Abstract P319: Racial Differences and Temporal Trends in Obesity Among Patients Hospitalized With Acute Decompensated Heart Failure With Preserved Ejection Fraction: The ARIC Study Community Surveillance

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Melissa C Caughey ◽  
Muthiah Vaduganathan ◽  
Sameer Arora ◽  
Arman Qamar ◽  
Robert J Mentz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Racial Differences ◽  
Acute Decompensated Heart Failure ◽  
Temporal Trends ◽  
Decompensated Heart Failure ◽  
Obesity Paradox ◽  
Black Patients ◽  
Aric Study ◽  
White Patients

Introduction: Obesity is disproportionately prevalent in black populations and strongly associated with heart failure with preserved ejection fraction (HFpEF). An “obesity paradox” or lower mortality risk with obesity, has been reported in HFpEF populations. Whether racial differences exist in the temporal trends and outcomes of obesity is uncertain. Methods: Hospitalizations for acute decompensated heart failure (ADHF) were sampled from 2005-2014 by the ARIC Study Community Surveillance and classified by physician review. BMI was calculated using the admission height and weight. Associations between obesity and 1-year all-cause mortality were analyzed with multivariable Cox regression. Results: There were 10,147 weighted hospitalizations for ADHF with ejection fraction ≥50% (64% female, 74% white). Overall, black patients had a higher mean BMI than white patients (34 vs. 30 kg/m 2 ; P <0.0001), and a greater prevalence of obesity (56% vs. 43%; P <0.0001). Mean BMI and obesity steadily increased from 2005-2014 for white patients (Trends: P = 0.003 and P = 0.002) while remaining stable for black patients. Within BMI groups (18.5-24, 25-30, 30-35, 35-40, and ≥40 kg/m 2 ) a U-shaped mortality risk was observed, with the lowest risk among patients with a BMI of 30-35 kg/m 2 ( Figure ). When defining obesity by a BMI cutpoint ≥30 kg/m 2 , the “obesity paradox” was apparent in 2005-2009 for white obese vs. non-obese patients (HR = 0.58, 95% CI: 0.38 - 0.80), but attenuated by 2010-2014 (HR = 1.11; 95% CI: 0.80 - 1.48); P for interaction =0.006. Among black patients, there was no survival benefit for a BMI ≥30 kg/m 2 in 2005-2009 (HR = 1.15; 95% CI; 0.65 - 2.02) or 2010-2014 (HR = 1.06; 95% CI: 0.68 - 1.66). Conclusion: In this decade-long community surveillance of HFpEF patients hospitalized with ADHF, obesity and mean BMI were stable for black patients but steadily increased for white patients. A BMI ≥30 kg/m 2 was initially associated with better survival among white patients but the association dissipated as obesity and mean BMI increased over time.

Abstract P024: Temporal Trends in Hospitalizations for Acute Decompensated Heart Failure in the U.S.: Calibration using The Atherosclerosis Risk in Communities (ARIC) Surveillance Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Sunil K Agarwal ◽  
Lisa Wruck ◽  
Miguel Quibrera ◽  
Kunihiro Matsushita ◽  
Laura R Loehr ◽  
...  
Keyword(s):  
Heart Failure ◽  
Regression Models ◽  
Acute Decompensated Heart Failure ◽  
Temporal Trends ◽  
Decompensated Heart Failure ◽  
Primary Position ◽  
Validation Data ◽  
Icd Codes ◽  
Aric Study ◽  
The U.S

Background: Trends for acute decompensated heart failure (ADHF) hospitalizations based on the primary discharge ICD codes have declined in the U.S. However, HF ICD codes are increasingly found in non-primary positions. Validation data are needed to estimate the frequency of ADHF hospitalizations. Methods: The ARIC Study conducts surveillance for hospitalized ADHF in four U.S. communities for age ≥ 55 years since 2005. Hospital records are sampled, abstracted, and classified as ADHF or not by an expert physician panel. Analyses were stratified on code groups (a) 428.xx in primary-position, (b) 428.xx in non-primary position, and (c) other sampled HF ICD code (398, 402, 404, 415, 416, 425, 518, 786) in any position. We calculated ADHF probability in each group overall (positive predictive value, PPV), and by using regression models. We estimated the nationwide trends of ADHF hospitalizations from the National Inpatient Sample (NIS), a 20% probability sample of U.S. community hospitals, by applying the calibration factors derived in the ARIC study. Results: In ARIC surveillance 42% of eligible hospitalizations (n=12,450 charts) validated as ADHF. NIS data included 9 million eligible hospitalizations during 1999-2010. The estimated numbers of US ADHF hospitalization in 2010 among Americans ≥ 55 years old was 1.8 (SE 0.02) million as compared to 0.8 (SE 0.002) million with 428.xx in the primary position ( Figure ). The estimated ADHF hospitalizations in the U.S. increased from 1.6 million in 1999 to 1.9 million in 2006, and then decreased to 1.8 million in 2010 (average annual increase of 1%, p-trend <0.01). Estimated ADHF based on regression models for each of the three code groups gave similar results. The temporal increase was steeper among men and in age category 55-64 years than older ages. Conclusions: Estimated frequency of ADHF hospitalizations by ARIC validation criteria is about two times higher than ICD 428 in primary position; with an overall increasing vs. declining trend over the last decade.

Abstract P013: Prevalence and Outcomes of Anemia in Patients Hospitalized with Acute Decompensated Heart Failure: The ARIC Study Community Surveillance

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Melissa Caughey ◽  
Loehr Laura ◽  
Christy Avery ◽  
Hanyu Ni ◽  
Brad Astor ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Length Of Hospital Stay ◽  
Decompensated Heart Failure ◽  
Population Based ◽  
Reduced Ejection Fraction ◽  
Physician Review ◽  
Aric Study

Background: Anemia has been associated with increased mortality in heart failure patients. The prevalence and outcomes of anemia in patients hospitalized with acute decompensated heart failure (ADHF) in population-based settings are unknown. Methods: Hospitalizations related to heart failure among black and white residents 55 years and older were sampled by stratified design from 4 US communities (total population age 55+ =177,000), January 1, 2005 -December 31,2008 in the Atherosclerosis Risk in Communities (ARIC) Study. Events were validated by physician review of medical records, and linked to mortality files. Those classified as definite or probable ADHF were included in the analysis; chronic, stable heart failure and hospitalizations not for heart failure were excluded. ADHF was further classified as heart failure with preserved (≥50%) or reduced (<50%) ejection fraction. Laboratory values were abstracted from the hospital record. Anemia was defined by WHO guidelines (< 12 g/dL for women; < 13 g/dL for men), using the lowest hemoglobin. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-Epi formula using serum creatinine. Length of stay and mortality outcomes were analyzed by linear and logistic regression, respectively. All analyses were weighted to account for the sampling design and adjusted for race, age, sex, eGFR and smoking. Results: Over four years, 13,554 (weighted) hospitalized events for definite or probable ADHF occurred, based on 2,804 sampled events. Comorbidities of ADHF included: hypertension (84%), coronary heart disease (55%), chronic bronchitis or COPD (34%), diabetes (48%), and chronic kidney disease (eGFR < 60 mL/min/1.73m 2 ) (73%). Prevalence of anemia was 77% (95%CI: 75-79%) overall and did not differ by race (p=0.6), gender (p=0.1) or by subtype of heart failure based on preserved or reduced ejection fraction (p=0.09). Anemia was more common in patients over age 75 (80%; 95%CI: 78-83%) than patients aged 55-74 (73%; 95% CI: 70-76%); p<.0001. Anemia was associated with an increased length of stay by 3.6 (95%CI: 3.0-4.3) days, and with 1-year mortality (OR=1.3, 95%CI: 1.0-1.8). In a subset of ADHF hospitalizations (N=7,989; 59%) with two hemoglobin values, anemia prevalence was 84% (95%CI:82-86%) by the lowest hemoglobin, improving to 72% (95%CI: 70-75%) by the last documented hemoglobin. Anemia resolved over the course of the hospitalization for 15% of patients; more commonly for women than men (18% vs. 11%; p=.002). Conclusion: Among patients hospitalized for ADHF in these 4 US areas, anemia was common, particularly for those over age 75, and was associated with a longer length of hospital stay and higher 1-year mortality.

Abstract P320: Temporal Trends In Prevalence & Prognostic Implications Of Cardiac And Non-cardiac Comorbidities Among Patients With Acute Decompensated Heart Failure: Aric Study Community Surveillance

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Ambarish Pandey ◽  
Muthiah Vaduganathan ◽  
Sameer Arora ◽  
Arman Qamar ◽  
Robert J Mentz ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Temporal Trends ◽  
Decompensated Heart Failure ◽  
Reduced Ejection Fraction ◽  
Risk Of Mortality ◽  
Prognostic Implications ◽  
Record Review ◽  
Aric Study ◽  
Over Time

Introduction: Patients with HF have multiple co-existing CV and non-CV comorbidities. The temporal trends in the burden of co-morbidities and associated risk of mortality among patients with acute decompensated HF (ADHF) is not well-established. Methods: HF related hospitalizations were captured in the ARIC surveillance cohort study across 4 US communities 2005 to 2014 using ICD-9 codes. HF hospitalizations were adjudicated using validated algorithm to identify ADHF with reduced ejection fraction (HFrEF, ejection fraction <50%) and preserved ejection fraction (HFpEF). Data on prevalence of CV and non-CV co-morbidities were obtained from medical record review. Mortality outcomes were ascertained for up to 1-year post-admission, by linking hospital records with death files. Results: Of the 22,805 hospitalizations sampled between 2005-2004, 8914 were classified as ADHF corresponding to 41,146 weighted hospitalizations for ADHF (53% HFrEF, 47% HFpEF). The burden of CV co-morbidities remained stable while that of and that of non-CV comorbidities increased significantly over time among patients with HFpEF and HFrEF. The overall burden of CV co-morbidities was not significantly associated with risk of mortality among patients with HFrEF and HFpEF. In contrast, greater burden of non-CV comorbidities was significantly associated with higher risk of in-hospital, 28-day, and 1-year mortality for both HFpEF and HFrEF. Among patients with HFrEF, the risk of mortality associated with higher burden of non-CV comorbidities did not change over time. In contrast, for HFpEF, there was a significant temporal decline in the non-CV burden associated risk of in-hospital mortality and an increase in the risk of 1-year mortality over time. Conclusion: The burden of non-CV co-morbidities among patients with ADHF has increased over time. Higher burden of non-CV comorbidities was associated with higher risk of mortality, with stable temporal associations in HFrEF and an increasing risk over time for 1-year mortality for HFpEF.

Abstract 13820: Temporal Trends and Prognosis of Physical Exam Findings in Patients Hospitalized With Acute Decompensated Heart Failure With Preserved versus Reduced Ejection Fraction the Aric Study Community Surveillance

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Abhigna Kolupoti ◽  
Ambarish Pandey ◽  
Anna Kucharska-newton ◽  
Michael E Hall ◽  
Muthiah Vaduganathan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Physical Examination ◽  
Acute Decompensated Heart Failure ◽  
Clinical Signs ◽  
Decompensated Heart Failure ◽  
Physical Exam ◽  
Lung Field ◽  
Annual Trend ◽  
Aric Study

Introduction: Bedside evaluation of congestion remains important in both heart failure (HF) with reduced and preserved ejection fraction (HFrEF and HFpEF). Whether presence of physical exam findings have changed over time, or if prognosis of physical examination differs by HF type is uncertain. Methods: From 2005-2014, the Atherosclerosis Risk in Communities (ARIC) Study conducted hospital surveillance of acute decompensated heart failure (ADHF). Events were verified by physician review, and clinical data were abstracted from the medical record. We examined presence of 3 physical exam findings suggesting congestion: lower extremity edema, jugular venous distension, and pulmonary rales > 1/3 of the lung field. Analyses were weighted by sampling fractions. Results: Of 24,937 hospitalizations for ADHF (mean age 75 years, 53% women, 32% black), 47% were HFpEF. Presence of edema increased from 2005-2009 to 2010-2014, both for HFpEF (66% to 72%; P for annual trend = 0.002) and HFrEF (62% to 67%; P for annual trend = 0.009), while presence of rales and jugular distention remained stable. There were 2640 (11%) and 7766 (31%) deaths within 28 days and 1 year of hospitalization, respectively. Patients with HFpEF and all 3 physical exam signs had a greater risk of short- and long-term mortality ( Figure ). After adjustments for demographics and length of stay, there was a differential association between clinical signs and 28-day mortality by HF type ( P for interaction = 0.02). Presence of all 3 vs. <3 signs was associated with increased mortality for HFpEF (HR = 2.22; 95% CI: 1.51 - 3.27) but not HFrEF (HR = 1.13; 95% CI: 0.79 - 1.61). A similar association was observed for 1-year mortality (HFpEF: HR = 1.49; 95% CI: 1.13 - 1.98) vs. (HFrEF: HR = 1.13; 95% CI: 0.91 - 1.40). Conclusion: The presence of edema on physical examination of patients with ADHF has increased in recent years, both for HFpEF and HFrEF. However, the prognostic utility of physical exam signs of congestion may differ by HF type.

Sign in / Sign up

Export Citation Format

Share Document