scholarly journals Impact of multi-disciplinary treatment strategy on systolic heart failure outcome

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Shyh-Ming Chen ◽  
Yen-Nan Fang ◽  
Lin-Yi Wang ◽  
Ming-Kung Wu ◽  
Po-Jui Wu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischemic Cardiomyopathy ◽  
Recurrent Events ◽  
Intervention Program ◽  
Demographic Data ◽  
Systolic Heart Failure ◽  
Total Mortality ◽  
Cox Proportional Hazards ◽  
Heart Failure Patients ◽  
Significant Difference

Abstract Background Patients with reduced ejection fraction have high rates of mortality and readmission after hospitalization for heart failure. In Taiwan, heart failure disease management programs (HFDMPs) have proven effective for reducing readmissions for decompensated heart failure or other cardiovascular causes by up to 30%. However, the benefits of HFDMP in different populations of heart failure patients is unknown. Method This observational cohort study compared mortality and readmission in heart failure patients who participated in an HFDMP (HFDMP group) and heart failure patients who received standard care (non-HFDMP group) over a 1-year follow-up period after discharge (December 2014 retrospectively registered). The components of the intervention program included a patient education program delivered by the lead nurse of the HFDMP; a cardiac rehabilitation program provided by a physical therapist; consultation with a dietician, and consultation and assessment by a psychologist. The patients were followed up for at least 1 year after discharge or until death. Patient characteristics and clinical demographic data were compared between the two groups. Cox proportional hazards regression analysis was performed to calculate hazard ratios (HRs) for death or recurrent events of hospitalization in the HFDMP group in comparison with the non-HFDMP group while controlling for covariates. Results The two groups did not significantly differ in demographic characteristics. The risk of readmission was lower in the HFDMP group, but the difference was not statistically significant (HR = 0.36, p = 0.09). In patients with ischemic cardiomyopathy, the risk of readmission was significantly lower in the HFDMP group compared to the non-HFDMP group (HR = 0.13, p = 0.026). The total mortality rate did not have significant difference between this two groups. Conclusion The HFDMP may be beneficial for reducing recurrent events of heart failure hospitalization, especially in patients with ischemic cardiomyopathy. Trial registration Longitudinal case-control study ISRCTN98483065, 24/09/2019, retrospectively registered.

Abstract P029: Is Non-Ischemic Cardiomyopathy (NICM) Associated With Better Prognosis Than Ischemic Cardiomyopathy (ICM) in Heart Failure Patients?

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Deepakraj Gajanana ◽  
Abel Romero-Corral ◽  
Mahek Shah ◽  
Parichart Junpapart ◽  
Vincent M Figueredo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischemic Cardiomyopathy ◽  
Clinical Characteristics ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Heart Failure Management ◽  
Heart Failure Patients ◽  
Significant Difference ◽  
All Cause Mortality

Background: Past data suggest ischemic cardiomyopathy (ICM) is associated with worse prognosis when compared to non-ischemic cardiomyopathy(NICM). With advances in heart failure management, this relationship deserves a fresh look. We hypothesize that all cause mortality from NICM is lower when compared to ICM over five year period. Methods: We retrospectively studied consecutive heart failure patients with left ventricular ejection fraction(EF) less than 35% admitted to Einstein Medical Center Philadelphia between 01/01/2007 to 12/31/2007. Data pertaining to patient demographics and clinical characteristics were obtained. All cause mortality was obtained at 5 years using hazard ratio to account for time to event. Results: The final cohort consisted of 360 patients of which 63%(224 of 360) had NICM. Mean age was 61±16 years for NICM and 66±11 yrs for ICM. African Americans constituted 83%(185 of 224) of NICM and 59%(80 of 136) of ICM. The clinical characteristics are as shown in the table. There were 160 deaths over the follow up period. Age, CKD, dyslipidemia and EF were significant predictors of mortality. ICM cohort had 81 deaths out of 136(60%) as compared to 85 out of 185((39%) in NICM over the follow up period. However, when adjusted for age, DM, CKD and days of follow-up, there was no statistically significant difference in mortality between the two groups over the five year follow up period. Conclusions: In this study, there was no significant mortality difference between ICM and NICM. We also found that despite advances in heart failure management in the last two decades, in clinical practice they are under-utilized.

scholarly journals Multipoint left ventricular pacing effects on hemodynamic parameters and functional status: HUMVEE single-arm clinical trial

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Konstantinou ◽  
P Xydis ◽  
C K Antoniou ◽  
N Magkas ◽  
P Manolakou ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Left Atrial ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Walking Distance ◽  
Additive Effects ◽  
Hemodynamic Parameters ◽  
Heart Failure Patients ◽  
Significant Difference

Abstract Objectives The aim of this study was to assess the capacity of optimized multipoint pacing (MPP) over optimized cardiac resynchronization therapy (CRT), in terms of clinical, functional, and echocardiographic parameters among dyssynchronous heart failure patients. Methods Eighty patients (Caucasian, 77.5% male, 68.4±10.1 years, 53.8% ischemic cardiomyopathy) sequentially received optimized CRT and optimized MPP over 6 and 12-month periods, in a single-arm clinical trial. Clinical, laboratory and echocardiographic assessment was conducted at baseline and following completion of each step. Results Significant additive effects of optimized MPP over optimized CRT were noted regarding 6-minute walking distance (baseline/optCRT/optMPP: 293±120m vs 367±94m vs 405±129m, p<0.001), NYHA class (2.36 vs 2.19 vs 1.45, p<0.001), VTIlvot (14.25±3.2cm vs 16.2±4cm vs 17.5±3.4cm, p<0.001), stroke volume (48±13.5ml vs 55±15ml vs 59±15ml, p<0.001), LVEF (29%±7.1% vs 33%±7.3% vs 37%±7.7%, p<0.001), maximal left atrial volume (77.2±34.2ml vs 74.2±39.5ml vs 67.7±32ml, p=0.02), pulmonary artery systolic pressure (35.9mmHg vs 33.5mmHg vs 31mmHg, p<0.001), and right ventricular strain (−8.3%±6.9% vs −8.8%±6.6% vs −11.8%±6.1%, p=0.022). Regarding VAC SW and CP as percentages of maximal, there was significant difference detected compared to baseline for both CRT and MPP. Additive effects persisted only if suitable MPP dipoles were present. Exploratory analysis revealed that ischemic cardiomyopathy continued to exhibit significant differences favoring MPP, whereas nonischemic cardiomyopathy had similar findings regarding total left atrial strain and quality of life. Conclusions Optimized MPP showed significant improvements on hemodynamic parameters and ventricular function, in heart failure patients over optimized CRT. The beneficial effect was more prominent in men and in those with rather reduced LVEF, consistent with findings suggesting a beneficial trend in VAC and CP with the more homogenous depolarization offered by optimized MPP FUNDunding Acknowledgement Type of funding sources: None.

Twin peaks diversity with sacubitril/valsartan treatment responses in cardiomyopathic heart failure patients of non-ischemic compared to ischemic etiologies

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.Y Chang ◽  
W.R Chiou ◽  
P.L Lin ◽  
C.Y Hsu ◽  
C.T Liao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Endpoint ◽  
Ischemic Cardiomyopathy ◽  
Ventricular Remodeling ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Heart Failure Patients ◽  
Twin Peaks ◽  
All Cause Mortality

Abstract Background Ischemic cardiomyopathy (ICM) has been associated with increased mortality when compared with non-ischemic cardiomyopathy (NICM) from several heart failure (HF) cohorts. Instead, PARADIGM study demonstrated similar event rates of cardiovascular (CV) death, all-cause mortality and HF readmissions between ICM and NICM patients. Although the beneficiary effect of sacubitril/valsartan (SAC/VAL) compared to enalapril on these endpoints was consistent across etiologic categories, PARADIGM study did not analyze the effect of ventricular remodeling of SAC/VAL on patients with different HF etiologies, which may significantly affect treatment outcomes. Purpose We aim to compare alterations of left ventricular ejection fraction (LVEF) following SAC/VAL treatment and its association with clinical outcomes in patients with different HF etiologies. Methods Treatment with angiotensin receptor neprilysin inhibitor for Taiwan heart failure patients (TAROT-HF) study is a multicenter study which enrolled 1552 patients with LVEF <40%, whom had been on SAC/VAL treatment from 9 hospitals between 2017 and 2018. After excluding patients without having follow-up echocardiographic studies, patients were grouped by HF etiologies and by LVEF changes following treatment for 8-month period. LVEF improvement ≥15% was defined as “significant improvement”, 5–15% as “marginal improvement”, and <5% or worse as “lack of improvement”. The primary endpoint was a composite of CV death or a first hospitalization for HF. Mean follow-up period was 726 days. Results A total of 1230 patients were analyzed. Patients with ICM were significantly older, more male, and prone to have associated hypertension and diabetes. On the other hand, patients with NICM had lower LVEF and higher likelihood of atrial fibrillation. LVEF increase was significantly greater in patients with NICM compared to those with ICM (11.2±12.4% vs. 6.9±9.8, p<0.001). The effect of ventricular remodeling of SAC/VAL on patients with NICM showed twin peaks diversity (Significant improvement 37.1%, lack of improvement 42.3%), whereas in patients with ICM the proportions of significant, marginal and lack of improvement groups were 19.4%, 28.2% and 52.4%, respectively. The primary endpoint showed twin peaks diversity also in patients with NICM in line with LVEF changes: adjusted HR for patients with NICM and significant improvement was 0.41 (95% CI 0.29–0.57, p<0.001), for patients with NICM and lack of improvement was 1.54 (95% CI 1.22–1.94, p<0.001). Analyses for CV death, all-cause mortality, and HF readmission demonstrated consistent results. Conclusion Patients with NICM had higher degree of LVEF improvement than those with ICM following SAC/VAL treatment, and significant improvement of LVEF in NICM patients may indicate favorable outcome. NICM patients without response to SAC/VAL treatment should serve as an indicator for poor clinical outcome and warranted meticulous HF management. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Cheng Hsin General Hospital

Abstract 18599: Clinical Assessment of Hemodynamic Profiles Predict Readmission and Mortality in Diastolic Heart Failure Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mohammed Siddiqui ◽  
Salpy V Pamboukian ◽  
Jose A Tallaj ◽  
Michael Falola ◽  
Sula Mazimba
Keyword(s):  
Heart Failure ◽  
Clinical Assessment ◽  
Diastolic Heart Failure ◽  
Clinical Care ◽  
Systolic Heart Failure ◽  
Health Care Expenditures ◽  
Left Ventricular ◽  
Readmission Rates ◽  
Heart Failure Patients ◽  
Increased Risk

Background: Reducing 30 day readmission rates for patients with heart failure (HF) has been a recent focus of lowering health care expenditures. Hemodynamic profiles (HP) have been associated with clinical outcomes in chronic systolic HF. The relationship of HP to outcomes in acute decompensated diastolic HF (DHF) has not been defined. Methods: This case-control study of 1892 DHF patients discharged alive from an academic hospital between 2002-2012 with left ventricular function greater or equal to 45% were categorized into 4 groups: Profile A, no evidence of congestion and hypoperfusion (dry-warm); Profile B, congestion with adequate perfusion (wet-warm); Profile C, congestion with hypoperfusion (wet-cold); and Profile L, hypoperfusion without congestion (dry-cold). All cause readmissions at 30 days and 1 year and mortality at 30 days and 1 year were examined. Statistical analysis using multivariable Cox Proportional hazard model was performed adjusting for demographic, clinical, care and hospital characteristics. Results: Of the 1892 patients, 1196 (63%) were females; mean age was 68 (±14) years. There were 724(38%), 1000 (53%), 88(5%) and 80 (4%) patients in the hemodynamic profiles A, B, C and L respectively. Profiles B and C were associated with an increased risk for 30-day all-cause HF readmission compared to profiles A and L: Hazard ratio (HR) [1.38 (95% C.I 1.17-1.61)], [1.39 (95% C.I 1.18-1.62)] for B and C profiles respectively. Profiles C and L were associated with increased mortality at 1 year: HR [1.46 (95% CI 1.06-1.89)] and [1.31 (95% CI 1.01-1.64)] for A and L profiles respectively (Table). Conclusions: Clinical assessment of HP can help identify DHF patients at increased risk of readmission and mortality, similar to systolic heart failure patients.

Prevalence of Erectile Dysfunction in Systolic Heart Failure Patients in a Developing Country: Tbilisi, Georgia, Eastern Europe

2010 ◽  
Vol 7 (12) ◽  
pp. 3991-3996 ◽  
Author(s):  
Kathy Hebert ◽  
Jatin Anand ◽  
Pat Trahan ◽  
Maria Delgado ◽  
Joseph Greene ◽  
...  
Keyword(s):  
Heart Failure ◽  
Erectile Dysfunction ◽  
Eastern Europe ◽  
Developing Country ◽  
Systolic Heart Failure ◽  
Heart Failure Patients

scholarly journals The Effect of Family-Centered Empowerment Model on the Illness Perception in Heart Failure Patients: a Randomized Controlled Clinical Trial

2018 ◽  
Vol 7 (4) ◽  
pp. 189-195 ◽  
Author(s):  
khadijeh Rahimi kordshooli ◽  
Mahnaz Rakhshan ◽  
Alireza Ghanbari
Keyword(s):  
Heart Failure ◽  
Statistical Tests ◽  
Illness Perception ◽  
Chronic Medical Condition ◽  
Controlled Clinical Trial ◽  
Demographic Information ◽  
Heart Failure Patients ◽  
Significant Difference ◽  
Empowerment Model ◽  
Family Centered

Introduction: Heart failure is a chronic medical condition that, despite the existing therapies, involves different aspects of an individual’s life (such as self-care capability). Illness perception is one of the most important variables which seem to improve the self-efficacy skills in chronic diseases such as heart failure. Therefore, this study aimed to investigate the effect of family–centered empowerment model on the perception of the illness in heart failure patients. Methods: This interventional study was performed on 70 heart failure patients, assigned into control and experimental groups, admitted to the heart clinic of Hazrate Fatemeh hospital in Shiraz. After the convenience sampling, the patients were divided into two control and intervention groups by block randomization method. For experimental group, the family-centered empowerment modeling was done in 5 sessions. The research materials included demographic information and Brief illness perception questionnaires (B-IPQ). Data were analyzed using SPSS v.13 software. The statistical tests included Wilcoxon, Man-Whitney, and Independent t-test. P value less than 0.05 was considered as significant. Results: In this study, both control and experimental groups were homogeneous with demographic information. Before the intervention in different dimensions of illness perception, all of the values in both groups were the same; However, after the intervention, a significant difference was observed in all of the dimensions of illness perception, except for Time line; so that the most and the least changes were related to the concern (1.09 (0.61) vs 3 (0.93)), and identity dimensions (0.97 (0.61) vs 2.11 (0.67)), respectively. Conclusion: On the basis of the above, it can be concluded that this model modifies the illness perceptions in heart failure patients. Cardiac nurses should consider family- based empowerment model as a treatment for heart failure patients

Sign in / Sign up

Export Citation Format

Share Document