-two consecutive ADHF patients, as adjudicated per ESC 2016 HF criteria, were enrolled in the study during 2018–2019. Results Mean age of the enrolled cohort was 70.8±9.3 years and 54.9% were women. Seventy percent of patients were in NYHA III functional class and nearly half had a reduced LVEF. Median CST value was 5.6 ng/mL (IQR 3, 12). During the 30-day follow-up, ten patients died (12.2%) due to all causes. CST levels were significantly higher among patients that died compared to survivors (21.9±6.3 vs. 10.2±1.5 ng/mL, p=0.0139, respectively). Patients in the highest CST quartile had higher mortality and disease burden accompanied by more prominent laboratory abnormalities, compared to patients in the lowest CST quartile. Compared groups did not significantly differ in terms of dosages and type of baseline HF pharmacotherapy. Table 1. Clinical characteristics Variable Lowest CST quartile (<3 ng/mL) Highest CST quartile (>12 ng/mL) p-value Age, years 72.8±8.3 70.0±7.9 0.281 Women, % 45.0 60.0 0.342 LVEF, biplane Simpson, % 39.0 41.0 0.645 30-day all-cause mortality, % 0.0 20.0 0.035 Mean NYHA functional class 2.83±0.38 3.21±0.42 0.007 Mean CKD stage, CKD-EPI 2.37±0.83 3.06±0.99 0.029 Mean arterial pressure, mmHg 99.7±17.8 100.1±19.2 0.953 NT-proBNP, pmol/L 535.3±522.4 1550.0±992.2 0.040 C-reactive protein, mg/L 9.37±7.47 32.90±18.35 0.015 High-sensitivity cardiac Troponin I, ng/L 20.60±18.05 30.02±27.38 0.256 Creatinine, μmol/L 102.9±38.9 150.6±91.2 0.038 Urea, mmol/L 9.6±3.5 14.3±7.1 0.012 Neutrophil-to-lymphocyte ratio 3.6±1.9 5.4±3.1 0.045 Hemoglobin, g/L 137.3±17.4 124.6±18.8 0.038 Figure 1. CST and 30-day mortality Conclusions Higher levels of catestatin measured during the hospitalization event among ADHF patients are associated with 30-day all-cause mortality and worse in-hospital profile thus might facilitate short-term prognosis. Acknowledgement/Funding None

scholarly journals Prognostic role of myocardial work in patients with heart failure and reduced ejection fraction treated by sacubitril/valsartan

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Galli ◽  
Y Bouali ◽  
A Gallard ◽  
A Hubert ◽  
C Leclercq ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Multivariable Analysis ◽  
Rank Test ◽  
P Value ◽  
Reduced Ejection Fraction ◽  
Funding Sources ◽  
Increase Risk ◽  
Echocardiographic Examination ◽  
Constructive Work

Abstract Funding Acknowledgements Type of funding sources: None. Background the non-invasive assessment of myocardial work (MW) by pressure-strain loops analysis (PSL) is a relative new tool for the evaluation of myocardial performance. Sacubitril/Valsartan is a treatment for heart failure with reduced ejection fraction (HFrEF) which has a spectacular effect on the reduction of cardiovascular events (MACEs). Purposes of this study were to evaluate 1) the short and medium term effect of Sacubitril/Valsartan treatment on MW parameters; 2) the prognostic value of MW in this specific group of patients. Methods 79 patients with HFrEF (mean age: 66 ± 12 years; LV ejection fraction: 28 ± 9%) were prospectively included in the study and treated with Sacubitril/Valsartan. Echocardiographic examination was performed at baseline, and after 6- and 12-month of therapy with Sacubitril/Valsartan. Results Sacubitril/Valsartan significantly increased myocardial constructive work (CW) (1023 ± 449 vs 1424 ± 484 mmHg%, p &lt; 0.0001) and myocardial work efficiency (WE) [87 (78-90) vs 90 (86-95), p &lt; 0.0001]. During FU (2.6 ± 0.9 years), MACEs occurred in 13 (16%) patients. After correction for LV size, LVEF and WE, global myocardial constructive work (CW) was the only predictor of MACEs [HR 0.99 (0.99-1.00), p = 0.05]. (Table 1). A CW &lt; 910 mmHg (AUC = 0.81, p &lt; 0.0001, Figure 1, left panel) identified patients at particularly increase risk of MACEs [HR 11.09 (1.45-98.94), p = 0.002, log-rank test p &lt; 0.0001] (Figure 2, Right panel). Conclusions in patients with HFrEF who receive a comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy, Sacubitril/Valsartan induces a significant improvement of myocardial CW and WE. In this population, the estimation of CW before the initiation of Sacubitril/Valsartan therapy allows the prediction of MACEs. Univariable analysis Multivariable analysis HR (95% CI) p-value HR (95% CI) p-value Age, per year 0.99 (0.95-1.04) 0.81 Ischemic cardiomyopathy 1.07 (0.36-3.21) 0.89 LVEDVi*, per ml/m2 1.01 (1.00-1.03) 0.03 LVESVi, per ml/m2 1.01 (1.00-1.03) 0.009 1.01 (0.99-1.02) 0.35 LVEF, per % 0.91 (0.85-0.98) 0.01 1.02 (0.93-1.12) 0.71 CW, per mmHg% 0.99 (0.99-1.00) 0.002 0.99 (0.99-1.00) 0.04 WE, per mmHg% 0.91 (0.86-0.96) 0.001 0.95 (0.88-1.02) 0.16 Predictors of MACEs at univariable and multivariable analysis Abstract Figure 1 A and B

scholarly journals Impact of polypharmacy on prognosis in patients with acute decompensated heart failure: from the CURE-HF registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Kanai ◽  
H Motoki ◽  
T Okano ◽  
K Kimura ◽  
M Minamisawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Poor Prognosis ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Study Cohort ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Funding Sources

Abstract Background Polypharmacy would be associated with poor prognosis in patients with heart failure (HF). Methods In 863 patients who discharged after treatment for HF were prospectively enrolled. Number of tablets prescribed at discharge was counted. Death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for HF were tracked. Results In our study cohort (median age, 78), 447 patients experienced adverse events during median 503 days follow-up. In Kaplan-Meier analysis, a greater number of prescribed tablets was associated with future adverse cardiac events in the crude population. Although patients with the greater number of non-HF medications showed worse outcome, those of HF medications were not associate with the outcome (Figure). Furthermore, the number of tablets was an independent predictor of future cardiovascular events after adjustment for age, gender, B-type natriuretic peptide, hemoglobin, albumin, estimated glomerular filtration rate, and left ventricular ejection fraction (HR 95% CI: 1.295 (1.066–1.573), p=0.009). Conclusions Polypharmacy was associated with poor prognosis. Although the numbers of tablets and non-HF medications were significantly associated with worse out come in HF patients, the number of HF medications was not. FUNDunding Acknowledgement Type of funding sources: None.

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