scholarly journals Determinants of Pulse Rate change and Time-To Default from Treatment among Congestive Heart Failure Patients in Felege- Hiwot Referral Hospital, Bahir Dar, Ethiopia; comparison of separate and joint models

2021 ◽  
Author(s):  
Yikeber Abebaw Moyehodie ◽  
Kasim Mohammed Yesuf ◽  
Adem Aragaw Sied ◽  
Bezanesh Melese Masresha
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Pulse Rate ◽  
Nyha Class ◽  
Referral Hospital ◽  
Bahir Dar ◽  
Joint Models ◽  
Heart Failure Patients ◽  
Felege Hiwot Referral Hospital

Abstract Background: Globally, heart failure is a rapidly growing public health issue with an estimated prevalence of >37.7 million individuals. It is a shared chronic phase of cardiac functional impairment secondary to many etiologies. The main purpose of this study was to identify factors that affect the longitudinal changes of pulse rate and survival endpoints, time-to default among Congestive Heart Failure Patients in Felege- Hiwot Referral Hospital, Bahir Dar, Ethiopia.Methods: Hospital based retrospective studies were conducted among 302 congestive heart failure patients who were 15 years old or older and who were on treatment follow-up from the first February 2016 to thirty-one December 2018 in Felege-Hiwot Referral Hospital, Bahir Dar, Ethiopia. First, data were analyzed using linear mixed model and survival models separately, and then the joint models of both sub-models were analyzed by linked their shared unobserved random effects using a shared parameter model. Results: Out of the total 302 CHF treatment followers, 103 (34.1%) of the patients were defaulting from treatment. The mean pulse rate of female and male patients was 87.25 and 90.20, respectively. Averagely 51.12 % of blood in the left ventricle is pushed out with each heartbeat. The results for separate and joint models were quite similar to each other but not identical. However, the estimated association parameter (α) in the joint model is (HR=1.0311, 95%CI: 1.0033,1.0597, P=0.0278), providing there is evidence of a positive association between the survival and the longitudinal sub-models. Thus, defaulting is more likely to occur in patients with higher pulse rates. Patients, being male, hypertensive, CKD, pneumonic, and NYHA class IV patients were associated with a higher risk of defaulting. Age, LVIF, follow-up time in a month had a negative significant effect and NYHA class, and male gender had a positive significant effect on average evaluation of pulse rate of patients. Conclusions: The patient who are male, NYHA class IV, had low LVIF and comorbid with hypertensive, CKD, pneumonia were risk factors of pulse rate change and defaulting from treatment of CHF patients. The joint model was preferred for simultaneous analyses of repeated measurement and survival data.

scholarly journals CardioMEMS in a Busy Cardiology Practice: Less than Optimal Implementation of a Valuable Tool to Reduce Heart Failure Readmissions

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Robby Singh ◽  
Leon Varjabedian ◽  
Georgy Kaspar ◽  
Marcel Zughaib
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Healthcare Expenditure ◽  
Financial Burden ◽  
Nyha Class ◽  
Hospital Readmissions ◽  
Class Iii ◽  
Current Standard ◽  
Heart Failure Patients ◽  
Cardiovascular Morbidity And Mortality

Introduction. Congestive heart failure is a leading cause of cardiovascular morbidity and mortality that results in a significant financial burden on healthcare expenditure. Though various strategies have been employed to reduce hospital readmissions, one valuable tool that remains greatly underutilized is the CardioMEMS (Abbott), a remote pulmonary artery pressure-monitoring system, which has been shown to help reduce heart failure rehospitalizations in the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients) trial. Methods. ICD-9/ICD-10 codes for chronic heart failure were used to identify patients who presented with congestive heart failure. Of this group, those eligible for CardioMEMS device placement, as based on the CHAMPION trial definition, were selected. Subsequently, a retrospective review of the electronic medical records was completed. All patients were on ACC/AHA guideline-directed medical therapy and had at least one hospital admission for NYHA class III symptoms. Results. 473 patients met the inclusion criteria, of which, 85 patients were found to be eligible for implantation of CardioMEMS device based on the CHAMPION trial definition. Only 18/85 patients received the device, roughly 21%, and the overall CardioMEMS implantation rate was only 4% (18/473) of the total cohort. Conclusion. Despite the benefits to patients and reducing healthcare expenditure, there has been a poor adaptation of this groundbreaking technology. Our study revealed that 79% of eligible heart failure patients did not receive the device. Therefore, efforts need to be undertaken to improve physician and patient education of the device to complement the current standard of care for congestive heart failure.

scholarly journals Automatic Continuous CRT Optimization to Improve Hemodynamic Response: An Italian Single-Center Experience

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Gregorio Covino ◽  
Mario Volpicelli ◽  
Paolo Capogrosso
Keyword(s):  
Heart Failure ◽  
Clinical Response ◽  
Nyha Class ◽  
Hemodynamic Response ◽  
Class Ii ◽  
Response To Therapy ◽  
Single Center ◽  
Heart Failure Patients ◽  
Single Center Experience

Background. Optimization of cardiac resynchronization therapy (CRT) settings after implant can improve response to therapy. In this Italian single-center experience, we investigated the rate of hemodynamic and clinical response in heart failure patients treated with continuously and automatically optimized CRT. Methods. Patients were selected from June 2015 to April 2017 according to the most recent CRT guidelines; all were in sinus rhythm at implant and received a CRT-defibrillator system equipped with SonR, which automatically optimizes AV and VV delays every week. SonR was activated just after implant and remained active during follow-up. The rate of hemodynamic response (R-HR) was defined as ΔLVEF>5%, super-response (R-HSR) as ΔLVEF>15%, and clinical response as a negative transition of NYHA class≥−1 at 6 months follow-up vs. baseline (preimplant). Results. Mean follow-up for the 31 patients (aged 69.9±9.4 years; 61% male; NYHA class II/III 19%/81%; ischemic etiology 65%) was 6±0.7 months. At baseline, LVEF was 29.1%±4.7% and QRS duration 146±13 ms. LBBB morphology was observed in 65%. At 6 months, R-HR was 74% (23/31), R-HSR 32% (10/31), and clinical response rate 77% (24/31). Hemodynamically, patients with ischemic etiology benefited more than those without ischemic etiology, both in terms of response (80% versus 64%) and super-response (35% versus 27%). Conclusions. Continuous automatic weekly optimization of CRT over 6 months consistently improved R-HR, R-HSR, and clinical response in NYHA class II/III heart failure patients versus baseline. Patients with ischemic etiology in particular may benefit hemodynamically from this type of CRT optimization.

scholarly journals Prognostic value of global longitudinal strain versus mitral annular plane systolic excursion in patients with ischemic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Liu ◽  
C Wagner ◽  
K Hu ◽  
B Lengenfelder ◽  
G Ertl ◽  
...  
Keyword(s):  
Heart Failure ◽  
Longitudinal Strain ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Ischemic Heart ◽  
Ischemic Heart Failure ◽  
Class Iii ◽  
Heart Failure Patients ◽  
All Cause Mortality

Abstract Background Mitral annular plane systolic excursion (MAPSE) derived from M-mode echocardiography is a classical risk factor of clinical outcome in heart failure patients. Two-dimensional-echocardiography (2DE) derived global longitudinal strain (GLS) is also related to outcome in patients with heart failure. This study aimed to compare the prognostic performance between GLS and MAPSE in ischemic heart failure patients with reduced ejection fraction. We sought to test the hypothesis that GLS might be superior to MAPSE as a risk stratification marker in these patients. Methods In total, 1277 ischemic heart failure patients with reduced left ventricular ejection fraction (LVEF<50%), referred to our department between 2009 and 2017, were included in this retrospective study. Offline standard echocardiographic measurements including MAPSE and GLS were performed. Average MAPSE of septal and lateral walls (MAPSE_Avg) was calculated. GLS was derived from the segmental averaging (18-segment) of the three apical views. All patients completed at least one-year clinical follow-up by telephone interview or clinical visit. The primary endpoint was defined as all-cause mortality or heart transplantation (HTx). Results At baseline visit, mean age was 70±11 years and 79.6% were men. NYHA class III-IV were identified in 33.5% of patients. Coronary artery disease was confirmed by coronary angiography. 63.0% patients had a history of myocardial infarction, 32.1% underwent PCI, and 16.8% underwent coronary artery bypass grafting. Over a median follow-up period of 26 (14–39) months, 369 (28.9%) patients died and 5 (0.4%) underwent HTx. Median LVEF was 39% (32–45%), and there were 48.0% patients with LVEF between 40–49%, 32.3% patients with LVEF between 30–49% and 19.7% patients with LVEF <30%. MAPSE_Avg was 8.0 (6.5–10.0) mm and median GLS was −9.9% (−7.7 to −12.3%). Clinical covariates significantly associated with all-cause mortality in this cohort included age (HR=1.048), NYHA class III-IV (HR=1.800), AF (HR=1.567), diabetes (HR=1.262), dyslipidemia (HR=0.657), hyperuricemia (HR=1.861), peripheral vascular disease (HR 1.858), chronic respiratory diseases (HR=1.680), and renal dysfunction (HR=2.705). Multivariable Cox regression analysis showed that reduced MAPSE_Avg (<7mm, HR=1.431, 95% CI 1.146–1.786) and reduced GLS (<8.3%, HR=1.519, 95% CI 1.230–1.875) were independent predictors of all-cause mortality after adjustment of above-mentioned clinical confounders. ROC curves demonstrated that the predictive performance of all-cause mortality among LVEF, MAPSE_Avg, and GLS were similar (AUC=0.608, 0.601, and 0.616, respectively, all P<0.001). Conclusions Both 2DE-guided GLS and MAPSE could provide additional prognostic information in ischemic heart failure patients with reduced LVEF. Prognostic performance of GLS, MAPSE, and LVEF is similar in ischemic heart failure patients with reduced LVEF. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The German Federal Ministry of Education and Research

1-Year Follow-Up of Urban Underserved Congestive Heart Failure Patients through Web-Based Telemedicine Monitoring System

2006 ◽  
Vol 12 (6) ◽  
pp. S72
Author(s):  
Mohammed A. Kashem ◽  
Marie T. Droogan ◽  
William P. Santamore ◽  
Joyce W. Wald ◽  
Robert C. Cross ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Monitoring System ◽  
Web Based ◽  
Heart Failure Patients

scholarly journals Congestive Heart Failure Patients’ Pulse Rate Progression and Time to Death at Debre Tabor Referral Hospital, Ethiopia

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Alebachew Taye Belay ◽  
Denekew Bitew Belay ◽  
Shewayiref Geremew Gebremichael ◽  
Setegn Bayabil Agegn
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Pulse Rate ◽  
Left Ventricular ◽  
Time To Death ◽  
Heart Failure Patients ◽  
Subject Specific ◽  
Debre Tabor

Background. Heart failure is a progressive condition marked by worsening symptoms such as shortness of breath, coughing, exhaustion and lethargy, fluid retention with swelling of the legs and abdomen, and a reduced ability to exercise. As a result, this study aims to use a joint model application to determine the joint risk factors of longitudinal change in pulse rate and time to death of congestive heart failure patients and their association admitted to a hospital. Methods. A retrospective study was undertaken on congestive heart failure patients admitted to the Debre Tabor Referral Hospital from January 2016 to December 2019. A statistical joint modeling strategy was employed to match the repeated biomarker pulse rate and a survival outcome at the same time. A total of 271 patients with congestive heart failure were chosen. Data were analyzed with R statistical software via joineRML. Results. According to the findings, the association between longitudinal changes in pulse rate and time to death in heart failure patients is statistically significant. Sex, residence, left ventricular injection fraction, New York Heart Association class, and diabetes mellitus were all found to be significant risk factors for congestive heart failure patients’ short survival time to death. Age, sex, residence, hypertension, left ventricular injection fraction, congestive heart failure, diabetes mellitus, tuberculosis, and etiology were all significant contributors in pulse rate progression. Conclusion. The computed association parameters revealed subject-specific values. The subject-specific linear time slope of PR measurement was positively related to the hazard rate of time to death of CHF patients in the study area. To reduce the risk level of CHF, health professionals, governmental organizations, and nongovernmental organizations must promote and allocate a suitable amount of budget for the treatment of CHF patients.

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