scholarly journals PATIENTS HOSPITALIZED WITH NEUTROPENIC FEVER WHO HAVE CONCOMITANT HEART FAILURE WITH REDUCED EJECTION FRACTION (HFREF) HAVE A HIGHER RISK OF ACUTE KIDNEY INJURY AND VENTRICULAR TACHYCARDIA: A NATIONWIDE STUDY

2020 ◽  
Author(s):  
Hassan Beydoun
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Ventricular Tachycardia ◽  
Ejection Fraction ◽  
Kidney Injury ◽  
Neutropenic Fever ◽  
Nationwide Study ◽  
Reduced Ejection Fraction

Abstract 13942: Down-titration of Renin-angiotensin System Inhibitors After Hospitalization for Heart Failure With Reduced Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Parag Goyal ◽  
Ligong Chen ◽  
Robert S Rosenson ◽  
John Umejiego ◽  
Alessandro Pontes-Arruda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Ejection Fraction ◽  
Kidney Injury ◽  
Renin Angiotensin System ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Reduced Ejection Fraction

Introduction: While there are data demonstrating poor outcomes associated with discontinuation of renin-angiotensin system inhibitors (RASI) after hospitalization for heart failure with reduced ejection fraction (HFrEF), less is known about the prevalence and outcomes of RASI dose reduction. Objective: To determine the proportion of older US adults with HFrEF who had RASI down-titration after hospitalization and identify characteristics associated with RASI down-titration. Methods: This study included US Medicare beneficiaries age > 65 years with fee-for-service coverage hospitalized with HFrEF in 2007-2017 who filled a prescription for a RASI in the 90 days prior to hospitalization. We compared dosages of RASI prescription fills prior to and up to 1 year after hospitalization. Diagnoses of conditions that can reduce RASI tolerance (hypotension, acute kidney injury, hyperkalemia, angioedema, syncope, fall-related injuries) were identified during the hospitalization. We used modified Poisson models to calculate prevalence ratios and 95% CIs. Results: Among 35,047 Medicare beneficiaries hospitalized with HFrEF, the average age was 78.5 (SD 8.0) years, 82.3% were white, and 50.8% were women. After hospitalization, 61.9% filled a prescription for the same or higher dose, 15.6% filled a lower dose, and 22.6% did not fill a prescription for a RASI. Among the beneficiaries who filled a prescription for a RASI after hospitalization, hypotension, acute kidney injury, and hyperkalemia were associated with a higher prevalence of RASI down-titration (Table). Conclusion: Down-titration of RASIs is common among older adults with HFrEF following hospitalization and is more frequent among individuals with hypotension, acute kidney injury, or hyperkalemia during hospitalization. Down-titration may reduce risks of adverse events during periods of reduced medication tolerance after hospitalization, but could also lead to sustained suboptimal treatment.

scholarly journals What factors are Associated with the Development of Contras-induced Nephropathy in Elderly Patients with Acute Coronary Syndrome in Real Clinical Practice?

2020 ◽  
Vol 16 (6) ◽  
pp. 908-915
Author(s):  
M. Yu. Gilyarov ◽  
E. V. Konstantinova ◽  
P. V. Kovalets ◽  
A. V. Slivin ◽  
A. E. Udovichenko ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Acute Coronary Syndrome ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Medical Records ◽  
Kidney Injury ◽  
Killip Class ◽  
Reduced Ejection Fraction ◽  
Coronary Syndrome

Aim. To study the factors associated with contrast-induced acute kidney injury in elderly patients with acute coronary syndrome (ACS).Material and Methods. A retrospective analysis of 514 electronic medical records of patients aged 75 years and over (38% men and 62% women) with confirmed acute coronary syndrome has been performed. The contrast-induced acute kidney injury was defined as an increase in serum creatinine ≥26.5 μmol/L in 48 h or as an increase in serum creatinine in 1.5 times within 7 days after the contrast media exposure. Patients were divided into contrast-induced acute kidney injury and non-contrast-induced acute kidney injury group. Clinical characteristics and in-hospital outcomes were extracted from patients' medical records. Procedural characteristics were obtained from laboratory database.Results. Angiographic intervention was performed in 74% of patients, 32% of them (more often in women, p=0.033) were diagnosed with contrast-induced acute kidney injury. Patients with contrast-induced acute kidney injury are characterized by a higher death rate (17% и 3%, p<0.001) and were more likely to have heart failure with reduced ejection fraction (34% и 21%, p=0.008) and acute heart failure (Killip class II-IV) (24% и 16%, p=0.015). The risk of developing contrast-induced acute kidney injury was related the volume of contrast medium administered.Conclusions. Prevention particular care should be taken to female patients older than 75 years with ACS, with a history of the chronic heart failure with reduced ejection fraction or acute heart failure (Killip class II-IV), and with a high volume of contrast media, highlighting that a perioperative comprehensive management strategy is needed to improve the prognosis.

Abstract 17371: In-Hospital Outcomes of Ablation for Ventricular Tachycardia in Heart Failure With Reduced Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Raj Patel ◽  
Dipesh Ludhwani ◽  
Harsh P Patel ◽  
Samarthkumar J Thakkar ◽  
Love shah ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Reference Group ◽  
Coronary Bypass ◽  
Reference Population ◽  
Reduced Ejection Fraction ◽  
Vt Ablation

Introduction: Ventricular tachycardia (VT) is a significant cause of morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF). Hypothesis: Data on efficacy, safety, and outcomes of catheter ablation for VT in HFrEF have not been studied well. Methods: The 2002-2014 Nationwide Inpatient Sample (NIS) was used to identify all hospitalizations with a principle diagnosis of VT (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] code 427.1) and a secondary diagnosis of HFrEF. Patients who underwent catheter ablation were identified using ICD-9-CM procedure code 37.34. Results: Of 228,557 patients with HFrEF & VT, 5845 (2.56%) underwent catheter ablation. The prevalence of Diabetes Mellitus (DM) and Chronic Kidney disease (CKD) was higher in the reference population contrary to a higher prevalence of prior myocardial infarction (MI), coronary bypass and AICD in those undergoing CA. The frequency of complications in the ablation group was 19.47%, the most common being post-operative hemorrhage (8.3%). This was followed by myocardial infarction (5.34%), pericardial complications (3.38%), and neurological complications (2.14%) (Figure 1.). The odds of in-hospital mortality were lower in the CA group compared to the reference group (5.08% vs 9.42%, p<0.05). Conclusions: Compared to medical therapy, VT ablation in HFrEF is associated with lower mortality though with significant complication rate. This suggests a need for future studies identifying the safety measures in VT ablations and instituting appropriate interventions to improve overall VT ablation outcomes.

Impact of cardiovascular comorbidities on mortality in patients admitted for neutropenic fever in 2016.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6586-6586
Author(s):  
Suheil Albert Atallah-Yunes ◽  
Faris Haddadin ◽  
Anis Kadado ◽  
Syed S. Ali
Keyword(s):  
Heart Failure ◽  
Linear Regression ◽  
Ejection Fraction ◽  
Neutropenic Fever ◽  
Multivariate Linear Regression ◽  
Smoking History ◽  
Reduced Ejection Fraction ◽  
Increased Risk ◽  
History Of ◽  
The Impact

6586 Background: Neutropenic fever (NF) remains one of the most common causes for hospitalization and mortality in oncology patients. Concomitant cardiovascular disease in patients with cancer is not uncommon. There is limited data on the impact of cardiovascular (CVS) comorbidities on mortality in cancer patients with NF. Methods: This is a retrospective cohort study using the 2016 National Inpatient Sample database (NIS) of adults ( > 18 years) admitted for NF based on the ICD-10 code. Mortality was the primary outcome. Multivariate linear regression adjusted for potential confounder of age, sex, race, Charlson comorbidity index and all the CVS comorbidities of the study including atrial fibrillation (AF), heart failure with preserved ejection fraction (HFpEF), heart failure with reduced ejection fraction (HFrEF), coronary artery disease (CAD), peripheral vascular disease (PVD), hypertension (HTN), history of smoking, history of cerebrovascular accident (CVA) or TIA and dyslipidemia. STATA 15 was used for analysis. Results: We identified 31,310 patients (mean age 44.6) (49.6% females) admitted with NF, among which 250 died during same admission. On multivariate linear regression there was a significant increase in adjusted all-cause mortality in patients with AF (OR: 2.39; 95%-CI 1.06- 5.40, P = 0.035) and HFpEF (OR: 4.30; 95%-CI 1.08- 17.17, P = 0.039). There was no significant increase in mortality in patients with HFrEF, dyslipidemia, HTN, PVD, CAD, history of CVA/TIA and smoking. Conclusions: Patients with NF and concomitant history of AF or HFpEF have an increased risk of mortality during hospitalization. Inflammation is emerging as a key player in AF pathogenesis. This may explain why AF appears to correlate with mortality, as those with more severe presentations are more likely to have a heightened state of inflammation. Patients with NF are more likely to receive fluids in the setting of infectious complications which could explain the increased mortality in CHF patients with NF. Identifying risk factors for increased mortality in patients with NF is important for risk stratification and in guiding clinicians in the management of this delicate population. [Table: see text]

scholarly journals Chronic heart failure and the frequency of taking nonsteroidal anti-inflammatory drugs: a register-based study on the possible risks

2020 ◽  
Vol 25 (1) ◽  
pp. 59-64 ◽  
Author(s):  
E. I. Tarlovskaya ◽  
Yu. V. Mikhailova
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Ejection Fraction ◽  
Kidney Injury ◽  
Outpatient Basis ◽  
Heart Failure Therapy ◽  
Nsaid Group ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Therapy Center

Aim. To study the frequency of taking nonsteroidal anti-inflammatory drugs (NSAIDs) and possible adverse events in patients with cardiovascular diseases and heart failure (HF) hospitalized in the Heart Failure Therapy Center (Nizhny Novgorod).Material and methods. According to the local register, the study included 336 patients (men — 156 and women — 180, average age — 71 (63; 80)), hospitalized in Heart Failure Therapy Center in Nizhny Novgorod from February 1 to November 1, 2019. Examination and treatment of patients was performed based on current clinical practice guidelines and standards. According to the results of echocardiography, HF with preserved ejection fraction was diagnosed in 70% of patients, HF with mid-range ejection fraction — in 20%, and HF with reduced ejection fraction — in 10%. Based on data on the outpatient NSAIDs taking, all participants were divided into 2 groups: NSAID+ (n=63) and NSAID(n=273).Results. Among hospitalized patients, 18,7% of patients took NSAIDs on an outpatient basis, without a doctor’s prescription, more often non-selective, mainly by mouth, for stopping arthralgia. The frequency of emergency hospitalizations due to acute HF decompensation depending on the NSAIDs taking did not significantly differ. In the NSAID+ group, acute kidney injury was diagnosed 3 times more often and 10 times more often when NSAIDs were taken ≥1 times a week. Anemia was diagnosed more often in the NSAID+ group, when taking NSAIDs ≥1 times a week. In the NSAID+ group, grade 2-4 anemia was significantly more often diagnosed.Conclusion. None of the patients took the recommended NSAIDs with a low cardiovascular risk. Patients taking NSAIDs were more likely to have a history of atrial fibrillation and acute cerebrovascular accident. Patients from the NSAID+ group had the higher incidence of acute kidney injury and anemia.

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