scholarly journals Clinical Risk Factors and Prognostic Impact of Osteoporosis in Patients With Chronic Heart Failure

2020 ◽  
Vol 84 (12) ◽  
pp. 2224-2234
Author(s):  
Satoshi Katano ◽  
Toshiyuki Yano ◽  
Takanori Tsukada ◽  
Hidemichi Kouzu ◽  
Suguru Honma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Clinical Risk Factors ◽  
Prognostic Impact ◽  
Clinical Risk

scholarly journals Clinical determinants and prognostic impact of osteoporosis in patients with chronic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Katano ◽  
T Yano ◽  
T Tsukada ◽  
H Kouzu ◽  
S Honma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Adverse Events ◽  
Gait Speed ◽  
Loop Diuretics ◽  
Clinical Risk Factors ◽  
Funding Source ◽  
Prognostic Impact ◽  
Clinical Risk

Abstract Background Despite accumulating evidence of a close association between orthopedic fractures and chronic heart failure (CHF), the clinical risk factors of osteoporosis, defined as reduction in bone mineral densities (BMDs), in CHF patients have not been systematically analyzed. In addition, the impact of osteoporosis on prognosis of CHF remains unclear. Aims We aimed to clarify the prevalence, clinical risk factors, and prognostic impact of osteoporosis in CHF patients. Methods We retrospectively examined 303 CHF patients (75 years, [interquartile range (IQR), 66–82 years]; 41% female). BMDs at the lumber spine, femoral neck, and total femur were measured by dual-energy X-ray absorptiometry (DEXA), and osteoporosis was diagnosed when BMD at any of the three sites was less than 70% of Young Adult Mean. Results The prevalence of osteoporosis in the CHF patients was 40%. Patients with osteoporosis were older (79 [IQR, 74–86] vs. 72 [IQR, 62–80] years), included a large percentage of females, had slower gait speed and had lower body mass index (BMI). Loop diuretics and warfarin were used more frequently and direct oral anticoagulants (DOACs) were used less frequently in patients with osteoporosis than in patients without osteoporosis. Multivariate logistic regression analysis indicated that sex (odds ratio [OR] 5.07, 95% Confidence Interval [CI] 2.68–9.61, p<0.01), BMI (OR, 0.83; 95% CI, 0.75–0.91; p<0.01), gait speed (OR, 0.80; 95% CI, 0.70–0.92; p<0.01), loop diuretics use (OR, 2.52; 95% CI, 1.20–5.27; p=0.01) and no DOACs use (OR, 0.43; 95% CI, 0.19–0.96; p=0.04) were independently associated with osteoporosis. During the mean follow-up period of 290±254 days, 92 patients (30.4%) had adverse events. When patients with osteoporosis were divided into subgroups according to the number of sites with BMD of an osteoporosis level, Kaplan-Meier survival curves showed that the rate of adverse events (death and cardiovascular events) was higher in patients with osteoporotic BMD at two or more sites than in patients without osteoporosis (51% vs. 23%, p=0.03) (Figure). In multivariate Cox regression analyses, osteoporotic BMD at two or more sites was an independent predictor of adverse events after adjustment for age, sex, and NT-proBNP level (Hazard ratio, 1.74; 95% CI, 1.01–2.99; p=0.04). Conclusion The risk of osteoporosis may be increased in users of loop diuretics and may be decreased in users of DOACs in CHF patients. Extent of osteoporosis is a novel predictor of adverse events in CHF patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Japan Society for the Promotion of Science KAKENHI

scholarly journals Clinical risk factors for mortality in an analysis of 1375 patients admitted for COVID treatment

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sean A. P. Clouston ◽  
Benjamin J. Luft ◽  
Edward Sun
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Clinical Risk Factors ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Clinical Risk ◽  
History Of

AbstractThe goal of the present work was to examine clinical risk factors for mortality in 1375 COVID + patients admitted to a hospital in Suffolk County, NY. Data were collated by the hospital epidemiological service for patients admitted from 3/7/2020 to 9/1/2020. Time until final discharge or death was the outcome. Cox proportional hazards models were used to estimate time until death among admitted patients. In total, all cases had resolved leading to 207 deaths. Length of stay was significantly longer in those who died as compared to those who did not (p = 0.007). Of patients who had been discharged, 54 were readmitted and nine subsequently died. Multivariable-adjusted Cox proportional hazards regression revealed that in addition to older age, male sex, and a history of chronic heart failure, chronic obstructive pulmonary disease, and diabetes, that a history of premorbid depression was a risk factors for COVID-19 mortality (aHR = 2.42 [1.38–4.23] P = 0.002), and that this association remained after adjusting for age and for neuropsychiatric conditions as well as medical comorbidities including cardiovascular disease and pulmonary conditions. Sex-stratified analyses revealed that associations between mortality and depression was strongest in males (aHR = 4.45 [2.04–9.72], P < 0.001), and that the association between heart failure and mortality was strongest in participants aged < 65 years old (aHR = 30.50 [9.17–101.48], P < 0.001). While an increasing number of studies have identified several comorbid medical conditions including chronic heart failure and age of patient as risk factors for mortality in COVID + patients, this study confirmed several prior reports and also noted that a history of depression is an independent risk factor for COVID-19 mortality.

Association of race/ethnicity with clinical risk factors, quality of care, and acute outcomes in patients hospitalized with heart failure

2011 ◽  
Vol 161 (4) ◽  
pp. 746-754 ◽  
Author(s):  
Kevin L. Thomas ◽  
Adrian F. Hernandez ◽  
David Dai ◽  
Paul Heidenreich ◽  
Gregg C. Fonarow ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Quality Of Care ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Race Ethnicity

scholarly journals Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients after Cardiac Surgery

2018 ◽  
Vol 67 (02) ◽  
pp. 107-116 ◽  
Author(s):  
Kennosuke Yamashita ◽  
Nan Hu ◽  
Ravi Ranjan ◽  
Craig Selzman ◽  
Derek Dosdall
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Meta Analysis ◽  
Postoperative Atrial Fibrillation ◽  
Clinical Risk Factors ◽  
Systemic Review ◽  
Left Ventricular Ejection ◽  
Clinical Risk

Background Postoperative atrial fibrillation (POAF) is a common arrhythmia following cardiac surgery and is associated with increased health-care costs, complications, and mortality. The etiology of POAF is incompletely understood and its prediction remains suboptimal. Using data from published studies, we performed a systemic review and meta-analysis to identify preoperative clinical risk factors associated with patients at increased risk of POAF. Methods A systematic search of PubMed, MEDLINE, and EMBASE databases was performed. Results Twenty-four studies that reported univariate analysis results regarding POAF risk factors, published from 2001 to May 2017, were included in this meta-analysis with a total number of 36,834 subjects. Eighteen studies were performed in the United States and Europe and 16 studies were prospective cohort studies. The standardized mean difference (SMD) between POAF and non-POAF groups was significantly different (reported as [SMD: 95% confidence interval, CI]) for age (0.55: 0.47–0.63), left atrial diameter (0.45: 0.15–0.75), and left ventricular ejection fraction (0.30: 0.14–0.47). The pooled odds ratios (ORs) (reported as [OR: 95% CI]) demonstrated that heart failure (1.56: 1.31–1.96), chronic obstructive pulmonary disease (1.36: 1.13–1.64), hypertension (1.29: 1.12–1.48), and myocardial infarction (1.18: 1.05–1.34) were significant predictors of POAF incidence, while diabetes was marginally significant (1.06: 1.00–1.13). Conclusion The present analysis suggested that older age and history of heart failure were significant risk factors for POAF consistently whether the included studies were prospective or retrospective datasets.

scholarly journals Identification of clinical risk factors of atrial fibrillation in congestive heart failure

2013 ◽  
Vol 20 (4) ◽  
pp. 364-369 ◽  
Author(s):  
Ryszard Targoński ◽  
Janusz Sadowski ◽  
Jerzy Romaszko ◽  
Leszek Cichowski
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Clinical Risk Factors ◽  
Clinical Risk

scholarly journals Diagnostic value and prognostic impact of various invasively derived hemodynamic parameters in patients with severe aortic stenosis undergoing TAVI

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Grundmann ◽  
M Linder ◽  
A Gossling ◽  
L Voigtlaender ◽  
S Ludwig ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Clinical Risk Factors ◽  
Volume Index ◽  
Prognostic Impact ◽  
Hemodynamic Parameters ◽  
Clinical Risk

Abstract Background Ejection time (ET) and Acceleration time (AT) have been described as echocardiographic markers for aortic stenosis (AS).1 Moreover, in a recent study time between invasively measured left ventricular and aortic systolic pressure peaks (T-LVAo) was associated with anatomic AS severity.2 However, the diagnostic value of these parameters has not been validated in a larger patient cohort and their prognostic impact in AS patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown. Purpose We aimed to assess the diagnostic value and prognostic impact of ET, AT, and T-LVAo as assessed by invasive measurements in patients undergoing TAVI for severe AS. Methods This retrospective single-centre analysis studied 1478 patients undergoing TAVI from 2014 to 2019 for severe AS. All patients received echocardiographic, multislice computed tomography (MSCT) and invasive hemodynamic evaluation with simultaneous pressure measurements in left ventricle and aorta prior to TAVI. Anatomic AS severity was assessed according to MSCT-derived aortic valve calcification density (AVCd) defined as calcium volume per annulus area. All hemodynamic parameters were calculated offline using a dedicated software. Results Median patients' age was 81.2 (76.8–84.7) years and 807 (54.6%) were women. Predicted operative risk for mortality was 3.8 (2.6–5.7)% according to STS Score. Medians of invasively derived parameters were 70.0 ms (46.0–98.0) for T-LVAo, 308.0 ms (276.0–336.0) for ET, 180.0 ms (146.0–206.0) for AT. In spline analysis correlation of T-LVAo (Spearman: r=0.35; p&lt;0.001) and ET (Spearman: r=0.18; p&lt;0.001) with AVCd was significant but weak. AT showed negligible correlation with ACVd (Spearman: r=−0.05; p=0.089). The optimal cutoff for death (CD) according to C-statistic was 274 ms for ET and 158 ms for AT. Patients with ET or AT ≥ CD showed lower short and mid-term mortality rates compared to patients with ET or AT &lt; CD (ET ≥ vs. &lt; CD: mortality at 1-year: 14.5 vs. 31.9%, 3-years: 28.3 vs. 53.5%, all p&lt;0.001; AT ≥ vs &lt; CD: mortality at 1-year: 15.5 vs. 25.9%, p&lt;0.001, 3-years: 34.0 vs. 41.0%, p=0.0032). Moreover, multivariate analysis for mortality identified ET (HR 0.58 [95% CI 0.43–0.77; p&lt;0.001]) and AT (HR 0.65 [95% CI 0.49–0.86; p=0.0027]) to be associated with beneficial outcome after TAVI, independent from clinical risk factors and echocardiography-derived parameters like LVEF, mean gradient or stroke volume index. In contrast, T-LVAo showed no prognostic impact according to uni- or multivariate analyses. Conclusion T-LVAo provides the highest diagnostic value among the investigational hemodynamic parameters, however correlation with AVCd was weak. ET and AT are strong independent outcome predictors beyond clinical risk factors and standard echocardiographic parameters in AS patients following TAVI. Accordingly, use of ET and AT might improve risk assessment in patients scheduled for TAVI. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 1122‐000161: Clinical Factors Associated with rtPA Inclusion in Ischemic Stroke Patients with and without Heart Failure

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Carolyn B Sanders ◽  
Camron Edrissi ◽  
Chase Rathfoot ◽  
Krista Knisely ◽  
Nicolas Poupore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Ischemic Stroke ◽  
Coronary Artery ◽  
Clinical Risk Factors ◽  
Clinical Factors ◽  
Factors Associated ◽  
Clinical Risk ◽  
Direct Admission ◽  
Stroke Center

Introduction : It is estimated that approximately 10–24% of acute ischemic stroke (AIS) patients have comorbid heart failure (HF). However, it is currently unknown if certain clinical risk factors associated with rtPA thrombolytic therapy differ based on HF diagnosis. The purpose of this study is to determine the clinical factors associated with rtPA inclusion in AIS patients with and without heart failure. Methods : Retrospective data for baseline clinical and demographic factors from January 2010 to January 2016 in a regional stroke center were analyzed. Of the 5,469 patients identified with AIS, 590 presented with heart failure while 4,879 did not. Odds ratios and 95% confidence intervals were used to determine which clinical factors were associated with rtPA inclusion. Results : Adjusted multivariate analysis demonstrated that within the AIS population, those without HF who received rtPA were more likely to be associated with Hispanic ethnicity (OR = 0.464, 95% CI, 0.247‐0.87, P = 0.017), coronary artery stenosis (OR = 0.55, 95% CI, 0.366‐0.83, P = 0.004), previous stroke (OR = 0.745, 95% CI, 0.609‐0.91, P = 0.004), previous TIA (OR = 1.447, 95% CI, 1.094‐1.91, P = 0.010), total cholesterol (OR = 1.487, 95% CI, 1.175‐1.88, P = 0.001), lipids (OR = 0.998, 95% CI, 0.996‐1, P = 0.038), serum creatinine (OR = 0.899, 95% CI, 0.854‐0.95, P<0.001), INR (OR = 0.825, 95% CI, 0.73‐0.93, P = 0.002), heart rate (OR = 0.13, 95% CI, 0.071‐0.24, P<0.001), and direct admission (OR = 2.87, 95% CI, 2.432‐3.39, P<0.001). AIS patients with HF who received rtPA were more likely to be associated with increasing age (OR = 0.982, 95% CI, 0.966‐1, P = 0.020), coronary artery disease (OR = 0.618, 95% CI, 0.391‐0.98, P = 0.0.040), INR (OR = 0.326, 95% CI, 0.129‐0.82, P = 0.018), and ambulatory improvement (OR = 1.69, 95% CI, 1.058‐2.7, P = 0.0.028). Conclusions : The results of this study demonstrate that within the AIS population, there are certain clinical risk factors that influence the likelihood of receiving rtPA in patients with and without HF. These findings provide further insight into AIS and HF and suggest the need for further research into the role the identified factors play in influencing clinical outcome.

scholarly journals Impact of clinical risk factor profile vs. atrial fibrillation phenotype on outcome after pulmonary vein isolation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Wittmer ◽  
L Chollet ◽  
S Baldinger ◽  
H Servatius ◽  
J Seiler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Female Gender ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Artery Disease

Abstract Aims Catheter ablation for atrial fibrillation (AF) is increasingly performed. Both clinical risk factors as well as the AF phenotype have been shown to influence ablation outcomes. The inter-relationship of the two however is incompletely understood. Methods In a retrospective analysis of a prospective registry of patients undergoing a first pulmonary vein isolation, the association of 8 predefined clinical risk factors (age &gt;70 years, female gender, hypertension, BMI &gt;30 kg/m2, coronary artery disease, heart failure, chronic kidney disease (CKD; eGFR&lt;60ml/min/1.73m2) and diabetes mellitus) and the AF phenotype (paroxysmal vs. persistent AF) were assessed as well as their impact on AF recurrence during follow-up. Results Overall, 715 patients were enrolled (median age 63 years, 27% females, 69% paroxysmal AF). The prevalence of obesity, hypertension, heart failure and CKD was significantly higher in persistent AF, while female gender was more prevalent in paroxysmal AF. After 2 years of follow-up, overall freedom from recurrence was 46%, and was higher in paroxysmal AF compared to persistent AF (54.1% vs. 29.1%, p&lt;0.001). Of the clinical risk factors, obesity (p=0.02), CKD (p=0.01) and heart failure (p=0.01) were significantly associated with lower arrhythmia-free survival, and there was a trend for hypertension and coronary artery disease (both p&lt;0.2). A risk score composed of those 5 factors was associated with recurrences in patients with paroxysmal AF (p=0.04, Figure 1), but not in those with persistent AF (p=0.85, Figure 2). Conclusion Clinical risk factors predict outcome after pulmonary vein isolation in patients with paroxysmal, but not persistent AF. This is likely due to a strong association of those risk factors with the occurrence of persistent AF. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

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