Determinants of mortality in a large group of hemodialysis patients hospitalized for COVID-19

Abstract Background Maintenance hemodialysis (MHD) patients are at increased risk for coronavirus disease 2019 (COVID-19). The aim of this study was to describe clinical, laboratory, and radiologic characteristics and determinants of mortality in a large group of MHD patients hospitalized for COVID-19. Methods This multicenter, retrospective, observational study collected data from 47 nephrology clinics in Turkey. Baseline clinical, laboratory and radiological characteristics, and COVID-19 treatments during hospitalization, need for intensive care and mechanical ventilation were recorded. The main study outcome was in-hospital mortality and the determinants were analyzed by Cox regression survival analysis. Results Of 567 MHD patients, 93 (16.3%) patients died, 134 (23.6%) patients admitted to intensive care unit (ICU) and 91 of the ones in ICU (67.9%) needed mechanical ventilation. Patients who died were older (median age, 66 [57–74] vs. 63 [52–71] years, p = 0.019), had more congestive heart failure (34.9% versus 20.7%, p = 0.004) and chronic obstructive pulmonary disease (23.6% versus 12.7%, p = 0.008) compared to the discharged patients. Most patients (89.6%) had radiological manifestations compatible with COVID-19 pulmonary involvement. Median platelet (166 × 103 per mm3 versus 192 × 103 per mm3, p = 0.011) and lymphocyte (800 per mm3 versus 1000 per mm3, p < 0.001) counts and albumin levels (median, 3.2 g/dl versus 3.5 g/dl, p = 0.001) on admission were lower in patients who died. Age (HR: 1.022 [95% CI, 1.003–1.041], p = 0.025), severe-critical disease clinical presentation at the time of diagnosis (HR: 6.223 [95% CI, 2.168–17.863], p < 0.001), presence of congestive heart failure (HR: 2.247 [95% CI, 1.228–4.111], p = 0.009), ferritin levels on admission (HR; 1.057 [95% CI, 1.006–1.111], p = 0.028), elevation of aspartate aminotransferase (AST) (HR; 3.909 [95% CI, 2.143–7.132], p < 0.001) and low platelet count (< 150 × 103 per mm3) during hospitalization (HR; 1.864 [95% CI, 1.025–3.390], p = 0.041) were risk factors for mortality. Conclusion Hospitalized MHD patients with COVID-19 had a high mortality rate. Older age, presence of heart failure, clinical severity of the disease at presentation, ferritin level on admission, decrease in platelet count and increase in AST level during hospitalization may be used to predict the mortality risk of these patients.

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Relative and Absolute Platelet Count Drops As a Risk Factor for Mortality, Bleeding, and Venous Thrombosis in Hospitalized Medical Patients

Blood ◽

10.1182/blood.v126.23.2258.2258 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2258-2258

Author(s):

Matthew E. Lebow ◽

Michael DeSarno ◽

Damon Eugene Houghton ◽

John P. Winters ◽

Samuel A. Merrill ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care Unit ◽

Intensive Care ◽

Platelet Count ◽

Inflammatory Disease ◽

Medical Patients ◽

Respiratory Dysfunction ◽

Full Dose ◽

Increased Risk ◽

Hospital Acquired

Abstract Introduction: There is little data on the incidence and consequences of hospital-acquired (HA) platelet count drops and no consensus on how to define HA-thrombocytopenia. We evaluated the incidence of relative and absolute HA-drops in platelet count among medical patients (general medicine, cardiology, and intensive care unit) to determine their association with mortality, HA-venous thromboembolism (VTE), and HA-bleeding. Methods: Data was abstracted from the electronic medical record at the University of Vermont Medical Center, a 540-bed tertiary care hospital in Burlington, VT for admissions between 2009-12. Exclusion criteria were age <18, pregnant, admitted to a non-medical service or to the oncology service, and platelet count <150 thousand (k) at admission. HA-platelet count drops were defined as listed in the table (absolute nadir, relative drop, absolute platelet count). We used logistic regression to evaluate the association of various definitions of platelet count drops with HA-VTE, HA-bleeding (based on the International Society of Thrombosis and Haemostasis definition), and in-hospital mortality. Models were adjusted for age, sex, service, admission platelet count, and for known risk factors for HA-VTE, HA-bleeding, and mortality (Table). Results: Of 11,863 admissions without thrombocytopenia on admission, 1,905 (16.1%) patients developed a platelet count <150k, 6,971 (58.8%) had at least a 10% drop in their platelet count, and 6,737 (56.8%) at least a 25k drop (Table). There were 939 (7.9%) deaths, 48 (0.4%) HA-VTE, and 106 (0.9%) HA-bleeding events. HA-platelet count drops were associated with increasing age, male sex, and admission to an intensive care unit (all p < 0.05). All definitions of platelet count drops were associated with mortality, HA-VTE, and HA-bleeding (Table). A 10% platelet count drop was associated with increased mortality (OR 1.52, CI: 95% 1.30-1.79), HA-VTE (OR 5.19, CI: 95% 1.83-14.74), and HA-bleeding (OR 8.83, CI: 95% 3.20-24.36) and an absolute 25k drop was associated with increased mortality (OR 1.60, CI: 95% 1.36-1.88), HA-VTE (OR 4.27, CI: 95% 1.64-11.11), and HA-bleeding (OR 5.22, CI: 95% 2.38-11.49). Conclusion: Platelet count drops, even those considered clinically insignificant, identify a large number of hospitalized medical patients at increased risk for mortality, HA-VTE, and HA-bleeding. Our findings are not driven by severe HA-thrombocytopenia as only 2% of admissions developed platelet counts <100,000. HA-platelet count drops are likely a good marker of illness severity in this population and could identify patients at increased risk for mortality, HA-VTE and HA-bleeding allowing targeted interventions to improve patient outcomes. Table 1. Association of Hospital-Acquired Platelet Count Drops with Mortality, HA-VTE and HA-Bleeding in Medical Patients Platelet Drop Admissions = 11,863 Odds Ratio (95% Confidence Interval) N, % Mortality N = 939 HA-VTE N = 48 HA-Bleeding N = 106 Absolute Nadir <150k 1,905 (16.1%) 2.0 (1.7, 2.5) 4.3 (2.3, 7.9) 2.7 (1.8, 4.2) <100k 235 (2.0%) 4.4 (3.0, 6.3) 5.4 (2.3, 12.5) 3.2 (1.8, 5.8) Relative Drop 50% 371 (3.1%) 3.8 (2.8, 5.2) 6.3 (3.1, 12.8) 5.0 (3.1, 8.0) 30% 1,748 (14.7%) 2.5 (2.1, 3.0) 4.2 (2.2, 7.9) 3.6 (2.3, 5.6) 10% 6,971 (58.8%) 1.5 (1.3, 1.8) 5.2 (1.8, 14.7) 8.8 (3.2, 24.4) Absolute Drop 100k 1,186 (10.0%) 2.7 (2.2, 3.3) 6.4 (3.2, 12.8) 4.3 (2.8, 6.8) 75k 2,019 (17.0%) 2.4 (2.0, 2.3) 5.0 (2.6, 9.9) 4.8 (3.1, 7.7) 50k 3,594 (30.3%) 1.9 (1.7, 2.3) 3.3 (1.7, 6.6) 5.5 (3.2, 9.4) 25k 6,737 (56.8%) 1.6 (1.4, 1.9) 4.3 (1.6, 11.1) 5.2 (2.4, 11.5) Mortality - Adjusted additionally for: Respiratory Rate, Respiratory Dysfunction (intubated or oxygen saturation <90%), Heart Rate, Temperature, Diabetes, Cancer, and HIV (Brabrand, PLoS ONE 2015) HA-VTE - Adjusted additionally for: Anticoagulation (prophylactic and full dose), Cancer, Heart Failure, Respiratory Dysfunction, Rheumatologic or Inflammatory Disease, and Tachycardia (Zakai, JTH 2013) HA-Bleeding - Adjusted additionally for: Anticoagulation (prophylactic and full dose), Cancer, Renal Function, Heart Failure, Respiratory Dysfunction, Rheumatologic or Inflammatory Disease, and Tachycardia (Decousis, Chest 2011) Disclosures No relevant conflicts of interest to declare.

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Abstract P316: Sleep Timing Correlates With Incident Congestive Heart Failure: A Community-based Cohort Study

Circulation ◽

10.1161/circ.141.suppl_1.p316 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Bin Yan ◽

Ruohan Li ◽

Xuting Jin ◽

Ya Gao ◽

Jingjing Zhang ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Prospective Study ◽

Sleep Duration ◽

Subgroup Analysis ◽

Cox Regression ◽

Sleep Habits ◽

Sleep Timing ◽

Increased Risk ◽

The Impact

Introduction: Previous studies have suggested that sleep habits were associated with cardiovascular risk factors. However, there is no evidence about the relationship between sleep timing and congestive heart failure (CHF). Hypothesis: We assessed the hypothesis that the bedtime and wake-up time on weekday and weekend may be associated with incident CHF. Methods: From the Sleep Heart Health Study (registration number, NCT00005275), participants without previous heart failure were enrolled in the present prospective study. Sleep timing including bedtime and wake-up time on weekday and weekend was acquired from a self-reported Sleep Habits Questionnaire. Bedtime on weekdays and weekend was divided into >24:00, 23:01 to 24:00, 22:01 to 23:00 and ≤22:00. Wake-up time on weekdays and weekend was classified as >8:00, 7:01 to 8:00, 6:01 to 7:00 and ≤6:00. Further subgroup analysis was conducted according to sleep duration of <6h, 6-8h and >8h. Participants were followed up until the first CHF diagnosed between the date of the completed questionnaire and the final censoring date. Cox regression analysis was used to investigate the association between sleep timing and CHF. Results: A total of 4765 participants including 2207 males and 2558 females with a mean age of 63.6±11.0 years were recruited in the study. During the mean follow-up period of 11 years, 519 participants were diagnosed with CHF. The incidence of CHF in participants with weekday bedtime at >24:00 was 15.6% (69 of 441), which is higher than those with bedtime at 23:01 to 24:00 [12.7% (166 of 1306)], 22:01 to 23:00 [7.0% (128 of 1837)], and ≤22:00 [13.2% (156 of 1181)]. Participants with wake-up time on weekday at > 8:00 also had the highest incidence of CHF [19.7% (45 of 229)] than those with wake-up time at 7:01 to 8:00 [14.2% (89 of 627)], 6:01 to 7:00 [11.5% (171 of 1485)], and ≤6:00 [8.8% (214 of 2424)]. After multivariate Cox regression analyses, individuals with bedtime at >24:00 on weekdays was associated with a higher incidence of CHF (HR 1.559, 95% CI 1.151-2.113, P = 0.004) than those with bedtime at 22:01 to 23:00. And compared with participants with wake-up time at ≤6:00, those with wake-up time at > 8:00 also had an increased risk of incident CHF (HR 1.525, 95% CI 1.074-2.166, P =0.018). After further subgroup analysis, the association between bedtime at >24:00 on weekdays and incident CHF were strengthened in the participants with 6-8 hours’ sleep duration (HR 2.087, 95% CI 1.446-3.013, P <0.001). Conclusion: In conclusion, late bedtime (>24:00) and late wake-up time (>8:00) on weekdays may correlate with an increased risk of CHF. The impact of sleep timing on incident cardiovascular diseases may be worth further prospective study.

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Clinical features and the maternal and neonatal outcomes of pregnant women with coronavirus disease 2019

10.1101/2020.03.22.20041061 ◽

2020 ◽

Cited By ~ 12

Author(s):

Rui Nie ◽

Shao-shuai Wang ◽

Qiong Yang ◽

Cui-fang Fan ◽

Yu-ling Liu ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Pregnant Women ◽

Clinical Features ◽

Neonatal Outcomes ◽

Clinical Severity ◽

Severe Illness ◽

Increased Risk ◽

Maternal And Neonatal Outcomes

ABSTRACTBACKGROUNDThere is little information about the coronavirus disease 2019 (Covid-19) during pregnancy. This study aimed to determine the clinical features and the maternal and neonatal outcomes of pregnant women with Covid-19.METHODSIn this retrospective analysis from five hospitals, we included pregnant women with Covid-19 from January 1 to February 20, 2020. The primary composite endpoints were admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Secondary endpoints included the clinical severity of Covid-19, neonatal mortality, admission to neonatal intensive care unit (NICU), and the incidence of acute respiratory distress syndrome (ARDS) of pregnant women and newborns.RESULTSThirty-three pregnant women with Covid-19 and 28 newborns were identified. One (3%) pregnant woman needed the use of mechanical ventilation. No pregnant women admitted to the ICU. There were no moralities among pregnant women or newborns. The percentages of pregnant women with mild, moderate, and severe symptoms were 13 (39.4%),19(57.6%), and 1(3%). One (3.6%) newborn developed ARDS and was admitted to the NICU. The rate of perinatal transmission of SARS-CoV-2 was 3.6%.CONCLUSIONSThis report suggests that pregnant women are not at increased risk for severe illness or mortality with Covid-19 compared with the general population. The SARS-CoV-2 infection during pregnancy might not be associated with as adverse obstetrical and neonatal outcomes that are seen with the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy. (Funded by the National Key Research and Development Program.)

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Adverse Cerebral Outcomes after Coronary Artery Bypass Surgery—More Than a Decade of Experience in a Single Center

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1618576 ◽

2018 ◽

Vol 66 (06) ◽

pp. 452-456 ◽

Cited By ~ 1

Author(s):

Carrie Consalvi ◽

Allison Healey ◽

Bridget Rivera ◽

Katherine Poulin ◽

Rephael Mohr ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Intensive Care ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Community Hospital ◽

Artery Bypass ◽

Historical Cohort ◽

Increased Risk ◽

Prior Stroke

Background Nonfatal strokes, transient ischemic attacks (TIAs), and reversible ischemic neurological deficits (RIND) after elective coronary artery bypass grafting (CABG) are devastating clinical problems. The anesthesiologist, surgical and intensive care teams in a community hospital adopted a strategy developed in an effort to minimize these adverse outcome events.The purpose of this study is to determine the incidence of and predictors for perioperative adverse neurologic events. Methods A historical cohort study of 1,108 consecutive CABG patients operated between 2002 and 2014. Outcomes were defined as (1) a new neurologic damage (a new stroke, TIA, or RIND) and (2) a new neurologic damage or 30 days mortality. Results Adverse cerebral outcomes occurred in 16 patients (1.4 percent). Nine patients had postoperative stroke, six suffered TIAs, and one had postoperative RIND.In multivariate analysis, older age (OR 1.07, 95% CI 1.01–1.14), congestive heart failure (OR 3.57, 95% CI 1.22–10.49) and prior stroke (OR 6.27, 95% CI 1.78–22.03) were significantly associated with increased risk of new neurologic damage. These parameters were also significantly associated with increased risk of the combined outcome (new neurologic damage/mortality). Conclusions A low incidence rate of adverse cerebral outcomes after CABG in community hospital can be achieved with the use of the suggested surgical intensive care, and anesthetic strategy. Advanced age, congestive heart failure, and prior stroke are associated with adverse outcomes.

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Hospitalization and Critical Illness in Chronic Kidney Disease

Cardiorenal Medicine ◽

10.1159/000507047 ◽

2020 ◽

Vol 10 (5) ◽

pp. 302-312

Author(s):

Jefferson Lorenzo Triozzi ◽

Jingbo Niu ◽

Carl P. Walther ◽

Wolfgang C. Winkelmayer ◽

Sankar D. Navaneethan

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Congestive Heart Failure ◽

Intensive Care ◽

Critical Illness ◽

Kidney Disease ◽

Safety Net ◽

Increased Risk ◽

Ckd Stage

Background: Patients with chronic kidney disease (CKD) who are hospitalized with a critical illness are at increased risk for adverse outcomes. We studied the predictors of hospitalization with critical illness among patients with non-dialysis-dependent CKD stages 3 and 4 in a safety-net healthcare setting. Methods: A retrospective cohort study was conducted among patients ≥18 years of age with CKD stages 3 and 4 using a CKD registry from a safety-net healthcare system. Hospitalizations with critical illness were identified among patients requiring nonelective admission or transfer to the intermediate or intensive care unit during a 3-year period after the diagnosis of CKD. Poisson regression was used to determine associations between baseline characteristics and hospitalization requiring intermediate or intensive care among all CKD patients and in those with different stages of CKD. Outcomes of these hospitalizations were also tabulated. Results: Among 8,302 patients with CKD stages 3 and 4, 1,298 were hospitalized and 495 required intermediate or intensive care during a 3-year follow-up period. In the adjusted analysis, advanced CKD, Hispanics (incident rate ratio [IRR]: 1.88), non-Hispanic Blacks (IRR: 1.48), presence of congestive heart failure (IRR: 2.09), cardiovascular disease (IRR: 1.57), chronic pulmonary disease (IRR: 1.60), liver disease, malignancy, and anemia were associated with higher risk of hospitalization requiring intermediate or intensive care. The association of age, gender, race/ethnicity, congestive heart failure, anemia, and body mass index with hospitalization requiring intermediate or intensive care differed significantly by CKD stage (p value for interaction term <0.05). Congestive heart failure and severity of anemia were associated with a higher risk of hospitalization requiring intermediate or intensive care among patients with mild CKD, and the magnitude of association attenuated among patients with advanced CKD. Conclusions: The burden of hospitalization with critical illness among patients with non-dialysis-dependent CKD stages 3 and 4 remains high and was associated with demographic factors and comorbid medical conditions, especially among those with congestive heart failure and cardiovascular disease. Targeted, effective interventions to reduce the burden of hospitalization and critical illness in CKD patients within safety-net healthcare systems are needed.

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Biochemical Markers in Patients with Readmission for Congestive Heart Failure

Revista de Chimie ◽

10.37358/rc.18.7.6395 ◽

2018 ◽

Vol 69 (7) ◽

pp. 1687-1691

Author(s):

Razan Al Namat ◽

Mihai Constantin ◽

Ionela Larisa Miftode ◽

Andrei Manta ◽

Antoniu Petris ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Rural Areas ◽

Discharge Planning ◽

Difficult Problem ◽

Uncontrolled Hypertension ◽

Medical Attention ◽

Family Doctors ◽

Increased Risk ◽

Risk Patients

Repetitive or recurrent hospitalizations are a general major health issue in patients with chronic disease. Congestive heart failure, is associated with a high incidence and presence of early rehospitalization, but variables in order to identify patients at increased risk and also an analysis of potentially remediable factors contributing to readmission have not been previously reported and it remains still a difficult problem. We retrospectively assessed 100 patients aged between 48-85 years old, of which 75% were men, who had been hospitalized with documentation of congestive heart failure in St. Spiridon County Emergency Hospital. They were hospitalized between 2010-2017. Even if recurrent heart failure was the most common cause for readmission or rehospitalization, other cardiac disorders and noncardiac illnesses were also accounted for readmission. Predictive factors of an increased probability of readmission included prior patient�s medical heart failure history, heart failure decompensation precipitated or accelerated by an ischaemic episode, atrial fibrillation or uncontrolled hypertension. Factors contributing to preventable readmissions included noncompliance with medications or diet, inadequate discharge planning or follow-up, failure of both social support system and the seek of a promp medical attention when symptoms reappeared. We also identified an inappropriate colaboration with family doctors especially for the patients from rural areas. Patients were more likely to cite side effects of prescribed medications rather than nonadherence as a precipitating factor for readmission. Thus, we can appreciate that early rehospitalization in patients with congestive heart failure may be avoidable in up to 50% of cases. Identification of high risk patients is possible and also necessary shortly after admission in order to identify nonpharmacological interventions designed to decrease readmission frequency.

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Incidence, Risk Factors and Outcomes of New Onset Supraventricular Arrhythmias in African American Patients with Severe Sepsis

Ethnicity & Disease ◽

10.18865/ed.26.2.205 ◽

2016 ◽

Vol 26 (2) ◽

pp. 205 ◽

Cited By ~ 6

Author(s):

O'Dene Lewis ◽

Julius Ngwa ◽

Richard F. Gillum ◽

Alicia Thomas ◽

Wayne Davis ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Congestive Heart Failure ◽

Severe Sepsis ◽

Intensive Care ◽

Respiratory Failure ◽

Hospital Mortality ◽

Supraventricular Arrhythmias ◽

Incidence Risk ◽

New Onset

Purpose: New onset supraventricular arrhythmias (SVA) are commonly reported in mixed intensive care settings. We sought to determine the incidence, risk factors and outcomes of new onset SVA in African American (AA) patients with severe sepsis admitted to medical intensive care unit (MICU).Methods: Patients admitted to MICU between January 2012 through December 2012 were studied. Patients with a previous history of arrhythmia or with new onset of ventricular arrhythmia were excluded. Data on risk factors, critical care interventions and outcomes were obtained.Results: One hundred and thirty-one patients were identified. New onset SVA occurred in 34 (26%) patients. Of those 34, 20 (59%) had atrial fibrillation (AF), 6 (18%) had atrial flutter and 8 (24%) had other forms of SVA. Compared with patients without SVA, patients with new onset SVA were older (69 ± 12 yrs vs 59 ± 13 yrs, P=.003), had congestive heart failure (47% vs 24%, P=.015) and dyslipidemia (41% vs 15%, P=.002). Additionally, they had a higher mean mortality prediction model (MPM II) score (65 ± 25 vs 49 ± 26, P=.001) and an increased incidence of respiratory failure (85% vs 55%, P=.001). Hospital mortality in patients with new onset SVA was 18 (53%) vs 30 (31%); P=.024; however, in a multivariate analysis, new onset SVA was associated with nonsignificantly increased odds (OR 2.58, 95% CI 0.86-8.05) for in-hospital mortality.Conclusion: New onset SVA was prevalent in AA patients with severe sepsis and occurred more frequently with advanced age, increased severity of illness, congestive heart failure, and acute respiratory failure; it was associated with higher unadjusted in hospital mortality. However, after multiple adjustments, new onset SVA did not remain an independent predictor of mortality. Ethn Dis.2016;26(2):205-212; doi:10.18865/ ed.26.2.205

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Abstract 14922: Prognostic Value of Baseline BNP and NT-ProBNP and its Interaction With Spironolactone in Patients With Heart Failure and Preserved Ejection Fraction in the TOPCAT Trial

Circulation ◽

10.1161/circ.132.suppl_3.14922 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Inder S Anand ◽

Scott D Solomon ◽

Brian Claggett ◽

Sanjiv J Shah ◽

Eileen O’Meara ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Primary Outcome ◽

Cox Regression ◽

Selection Criterion ◽

Adverse Outcomes ◽

Preserved Ejection Fraction ◽

Patient Selection Criterion ◽

Increased Risk ◽

Patients With Heart Failure

Background: Plasma natriuretic peptides (NP) are helpful in the diagnosis of heart failure (HF) with preserved ejection fraction (HFpEF) and predict adverse outcomes. Levels of NP beyond a certain cut-off level are often used as inclusion criteria in clinical trials to ensure that the patients have HF, and to select patients at higher risk. Whether treatments have a differential effect on outcomes across the spectrum of NP levels is unclear. In the I-Preserve trial a benefit of irbesartan on all outcomes was only seen in HFpEF patients with low but not high NP levels. We hypothesized that in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, spironolactone might have a greater benefit in patients with lower NP levels. Methods and Results: BNP (n=468) or NT-proBNP (n=400) levels were available at baseline in 868 patients with HFpEF enrolled in the natriuretic peptide stratum (BNP ≥100 pg/mL or an NT- proBNP ≥360 pg/mL) of the TOPCAT trial. In a multi-variable Cox regression model, that included age, gender, region (Americas vs. Russia/Georgia), atrial fibrillation, diabetes, eGFR, BMI and heart rate, higher BNP or NT-proBNP as a continuous, standardized log-transformed variable or grouped by terciles (see Figure for BNP & NT-proBNP tercile values) was independently associated with an increased risk of the primary endpoint of cardiovascular mortality, aborted cardiac arrest, or hospitalization for heart failure (Figure-1). There was a significant interaction between the effect of spironolactone and baseline BNP or NT-proBNP terciles for the primary outcome (P=0.02, Figure-2), with greater benefit of the drug in the lower compared to higher NP terciles. Conclusions: The benefit of spironolactone in lower risk HFpEF patients may indicate effects of the drug on early, but not late higher-risk stage of the disease. These findings question the strategy of using elevated NP as a patient selection criterion in HFpEF trials.

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Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

Journal of Intensive Care Medicine ◽

10.1177/08850666211061472 ◽

2021 ◽

pp. 088506662110614

Author(s):

Mohinder R. Vindhyal ◽

Liuqiang (Kelsey) Lu ◽

Sagar Ranka ◽

Prakash Acharya ◽

Zubair Shah ◽

...

Keyword(s):

Heart Failure ◽

Septic Shock ◽

Congestive Heart Failure ◽

Hospital Mortality ◽

Secondary Analysis ◽

Kidney Injury ◽

Cross Sectional ◽

Increased Risk ◽

Icd 10 ◽

Nationwide Readmission Database

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

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Abstract 013: Trajectories Of Self-rated Health After Hospitalization: A 30 Year Cohort Study

Circulation ◽

10.1161/circ.143.suppl_1.013 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Scott Mu ◽

Caitlin W Hicks ◽

Natalie R Daya ◽

Randi E Foraker ◽

Anna Kucharska-newton ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Heart Failure ◽

Congestive Heart Failure ◽

Cerebrovascular Disease ◽

Cox Regression ◽

Partial Recovery ◽

Prognostic Information ◽

Patient Centered ◽

Self Rated Health

Introduction: Hospitalization is a complex health exposure and the period immediately following acute-care hospitalization is a high-risk state. Self-rated health is a subjective indicator of health and the long-term trends in self-rated health after hospitalization are not well characterized. Hypotheses: 1. Self-rated health decreases after hospitalization, with only partial recovery in the following years. 2. Poor self-rated health after hospitalization is associated with increased mortality. Methods: We analyzed 13,758 participants in the Atherosclerosis Risk in Communities (ARIC) Study with at least 1 hospitalization. Self-rated health was assessed annually and rated on a 4-point scale as follows: “Over the past year, compared to other people your age, would you say that your health has been excellent(=4), good(=3), fair(=2) or poor(=1)?" Using Cox regression and Kaplan-Meier methods, we evaluated mortality after hospitalization for myocardial infarction, congestive heart failure, cerebrovascular disease, pneumonia or diabetes mellitus with complications. Results: The mean self-rated health the year prior to hospitalization was 2.82 and the nadir of self-rated health was 2.62, occurring 1 year after hospitalization (Fig 1a). As compared to “excellent” self-rated health, “poor” self-rated health after any hospitalization was strongly associated with mortality (HR 4.65, 95% CI 4.27-5.07). Corresponding HRs (95% CI) for mortality post-hospitalization were 3.12 (2.30-4.22) for acute myocardial infarction, 3.08 (2.39-3.96) for congestive heart failure, 2.15 (1.43-3.23) for acute cerebrovascular disease, 4.54 (3.39-6.09) for pneumonia, and 3.32 (2.35-4.69) for diabetes mellitus with complications (Fig 1b). Conclusion: Mean self-rated health decreases significantly after hospitalization and worse self-rated health is associated with higher mortality. Self-rated health is an easily obtained patient centered outcome with valuable prognostic information.

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