Abstract P164: Urban-rural Disparities Amongst Heart Failure Patients With Reduced Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Sherrie Khadanga ◽  
Daniel N Silverman ◽  
Timothy B Plante ◽  
Charles Cubberly ◽  
Johannes Steiner
Keyword(s):  
Heart Failure ◽  
Relative Risk ◽  
Ejection Fraction ◽  
New England ◽  
Urban Areas ◽  
Care Delivery ◽  
Smoking Status ◽  
Medical Center ◽  
Reduced Ejection Fraction ◽  
Urban Rural

Intro: Differences in health care delivery between urban and rural populations have been described, but the extent to which this impacts treatment and outcomes in patients with heart failure with reduced ejection fraction (HFrEF) within a large, rural HF referral network has not been evaluated to date. Objective: To describe differences in guideline directed medical therapy (GDMT) usage and cardiovascular (CV) mortality in urban vs rural dwelling individuals with HFrEF in Vermont. Methods: A retrospective analysis was performed on adult HFrEF patients residing in Vermont referred to University of Vermont Medical Center between January 1, 2015-2017. The study included all patients with a documented EF < 35% on echo. Demographics, risk factors, use of GDMT, and all-cause CV mortality were obtained. Urban and rural designations were based on the ZIP code version of the Rural-Urban Commuting Area (RUCA) classification system. Poisson regression analysis was used to compare the relative risk for mortality and use of GDMT by rurality. Results: 838 patients were identified (mean age 71.4 + 12.9 years old; 66.5% male) and divided into 3 RUCA groups (urban, rural, isolated). Adjusting for age, sex, hypertension, diabetes mellitus, atrial fibrillation and smoking status, no difference was seen in GDMT (table 1) between urban and rural patients (relative risk [RR], 1.03; 95% CI, 0.64-1.67). Urban patients were less likely than isolated patients to use GDT (RR, 0.75; 95% CI 0.52-1.08). There was a CV mortality benefit for those in rural (RR, 0.50; 95% CI 0.34-0.73) or isolated areas (RR, 0.74; 95% CI 0.62-0.89) compared to those in urban areas. Conclusion: While GDMT reduces morbidity and mortality in HFrEF patients, it was underutilized throughout Vermont. Findings from this state-wide cohort of decreased CV mortality in rural and isolated areas are contrary to prior studies. This finding highlights the unique socioeconomic environment of Northern New England and has important implications for CHF management and resource allocation.

scholarly journals Clinical Characteristics and Outcomes of Adults With a History of Heart Failure Hospitalized for COVID-19

2021 ◽  
Author(s):  
Parag Goyal ◽  
Evgeniya Reshetnyak ◽  
Sadiya Khan ◽  
Mahad Musse ◽  
Babak B. Navi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Relative Risk ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
History Of ◽  
Adjusted Model

Background: It is important to understand the risk for in-hospital mortality of adults hospitalized with acute coronavirus disease 2019 (COVID-19) infection with a history of heart failure (HF). Methods: We examined patients hospitalized with COVID-19 infection from January 1, 2020 to July 22, 2020, from 88 centers across the US participating in the American Heart Association’s COVID-19 Cardiovascular Disease registry. The primary exposure was history of HF and the primary outcome was in-hospital mortality. To examine the association between history of HF and in-hospital mortality, we conducted multivariable modified Poisson regression models that included sociodemographics and comorbid conditions. We also examined HF subtypes based on left ventricular ejection fraction in the prior year, when available. Results: Among 8920 patients hospitalized with COVID-19, mean age was 61.4±17.5 years and 55.5% were men. History of HF was present in 979 (11%) patients. In-hospital mortality occurred in 31.6% of patients with history of HF, and 16.9% in patients without a history of HF. In a fully adjusted model, history of HF was associated with increased risk for in-hospital mortality (relative risk: 1.16 [95% CI, 1.03–1.30]). Among 335 patients with left ventricular ejection fraction, heart failure with reduced ejection fraction was significantly associated with in-hospital mortality in a fully adjusted model (heart failure with reduced ejection fraction relative risk: 1.40 [95% CI, 1.10–1.79]; heart failure with mid-range ejection fraction relative risk: 1.06 [95% CI, 0.65–1.73]; heart failure with preserved ejection fraction relative risk, 1.06 [95% CI, 0.84–1.33]). Conclusions: Risk for in-hospital mortality was substantial among adults with history of HF, in large part due to age and comorbid conditions. History of heart failure with reduced ejection fraction may confer especially elevated risk. This population thus merits prioritization for the COVID-19 vaccine.

scholarly journals Heart Failure Care Delivery in the COVID-19 Era: The Patients’ Perspective

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 245
Author(s):  
Meg Fraser ◽  
Melinda Mutschler ◽  
Christie Newman ◽  
Kerry Sackman ◽  
Batul Mehdi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Care Delivery ◽  
Statistical Significance ◽  
Healthcare Delivery ◽  
Severe Infection ◽  
Reduced Ejection Fraction ◽  
Heart Failure Care ◽  
Increased Risk ◽  
Virtual Visits

Purpose: The SARS-CoV-2 pandemic is changing healthcare delivery around the world with hospital systems experiencing a dramatic decline in patient volumes. Surveying our center’s heart failure (HF) clinic population, we aimed to understand our patients’ perception of coronavirus disease 2019 (COVID-19) and care delivery preferences. Methods: Patients with chronic HF presenting either in-person or virtually were approached to complete a ten question, anonymous, voluntary survey. Acutely decompensated patients and heart transplant recipients were excluded. Results: 109 patients completed the survey. Average age was 62 ± 14 years, 67% were male, and 59% had HF with reduced ejection fraction (HFrEF). Overall, patients were worried about contracting COVID-19 and believed they were prone to more severe infection given their underlying HF. However, they were not hesitant to initiate healthcare contact for symptoms and preferred in-person appointments over virtual visits. Although the difference did not reach statistical significance, female patients and those with HF with preserved ejection fraction (HFpEF) were more concerned. Conclusions: Patients with HF are concerned about their increased risk of contracting COVID-19. However, they are actively seeking healthcare contact and prefer in-person over virtual visits.

Abstract 15532: Characteristics and Outcomes of Patients With Heart Failure With Reduced Ejection Fraction and a Worsening Heart Failure Event

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anthony P CARNICELLI ◽  
Robert M Clare ◽  
Paul Hofmann ◽  
Karen Chiswell ◽  
Adam D Devore ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Heart Transplant ◽  
Medical Center ◽  
Left Ventricular ◽  
Eligibility Criteria ◽  
Ventricular Assist ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Duke University

Background: Several recent heart failure trials enrolled patients with heart failure with reduced ejection fraction (HFrEF) who had a worsening heart failure (WHF) event. Aim: To describe the characteristics and outcomes of patients with HFrEF and a WHF event at a large tertiary medical center. Methods: We identified patients 18-85 years of age with chronic symptomatic HFrEF (EF ≤35% and ≥2 HF encounters in the prior 18 months) treated at Duke University between Jan 2009-Dec 2018 through the Duke Echo Lab Database. A WHF event was defined as either a hospitalization or ED visit for HF in the prior 12 mos. A set of exclusion criteria [e.g., renal dysfunction, left ventricular assist device (LVAD), heart transplant] were applied to patients with a WHF event to generate a patient cohort similar to those enrolled in contemporary HF trials. We did not restrict the cohort based on BP or BNP levels since these vary over time. Baseline characteristics and outcomes including death and hospitalization were assessed. Results: Of 4846 unique patients with HFrEF, 3668 (76%) had a WHF event in the year prior to index echo. Sequentially, patients with GFR <20 mL/min/1.73 m 2 (n=458), LVAD (n=291), or heart transplant (n=95) were excluded; 2824/4846 (58%) remained in the WHF study population. HFrEF patients with WHF were typically men (68%) with median age of 65 years (IQR 54, 73) and low EF (EF <25% in 57%). Coronary disease (71%), diabetes (44%), and elevated NT-proBNP (median 2405 pg/mL [698, 6841]) were common. Beta-blocker, ACEi/ARB, and MRA use were 88%, 79% and 44%, respectively. HFrEF patients with WHF had a high 30-day, 1-year, and 5-year cumulative incidence of all-cause mortality and HF hospitalization after index echo (FIGURE). Conclusions: In patients with chronic HFrEF at Duke University, 76% had a WHF event in the past year and 58% met several of the key eligibility criteria of contemporary HF trials. Patients with recent WHF had a high burden of comorbidities and very high event rates.

Heart Failure with Preserved Ejection Fraction – A Review

2012 ◽  
Vol 9 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Otto A Smiseth ◽  
Anders Opdahl ◽  
Espen Boe ◽  
Helge Skulstad
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Heart Failure ◽  
The Elderly ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Objective Evidence

Heart failure with preserved left ventricular ejection fraction (HF-PEF), sometimes named diastolic heart failure, is a common condition most frequently seen in the elderly and is associated with arterial hypertension and left ventricular (LV) hypertrophy. Symptoms are attributed to a stiff left ventricle with compensatory elevation of filling pressure and reduced ability to increase stroke volume by the Frank-Starling mechanism. LV interaction with stiff arteries aggravates these problems. Prognosis is almost as severe as for heart failure with reduced ejection fraction (HF-REF), in part reflecting co-morbidities. Before the diagnosis of HF-PEF is made, non-cardiac etiologies must be excluded. Due to the non-specific nature of heart failure symptoms, it is essential to search for objective evidence of diastolic dysfunction which, in the absence of invasive data, is done by echocardiography and demonstration of signs of elevated LV filling pressure, impaired LV relaxation, or increased LV diastolic stiffness. Antihypertensive treatment can effectively prevent HF-PEF. Treatment of HF-PEF is symptomatic, with similar drugs as in HF-REF.

Evaluation of the Efficacy of ST2 and NT-proBNP in the Diagnosis and Prediction of Short- Term Prognosis in Heart Failure with Reduced Ejection Fraction

2017 ◽  
Vol 9 (04) ◽  
Author(s):  
Shivananda B Nayak ◽  
Dharindra Sawh ◽  
Brandon Scott ◽  
Vestra Sears ◽  
Kareshma Seebalack ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Biomarkers ◽  
Double Blind Study ◽  
Short Term ◽  
Double Blind ◽  
Reduced Ejection Fraction ◽  
The Mean ◽  
Design And Methods ◽  
The Relationship

Purpose: i) To determine the relationship between the cardiac biomarkers ST2 and NT-proBNP with ejection fraction (EF) in heart failure (HF) patients. ii) Assess whether a superiority existed between the aforementioned cardiac markers in diagnosing the HF with reduced EF. iii) Determine the efficacy of both biomarkers in predicting a 30-day cardiovascular event and rehospitalization in patients with HF with reduced EF iv) To assess the influence of age, gender, BMI, anaemia and renal failure on the ST2 and NT-proBNP levels. Design and Methods: A prospective double-blind study was conducted to obtain data from a sample of 64 cardiology patients. A blood sample was collected to test for ST2 and NT-proBNP. An echocardiogram (to obtain EF value), electrocardiogram and questionnaire were also obtained. Results: Of the 64 patients enrolled, 59.4% of the population had an EF less than 40%. At the end of the 30- day period, 7 patients were warded, 37 were not warded, one died and 17 were non respondent. Both biomarkers were efficacious at diagnosing HF with a reduced EF. However, neither of them were efficacious in predicting 30-day rehospitalization. The mean NT-proBNP values being: not rehospitalized (2114.7486) and 30 day rehospitalization (1008.42860) and the mean ST2 values being: not rehospitalized (336.1975), and 30-day rehospitalization. (281.9657). Conclusion: Neither ST2 or NT-proBNP was efficacious in predicting the short- term prognosis in HF with reduced EF. Both however were successful at confirming the diagnosis of HF in HF patients with reduced EF.

Sign in / Sign up

Export Citation Format

Share Document