scholarly journals Readmission Rates and Medication Selection for Patients with Heart Failure Preserved Ejection Fraction

2020 ◽  
Author(s):  
Troy Kramer ◽  
Carrie Vogler ◽  
Robert Robinson ◽  
Mukul Bhattarai
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Ejection Fraction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Prescribing Patterns ◽  
Preserved Ejection Fraction ◽  
Multivariate Logistic Regression ◽  
Readmission Rates

Purpose Heart failure with preserved ejection fraction (HFpEF) has less guideline driven treatment options due to a lack of trials demonstrating medications with improved clinical outcomes for this patient population. The primary objective of this study is to determine which medications and dosages are related to high readmission rates for HFpEF patients. Methods A retrospective, single center, chart review was performed on patients with HFpEF at an academic medical center. Heart failure patients ages between 18-89 with an ejection fraction ≥45% from a transthoracic echocardiogram (TTE) were included. Primary outcomes include 30-day all cause readmission rates, prescribing patterns, and avoidance of potentially harmful medications. Descriptive statistics and multivariate logistic regression were used to assess potential risk factors. Results This study analyzed 455 patient admissions. Univariate analysis shows patients who were not readmitted were more likely to be on furosemide (54% vs 42%; p = 0.019). Conversely, readmitted patients were more likely to be taking bumetanide (4% vs 1%; p = 0.039). Lisinopril was the only angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) associated with lower readmission rates (p = 0.036). Multivariate logistic regression showed bumetanide on admission (OR 14.6, p = 0.001), discharged on rosuvastatin (OR 6.29, p = 0.003) and meloxicam therapy (OR 6.33, p = 0.003) to be independent predictors of hospital readmission. Conclusion Three independent pharmacologic predictors for 30-day readmissions for patients with HFpEF were therapy with bumetanide, meloxicam, or rosuvastatin. Further research is needed to clarify the significance of these results.

P2610Increase in comfortable walking speed during hospitalization predicts the readmission due to decompensated heart failure in heart failure patients with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Tabata ◽  
M Kato ◽  
N Hamazaki ◽  
T Masuda
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Ejection Fraction ◽  
Exercise Capacity ◽  
Walking Speed ◽  
Decompensated Heart Failure ◽  
Preserved Ejection Fraction ◽  
Functional Classification ◽  
Multivariate Logistic Regression ◽  
Heart Failure Patients

Abstract Background Heart failure patients with preserved ejection fraction (HFpEF) have reduced exercise capacity and poor prognosis as well as those with reduced ejection fraction (HFrEF). Both cardiac function and exercise capacity have been known as prognostic factors for patients with HFrEF. However, few reports documented the relations of comfortable walking speed (CWS) during hospitalization to exercise capacity and prognosis. is used as a clinical measure to assess their exercise capacity and prognosis. However, few reports documented the correlations of CWS with exercise capacity and prognosis in patients with HFpEF. Purpose This study aimed to investigate whether CWS at hospital discharge and the increase in CWS during hospitalization predicted the readmission due to decompensated heart failure in patients with HFpEF and HFrEF. Methods Patients who were hospitalized due to heart failure with New York Heart Association (NYHA) Functional Classification III or IV were prospectively followed up for 3 years after hospital discharge. Consequently, 264 patients, 173 males and 92 females, aged 73.2±6.8 years were studied. Patients were divided into 3 groups based on their ejection fraction (EF): HFpEF group (EF≥50%; n=98), HFrEF group (EF<40%; n=138) and heart failure with mid-range ejection fraction (HFmrEF) group (40%≤EF≤49%; n=28). We assessed clinical characteristics including age, gender, height, NYHA functional classification, etiology of CHF, plasma brain natriuretic peptide and left ventricular ejection fraction (LVEF) on admission, and measured CWS several days after admission and at discharge. We determined significant factors affecting the readmission and their cut-off values using univariate and multivariate logistic regression analyses and the area under the receiver operating characteristics curves in the three groups. Results Forty patients (40.8%), 54 (39.1%) and 6 (21.4%) were readmitted in the HFpEF, HFrEF and HFmrEF groups, respectively, within 3 years after the discharge. Univariate logistic regression analysis detected the age, LVEF, CWS at discharge and the CWS increase during hospitalization as significant limiting factors for readmission in the HFpEF and HFrEF groups (P<0.05, respectively). The multivariate logistic regression analysis detected the CWS increase during hospitalization as significant limiting factor for readmission in the HFpEF and HFrEF groups (P<0.001 and P<0.05, respectively). The odds ratios of readmission were 1.86 (P<0.01) and 1.44 (P<0.001) with each 5-meter decrease of CWS increase during hospitalization and predictive cut-off values of the CWS increase were 7.5 and 8.5 meters/min in the HFpEF and HFrEF groups, respectively. Conclusion This study demonstrated that the CWS increase during hospitalization was a strong predictor for readmission due to decompensated heart failure in patients not only with HFrEF but also with HFpEF and each predictive the cut-off value was 7.5 and 8.5 meters/min.

scholarly journals Heart Failure Drug Class Effects on 30-Day Readmission Rates in Patients with Heart Failure with Preserved Ejection Fraction: A Retrospective Single Center Study

Medicines ◽  
2020 ◽  
Vol 7 (5) ◽  
pp. 30
Author(s):  
Priyanka Parajuli ◽  
Odalys Lara-Garcia ◽  
Manjari Regmi ◽  
Warren Skoza ◽  
Mukul Bhattarai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Ejection Fraction ◽  
Hospital Readmission ◽  
Lower Risk ◽  
Loop Diuretics ◽  
Preserved Ejection Fraction ◽  
Day Hospital ◽  
Multivariate Logistic Regression ◽  
Early Readmission

Background: The pharmacologic management of heart failure with preserved ejection fraction (HFpEF) involves far fewer options with demonstrated additional benefit. Therefore, we examined the effect of combination of multiple classes of HF medication in the 30-day hospital readmission in patients with HFpEF. Methods: All adult patients discharged with a diagnosis of HFpEF and a left ventricular ejection fraction (LVEF) of ≥ 50% reported during the admission or within the previous six months from our institution were retrospectively studied for a 30-day hospital readmission risk. Individual as well as combination drug therapy at the time of hospital discharge were evaluated using Pearson chi2 test and multivariate logistic regression. Results: The overall 30-day readmission rate in this HFpEF cohort of 445 discharges was 29%. Therapy with loop diuretics (p = 0.011), loop diuretics and angiotensin receptor blocker (p = 0.043) and loop diuretics and beta blockers (p = 0.049) were associated with a lower risk of 30-day hospital readmission. Multivariate logistic regression revealed only loop diuretics to be associated with a lower risk of hospital readmission in patients with HFpEF (OR 0.59; 95% CI, 0.39-0.90; p = 0.013). Conclusions: Our study revealed that loop diuretics at discharge decreases early readmission in patients with HFpEF. Further, our study highlights the implication of a lack of guidelines and treatment challenges in HFpEF patients and emphasizes the importance of a conservative approach in preventing early readmission in patients with HFpEF.

scholarly journals 46 A clinical and echocardiographic score to differentiate pulmonary hypertension due to heart failure with preserved ejection fraction from idiopathic pulmonary hypertension: the PH-HFpEF score

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesco Chietera ◽  
Fabio Dardi ◽  
Mariangela Rotunno ◽  
Massimiliano Palazzini ◽  
Daniele Guarino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Logistic Regression ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical History ◽  
Pulmonary Vascular Disease ◽  
Preserved Ejection Fraction ◽  
Multivariate Logistic Regression

Abstract Aims One of the most challenging differential diagnoses in pulmonary hypertension clinical practice, is the discrimination between idiopathic pulmonary arterial hypertension (IPAH) and pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF). We elaborate a score (considering patient clinical history, demographics, and echocardiographic characteristics) that can predict, noninvasively, PH-HFpEF vs. IPAH diagnosis. Methods and results Data were prospectively collected on 466 consecutive patients with a final diagnosis of IPAH or PH-HFpEF referred to a single tertiary pulmonary vascular disease centre. Data included clinical history, demographics, and parameters of an electrocardiogram and a transthoracic echocardiogram. A multivariate regression model was developed to predict a PH-HFpEF diagnosis, and an integer risk score was generated using adjusted regression coefficients of the multivariate logistic regression analysis. At the multivariate logistic regression a high ratio between left and right ventricular dimensions, a history of atrial fibrillation (AF), a high body mass index (BMI), a reduced mitral deceleration time and a high E-wave at trans-mitral Doppler, an advanced age and a high right ventricular fractional area change (FAC) were predictors of PH-HFpEF. The derived PH-HFPEF score (Figure), with a cut-point ≥11, yielded a specificity/sensitivity, respectively, for the diagnosis of PH-HFpEF, of 100%/49% with an AUC of 0.987. ED, end-diastolic; LV, left ventricle; RV, right ventricle. Conclusions The PH-HFPEF score can predict PH-HFpEF vs. IPAH. The PH-HFPEF score may be used to potentially avoid an invasive diagnostic testing in almost half of PH-HFpEF patients.

scholarly journals Trends in cause-specific readmissions in heart failure with preserved versus reduced and mid-range ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.T Cui ◽  
E Thunstrom ◽  
U Dahlstrom ◽  
J.M Zhou ◽  
J.B Ge ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Temporal Trend ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Readmission Rates ◽  
P Values ◽  
National Board ◽  
Over Time

Abstract Background It remains unclear whether the readmission of heart failure (HF) patients has decreased over time and how it differs among HF with preserved ejection fraction (EF) (HFpEF) versus reduced EF (HFrEF) and mid-range EF (HFmrEF). Methods We evaluated HF patients index hospitalized from January 2004 to December 2011 in the Swedish Heart Failure Registry with 1-year follow-up. Outcome measures were the first occurring all-cause, cardiovascular (CV) and HF readmissions. Results Totally 20,877 HF patients (11,064 HFrEF, 4,215 HFmrEF, 5,562 HFpEF) were included in the study. All-cause readmission was highest in patients with HFpEF, whereas CV and HF readmissions were highest in HFrEF. From 2004 to 2011, HF readmission rates within 6 months (from 22.3% to 17.3%, P=0.003) and 1 year (from 27.7% to 23.4%, P=0.019) in HFpEF declined, and the risk for 1-year HF readmission in HFpEF was reduced by 7% after adjusting for age and sex (P=0.022). Likewise, risk factors for HF readmission in HFpEF changed. However, no significant changes in cause-specific readmissions were observed in HFrEF. Time to the first readmission did not change significantly from 2004 to 2011, regardless of EF subgroup (all P-values&gt;0.05). Conclusions Although the burden of all-cause readmission remained highest in HFpEF versus HFrEF and HFmrEF, a declining temporal trend in 6-month and 1-year HF readmission rates was found in patients with HFpEF, suggesting that non-HF-related readmission represents a big challenge for clinical practice. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The SwedeHF was funded by the Swedish National Board of Health and Welfare, the Swedish Association of Local Authorities and Regions.

Abstract 17264: Predictive Value of Plasma Ceramide C24:0/C16:0 Ratio in Patients With Heart Failure With Preserved Ejection Fraction in the TOPCAT Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Linda R Peterson ◽  
Xuntian Jiang ◽  
Hannah Campbell ◽  
Sharon Cresci
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cell Structure ◽  
Univariate Analysis ◽  
The United States ◽  
Preserved Ejection Fraction ◽  
Bioactive Lipids ◽  
Confidence Bounds ◽  
Liquid Chromatograph ◽  
Reduced Ejection Fraction

Introduction: Heart failure (HF) with preserved ejection fraction (HFpEF) is an “emerging epidemic” as nearly half of all patients with HF have HFpEF. However, most HF biomarkers, including plasma brain natriuretic peptide, have less robust utility in HFpEF than in those with HF with reduced ejection fraction. In order to better understand HFpEF and its associated morbidity and mortality, it is vital to identify robust biomarkers that predict outcomes in patients who suffer from HFpEF. Ceramides are bioactive lipids involved in signaling, cell death programs, mitochondrial function, and cell structure. Our group showed that the ratio of specific plasma ceramides (C24:0/C16:0) is inversely related to primary incident HF and to death in large community-based cohorts. Whether plasma C24:0/C16:0 has utility in prediction of secondary events/outcomes in patients with HFpEF is unclear. Hypothesis: We hypothesized that there is an association between plasma C24:0/16:0 ratio and outcomes in HFpEF. Methods: Data and plasma was obtained from 477 subjects in the TOPCAT study via the BioLINCC biobank. Plasma ceramides C24:0 and C16:0 were measured using targeted liquid chromatograph/tandem mass spectrometry. Results: Inclusion criteria for TOPCAT was age >50 years, ejection fraction of 45% or higher and diagnosis of HF. Subjects were randomized to treatment with spironolactone or placebo. In the 477 subjects who provided samples to BioLINCC, the mean age was 69.3 years; 47% were women; 43.9% were from the United States; 94.4% had hypertension; 31 were African American. Mean follow-up was 3.3 years. Univariate analysis showed that time to hospitalization for heart failure was inversely related to plasma C24:0/C16:0 concentration (Hazard ratio 0.901 [Confidence bounds 0.82,0.99], P = 0.026. Conclusions: Plasma ceramide (C24:0/C16:0) is inversely related to time to hospitalization in patients with HFpEF. Plasma C24:0/C16:0 may be a useful new biomarker in HFpEF and may point to novel, targetable pathophysiologic pathways .

3057Relation of atrial remodeling to circulating biomarkers of myocardial fibrosis and apoptotic microparticles in patients with atrial fibrillation and heart failure with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M S Dzeshka ◽  
E Shantsila ◽  
V A Snezhitskiy ◽  
G Y H Lip
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Matrix Metalloproteinase ◽  
Myocardial Fibrosis ◽  
Univariate Analysis ◽  
Volume Index ◽  
Atrial Remodeling ◽  
Preserved Ejection Fraction ◽  
Circulating Biomarkers

Abstract Introduction Left atrial (LA) remodeling is a mainstay for atrial fibrillation (AF) occurrence. AF further promotes structural changes in LA, as fibrosis and stretching, followed by AF progression to its permanent form. Many profibrotic pathways have been studied, and circulating microparticles (MPs) may have a role. MPs are extracellular submicron anucleoid phospholipid vesicles released from different cells. Annexin V-binding (AnV+) MPs were suggested as a marker of apoptosis. Purpose To evaluate association of circulating biomarkers of myocardial fibrosis and MPs subsets with LA remodeling in patients with AF and heart failure with preserved ejection fraction. Methods We studied 274 patients (median age 62 years, 37% females). Paroxysmal AF was diagnosed in 150 patients (55%) and non-paroxysmal AF (persistent or permanent) in 124 (45%). Median CHA2DS2-VASc score was 3 in males and 4 in females. Patients with valvular AF, recent (<6 months) thromboembolic or hemorrhagic event, advanced chronic kidney or hepatic dysfunction, malignancy or active inflammatory disorders were excluded. Transthoracic echocardiography was performed. LA maximum volume index (LAVi) was measured as an index of LA structural remodeling in AF. Average values from ten consecutive cardiac cycles were calculated. Blood levels of galectin 3, interleukin-1 receptor-like 1 (ST2), transforming growth factor beta 1 (TGF-β1), procollagen type III aminoterminal propeptide (PIIINP), matrix metalloproteinase 9 (MMP-9), tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), angiotensin II and aldosterone were assayed as surrogate biomarkers of myocardial fibrosis with ELISA. Using microflow cytometry (Figure), numbers of platelet-derived (CD42b+), monocyte-derived (CD14+), endothelial (CD144+), and apoptotic MPs (AnV+) were quantified in plasma samples. Linear regression was used to reveal parameters associated with LAVi. Raw data were normalized with Box-Cox transformation. Results Median LAVi in studied patients was 48 (39–59) ml/m2 and increased from patients with paroxysmal AF (42 [35–51] ml/m2) to persistent AF (53 [43–62] ml/m2) and permanent AF (57 [46–69] ml/m2), p<0.001. On univariate analysis male gender (β=0.11, p=0.04); history of hypertension (β=0.18, p=0.03); AF type, i.e. progression from paroxysmal to permanent (β=0.38, p<0.001); AnV+ MPs (β=0.19, p=0.005); ST2 (β=0.15, p=0.02); and early mitral inflow velocity (E)/early mitral annular diastolic velocity (E/E') averaged for LV septal and lateral basal regions (β=0.18, p=0.005) were associated with LAVi. Using stepwise multivariate regression AnV+ MPs (β=0.14, p=0.03); AF type (β=0.35, p<0.001); and E/E' ratio (β=0.11, p=0.04) remained significant predictors of LAVi (adjusted for age and gender). Apoptotic MPs detection with microFCM Conclusion Level of circulating apoptotic MPs is associated with LAVi in AF patients with HFpEF, and may be involved in remodeling process or could represent surrogate markers of myocardial damage in AF. Acknowledgement/Funding ESC Research Grant, EHRA Academic Research Fellowship Programme

P1088Effect of coronary artery disease on patients with atrial fibrillation and heart failure with preserved ejection fraction - from vicious twins to vicious triplets?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Stephan ◽  
A Kuehberger ◽  
M Baumhardt ◽  
K Weinmann ◽  
D Felbel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Catheter Ablation ◽  
Clinical Outcome ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Multivariate Logistic Regression ◽  
Artery Disease

Abstract Background Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) are common diseases and associated with increased morbidity and mortality, which even aggravates if both conditions are coexisting. Coronary artery disease (CAD) is highly prevalent in both, patients with AF (17-46%) and HFpEF (50-80%). Notably, all three entities share several common risk factors. While it is well established that the emergence of the vicious twins HFpEF and AF is mechanistically linked, CAD can also be pathophysiological related to HFpEF, as well as AF by several mechanisms. Aim The study aimed to evaluate the influence of CAD on patients with concomitant AF and HFpEF and to identify parameters affecting the patients clinical outcome. Methods We retrospectively screened patients with AF and HFpEF for CAD. Patients with and without CAD were compared by relevant patient characteristics and echocardiographic parameters at baseline and at the end of follow-up. Additionally, we assessed hospitalization rates and  performed multivariate logistic regression to analyze parameters influencing the clinical outcome.  Results Between January 2013 and December 2016 6.114 patients with atrial fibrillation and 2.187 patients with echocardiographic diastolic dysfunction were treated at our university hospital department. Of those, 127 patients had concomitant diagnosis of HFpEF according to current guidelines and AF. In 77 patients (61%) CAD had been diagnosed by coronary angiography. At baseline, CAD patients had significantly more myocardial infarction, dyslipidemia, use of aspirin, lower left ventricular ejection fraction, larger left ventricular diastolic diameter and a higher CHA2DS2-VAsc score. Moreover, CAD patients had significantly higher rates of all-cause and cardiovascular hospitalizations. Interestingly, NYHA-class and left ventricular mass index improved significantly in the group without CAD, whereas there was no change in the CAD-group. Multivariate logistic regression only associated catheter ablation for AF significantly with NYHA improvement in the total cohort. Assessment of all-cause and cardiovascular hospitalization in CAD patients undergoing either catheter ablation or medical therapy revealed, that catheter ablation significantly decreased event rates. Moreover, catheter ablation for AF was associated with echocardiographic signs of reverse remodelling, whereas conservative treatment resulted in progression of remodelling.  Conclusion This is the first study to evaluate the effect of CAD on patients with concomitant AF and HFpEF. As expected, presence of CAD was related to a worse clinical outcome. Interestingly, in CAD patients catheter ablation was significantly associated with functional and clinical improvement. In conclusion, catheter ablation for AF might display an effective therapeutic approach in this vulnerable population.

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