Preliminary results of the acute Heart Failure registry in the DELTA region of Egypt (DELTA-HF): a database and a quality initiative project

Abstract Background Data about heart failure in Egypt is scarce. We aimed to describe the clinical characteristics and diagnostic and treatment options in patients with acute heart failure in the Delta region of Egypt and to explore the gap in the management in comparison to the international guidelines. Results DELTA-HF is a prospective observational cohort registry for all consecutive patients with acute heart failure (AHF) who were admitted to three tertiary care cardiac centers distributed in the Delta region of Egypt. All patients were recruited in the period from April 2017 to May 2018, during which, data were collected and short-term follow-up was done. A total of 220 patients (65.5% were males with a median age of 61.5 years and 50.9% had acute decompensation on top of chronic heart failure) was enrolled in our registry. The risk factors for heart failure included rheumatic valvular heart disease (10.9%), smoking (65.3%), hypertension (48.2%), diabetes mellitus (42.7%), and coronary artery disease (28.2%). Left ventricular ejection fraction (LVEF) was less than 40% in 62.6%. Etiologies of heart failure included ischemic heart disease (58.1%), valvular heart disease (16.3%), systemic hypertension (9.1%), and dilated non-ischemic cardiomyopathy (15.5%). Exacerbating factors included infections (28.1%), acute coronary syndromes (25.5%), non-compliance to HF medications (19.6%), and non-compliance to diet (23.2%) in acute decompensated heart failure (ADHF) patients. None of our patients had been offered heart failure device therapy and only 50% were put on beta-blockers upon discharge. In-hospital, 30 days and 90 days all-cause mortality were 18.2%, 20.7%, and 26% respectively. Conclusions There is a clear gap in the management of patients with acute heart failure in the Delta region of Egypt with confirmed under-utilization of heart failure device therapy and under-prescription of guideline-directed medical therapies particularly beta-blockers. The short-term mortality is high if compared with Western and other local registries. This could be attributed mainly to the low-resource health care system in this region and the lack of formal heart failure management programs.

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Characteristics, outcome and predictors of one year mortality rate in patients with acute heart failure

Vojnosanitetski pregled ◽

10.2298/vsp1102136b ◽

2011 ◽

Vol 68 (2) ◽

pp. 136-142

Author(s):

Marko Banovic ◽

Zorana Vasiljevic-Pokrajcic ◽

Bosiljka Vujisic-Tesic ◽

Sanja Stankovic ◽

Ivana Nedeljkovic ◽

...

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Acute Heart Failure ◽

Local Population ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Clinical Center ◽

Previous Hospitalization ◽

One Year

Background/Aim. Acute heart failure (AHF) is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and longterm mortality. The aim of this study was to investigate characteristics, outcomes and one year mortality of patients with AHF in the local population. Methods. This prospective study consisted of 64 consecutive unselected patients treated in the Coronary Care Unit of the Emergency Centre (Clinical Center of Serbia, Belgrade) and were followed for one year after the discharge. Results. Mean age of the patients was 63.6 ? 12.6 years and 59.4% were males. Acute congestion (43.8%) and pulmonary edema (39.1%) were the most common presentations of AHF. Mean left ventricular ejection fraction (LVEF) was 39.7% ? 9.25%, while 44.4% of the patients had LVEF ? 50%. At discharge, 55.9% of the patients received therapy with ?-blockers, 94.9% diuretics, out of which 47.7% spironolactone, 94.9% patients were given ACE-inhibitors or angiotensin receptor blokcers (ARB). The 12-month all-cause mortality was 26.5%. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF, reduced fraction of shortening (FS) and a higher tricuspid velocity. Conclusion. One year mortality of our patients with AHF was high, similar to the known European studies. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF and LVFS and a higher tricuspid velocity.

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P1657Hyperuricaemia treatment in acute heart failure patients does not improve their long-term prognosis: a propensity score matched analysis from the AHEAD registry

European Heart Journal ◽

10.1093/eurheartj/ehz748.0415 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Miklikova ◽

J Jarkovsky ◽

K Benesova ◽

R Miklik ◽

M Felsoci ◽

...

Keyword(s):

Heart Failure ◽

Survival Rate ◽

Propensity Score ◽

Acute Heart Failure ◽

Beta Blockers ◽

Stable Condition ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Primary Analysis ◽

Ventricular Ejection Fraction

Abstract Background Hyperuricaemia is associated with a poorer prognosis in heart failure (HF) patients. Benefits of hyperuricaemia treatment with allopurinol have not yet been confirmed in clinical practice. The aim of our work was to assess the benefit of allopurinol treatment in a large cohort of HF patients. Methods and results The prospective acute heart failure registry (AHEAD) was used to select 3,160 hospitalized patients with a known level of uric acid (UA) who were discharged in a stable condition. Hyperuricaemia was defined as UA ≥500μmol/l and/or allopurinol treatment at admission. The patients were classified into three groups: without hyperuricaemia, with treated hyperuricaemia and with untreated hyperuricaemia at discharge. Two- and five-year all-cause mortality were defined as endpoints. Patients without hyperuricaemia, unlike those with hyperuricaemia, had a higher left ventricular ejection fraction, a better renal function and higher haemoglobin levels, had less frequently diabetes mellitus and atrial fibrillation, and showed better tolerance to treatment with ACEIs/ARBs and/or beta-blockers. In a primary analysis, the patients without hyperuricaemia had the highest survival rate. After using the propensity score to set up comparable groups, the patients without hyperuricaemia had a similar five-year survival rate as those with untreated hyperuricaemia (42.0% vs 39.7%, p=0.362) whereas those with treated hyperuricaemia had a poorer prognosis (32.4% survival rate; p=0.006 vs non-hyperuricaemia group and p=0.073 vs untreated group). Conclusion Hyperuricaemia was associated with an unfavourable cardiovascular risk profile in HF patients. Treatment of hyperuricaemia with low doses of allopurinol did not improve the longterm prognosis of HF patients. Acknowledgement/Funding Ministry of Health CZ 65269705 and MUNI/A/1250/2017

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Abstract 2406: Coronary Microvascular Function as a Target for Prevention of Systolic Heart Failure in Chronic Valvular Heart Disease: Aortic Regurgitation versus Mitral Regurgitation

Circulation ◽

10.1161/circ.118.suppl_18.s_720 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Hideki Okui ◽

Shuichi Hamasaki ◽

Sanemasa Ishida ◽

Masakazu Ogawa ◽

Keishi Saihara ◽

...

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Coronary Artery ◽

Mitral Regurgitation ◽

Aortic Regurgitation ◽

Valvular Heart Disease ◽

Systolic Function ◽

Systolic Heart Failure ◽

Left Ventricular ◽

Left Ventricular Ejection

Background: The coronary microvascular vasodilating function is an important determinant of patient outcomes in a number of clinical settings, including coronary artery disease, hypertensive heart disease, or cardiomyopathy. However, the characteristics or the implication of coronary microcirculation in valvular heart disease has not been fully elucidated. The present study was designed to assess coronary vasodilating function and its effects on systolic function in patients with aortic regurgitation (AR) and mitral regurgitation (MR). Methods: Forty-four consecutive patients (66 yrs) with moderate to severe AR and 45 consecutive patients with moderate to severe MR (64 yrs) were enrolled for this study. All patients were free of coronary artery stenosis. Fifty-one age-matched patients without underlying cardiovascular disease served as controls. Endothelium-dependent and endothelium-independent vasodilating function of resistance coronary artery were assessed by coronary blood flow (CBF) response to acetylcholine and papaverine, respectively. Left ventricular ejection fraction (LVEF) was determined by echocardiography as an indicator of systolic function. Results: In patients with AR, both %change in CBF response to acetylcholine and papaverine were significantly lower than controls (32 ± 61 vs 64 ± 84, 172 ± 87 vs 268 ± 105, p < 0.05, p < 0.01, respectively). Further, %change in CBF response to acetylcholine positively correlated with LVEF (r = 0.45, p < 0.01). In patients with MR, %change in CBF response to papaverine was significantly lower than controls (221 ± 123 vs 268 ± 105, p < 0.05), but %change in CBF response to acetylcholine was comparable with controls. Moreover, neither %change in CBF response to acetylcholine nor CBF response to papaverine had significant correlation with LVEF. Conclusion: In patients with AR, both endothelium-dependent and endothelium-independent vasodilating function of resistance coronary artery were deteriorated. Further, endothelium-dependent vasodilating function may be associated with left ventricular systolic function. Our findings indicate coronary microvascular endothelial dysfunction as a potential target for prevention of systolic heart failure in patients with AR.

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Beta-Blockers and Cardiovascular Outcomes in Acute Heart Failure with a History of Coronary Artery Disease and an Ejection Fraction ≥ 40%

Current Vascular Pharmacology ◽

10.2174/1570161118666191231114203 ◽

2020 ◽

Vol 18 (6) ◽

pp. 644-651 ◽

Cited By ~ 1

Author(s):

Charbel Abi Khalil ◽

Kadhim Sulaiman ◽

Nidal Asaad ◽

Khalid F. AlHabib ◽

Alawi Alsheikh-Ali ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Ejection Fraction ◽

Acute Heart Failure ◽

Beta Blockers ◽

Previous History ◽

Left Ventricular Ejection ◽

History Of ◽

Artery Disease

The prognostic impact of beta-blockers (BB) in coronary artery disease (CAD) is controversial, especially in the post-reperfusion era. We studied in-hospital cardiovascular events in patients hospitalized for acute HF, a previous history of CAD and a left ventricular ejection fraction (LVEF) ≥40%, in relation to BB on admission; and 1-year outcome in relation to BB on discharge, in the GULF aCute heArt failuRe (GULF-CARE) registry. From a total of 5005 patients included in the GULF-CARE registry, 303 patients with a previous history of CAD and a LVEF ≥40% on BB were propensity-matched to 303 patients without BB on admission. In-hospital mortality (OR= 0.82; 95% CI [0.35-1.94]), stroke and cardiogenic shock were not reduced by BB. On discharge, 306 patients on BB, including the ones newly diagnosed with myocardial infarction as a precipitating cause of HF, were propensity-scored matched with 306 patients without BB. Mortality (OR= 0.86; 95%CI [0.51-1.45], hospitalization for HF or PCI/CABG at 1 year were also not reduced by BB at discharge. In summary, our data show that BB have a neutral effect on in-hospital and 1-year outcomes in acute heart failure patients with a previous history of CAD and a LVEF ≥40%.

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Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome

Clinical Research in Cardiology ◽

10.1007/s00392-016-1063-0 ◽

2016 ◽

Vol 106 (5) ◽

pp. 359-368 ◽

Cited By ~ 30

Author(s):

Dimitrios Farmakis ◽

Panagiotis Simitsis ◽

Vasiliki Bistola ◽

Filippos Triposkiadis ◽

Ignatios Ikonomidis ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Acute Heart Failure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Short Term ◽

Term Outcome ◽

Ventricular Ejection Fraction ◽

Short Term Outcome

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Assessing left ventricular systolic function: from ejection fraction to strain analysis

European Heart Journal ◽

10.1093/eurheartj/ehaa587 ◽

2020 ◽

Author(s):

Brian P Halliday ◽

Roxy Senior ◽

Dudley J Pennell

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Valvular Heart Disease ◽

Left Ventricular ◽

Adverse Outcomes ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Patients With Heart Failure

Abstract The measurement of left ventricular ejection fraction (LVEF) is a ubiquitous component of imaging studies used to evaluate patients with cardiac conditions and acts as an arbiter for many management decisions. This follows early trials investigating heart failure therapies which used a binary LVEF cut-off to select patients with the worst prognosis, who may gain the most benefit. Forty years on, the cardiac disease landscape has changed. Left ventricular ejection fraction is now a poor indicator of prognosis for many heart failure patients; specifically, for the half of patients with heart failure and truly preserved ejection fraction (HF-PEF). It is also recognized that LVEF may remain normal amongst patients with valvular heart disease who have significant myocardial dysfunction. This emphasizes the importance of the interaction between LVEF and left ventricular geometry. Guidelines based on LVEF may therefore miss a proportion of patients who would benefit from early intervention to prevent further myocardial decompensation and future adverse outcomes. The assessment of myocardial strain, or intrinsic deformation, holds promise to improve these issues. The measurement of global longitudinal strain (GLS) has consistently been shown to improve the risk stratification of patients with heart failure and identify patients with valvular heart disease who have myocardial decompensation despite preserved LVEF and an increased risk of adverse outcomes. To complete the integration of GLS into routine clinical practice, further studies are required to confirm that such approaches improve therapy selection and accordingly, the outcome for patients.

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Systolic Blood Pressure and Outcome in Patients Admitted With Acute Heart Failure: An Analysis of Individual Patient Data From 4 Randomized Clinical Trials

Journal of the American Heart Association ◽

10.1161/jaha.121.022288 ◽

2021 ◽

Author(s):

Johannes Grand ◽

Kristina Miger ◽

Ahmad Sajadieh ◽

Lars Køber ◽

Christian Torp‐Pedersen ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Acute Heart Failure ◽

Left Ventricular Ejection ◽

Long Term Outcomes ◽

Short Term ◽

End Point ◽

All Cause Mortality

BACKGROUND In acute heart failure (AHF), systolic blood pressure (SBP) is an important clinical variable. This study assessed the association between SBP and short‐term and long‐term outcomes in a large cohort of patients with AHF. METHODS AND RESULTS This is an analysis of 4 randomized controlled trials investigating serelaxin versus placebo in patients admitted with AHF and SBPs from 125 to 180 mm Hg. Outcomes were 180‐day all‐cause mortality and a composite end point of all‐cause mortality, worsening heart failure, or hospital readmission for heart failure the first 14 days. Left ventricular ejection fraction (LVEF) was examined as LVEF<40% and LVEF≥40%. Multivariable Cox regression models were adjusted for known confounders of outcomes in AHF. A total of 10 533 patients with a mean age of 73 (±12) years and a mean SBP of 145 (±7) mm Hg were included. LVEF was assessed in 9863 patients (93%); 4737 patients (45%) had LVEF<40%. Increasing SBP was inversely associated with 180‐day mortality (adjusted hazard ratio [HR adjusted ], 0.93; 95% CI, 0.89–0.98; P =0.008 per 10 mm Hg increase) and with the composite end point (HR adjusted , 0.90; 95% CI, 0.85–0.94; P <0.001 per 10 mm Hg increase). A significant interaction with LVEF was observed, revealing that SBP was not associated with mortality in patients with LVEF≥40% (HR adjusted , 0.98; 95% CI, 0.91–1.04; per 10 mm Hg increase), but was strongly associated with increased mortality in LVEF<40% (HR adjusted , 0.84; 95% CI, 0.77–0.92; per 10 mm Hg increase). CONCLUSIONS Elevated SBP is associated with favorable short‐term and long‐term outcomes in patients with AHF. In our predefined subgroup analysis, we found that baseline SBP was not associated with mortality in LVEF≥40%, but was strongly associated with mortality in patients with LVEF<40%.

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