scholarly journals Relationship Between The Place Of Living And Mortality In Patients With Advanced Heart Failure.

2020 ◽  
Author(s):  
Miguel-Angel Munoz ◽  
Raquel Garcia ◽  
Elena Navas ◽  
Julio Duran ◽  
José-Luis Del Val-Garcia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
New York ◽  
Rural Areas ◽  
Cox Regression ◽  
Heart Association ◽  
Population Based ◽  
Advanced Heart Failure ◽  
Functional Class ◽  
Increased Risk

Abstract Background Social and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. This study analyzes health inequalities and mortality according to place of residence (rural vs urban) in HF patients at advanced stages of the disease.Methods Population-based cohort study including 1148 adult patients with HF attended in 279 primary care centers. Patients were followed for at least one year after reaching New York Heart Association IV functional class, between 2010 and 2014.Data came from primary care electronic medical records. Cox regression models were applied to determine the hazard ratios (HR) of mortality. Results Mean age was 81.6 (SD 8.9) years, and 62% were women. Patients in rural areas were older, particularly women aged >74 years (p=0.036), and presented lower comorbidity. Mortality percentages were 59% and 51% among rural and urban patients, respectively (p=0.030). Urban patients living in the most socio-economically deprived neighborhoods presented the highest rate of health service utilization, particularly with primary care nurses (p-trend <0.001). Multivariate analyses confirmed that men (HR 1.60, 95% confidence interval (CI) 1.34-1.90), older patients (HR 1.05, 95% CI 1.04-1.06), Charlson comorbidity index (HR 1.16, 95% CI 1.11-1.22), and residing in rural areas (HR 1.35, 95% CI 1.09 to 1.67) was associated with higher mortality risk.Conclusions Living in rural areas determines an increased risk of mortality in patients at final stages of heart failure.

scholarly journals Effect of the Place of Living on Mortality in Patients with Advanced Heart Failure

2020 ◽  
Author(s):  
Miguel-Angel Munoz ◽  
Raquel Garcia ◽  
Elena Navas ◽  
Julio Duran ◽  
José-Luis Del Val-Garcia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
New York ◽  
Rural Areas ◽  
Cox Regression ◽  
Heart Association ◽  
Population Based ◽  
Advanced Heart Failure ◽  
Rural And Urban ◽  
Increased Risk

Abstract BackgroundSocial and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. This study analyzes health inequalities and mortality according to place of residence (rural vs urban) in HF patients at advanced stages of the disease.MethodsPopulation-based cohort study including 1148 adult patients with HF attended in 279 primary care centers. Patients were followed for at least one year after reaching New York Heart Association IV, between 2010 and 2014.Data came from primary care electronic medical records. Cox regression models were applied to determine the hazard ratios (HR) of mortality.ResultsMean age was 81.6 (SD 8.9) years, and 62% were women. Patients in rural areas were older, particularly women aged >74 years (p=0.036), and presented lower comorbidity. Mortality percentages were 59% and 51% among rural and urban patients, respectively (p=0.030). Urban patients living in the most socio-economically deprived neighborhoods presented the highest rate of health service utilization, particularly with primary care nurses (p-trend <0.001). Multivariate analyses confirmed that men (HR 1.60, 95% confidence interval (CI) 1.34-1.90), older patients (HR 1.05, 95% CI 1.04-1.06), Charlson comorbidity index (HR 1.16, 95% CI 1.11-1.22), and residing in rural areas (HR 1.35, 95% CI 1.09 to 1.67) was associated with higher mortality risk.ConclusionsLiving in rural areas determines an increased risk of mortality in patients at final stages of heart failure.

scholarly journals Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management

2019 ◽  
Vol 28 (1) ◽  
pp. 3-13 ◽  
Author(s):  
J. F. Veenis ◽  
J. J. Brugts
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Remote Monitoring ◽  
Heart Association ◽  
The United States ◽  
Pharmacological Therapy ◽  
Functional Class ◽  
Class Iii ◽  
Additional Tool

AbstractExacerbations of chronic heart failure (HF) with the necessity for hospitalisation impact hospital resources significantly. Despite all of the achievements in medical management and non-pharmacological therapy that improve the outcome in HF, new strategies are needed to prevent HF-related hospitalisations by keeping stable HF patients out of the hospital and focusing resources on unstable HF patients. Remote monitoring of these patients could provide the physicians with an additional tool to intervene adequately and promptly. Results of telemonitoring to date are inconsistent, especially those of telemonitoring with traditional non-haemodynamic parameters. Recently, the CardioMEMS device (Abbott Inc., Atlanta, GA, USA), an implantable haemodynamic remote monitoring sensor, has shown promising results in preventing HF-related hospitalisations in chronic HF patients hospitalised in the previous year and in New York Heart Association functional class III in the United States. This review provides an overview of the available evidence on remote monitoring in chronic HF patients and future perspectives for the efficacy and cost-effectiveness of these strategies.

Abstract 216: Left Ventricular Enlargement and Heart Failure Events: Is Bigger Better?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Farbod Raiszadeh ◽  
Neeraja Yedlapati ◽  
Ileana L Piña ◽  
Daniel M Spevack
Keyword(s):  
Heart Failure ◽  
New York ◽  
Cox Regression ◽  
Systolic Heart Failure ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Volumes ◽  
End Diastolic Volume ◽  
New York Heart Association ◽  
The Individual

Background: Since stroke volume (SV) is a function of ejection fraction (EF) and end-diastolic volume (EDV) (SV = EF x EDV), we hypothesized that increased EDV may be advantageous in systolic heart failure (HF), allowing the left ventricle to supply increased cardiac output. Methods: Echocardiograms from 968 consecutive patients seen in our hospital’s HF clinic were reviewed. Left ventricular volumes were measured both at end systole and end diastole using the bi-plane Simpson’s method and were indexed to body surface area. EF was calculated using (EDV-ESV)/EDV. Dates of subsequent HF events (death or admission for HF exacerbation) were obtained from our database. Results: Systolic HF (EF < 50%) was found in 649 of the study subjects. Increased SV index was associated with increased EDV index. The strength of this association varied with EF, Figure. In a bivariate Cox regression model, lower SV index and higher EDV index were each independent predictors of HF events. Increase in EDV by 50 cc was associated with a 20% increase in HF events, p<0.001. Decrease in SVI by 5 cc was associated with 5% increase in HF events, p<0.001. These associations were limited to those with systolic HF. The associations between both EDVI and SVI and HF events were not confounded by patient age, sex and New York Heart Association Class. Conclusion: Increased EDV index was independently associated with increased HF events, indicating that LV enlargement in HF is not favorable. These findings underscore the individual contributions of the components of EF (SV and EDV) in predicting HF outcomes.

Effect of Cardiac Resynchronization Therapy in Patients With New York Heart Association Functional Class IV Heart Failure

2010 ◽  
Vol 106 (8) ◽  
pp. 1146-1151 ◽  
Author(s):  
Rutger J. van Bommel ◽  
Eva van Rijnsoever ◽  
C. Jan Willem Borleffs ◽  
Victoria Delgado ◽  
Nina Ajmone Marsan ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Cardiac Resynchronization Therapy ◽  
Heart Association ◽  
Functional Class ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
New York Heart Association ◽  
Class Iv

scholarly journals Evaluation of the influence of the therapy with fosinopril and zofenopril on the regulatory-adaptive status of patients with diastolic chronic heart failure

2019 ◽  
Vol 10 (4) ◽  
pp. 23-28
Author(s):  
Svetlana N. Nedvetskaya ◽  
Vitalii G. Tregubov ◽  
Iosif Z. Shubitidze ◽  
Vladimir M. Pokrovskiy
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Subjective Evaluation ◽  
Heart Association ◽  
Functional Class ◽  
New York Heart Association

Aim. Еvaluate the influence of combination therapy with fosinopril or zofenopril on the regulatory-adaptive status (RAS) of patients with diastolic chronic heart failure (CHF). Material and methods. The study includes 80 patients with CHF I-II functional class according to the classification of the New York heart Association with left ventricle ejection fraction ≥50% because of hypertensive disease (HD) of III stage, who were randomized into two groups for treatment with fosinopril (14.7±4.2 mg/day, n=40) or zofenopril (22.5±7.5 mg/day, n=40). As part of combination pharmacotherapy, patients were included nebivolol (7.1±2.0 mg/day and 6.8±1.9 mg/day), in the presence of indications, atorvastatin and acetylsalicylic acid in the intestinal shell were prescribed. Initially and after six months, the following was done: a quantitative evaluation of the RAS (by cardio-respiratory synchronism test), echocardiography, tredmil-test, six-minute walking test, determination of the N-terminal precursor of the natriuretic brain peptide level in blood plasma and subjective evaluation of quality of life. Results. Therapy, using fosinopril, in comparison with zofenopril, more improved RAS (by 66.5%, p

scholarly journals Understanding Iron Deficiency in Heart Failure: Clinical Significance and Management

2018 ◽  
Vol 12 (2) ◽  
pp. 110
Author(s):  
Rajalakshmi Santhanakrishnan ◽  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Iron Deficiency ◽  
Treatment Guidelines ◽  
Current Knowledge ◽  
Heart Association ◽  
Functional Class ◽  
Iron Therapy ◽  
Co Morbidity ◽  
Iv Iron

Iron deficiency (ID) has been increasingly recognized as an important co-morbidity associated with heart failure (HF). ID significantly impairs exercise tolerance and is an independent predictor of poor outcomes in people with HF irrespective of their anemic status. Diagnosis of ID in people with HF is often missed and therefore routine screening for ID is necessary for these patients. IV iron repletion has been recommended in HF treatment guidelines to improve symptoms and exercise capacity. People with ID and HF who are treated with IV iron have an improved quality of life, better 6-minute walk test results and New York Heart Association functional class. The effect of iron therapy on re-hospitalization and mortality rates in people with HF remains unclear. Large-dose oral iron treatment has been found to be ineffective in improving symptoms in people with HF. This review summarizes the current knowledge on prevalence, clinical relevance, and the molecular mechanism of ID in patients with chronic HF and the available evidence for the use of parenteral iron therapy.

scholarly journals Predictive Value of HFA-PEFF Score in Patients With Heart Failure With Preserved Ejection Fraction

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuxi Sun ◽  
Jinping Si ◽  
Jiaxin Li ◽  
Mengyuan Dai ◽  
Emma King ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Ejection Fraction ◽  
Roc Analysis ◽  
Cox Regression ◽  
Nyha Class ◽  
Area Under The Curve ◽  
Heart Association ◽  
Preserved Ejection Fraction ◽  
All Cause Mortality

Aims: HFA-PEFF score has been proposed for diagnosing heart failure with preserved ejection fraction (HFpEF). Currently, there are only a limited number of tools for predicting the prognosis. In this study, we evaluated whether the HFA-PEFF score can predict mortality in patients with HFpEF.Methods: This single-center, retrospective observational study enrolled patients diagnosed with HFpEF at the First Affiliated Hospital of Dalian Medical University between January 1, 2015, and April 30, 2018. The subjects were divided according to their HFA-PEFF score into low (0–2 points), intermediate (3–4 points), and high (5–6 points) score groups. The primary outcome was all-cause mortality.Results: A total of 358 patients (mean age: 70.21 ± 8.64 years, 58.1% female) were included. Of these, 63 (17.6%), 156 (43.6%), and 139 (38.8%) were classified into the low, intermediate, and high score groups, respectively. Over a mean follow-up of 26.9 months, 46 patients (12.8%) died. The percentage of patients who died in the low, intermediate, and high score groups were 1 (1.6%), 18 (11.5%), and 27 (19.4%), respectively. A multivariate Cox regression identified HFA-PEFF score as an independent predictor of all-cause mortality [hazard ratio (HR):1.314, 95% CI: 1.013–1.705, P = 0.039]. A Cox analysis demonstrated a significantly higher rate of mortality in the intermediate (HR: 4.912, 95% CI 1.154–20.907, P = 0.031) and high score groups (HR: 5.291, 95% CI: 1.239–22.593, P = 0.024) than the low score group. A receiver operating characteristic (ROC) analysis indicated that the HFA-PEFF score can effectively predict all-cause mortality after adjusting for age and New York Heart Association (NYHA) class [area under the curve (AUC) 0.726, 95% CI 0.651–0.800, P = 0.000]. With an HFA-PEFF score cut-off value of 3.5, the sensitivity and specificity were 78.3 and 54.8%, respectively. The AUC on ROC analysis for the biomarker component of the score was similar to that of the total score.Conclusions: The HFA-PEFF score can be used both to diagnose HFpEF and predict the prognosis. The higher scores are associated with higher all-cause mortality.

The Pharmacotherapy Implications of Ventricular Assist Device in the Patient With End-Stage Heart Failure

2012 ◽  
Vol 25 (2) ◽  
pp. 232-249 ◽  
Author(s):  
Serena A. S. Von Ruden ◽  
Margaret A. Murray ◽  
Jennifer L. Grice ◽  
Amy K. Proebstle ◽  
Karen J. Kopacek
Keyword(s):  
Heart Failure ◽  
New York ◽  
Heart Association ◽  
Functional Class ◽  
Neurological Dysfunction ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
End Stage Heart Failure ◽  
End Stage

Advances in mechanical circulatory support, such as the use of ventricular assist devices (VADs), have become a means for prolonging survival in end-stage heart failure (HF). VADs decrease the symptoms of HF and improve quality of life by replacing some of the work of a failing heart. They unload the ventricle to provide improved cardiac output and end-organ perfusion, resulting in improvement in cardiorenal syndromes and New York Heart Association functional class rating. VADs are currently used as a bridge to heart transplantation, a bridge to recovery of cardiac function, or as destination therapy. Complications of VAD include bleeding, infections, arrhythmias, multiple organ failure, right ventricular failure, and neurological dysfunction. Patients with VAD have unique pharmacotherapeutic requirements in terms of anticoagulation, appropriate antibiotic selection, and continuation of HF medications. Pharmacists in acute care and community settings are well prepared to care for the patient with VAD. These patients require thorough counseling and follow-up with regard to prevention and treatment of infections, appropriate levels of anticoagulation, and maintenance of fluid balance. A basic understanding of this unique therapy can assist pharmacists in attending to the needs of patients with VAD.

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