scholarly journals OUTpatient intravenous LASix Trial in reducing hospitalization for acute decompensated heart failure (OUTLAST)

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253014
Author(s):  
Carine E. Hamo ◽  
Sahar S. Abdelmoneim ◽  
Seol Young Han ◽  
Elizabeth Chandy ◽  
Cornelia Muntean ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Care Group ◽  
Double Blind Study ◽  
Infusion Group ◽  
Care Protocol ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background Hospitalization for acute decompensated heart failure (ADHF) remains a major source of morbidity and mortality. The current study aimed to investigate the feasibility, safety, and efficacy of outpatient furosemide intravenous (IV) infusion following hospitalization for ADHF. Methods In a single center, prospective, randomized, double-blind study, 100 patients were randomized to receive standard of care (Group 1), IV placebo infusion (Group 2), or IV furosemide infusion (Group 3) over 3h, biweekly for a one-month period following ADHF hospitalization. Patients in Groups 2/3 also received a comprehensive HF-care protocol including bi-weekly clinic visits for dose-adjusted IV-diuretics, medication adjustment and education. Echocardiography, quality of life and depression questionnaires were performed at baseline and 30-day follow-up. The primary outcome was 30-day re-hospitalization for ADHF. Results Overall, a total of 94 patients were included in the study (mean age 64 years, 56% males, 69% African American). There were a total of 14 (15%) hospitalizations for ADHF at 30 days, 6 (17.1%) in Group 1, 7 (22.6%) in Group 2, and 1 (3.7%) in Group 3 (overall p = 0.11; p = 0.037 comparing Groups 2 and 3). Patients receiving IV furosemide infusion experienced significantly greater urine output and weight loss compared to those receiving placebo without any significant increase creatinine and no significant between group differences in echocardiography parameters, KCCQ or depression scores. Conclusion The use of a standardized protocol of outpatient IV furosemide infusion for a one-month period following hospitalization for ADHF was found to be safe and efficacious in reducing 30-day re-hospitalization.

Abstract 15299: Outpatient Intravenous Lasix Trial in Reducing Hospitalization for Acute Decompensated Heart Failure (OUTLAST)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Carine E Hamo ◽  
Sahar S Abdelmoneim ◽  
Seol Young Han ◽  
Elizabeth Chandy ◽  
Cornelia Muntean ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Diuretic Therapy ◽  
Decompensated Heart Failure ◽  
Double Blind Study ◽  
Infusion Group ◽  
Care Protocol ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Introduction: Hospitalization for acute decompensated heart failure (ADHF) remains a major source of morbidity and mortality. While previous studies have shown outpatient intravenous (IV) diuretic therapy to be safe and cost-effective, there have been no randomized controlled trials to evaluate the utilization of continued outpatient IV furosemide diuretic maintenance treatment in patients with HF following hospitalization for ADHF. Hypothesis: We hypothesized that 30-day hospital readmission from ADHF would be lower with routine, standardized outpatient IV diuretic treatment along with a comprehensive HF care approach vs standard treatment. Methods: In a single center, prospective, randomized, double-blind study, 100 patients were randomized to receive standard of care (Group 1), IV placebo infusion (Group 2), or IV furosemide infusion (Group 3) over 3 hours, biweekly for a one-month period following hospitalization for ADHF. Patients in Groups 2 and 3 also received a comprehensive HF care protocol including bi-weekly clinic visits for dose-adjusted IV-diuretics, medication adjustment, laboratory, weight, and blood pressure-monitoring, and education during infusion visits. Echocardiography, Kansas City Cardiomyopathy Questionnaire (KCCQ) and depression questionnaires were performed at baseline and 30-day follow-up. The primary outcome was 30-day re-hospitalization for ADHF. Results: Overall, a total of 94 patients were included in the study (mean age 64 years, 56% males, 69% African American, 70% HF reduced ejection fraction). There were a total of 14 (15%) readmissions for ADHF at 30 days, 6 (17.1%) in Group 1, 7 (22.6%) in Group 2, and 1 (3.7%) in Group 3 (overall p=0.11; p=0.037 comparing Group 2 and Group 3). Patients receiving IV furosemide infusion experienced significantly greater urine output and weight loss compared to those receiving placebo without any significant increase creatinine and no significant between group differences in echocardiography parameters, KCCQ or depression scores. Conclusions: The use of a standardized protocol of outpatient IV furosemide infusion for a one-month period following hospitalization for ADHF was found to be safe and efficacious in reducing 30-day re-hospitalization.

scholarly journals Experience of introducing a new form of organization of medical care for patients with heart failure in the Russian Federation

Kardiologiia ◽  
2021 ◽  
Vol 61 (3) ◽  
pp. 42-51
Author(s):  
I. V. Fomin ◽  
N. G. Vinogradova ◽  
D. S. Polyakov ◽  
V. A. Pogrebetskaya
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Clinical Signs ◽  
Decompensated Heart Failure ◽  
Place Of Residence ◽  
Short Period ◽  
Duration Of Hospitalization ◽  
Group 2 ◽  
Group 1

Aim    To present clinical characteristics of patients after hospitalization for acute decompensated heart failure (ADHF) and to analyze hemodynamic indexes and compliance with the treatment at two years depending on the conditions of outpatient follow-up.Material and methods    The study included 942 patients with chronic heart failure (CHF) older than 18 years who had been hospitalized for ADHF. Based on patients’ decisions, two groups were isolated: patients who continued the outpatient follow-up at the Center of CHF (CCHF) (group 1, n=510) and patients who continued the follow-up in outpatient multidisciplinary clinics (OMC) at their place of residence (group 2, n=432). The clinical portrait of patients was evaluated after ADHF, and hemodynamic parameters were evaluated on discharge from the hospital. Also, the patient compliance with the treatment was analyzed during two years of follow-up. Statistical analysis was performed with Statistica 7.0 for Windows.Results    The leading causes for CHF included arterial hypertension, ischemic heart disease, atrial fibrillation, and type 2 diabetes mellitus. With the mean duration of hospitalization of 11 inpatient days, 88.1 % and 88.4 % of patients of groups 1 and 2 were discharged with complaints of shortness of breath; 62 % and 70.4 % complained of palpitations; and 73.6 % and 71.8 % complained of general weakness. On discharge from the hospital, the following obvious signs of congestion remained: peripheral edema in 54.3 % and 57.9 %; pulmonary rales in 28.8 % and 32.4 %; orthopnea in 21.4 % and 26.2 %; and cough in 16,5 % and 15.5 % of patients of groups 1 and 2, respectively. For the time of hospitalization, CHF patients did not achieve their targets of systolic BP (SBP), diastolic BP (DBP) and heart rate (HR). Patients of group 1 achieved the recommended values of SBP, DBP and HR already at one year of the follow-up at CCHF. Patients of group 2 had no significant changes in hemodynamic indexes. At one and two years of the follow-up, group 2 showed a considerable impairment of the compliance with the basis therapy for CHF compared to group 1.Conclusions    During the short period of hospitalization (11 inpatient days), the patients retained pronounced symptoms of HF and clinical signs of congestion and did not achieve their hemodynamic targets. The patients who were followed up for a long time at CCHF were more compliant with the basis therapy, which resulted in improvement of hemodynamic indexes, compared to the patients who were managed in OMS at the place of residence.

scholarly journals How is juvenile rheumatic heart disease different: baseline results from a prospective north Indian registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Mahajan ◽  
D.R Prakash Chand Negi
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Funding Source ◽  
Thromboembolic Events ◽  
Group 3 ◽  
Group 2 ◽  
Rheumatic Heart ◽  
Group 1

Abstract Introduction Juvenile rheumatic heart disease (RHD) refers to RHD in patients <20 years of age. There are no contemporary data highlighting the differences between juvenile and older RHD patients. Purpose We aim to report the age related differences in the pattern, and consequencies of valvular dysfunction in patients of RHD. Methods The 2475 consecutive patients of RHD diagnosed using clinical and echocardiographic criteria were registered prospectively from 2011 till December 2019. Patients were divided into 3 groups according to their age: Group 1 (Juvenile RHD), Group 2 (21–50 years), and Group 2 (>51 years).The data concerning the socio-demographic and clinical profile were recorded systematically, and the nature and severity of valvular dysfunction was assessed by echocardiography. The data were analyzed using the Epi-InfoTM Software. Results Out of 2475 RHD patients, Juvenile RHD comprised of 211 (8.5%) patients. Group 2 and 3 comprised of 1691 (68.3%) and 573 (23.2%) patients respectively. Overall, 1767 (71.4%) patients were females, however this female predilection was less pronounced in juvenile RHD (55.5% females vs 44.5% males) as compared to older groups. Past history of acute rheumatic fever was more commonly recorded in Juvenile RHD group (37.9% vs 18.8% in group 2 and 10% in group 3, p=0.0001). At the time of registration, the presence of advanced heart failure symptoms (dyspnea class III and IV) (11.4% group 1 vs 13.9% group 2 vs 20.6% group 3, p<0.0001), right heart failure symptoms (0.9% group 1 vs 2.5% group 2 vs 7.3% group 3, p<0.01), thromboembolic events (0% group 1 vs 4.1% group 2 vs 3.3% group 3, p<0.01), atrial fibrillation (2.8% group 1 vs 24.5% group 2 vs 45.9% group 3, p<0.0001), and pulmonary hypertension (27.1% group 1 vs 40.3% group 2 vs 51.9% group 3, p<0.01), were all more commonly recorded in non-juvenile older RHD groups. Multivalvular involvement was also less common in juvenile RHD (34.6% vs 42.4% and 44.5%, p=0.04). Mitral regurgitation was the most common lesion in Juvenile RHD followed by aortic regurgitation (68.7% and 40.2% respectively). Stenotic lesions (both mitral and aortic) were present more commonly in older age groups. Conclusion RHD is predominantly a disease of females, however the predilection is less common in juvenile patients. Juvenile RHD predominantly affects the mitral valve and mainly leads to regurgitant lesions. As the age advances, the complications of RHD, mainly heart failure symptoms, thromboembolic events, pulmonary hypertension, and atrial fibrillation, become more common. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Self sponsored registry

Abstract 13073: ECG, Clinical, and Imaging Characteristics of Arrhythmogenic Right Ventricular Cardiomyopathy With Fat and Fibrotic Invasion Into the Left Ventricular Myocardium Revealed by Four-dimensional (4D) Cardiac CT

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nobusada FUNABASHI ◽  
Yoshio Kobayashi
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Cardiac Ct ◽  
4D Ct ◽  
Imaging Characteristics ◽  
Group 3 ◽  
Clinical Heart Failure ◽  
Group 2 ◽  
Group 1 ◽  
T Waves

Introduction: 4D cardiac CT can reveal characteristics of arrhythmogenic right ventricular (RV) cardiomyopathy (ARVC) such as fat and fibrotic invasion into the RV and LV myocardium (RVM, LVM), an enlarged RV, reduced RV motion and bulging. Hypothesis: We could differentiate ARVC patients with fat and fibrotic invasion into the LVM from those without, using ECG, clinical, and other imaging characteristics. Methods: Retrospective analysis of 17 patients (11 males, 57±17 years) with suspected ARVC who underwent 4D cardiac CT. Results: 9 patients met the 2010 ARVC task force criteria. 4 had fat and fibrotic invasion into the LVM (group 1) but 5 did not (group 2). The remaining 8 did not fulfill the ARVC criteria (group 3). The proportion of males and age did not differ between groups. In groups 1, 2 and 3, respectively, 3 (75%), 4 (80%), and 1 (13%) patients had epsilon waves in V1-3 (group 1>3, P=0.033, group 2>3, P=0.005). 2 (50%), one (20%) and 4 (50%) had complete right bundle branch block (CRBBB) (all P=NS). Three (75%), 3 (60%), and 1 (13%) had inverted T waves in V1-3 or beyond (group 1>3, P=0.033). One (50%), 3 (75%), and 2 (50%) had terminal activation duration of QRS ≥55 ms measured from the nadir of the S wave to the end of the QRS, including R’, in V1, V2, or V3, in the absence of CRBBB (all P=NS). One (25%), 4 (80%) and 1 (13%) had sustained ventricular tachycardia (SVT; group 2>3, P=0.005). Two (50%), 1 (20%), and 3 (38%) had non-SVT (all P=NS). 4 (100%), 2 (40%), and 2 (25%) had clinical heart failure (group 1>2, P=0.019, group 1>3, P<0.001). Finally, 4 (100% and 80%) and 6 (75%) had RV enlargement on TTE (all P=NS). On 4D CT, 4 (100%), 5 (100%), and 5 (63%) of patients in groups 1, 2 and 3, showed RV enlargement (all P=NS); 4 (100%), 2 (40%), and 1 (13%) showed reduced RV motion (group 1>2, P=0.019, group 1>3, P<0.001); 75, 100, and 0%, had RV fat invasion (group 1>3, P=0.002, group 2>3, P<0.001); and 25, 0, and 0% showed bulging (all P=NS). Conclusions: Most patients had RV enlargement on TTE and/or 4D CT. Presence of epsilon waves, reduced RV motion, and RV fat invasion on 4D CT may differentiate groups 1 and 2 from group 3, inverted T waves in V1-3 leads or beyond may differentiate group 1 from group 3, SVT may differentiate group 2 from group 3 but only clinical heart failure may differentiate groups 1 and 2.

Abstract 9411: Urine Aquaporin-2 Level is a Novel Marker for the Better Prognosis After Long-Term Tolvaptan Treatment in Patients With Advanced Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Teruhiko Imamura ◽  
Koichiro Kinugawa ◽  
Takeo Fujino ◽  
Toshiro Inaba ◽  
Hisataka Maki ◽  
...  
Keyword(s):  
Heart Failure ◽  
De Novo ◽  
Collecting Duct ◽  
Initial Response ◽  
Aquaporin 2 ◽  
Long Term Treatment ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Introduction: Preserved function of collecting duct is essential for the response to tolvaptan (TLV), and urinary level of aquaporin 2 (U-AQP2) can be a marker for vasopressin-dependent activity of collecting duct. Hypothesis: Higher levels of U-AQP2 in proportion to plasma levels of vasopressin (P-AVP) may be associated with better initial responses to TLV and eventually result in the improved prognosis after long-term treatment of TLV. Methods: Consecutive 60 in-hospital patients with stage D heart failure (HF) who received TLV on a de novo basis were enrolled during 2011-2013. We also selected 60 HF patients by propensity score matching who were hospitalized during the same period but never treated with TLV. Events were defined as death and/or HF re-hospitalization. Results: TLV (3.75-15 mg/day) was continuously administered except death or ventricular assist device implantation occurred. There were 41 patients (group 1) who had increases in UV over the first 24 h after TLV initiation, and all of them had U-AQP2/P-AVP ≥0.5 х103 with higher U-AQP2 levels (5.42 ± 3.54 ng/mL) before TLV treatment. On the other hand, UV rather decreased even after TLV initiation in 19 patients over the first 24 h (group 2). Those in the group 2 universally had U-AQP2/P-AVP <0.5 х103, extremely low U-AQP2 levels (0.76 ± 0.59 ng/mL, p<0.001 vs. group 1), and similar P-AVP with the group 1 at baseline. The 41 and 19 patients without TLV treatment (group 3 and 4) were respectively matched to the group 1 and 2 by propensity scores. Interestingly, every patient in the group 3 had U-AQP2/P-AVP ≥0.5 х103, and vice versa in the group 4. Among the four groups, congestion-related symptoms were only improved in the group 1 after 1 month of enrollment. The patients in the group 1 had significantly better event-free survival over 2-year by TLV treatment compared with the group 3 (76% vs. 43%, p<0.014). In contrast, the patients in the group 2 and 4 had very poor prognoses regardless of TLV treatment (7% vs. 11%, p=0.823). Conclusions: U-AQP2/P-AVP is a novel predictor for the initial response to TLV in HF patients. Patients with higher U-AQP2/P-AVP may enjoy a better prognosis by long-term TLV treatment probably due to efficient resolution of congestion.

Effect of Chlorhexidine Cleansing of Umbilical Cord for Prevention of Infection

2018 ◽  
Vol 4 (2) ◽  
pp. 35-39
Author(s):  
Md Khairuzzaman ◽  
MA Mannan ◽  
Abdul Matin ◽  
Mst Monjuman Ara Sarker ◽  
Nihar Ranjan Sarker ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Controlled Trial ◽  
Care Group ◽  
Cord Care ◽  
Randomized Controlled ◽  
Group 3 ◽  
Group 2 ◽  
To Receive ◽  
Level Hospital ◽  
Group 1

Background: Chlorhexidine cleansing of the cord can reduce neonatal mortality among newborns.Objective: The aim of study was to determine the effect of cord cleansing with chlorhexidine in reduction of umbilical infection among newborns in hospital settings.Methodology: This randomized controlled trial was carried out between April 2013 to July 2014 and 510 newborns were randomly assigned within a tertiary level hospital in Bangladesh to receive 1 of 3 cord care regimens single cord cleansing with 4% chlorhexidine(Group-1), multiple cord cleansing with 4% chlorhexidine (Group-2)  and clean and dry cord care (Group-3 : control).Results: The risk of umbilical cord infection (omphalitis) was significantly reduced in both the single (Relative risk [RR] 0.15 [95% CI] 0.008-0.93) and multiple chlorhexidine cleansing group (RR 0.37 [95% CI] 0.04- 0.99) compared to the dry cord care group.  The risk of omphalitis was not significantly different between multiple and single chlorhexidine cleansing group (RR 3.14 [0.13-76.54]). Conclusion: Chlorhexidine significantly reduce the risk of umbilical infection in both single and multiple cord cleansing neonates.Bangladesh Journal of Infectious Diseases 2017;4(2):35-39

scholarly journals Different Pathophysiology and Outcomes of Heart Failure With Preserved Ejection Fraction Stratified by K-Means Clustering

2020 ◽  
Vol 7 ◽  
Author(s):  
Daisuke Harada ◽  
Hidetsugu Asanoi ◽  
Takahisa Noto ◽  
Junya Takagawa
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricle ◽  
Preserved Ejection Fraction ◽  
Stratified Medicine ◽  
Cardiac Events ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Stratified medicine may enable the development of effective treatments for particular groups of patients with heart failure with preserved ejection fraction (HFpEF); however, the heterogeneity of this syndrome makes it difficult to group patients together by common disease features. The aim of the present study was to find new subgroups of HFpEF using machine learning.Methods: K-means clustering was used to stratify patients with HFpEF. We retrospectively enrolled 350 outpatients with HFpEF. Their clinical characteristics, blood sample test results and hemodynamic parameters assessed by echocardiography, electrocardiography and jugular venous pulse, and clinical outcomes were applied to k-means clustering. The optimal k was detected using Hartigan's rule.Results: HFpEF was stratified into four groups. The characteristic feature in group 1 was left ventricular relaxation abnormality. Compared with group 1, patients in groups 2, 3, and 4 had a high mean mitral E/e′ ratio. The estimated glomerular filtration rate was lower in group 2 than in group 3 (median 51 ml/min/1.73 m2 vs. 63 ml/min/1.73 m2p &lt; 0.05). The prevalence of less-distensible right ventricle and atrial fibrillation was higher, and the deceleration time of mitral inflow was shorter in group 3 than in group 2 (93 vs. 22% p &lt; 0.05, 95 vs. 1% p &lt; 0.05, and median 167 vs. 223 ms p &lt; 0.05, respectively). Group 4 was characterized by older age (median 85 years) and had a high systolic pulmonary arterial pressure (median 37 mmHg), less-distensible right ventricle (89%) and renal dysfunction (median 54 ml/min/1.73 m2). Compared with group 1, group 4 exhibited the highest risk of the cardiac events (hazard ratio [HR]: 19; 95% confidence interval [CI] 8.9–41); group 2 and 3 demonstrated similar rates of cardiac events (group 2 HR: 5.1; 95% CI 2.2–12; group 3 HR: 3.7; 95%CI, 1.3–10). The event-free rates were the lowest in group 4 (p for trend &lt; 0.001).Conclusions: K-means clustering divided HFpEF into 4 groups. Older patients with HFpEF may suffer from complication of RV afterload mismatch and renal dysfunction. Our study may be useful for stratified medicine for HFpEF.

1409Use of phenomapping to determine response of treatment by sacubitril/valsartan in patients with heart failure with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Godet ◽  
O Raitiere ◽  
H Chopra ◽  
P Guignant ◽  
C Fauvel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Heat Map ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Treatment by sacubitril/valsartan decreases mortality, improves KCCQ score and ejection fraction in patients with heart failure with reduced ejection fraction (HF REF), but there is currently no data to predict response to treatment. Purpose The purpose of our work was to assess whether unbiased clustering analysis, using dense phenotypic data, could identify phenotypically distinct HF-REF subtypes with good or no response after 6 months of sacubitril/valsartan administration. Methods A total of 78 patients in NYHA functional class 2–3 and treated by ACE inhibitor or AAR2, were prospectively assigned to equimolar sacubitril/valsartan replacement. We collected demographic, clinical, biological and imaging continuous variables. Phenotypic domains were imputed with 5 eigenvectors for missing value, then filtered if the Pearson correlation coefficient was >0.6 and standardized to mean±SD of 0±1. Thereafter, we used agglomerative hierarchical clustering for grouping phenotypic variables and patients, then generate a heat map (figure 1). Subsequently, participants were categorized using Penalized Model-Based Clustering. P<0,05 was considered significant. Results Mean age was 60.4±13.4 yo and 79.0% patients were males. Mean ejection fraction was 29.3±7.0%. Overall, 16 phenotypic domains were isolated (figure 1) and 3 phenogroups were identified (Table 1). Phenogroup 1 was remarkable by isolated left ventricular involvement (LVTDD 64.3±5.9mm vs 73.9±8.7 in group 2 and 63.8±5.7 in group3, p<0.001) with moderate diastolic dysfunction (DD), no mitral regurgitation (MR) and no pulmonary hypertension (PH). Phenogroups 2 and 3 corresponded to patients with severe PH (TRMV: 2.93±0.47m/s in group 2 and 3.15±0.61m/s in groupe 3 vs 2.16±0.32m/s in group 1), related to severe DD (phenogroup 2) or MR (phenogroup 3). In both phenogroups, the left atrium was significantly enlarged and the right ventricle was remodeled, compared with phenogroup 1. Despite more severe remodeling and more compromised hemodynamic in phenogroups 2 and 3, the echocardiographic response to sacubitril/valsartan was comparable in all groups with similar improvement of EF and reduction of cardiac chambers dimensions (response of treatment, defined by improvement of FE +15% and/or decreased of indexed left ventricule diastolic volume −15% = group 2: 22 (76%); group 3: 18 (60%); group 1: 9 (50%); p=0.17; OR group 2 vs 1: OR=3.14; IC95% [0.9–11.03]; p=0.074; OR group 3 vs 1: OR=1.5; IC95% [0.46–4.87]; p=0.5)). The clinical response was even better in phenogroups 2 and 3 (Group 2: 19 (66%); group 3: 21 (78%) vs group 1: 9 (50%); p=0.05). Heat map Conclusion HF-REF patients with severe diastolic dysfunction, significant mitral regurgitation and elevated pulmonary hypertension by echocardiographic had similar reverse remodeling but better clinical improvement than patients with isolated left ventricular systolic dysfunction.

scholarly journals Utility of Complete Blood Picture for Predicting In-hospital Mortality in Patients with Acute Decompensated Heart Failure with Dilated Cardiomyopathy

2017 ◽  
Vol 02 (03) ◽  
pp. 044-048
Author(s):  
Dangeti Rao ◽  
Garre Indrani ◽  
M. RaviKiran
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Eosinophil Count ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Mean Corpuscular Hemoglobin ◽  
Index Hospitalization ◽  
Corpuscular Hemoglobin ◽  
Blood Picture ◽  
Group 1

Background Congestive heart failure (CHF) is one of the leading causes of acute hospital admissions. Despite recent advances in heart failure therapy, prognosis is still poor, rehospitalization rate is very high, and quality of life is worse. It is important to identify patients at increased risk of adverse events. We tried to investigate role of components of complete blood picture on in-hospital mortality in patients hospitalized with heart failure. Methods It was an observational study of consecutive patients who admitted with a diagnosis of acute decompensated heart failure (ADHF) with dilated cardiomyopathy (DCM) in the our department between January 1, 2016 and December 31, 2016, age above 18 years. Ischemic cardiomyopathy was ruled by doing coronary angiograms either in this admission or previously known. Baseline investigations including complete blood picture were done and the patients were followed up till discharge or in hospital mortality. Results A total of 74 patients (female:male::24:50) enrolled into the study (mean age 51.86 ± 13.5 years) in 12 months. A total of 8 (10.8%) patients died during hospitalization. Among the 74 heart failure patients, 24 (32.5%) had anemia. Group 1 included patients who died during index hospitalization (n = 8) and group 2 comprised patients who were discharged in a stable condition after index hospitalization (n = 66). Group 1 patients had low hemoglobin (12.34 ± 2.93 vs. 14.4 ± 0.21 g/dL, p = 0.000) and high leukocyte count (11,600 ± 2,780 vs. 9,047 ± 3,355 cells/mcL, p = 0.040) with more eosinophils (1 ± 1.06 vs. 4.16 ± 3.48%, p = 0.000) and lymphocytes (20.5 ± 0.53 vs. 17.56 ± 7.45%, p = 0.002). Regression analysis showed a significant association between low hemoglobin and low packed cell volume (PCV) with in-hospital mortality. Mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) rather than mean corpuscular hemoglobin concentration (MCHC) predicted worse outcome. There was a significantly higher risk of in-hospital mortality with increasing eosinophil count. On the other hand, there was no association between platelet count, total white blood cell (WBC) count, neutrophil, monocyte, or lymphocyte count with clinical outcome. Conclusion Low hemoglobin, low PCV, and high eosinophil count have been shown to predict in-hospital mortality. Complete blood picture can, therefore, be utilized in risk-stratifying patients with ADHF due to DCM.

Effects of home-based exercise training for patients with chronic heart failure and sleep apnoea: a randomized comparison of two different programmes

2011 ◽  
Vol 26 (1) ◽  
pp. 45-57 ◽  
Author(s):  
Denise Maria Servantes ◽  
Amália Pelcerman ◽  
Xiomara Miranda Salvetti ◽  
Ana Fátima Salles ◽  
Pedro Ferreira de Albuquerque ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Exercise Training ◽  
Strength Training ◽  
Sleep Apnoea ◽  
Heart Failure Patients ◽  
Home Based ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: To evaluate the effects of home-based exercise for patients with chronic heart failure and sleep apnoea and to compare two different training programmes. Design: A randomized, prospective controlled trial. Setting: Department of Cardiology, University Hospital, Brazil. Subjects: Fifty chronic heart failure patients with sleep apnoea were randomized in three groups: Group 1 (aerobic training, n = 18), Group 2 (aerobic with strength training, n = 18), and Group 3 (untrained, n = 14). Interventions: The training programme for Groups 1 and 2 began with three supervised exercise sessions, after they underwent three months of home-based exercise. Patients were followed by weekly telephone call and were reviewed monthly. Group 3 had the status of physical activity evaluated weekly by interview to make sure they remained untrained. Main outcome measures: At baseline and after three months: cardiopulmonary exercise testing, isokinetic strength and endurance, Minnesota living with heart failure questionnaire and polysomnography. Adherence was evaluated weekly. Results: Of the 50 patients enrolled in the study, 45 completed the programme. Clinical events: Group 1 (one death), Group 2 (one myocardial infarction), Group 3 (one death and two strokes). None were training related. Training groups showed improvement in all outcomes evaluated and the adherence was an important factor (Group 1 = 98.5% and Group 2 = 100.2%, P = 0.743). Untrained Group 3 demonstrated significant decrease or no change on measurements after three months without training. Conclusion: Home-based exercise training is an important therapeutic strategy in chronic heart failure patients with sleep apnoea, and strength training resulted in a higher increase in muscle strength and endurance.

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