Abstract P146: Depression Predicts Increased Healthcare Utilization and Death Among Community Patients with Heart Failure

Background: The increasing prevalence of heart failure (HF) and high associated costs has spurred investigation of factors related to adverse outcomes in these patients. Reports to date present discrepant evidence regarding the link between depression and HF outcomes, and only scarce data related to healthcare utilization in the form of emergency department (ED) visits are available. Purpose: To evaluate the relationship of depression with healthcare utilization and death among HF patients in the community. Methods: Residents of Olmsted, Dodge, and Fillmore, MN counties with HF were prospectively recruited between October 2007 and December 2010, and completed a 9-item Patient Health Questionnaire (PHQ-9) for depression categorized as: none-minimal (PHQ-9 score 0-4), mild (5-9), or moderate-severe (≥10). Anderson-Gill models were used to determine if depression predicted hospitalizations and ED visits while proportional hazards regression estimated hazard ratios for death. Results: Among 411 HF patients (mean age 73±13, 58% male), 15% had moderate-severe depression, 27% mild, and 58% none-minimal. Over a mean follow-up of 1.5 years, 613 hospitalizations, 786 ED visits, and 75 deaths occurred. The risk of all adverse outcomes increased stepwise with increasing severity of depression (Table). After adjustment for key clinical characteristics, moderate-severe depression was associated with nearly a 2-fold increased risk of hospitalization and ED visits, and almost a 4-fold increased risk of death. These results are independent of coexisting comorbidities. Conclusions: Depression is frequent among HF patients in the community and independently predicts a significant increase in the use of healthcare resources and mortality. Greater attention to the recognition and management of depression in HF may improve clinical outcomes and decrease healthcare utilization and expenditures in these patients. Hazard Ratios (95%CI) for Hospitalizations and All-Cause Mortality by Severity of Depression None-Minimal Mild Moderate-Severe P for trend Hospitalizations Crude 1.00 (ref) 1.23 (0.91-1.66) 2.01 (1.39-2.89) <0.001 Fully-Adjusted * 1.00 (ref) 1.15 (0.86-1.54) 1.93 (1.37-2.71) 0.001 Emergency Department Visits Crude 1.00 (ref) 1.42 (1.03-1.96) 1.99 (1.42-2.79) <0.001 Fully-Adjusted * 1.00 (ref) 1.39 (1.00-1.93) 1.98 (1.40-2.79) <0.001 All-Cause Mortality Crude 1.00 (ref) 1.53 (0.87-2.68) 3.33 (1.95-5.70) <0.001 Fully-Adjusted * 1.00 (ref) 1.55 (0.88-2.74) 3.84 (2.21-6.68) <0.001 * Adjusted for age, sex, and Charlson comorbidity index

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Abstract P117: Frailty and Outcomes among Heart Failure Patients in the Community

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap117 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Sheila M McNallan ◽

Shannon M Dunlay ◽

Mandeep Singh ◽

Alanna M Chamberlain ◽

Margaret M Redfield ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Emergency Department Visits ◽

Physical Component Score ◽

Risk Of Death ◽

Increased Risk ◽

Ed Visits

Objective: To determine among community heart failure (HF) patients whether frailty is associated with an increased risk of hospitalization, emergency department (ED) visits and death, independently of comorbidities. Background: Frailty is associated with adverse outcomes in some populations; however the prognostic value of frailty among HF patients is not fully documented, particularly for healthcare utilization. Methods: Olmsted, Dodge and Fillmore County residents with HF between 10/2007 and 12/2010 were prospectively recruited to undergo frailty assessment. Frailty was defined as 3 or more of the following: unintentional weight loss >10 lbs. in 1 year, physical exhaustion, weak grip strength, and slowness and low activity measured by the SF-12 physical component score. Intermediate frailty was defined as having 1-2 components. To account for repeated events, Anderson-Gill modeling was used to determine if frailty predicted hospitalization or ED visits. Cox proportional hazards regression examined associations between frailty and death. Results: Among 409 patients (mean age 73±13, 58% male), 19% were frail and 55% had intermediate frailty. Within one year, 449 hospitalizations, 523 ED visits and 34 deaths occurred. There was a positive graded association between frailty and hospitalization and ED visits (Table). After adjustment for age, sex, ejection fraction and comorbidity, frailty was associated with an 80% increased risk of hospitalization and a 60% increased risk of ED visits. Frailty was also associated with more than a 2-fold increased risk of death after adjustment. Conclusion: In the community, frailty is prevalent and is a strong and independent predictor of hospitalizations, ED visits and death among HF patients. As it is independent from coexisting comorbidities, frailty defines new avenues for intervention and should be formally assessed clinically. Hazard Ratios (95% CI) for Hospitalizations, Emergency Department Visits and Death by Frailty Status Not Frail Intermediate Frail Frail P for trend Hospitalization Crude 1.00 1.46 (1.05-2.02) 2.15 (1.45-3.19) <0.001 Fully-adjusted 1.00 1.29 (0.94-1.77) 1.82 (1.22-2.73) 0.005 Emergency Department Visits Crude 1.00 1.59 (1.14-2.21) 1.88 (1.22-2.90) 0.002 Fully-adjusted 1.00 1.46 (1.05-2.05) 1.58 (1.01-2.48) 0.034 Death Crude 1.00 1.40 (0.73-2.69) 3.98 (2.01-7.90) <0.001 Fully-adjusted 1.00 0.87 (0.44-1.73) 2.42 (1.19-4.95) 0.003

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Digoxin Use to Control Ventricular Rate in Patients with Atrial Fibrillation and Heart Failure Is Not Associated with Increased Mortality

Cardiology Research and Practice ◽

10.1155/2015/314041 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 6

Author(s):

Surbhi Chamaria ◽

Anand M. Desai ◽

Pratap C. Reddy ◽

Brian Olshansky ◽

Paari Dominic

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Meta Analysis ◽

Ventricular Rate ◽

Point Estimate ◽

Hazard Ratios ◽

Inverse Variance ◽

Increased Risk ◽

All Cause Mortality ◽

Meta Analyses

Introduction.Digoxin is used to control ventricular rate in atrial fibrillation (AF). There is conflicting evidence regarding safety of digoxin. We aimed to evaluate the risk of mortality with digoxin use in patients with AF using meta-analyses.Methods.PubMed was searched for studies comparing outcomes of patients with AF taking digoxin versus no digoxin, with or without heart failure (HF). Studies were excluded if they reported only a point estimate of mortality, duplicated patient populations, and/or did not report adjusted hazard ratios (HR). The primary endpoint was all-cause mortality. Adjusted HRs were combined using generic inverse variance and log hazard ratios. A multivariate metaregression model was used to explore heterogeneity in studies.Results.Twelve studies with 321,944 patients were included in the meta-analysis. In all AF patients, irrespective of heart failure status, digoxin is associated with increased all-cause mortality (HR [1.23], 95% confidence interval [CI] 1.16–1.31). However, digoxin is not associated with increased mortality in patients with AF and HF (HR [1.08], 95% CI 0.99–1.18). In AF patients without HF digoxin is associated with increased all-cause mortality (HR [1.38], 95% CI 1.12–1.71).Conclusion.In patients with AF and HF, digoxin use is not associated with an increased risk of all-cause mortality when used for rate control.

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Albuminuria and Dipstick Proteinuria for Predicting Mortality in Heart Failure: A Systematic Review and Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.665831 ◽

2021 ◽

Vol 8 ◽

Author(s):

Wei Liang ◽

Qian Liu ◽

Qiong-ying Wang ◽

Heng Yu ◽

Jing Yu

Keyword(s):

Heart Failure ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

Prognostic Indicator ◽

Adverse Outcomes ◽

Rapid Screening ◽

Dipstick Test ◽

Heart Failure Patients ◽

Increased Risk ◽

All Cause Mortality

Background: Research suggest that albuminuria is not only an independent risk factor for the development of heart failure but may also act as a biomarker for predicting adverse outcomes. To date, no study has synthesized evidence on its role as a prognostic indicator. Thus, the current study aimed to quantitatively assess the prognostic utility of albuminuria as well as dipstick proteinuria in predicting mortality in heart failure patients.Methods: PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched up to October 10, 2020. All studies reporting multivariable-adjusted hazard ratios (HR) for albuminuria or dipstick proteinuria for mortality and/or hospitalization in heart failure patients were included.Results: Eleven studies were included. Seven assessed albuminuria and five assessed dipstick proteinuria. Our analysis revealed a statistically significant increased risk of all-cause mortality with microalbuminuria (HR: 1.54; 95% CI, 1.23–1.93; I2 = 79%; p = 0.0002) and macroalbuminuria (HR: 1.76; 95% CI, 1.21–2.56; I2 = 88%; p = 0.003) in heart failure patients. The risk of all-cause mortality and hospitalization was also significantly increased with macroalbuminuria. Microalbuminuria was associated with significantly increased cardiovascular mortality and combined cardiovascular mortality and hospitalization. Positive dipstick test for proteinuria was significantly associated with mortality in heart failure (HR: 1.54; 95% CI, 1.28–1.84; I2 = 67%; p < 0.00001).Conclusion: Both microalbuminuria and macroalbuminuria are predictors of mortality in patients with heart failure. Dipstick proteinuria may be used as a rapid screening test to predict mortality in these patients.

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Geriatric screening, fall characteristics and 3- and 12 months adverse outcomes in older patients visiting the emergency department with a fall

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00859-5 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Laura C. Blomaard ◽

Simon P. Mooijaart ◽

Leonie J. van Meer ◽

Julia Leander ◽

Jacinta A. Lucke ◽

...

Keyword(s):

Emergency Department ◽

High Risk ◽

Older Patients ◽

Clinical Care ◽

Adverse Outcomes ◽

Increased Risk ◽

Geriatric Screening ◽

Ed Visits ◽

Screening Result

Abstract Background Falls in older Emergency Department (ED) patients may indicate underlying frailty. Geriatric follow-up might help improve outcomes in addition to managing the direct cause and consequence of the fall. We aimed to study whether fall characteristics and the result of geriatric screening in the ED are independently related to adverse outcomes in older patients with fall-related ED visits. Methods This was a secondary analysis of the observational multicenter Acutely Presenting Older Patient (APOP) study, of which a subset of patients aged ≥70 years with fall-related ED visits were prospectively included in EDs of two Dutch hospitals. Fall characteristics (cause and location) were retrospectively collected. The APOP-screener was used as a geriatric screening tool. The outcome was 3- and 12-months functional decline and mortality. We assessed to what extent fall characteristics and the geriatric screening result were independent predictors of the outcome, using multivariable logistic regression analysis. Results We included 393 patients (median age 80 (IQR 76–86) years) of whom 23.0% were high risk according to screening. The cause of the fall was extrinsic (49.6%), intrinsic (29.3%), unexplained (6.4%) or missing (14.8%). A high risk geriatric screening result was related to increased risk of adverse outcomes (3-months adjusted odds ratio (AOR) 2.27 (1.29–3.98), 12-months AOR 2.20 (1.25–3.89)). Independent of geriatric screening result, an intrinsic cause of the fall increased the risk of 3-months adverse outcomes (AOR 1.92 (1.13–3.26)) and a fall indoors increased the risk of 3-months (AOR 2.14 (1.22–3.74)) and 12-months adverse outcomes (AOR 1.78 (1.03–3.10)). Conclusions A high risk geriatric screening result and fall characteristics were both independently associated with adverse outcomes in older ED patients, suggesting that information on both should be evaluated to guide follow-up geriatric assessment and interventions in clinical care.

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Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients

BMC Geriatrics ◽

10.1186/s12877-021-02072-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Pei-Pei Zheng ◽

Si-Min Yao ◽

Wei He ◽

Yu-Hao Wan ◽

Hua Wang ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Left Ventricular Ejection ◽

Structural Abnormality ◽

Frailty Phenotype ◽

Ventricular Ejection Fraction ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Frailty increases the adverse outcomes of clinical heart failure; however, the relationship between frailty and stage-B heart failure (SBHF) remains unknown. We aimed to explore the epidemiology and predictive value of frailty in older adults with SBHF. Methods A prospective cohort of SBHF inpatients aged 65 years or older who were hospitalized between September 2018 and February 2019 and were followed up for 6 months were included. SBHF was defined as systolic abnormality, structural abnormality (left ventricular enlargement, left ventricular hypertrophy, wall motion abnormalities, valvular heart disease), or prior myocardial infarction. Frailty was assessed by the Fried frailty phenotype. Multivariable Cox proportional hazards regression was used to explore the independent risk and prognostic factors. Results Data of 443 participants (age: 76.1 ± 6.79 years, LVEF: 62.8 ± 4.92%, men: 225 [50.8%], frailty: 109 [24.6%]) were analyzed. During the 6-month follow-up, 83 (18.7%) older SBHF inpatients experienced all-cause mortality or readmission, and 29 (6.5%) of them developed clinical HF. Frail individuals had a 1.78–fold (95%CI: 1.02–3.10, P = 0.041) higher risk of 6-month mortality or readmission and a 2.83–fold (95%CI 1.24–6.47, P = 0.014) higher risk of developing clinical HF, independent of age, sex, left ventricular ejection fraction, and N-terminal pro-B-type natriuretic peptide level. Conclusions Frailty is common in older SBHF inpatients and should be considered to help identify individuals with an increased risk of mortality or readmission, and developing clinical HF. Trial registration ChiCTR1800017204.

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Rurality, Death, and Healthcare Utilization in Heart Failure in the Community

Journal of the American Heart Association ◽

10.1161/jaha.120.018026 ◽

2021 ◽

Vol 10 (4) ◽

Author(s):

Sheila M. Manemann ◽

Jennifer St. Sauver ◽

Carrie Henning‐Smith ◽

Lila J. Finney Rutten ◽

Alanna M. Chamberlain ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Rural Area ◽

Healthcare Utilization ◽

International Classification Of Diseases ◽

Emergency Department Visits ◽

Risk Of Death ◽

Increased Risk ◽

Classification Of Diseases

Background Prior reports indicate that living in a rural area may be associated with worse health outcomes. However, data on rurality and heart failure (HF) outcomes are scarce. Methods and Results Residents from 6 southeastern Minnesota counties with a first‐ever code for HF ( International Classification of Diseases, Ninth Revision [ ICD‐9 ], code 428, and International Classification of Diseases, Tenth Revision [ ICD‐10 ] code I50) between January 1, 2013 and December 31, 2016, were identified. Resident address was classified according to the rural‐urban commuting area codes. Rurality was defined as living in a nonmetropolitan area. Cox regression was used to analyze the association between living in a rural versus urban area and death; Andersen‐Gill models were used for hospitalization and emergency department visits. Among 6003 patients with HF (mean age 74 years, 48% women), 43% lived in a rural area. Rural patients were older and had a lower educational attainment and less comorbidity compared with patients living in urban areas ( P <0.001). After a mean (SD) follow‐up of 2.8 (1.7) years, 2440 deaths, 20 506 emergency department visits, and 11 311 hospitalizations occurred. After adjustment, rurality was independently associated with an increased risk of death (hazard ratio [HR], 1.18; 95% CI, 1.09–1.29) and a reduced risk of emergency department visits (HR, 0.89; 95% CI, 0.82–0.97) and hospitalizations (HR, 0.78; 95% CI, 0.73–0.84). Conclusions Among patients with HF, living in a rural area is associated with an increased risk of death and fewer emergency department visits and hospitalizations. Further study to identify and address the mechanisms through which rural residence influences mortality and healthcare utilization in HF is needed in order to reduce disparities in rural health.

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P4715Association of heart failure duration with clinical prognosis after transcatheter mitral valve repair

European Heart Journal ◽

10.1093/eurheartj/ehz745.1095 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Sugiura ◽

N Tabata ◽

M Weber ◽

C Oezturk ◽

S Zimmer ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Adverse Outcomes ◽

Left Ventricular Ejection ◽

Valve Repair ◽

Clinical Prognosis ◽

Transcatheter Mitral Valve Repair ◽

Increased Risk ◽

All Cause Mortality

Abstract Background/Introduction Transcatheter mitral valve repair (TMVR) in patients with heart failure (HF) and severe mitral regurgitation (MR) entails better clinical and symptomatic status. While emerging evidence indicate that HF duration is linked to adverse outcomes in patients with HF, it is not known whether the HF duration before TMVR has an effect on adverse outcomes. Purpose We aimed to assess the association between duration of HF before TMVR and clinical prognosis after the procedure. Methods We retrospectively enrolled a total of 345 patients who underwent TMVR procedure with MitraClip or Cardioband system for the treatment of symptomatic MR after guideline recommended therapy. The patients were divided into 2 groups according to the duration of HF (>18 months:, n=161, ≤18 months: shorter HF group, n=184). Cox proportional hazards analysis was performed to assess the association between duration and two-year composite endpoint (all-cause mortality, unexpected hospitalization due to HF, and repeat mitral valve therapy). Results Patients with longer duration of HF were more likely to be male, had greater incidence of coronary artery disease (77.0% vs. 51.6%, p<0.001), had received more frequently implantable cardioverter defibrillator or cardiac resynchronization therapy (41.0% vs. 10.3%, p<0.001), and had more decreased left ventricular ejection fraction (41.1±14.5% vs. 49.3±16.0%, p<0.001) compared to patients with shorter duration of HF. Two-year event-free survival rate was significantly lower in patients with longer duration of HF (66.3% vs. 83.8%, Log-rank p=0.01) compared to whose with shorter duration of HF. Similar trends were observed for all-cause mortality (84.8% vs. 95.9%, p=0.06) and repeat mitral valve therapy (93.4% vs. 100%, p=0.02). In the Cox proportional hazard analysis, longer duration of HF was independently associated with increased risk of adverse outcomes (Hazard ratio, 2.26; 95% confidence interval, 1.11–4.62; p=0.02) compared with shorter duration of HF. Conclusion Patients with the longer duration of HF before TMVR is independently associated with increased risk of adverse outcomes after the procedure. It is, however, accompanied by higher prevalence of cardiac co-morbidities in these patients. Our findings suggest that a longer duration of HF is a risk indicator and should be considered into in future clinical trials of TMVR.

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Digoxin and association with mortality in patients discharged from hospital with atrial fibrillation, with or without heart failure

EP Europace ◽

10.1093/europace/euab116.183 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

M Mpotis ◽

A Kartas ◽

A Samaras ◽

E Akrivos ◽

E Vrana ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Propensity Scores ◽

Adverse Outcomes ◽

Secondary Outcome ◽

Event Analysis ◽

Risk Of Death ◽

Funding Sources ◽

Increased Risk ◽

All Cause Mortality

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf MISOAC- AF study group BACKGROUND Digoxin is widely used in atrial fibrillation (AF) and heart failure (AF). However, established evidence is conflicting regarding its association with clinical outcomes. AIM To investigate the relation between digoxin and adverse outcomes in patients with AF, with or without HF, in a contemporary AF cohort. METHODS We performed a retrospective analysis of data from 698 patients, originating from the MISOAC- AF (Motivational Interviewing to Support Oral AntiCoagulation Adherence in patients with non-valvular Atrial Fibrillation) trial, and followed over a median of 2.5 years. HF was denoted at baseline. The primary outcome was all-cause mortality and the secondary outcome was all-cause hospitalization, in a time-to-event analysis. Propensity scores were used to derive matched populations, balanced on key baseline covariates. To limit potential confounding, we also implemented inverse probability of treatment weighting (IPTW) analysis. RESULTS Among patients with HF, 10.5% (n = 39) were administered digoxin at baseline, whereas 89.5% (n = 331) were not. Digoxin administration was not associated with an increased risk of death (hazard ratio (HR) in the digoxin group, 1.21; 95% Confidence Interval (CI), 0.69 to 2.13, p = 0.5) or hospitalization of any cause (HR 1.15; 95% CI, 0.67 to 1.96; p = 0.6). Among patients without HF, 3.5% (n = 11) were administered digoxin, with neutral effects on all-cause mortality (HR: 3.25; 95% CI, 0.98 to 10.70), p = 0.06) and all-cause hospitalization (HR, 1.15; 95% CI, 0.67 to 1.96, p = 0.60). Consistent qualitatively results were observed using IPTW. CONCLUSIONS Among patients with AF, digoxin administration was not associated with an increased risk of death and hospitalization of any cause, irrespective of HF status. Abstract Figure.

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Serum Cortisol as a Predictor of Major Adverse Pulmonary Event in Emergency Department Acutely Dyspneic Patients

Emergency Medicine International ◽

10.1155/2018/1758643 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Ozlem Dikme ◽

Ozgur Dikme

Keyword(s):

Heart Failure ◽

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Adrenal Glands ◽

Steroid Hormone ◽

Serum Cortisol ◽

Adverse Outcomes ◽

All Cause Mortality ◽

Cortisol Levels

Cortisol is a steroid hormone released from the adrenal glands in response to stressful conditions. Elevated cortisol levels have been described in stress, but it is unclear whether these are associated with adverse outcomes. In this study, we assess whether cortisol levels drawn in patients presenting with dyspnea to the ED were a predictor of major adverse pulmonary event (MAPE). In 87 patients presenting with dyspnea to the ED, cortisol levels were determined. Patients were then assessed to determine the following MAPE: endotracheal intubation (ETI) in the ED, admission to the intensive care unit (ICU), and in-hospital all-cause mortality. Forty-four patients (50.6%) were female and 33 (37.9%) were diagnosed with heart failure. Cortisol levels in patients with and without MAPE were 34.3μg/dL and 23.8μg/dL, respectively (p<0.001). Also, cortisol levels were found higher in patients intubated in the ED than nonintubated patients (54.2μg/dL vs 25.7μg/dL, p<0.001), higher in patients admitted to the ICU (38.7μg/dL vs 24 μg/dL, p<0.001), and higher in patients who died in hospital (50μg/dL vs 24.3μg/dL, p<0.001). The area under the ROC curve using cortisol to detect any component of MAPE—ETI or ICU admission or in-hospital all-cause mortality—was 0.76 (95% CI, 0.65-0.84). A cortisol value of 31.4μg/dL had sensitivity of 70.8% and specificity of 79.4% for predicting MAPE. Patients in the MAPE group had higher serum cortisol levels than those without any MAPE. Cortisol may be used as a marker to predict MAPE in nontraumatic acutely dyspneic adult patients on ED admission.

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