“Rehospitalization Prognostic Factors In Patients with Heart Failure”

Introduction: The prognosis of chronic heart failure (CHF) is determined by the complex relationship of neurohormonal, mechanical and polyorgan pathological changes emerging in the course and progression of the disease. Objective: To assess the risk and rate of rehospitalisation due to decompensation of chronic heart failure (CHF) in relation to certain biologic, clinical and instrumental characteristics. Material and Methods: This study conducted in the Department of Cardiology, Community Based Medical College & Hospital, Bangladesh. Prospective study on 228 consecutive CHF patients. The follow-up period was 12 to 24 months. The primary endpoint was rehospitalization due to HF decompensation. The risk values were calculated using the Cox regression models. Results: Median survival time was 8 months. The total number of rehospitalizations was 86 (37.7%). Rehospitalization risk values were insignificantly lower in women (HR 0.7, 95% CI 0.4-1.1, р >0.05) and higher in older age groups (HR 1.4 95% CI 0.8-2.2, р>0.05). Univariate regression analysis showed a higher rehospitalization risk in patients with survived myocardial infarction, clinical signs of CHF, high functional class and pulmonary pressure. Multivariate regression analyses revealed the leading role of functional class on rehospitalization risk. Conclusion: rehospitalization rates due to decompensation of CHF are high. Age and gender are insignificant predictors for rehospitalization in our study. Functional class is the prognostic factor with an independent effect on rehospitalization risk over the defined follow-up period among the examined group of patients.

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Implantation of a cardiac contractility modulator in chronic heart failure and atrial fibrillation: results of a 6-month follow-up of one hundred patients

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2021-1-30-37 ◽

2021 ◽

Vol 23 (1) ◽

pp. 30-37

Author(s):

T. M. Uskach ◽

O. V. Sapelnikov ◽

A. A. Safiullina ◽

I. R. Grishin ◽

V. A. Amanatova ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Chronic Heart Failure ◽

Cardiac Contractility ◽

Treatment Method ◽

Functional Class ◽

Life Questionnaire ◽

Medication Therapy ◽

6 Minute Walk Test

Aim: to study the effect of cardiac contractility modulation (CCM) in patients with chronic heart failure (CHF) and atrial fibrillation (AF). Materials and methods. In a group of 100 patients with CHF and AF, the following studies were performed before implantation of the CCM and after 6 months of follow-up: 12-channel ECG, transthoracic Echocardiography, 6-minute walk test, determination of the level of pro-natriuretic N-terminal peptide (NT-proBNP), and a questionnaire based on the Minnesota quality of life questionnaire for patients with CHF (MHFLQ). All patients received long-term optimal medication therapy for CHF before surgery. Results. The results show a positive effect of the use of MCC in patients with CHF and AF on reverse LV remodeling, functional class of CHF, and levels of NT-pro-BNP regardless of the form of AF. Conclusion. The use of MCC may be a promising treatment method in addition to optimal medication therapy in patients with CHF and AF.

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Abstract 3395: Potassium Supplement Use May Increase Hospitalization without Affecting Mortality in Chronic Heart Failure: Implications for Use of Aldosterone Antagonists to Maintain Potassium Balance in Chronic Heart Failure

Circulation ◽

10.1161/circ.116.suppl_16.ii_766-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Ali Ahmed ◽

Chris Adamopoulos ◽

Xuemei Sui ◽

Thomas E Love

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Propensity Scores ◽

Cox Regression ◽

Hazard Ratio ◽

Aldosterone Antagonists ◽

Potassium Supplement ◽

Supplement Use ◽

Group Trial

Background: Hypokalemia is common in heart failure (HF). Aldosterone antagonists can raise serum potassium (K) and also improve survival. Yet, K-supplements are often used to correct hypokalemia; although little is known about the effects of K-supplements in HF. Methods: Of the 7788 ambulatory chronic HF patients in the Digitalis Investigation Group trial, 2199 (28%) were receiving K-supplements. Propensity scores for K-supplement use was calculated for each patient and were used to match 2131 patients receiving K-supplements with 2131 no-K-supplements patients (absolute standardized differences <10% for all measured covariates). Matched Cox regression models were used to estimate effects of K-supplements on outcomes during 40 months of median follow-up. Results: Compared with 68% (rate, 4120/10000 person-years) of no-K-supplement patients, 71% (rate, 4777/10000 person-years) of patients receiving K-supplements were hospitalized from all causes (hazard ratio, 1.15; 95% CI, 1.05–1.26; P=0.004). Compared with 38% (rate, 1313/10000 person-years) of no-K-supplement patients, 38% (rate, 1327/10000 person-years) of patients receiving K-supplements died from all causes (hazard ratio, 1.05; 95% CI, 0.94–1.18; P=0.390). Conclusion: K-supplement use was associated with no mortality reduction but increased hospitalization. This first report on the effect of K-supplement in HF raises question about the wisdom of K-supplement use to correct hypokalemia and maintain normokalemia in HF. Given the proven mortality benefits of aldosterone antagonists and their ability to raise serum K, spironolactone may be preferable to maintain normokalemia in chronic HF. Figure 1. Association of potassium supplement use and all-cause hospitalization

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Role of soluble Fas ligand in myocardial remodeling, severity and outcomes of chronic heart failure

Terapevticheskii arkhiv ◽

10.17116/terarkh201688910-16 ◽

2016 ◽

Vol 88 (9) ◽

pp. 10-16 ◽

Cited By ~ 1

Author(s):

A T Teplyakov ◽

E N Berezikova ◽

S N Shilov ◽

E V Grakova ◽

Yu Yu Torim ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Fas Ligand ◽

Functional Class ◽

Control Group ◽

Myocardial Remodeling ◽

Soluble Fas ◽

Soluble Fas Ligand

Aim. To reveal the specific features of Fas ligand-mediated ischemic myocardial remodeling and those of chronic heart failure (CHF) development during a 12-month prospective follow-up. Subjects and methods. A total of 94 patients with ischemic CHF were examined and divided into 3 groups according to NYHA Functional Class (FC): 1) FC II CHF in 35 patients; 2) FC III CHF in 31; 3) FC IV CHF in 28. According to the results of the 12-month follow-up, the patients were randomized into 2 groups: A) 49 patients with a favorable course of cardiovascular disease and B) 45 patients with its poor course. Serum soluble Fas ligand (sFas-L) levels were measured by enzyme immunoassay. Results. In the patients with CHF, the baseline sFas-L levels substantially exceeded that in the control group by 3—6 times (p

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Differential approach in selecting beta-adrenoblocker therapy for patients with chronic heart failure and anaemia

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2012-2-62-69 ◽

2012 ◽

Vol 11 (2) ◽

pp. 62-69

Author(s):

T. M. Uskach ◽

A. G. Kochetov ◽

S. N. Tereschenko

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Clinical Course ◽

Functional Class ◽

International Studies ◽

Ambulatory Patients ◽

Maximal Reduction ◽

Pronounced Reduction

Currently, beta-adrenoblockers (β-AB) are regarded as one of the major medication classes in the treatment of patients with chronic heart failure (CHF). In several international studies, β -AB therapy of CHF patients was associated with reduced levels of haemoglobin (Hb) and development of new anaemia cases. Anaemia is known as an adverse prognostic factor in CHF. Aim. To study the effects of β -AB therapy on the anaemia clinical course among CHF patients. Material and methods. The study included 90 ambulatory patients with Functional Class (FC) II-IV CHF and anaemia. The participants were divided into 3 equally sized groups (n=30 per group) and treated with carvedilol, metoprolol, or nebivolol for 6 months. Results. By the end of the follow-up, baseline Hb levels increased in the nebivolol group (p=0,028), and were also significantly higher than in the other two groups. In the carvedilol group, the levels of haematocrit (Ht) and glomerular filtration rate (GFR) significantly decreased (p=0,017 and 0,06, respectively). In the metoprolol group, no substantial changes of laboratory parameters were observed. The maximal reduction in baseline CHF FC was registered in the patients receiving nebivolol (p=0,037). A significant improvement in myocardial contractility, based on the echocardiography data, was registered in the carvedilol and nebivolol groups. Conclusion. Nebivolol therapy was associated with a significantly more pronounced reduction in pro-BNP levels, compared to carvedilol or metoprolol treatment (p<0,001). The nebivolol group also demonstrated the most pronounced improvement in quality of life of CHF patients (p<0,001). These findings suggest that nebivolol could be recommended as a medication of choice in patients with CHF and anaemia.

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New foundational therapy in heart failure with reduced ejection fraction: should we keep following the 2016 European Society of Cardiology Heart Failure Guideline in 2021?

European Heart Journal ◽

10.1093/eurheartj/ehab724.0923 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

J Brito ◽

J.R Agostinho ◽

S Pereira ◽

P Silverio-Antonio ◽

P Silva ◽

...

Keyword(s):

Heart Failure ◽

Cox Regression ◽

Sequential Therapy ◽

Functional Class ◽

Reduced Ejection Fraction ◽

Nyha Functional Class ◽

Therapy Initiation ◽

All Cause Mortality ◽

European Society Of Cardiology

Abstract Introduction The 2016 European Society of Cardiology Heart Failure Guidelines (2016 HF GL) suggest sequential therapy initiation with angiotensinogen converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB), beta-blocker (BB) and mineralocorticoid receptor antagonist (MRA) for patients with heart failure with reduced ejection fraction (HFrEF). Since their publication, major trials established the benefit of sacubitril/valsartan (ARNi) and SGLT2 in HFrEF, and ARNi are suggested to replace ACEi/ARB as first line therapy. So, with HFrEF foundational therapy evolvement, the 2016 HF GL sequential therapy initiation algorithm has been raised into question. Purpose To compare in the real-world practice, the effect on all-cause mortality of the simultaneous use of every pharmacological class currently included in the HFrEF foundational therapy with conventional sequential therapy. Methods A population of consecutive patients (pts) included in a post-discharge structured follow-up programin in a tertiary center was analyzed. Two groups were defined: 1) patients medicated with all pharmacological classes considered the HFrEF foundational therapy (ARNi, BB, MRA and SGLT2 inhibitor), independently of the dosages – “FT group”; 2) patients medicated with ACEi/ARB, BB and MRA on maximal tolerated doses – “2016 HF GL group”. Pts under other therapeutical combinations were excluded. The study groups were compared with Chi-square and Mann-Whitney tests. Impact on all-cause mortality was established with Kaplan-Meier survival analysis and multivariate Cox regression after adjustment for age, sex and baseline creatinine, NYHA functional class and LVEF. Results From 2016 to February 2021, a total of 101 pts with HFrEF were included and followed for 25±16 months. 54 pts were included in the FT group and 47 in the 2016 HF GL. The study population (69.3% males, 64.6±11.4 years) were mainly in NYHA functional class II (48%) and III (48%). The most common HF aethiologies were ischemic heart disease (49.5%) and dilated cardiomyopathy (30.7%), median LVEF was 26% and 22% were under CRT. Baseline characteristics were similar between groups, except for diabetes (more common in FT group, 70 vs 22%, p<0.001). All-cause mortality rate during follow-up was significantly different between two groups: 1.9% in FT group and 17% in the HF GL group (p: 0.047) – Figure 1. The implementation of all foundational therapy classes was an independent protective factor for all-cause mortality (HR 0.41; IQR 0.004–0.468; P: 0.010) in multivariate Cox regression. Conclusion This real-world study suggests that conventional sequential therapy suggested by the 2016 HF GL may be less effective on reducing all-cause mortality in HFrEF than simultaneous use of all pharmacological classes that nowadays compose the foundation therapy. These results support the hypothesis of promoting early introduction of all therapy classes followed by a tailored uptitration may be beneficial. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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P6330Obesity paradox in heart failure with mid-range ejection fraction

European Heart Journal ◽

10.1093/eurheartj/ehz746.0927 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

E Zamora ◽

J Lupon ◽

M De Antonio ◽

M Domingo ◽

P Moliner ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Protective Effect ◽

Cox Regression ◽

Normal Weight ◽

Functional Class ◽

Lower Mortality ◽

Survival Curves ◽

Nyha Functional Class

Abstract Background Obesity is identified as an independent risk factor for developing congestive heart failure (HF). Paradoxically it has been reported that obesity is associated with improved survival in different cohorts of HF patients. Nevertheless, the presence of obesity paradox in HF with mid-range ejection fraction (HFmrEF) is not completely elucidated. Objective To analyse the relationship between body mass index (BMI) and mortality in a HFmrEF ambulatory cohort of different aetiologies followed in a HF unit, with especial focus on the role of obesity in prognosis. Methods Baseline BMI was analysed as continuous variable and categorized in 4 groups based on 2009 WHO classification: low weight (BMI <20.5 kg/m2), normal weight (BMI 20.5 to <25.5 kg/m2), overweight (BMI 25.5 to <30 kg/m2) and obesity (BMI ≥30 kg/m2). All-cause mortality was the primary end-point of the study. Cox regression analyses adjusted by age, sex and NYHA functional class were performed and survival curves plotted. Results Three-hundred thirty patients were included in the study (age 65.9±13.2 years, 68% men). The main aetiology was ischemic heart disease (52%, followed by dilated cardiomyopathy (11%) and hypertensive cardiomyopathy (11%). The majority of patients were in NYHA class II (65%) and III (26%). Mean ejection fraction was 43.2% ± 2.7. During a mean follow-up of 5.3±4.6 years 142 patients (42%) died. BMI showed a protective effect on survival in Cox regression analysis (HR 0.96 [95% CI 0.92–0.99], p=0.01). When categorized groups of BMI were analysed, obese patients showed a trend towards lower mortality than normal weight patients (reference): adjusted HR 0.65 [95% CI 0.40–1.03], p=0.07. Survival curves adjusted by age, sex and NYHA functional class according to BMI category are depicted in the figure. As a significant interaction (p=0.02) was found between BMI and ischemic aetiology of HF, separate analyses were performed for BMI categories for ischemic and non-ischemic patients, with remarkably different results: ischemic aetiology: HR 0.97 [95% CI 0.52–1.79], p=0.91; non-ischemic aetiology HR 0.28 [95% CI 0.13–0.64], p=0.003. Conclusions A greater BMI was associated with lower mortality rates in patients with HFmrEF during a mean follow-up of five years. Obesity showed a protective effect in HFmrEF patients, which remarkable in patients from non-ischemic aetiology and was absent in patients from ischemic aetiology.

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N-acetyl-ß-D-glucosaminidase is predictive of mortality in chronic heart failure: a 10-year follow-up

Biomarkers in Medicine ◽

10.2217/bmm-2020-0366 ◽

2021 ◽

Author(s):

Christina Strack ◽

Susanne Bauer ◽

Ute Hubauer ◽

Ekrem Ücer ◽

Christoph Birner ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Cox Regression ◽

Kidney Injury ◽

Blood Samples ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Long Term Follow Up

Aim: The study focused on biomarkers of kidney injury as predictors of mortality in patients with chronic heart failure (CHF) in a long-term follow-up (median 104 months). Methods/results: KIM-1, NAG and NGAL were assessed from urine, NT-proBNP from blood samples. 149 patients (age 62 ± 12 years) with CHF (mean EF 30% [IQR 24–40%]) were enrolled. 79 (53%) patients died. Cox regression analysis revealed Log2NAG (HR: 1.46, CI: 1.12–1.89), Log2KIM-1 (HR: 1.23, CI: 1.02–1.49) and Log2NT-proBNP (HR: 1.50, CI: 1.32–1.72) as significant predictors of all-cause mortality as opposed to Log2NGAL (HR: 1.04, CI: 0.90–1.20). Log2NAG remained a significant predictor of all-cause mortality in a multivariate Cox regression model but lost its predictive value in combination with Log2NT-proBNP. Conclusion: The 10-year follow-up suggests NAG as a predictive tubular marker in CHF patients.

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Clinical effects of the enhanced external counterpulsation therapy in patients with ischemic chronic heart failure exacerbation COVID-19

European Heart Journal ◽

10.1093/eurheartj/ehab724.0928 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

I Shashenkov ◽

S.A Gabrusenko ◽

S.L Babak ◽

A.G Maliavin

Keyword(s):

Heart Failure ◽

Treatment Group ◽

Chronic Heart Failure ◽

Nyha Class ◽

Functional Class ◽

Clinical Effects ◽

External Counterpulsation ◽

Nyha Functional Class ◽

Enhanced External Counterpulsation

Abstract Objectives The aim of the study was to assess the effects of the enhanced external counterpulsation (EECP) therapy as a rehabilitation method in patients with ischemic chronic heart failure (CHF) after COVID-19. Methods 54 (n=54) stable symptomatic CHF (NYHA, functional class I-II; 35%≤LVEF≤50%) subjects (44 male and 10 female; mean age 61±9,8) with prior anamnesis of CAD, at least one myocardial infarction got the exacerbation of CHF after COVID-19 episode. They were randomized in a 2:1 manner into either 35 1-hour 250–300 mm Hg sessions of EECP (n=36; 30 male, 6 female) or Sham-EECP (n=18; 14 male, 4 female). All subjects had been received optimal CHF and CAD drug therapy. At baseline, a month and half a year after EECP course every subject was examined with echocardiography and 6-minute walk test. Results All 36 active EECP treatment group subjects improved by at least 1 NYHA class, 66% of them had no heart failure symptoms post treatment (p<0.01). 84% of treatment group pts. had sustained NYHA class improvement at half a year follow-up (p<0.01), compared with baseline. There was significant difference between LVEF 44±6,5% at baseline vs post-EECP LVEF 50±4,6% (p<0.01) in active EECP treatment group subjects. At the same time there were no significant changes of NYHA class and LVEF in Sham-EECP subjects. No one subject dies after half a year of follow up. Conclusions Enhanced external counterpulsation (EECP) therapy sustainably improves NYHA functional class and LVEF in patients with ischemic CHF exacerbation after COVID-19. FUNDunding Acknowledgement Type of funding sources: None.

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