scholarly journals Hemodynamic Congestion at Hospital Discharge Predicts Rehospitalization during Short Term Follow Up in Acute Heart Failure Patients

2019 ◽  
Vol 40 (3) ◽  
Author(s):  
Yoga Waranugraha ◽  
Mohammad Saifur Rohman ◽  
Setyasih Anjarwani

Background: Hemodynamic congestion is an increase in left ventricular diastolic pressure (LVEDP) without clinical symptoms and signs of congestion. Current acute heart failure (AHF) treatment goals only focused on improving clinical congestion. The purpose of this study was to investigate whether hemodynamic congestion measured by NT-proBNP level and ePCWP at hospital discharge could predict short term clinical outcomes in AHF patients. Method: This prospective cohort study was conducted at dr. Saiful Anwar General Hospital Malang from January to July 2018. All patients got AHF treatment according to the 2016 ESC guidelines for heart failure. All patients were discharged without symptoms and signs of clinical congestion. Hemodynamic congestion at hospital discharge was defined as failure of treatment during hospitalization to achieve a reduction in NT-proBNP level >30% and/or ePCWP at hospital discharge >16 mmHg. NT-proBNP level and ePCWP were measured at 0-12 hours after hospital admisssion and at hospital discharge. ePCWP was measured using echocardiography. The clinical outcomes assessed were AHF rehospitalization and cardiovascular mortality within 30 days after hospitral discharge. Subgroup analysis was performed to determine therapeutic regimens that are effective in improving hemodynamic congestion. Result: A total of 33 AHF patients were included in this study. 48% patients were discharged with hemodynamic congestion and 52% patients discharged without hemodynamic congestion. Patients with hemodynamic congestion at hospital discharge showed a higher rehospitalization within 30 days (8 [50%] vs 1 [5.9%]; P = 0.007). Mortality within 30 days in both groups did not show a significant difference (2 [12.5%] vs 0 [0%]; P = 0.277). Treatment regiment of optimal dose of ACEi/ARB, β-blockers, and diuretics was associated with improvement of hemodynamic congestion (P = 0.026; r = 0.454), a decrease in NT-proBNP> 66% (P = 0.02; r = 0,574), and achievement of ePCWP <16 (P = 0,013; r = 0,493) at hospital discharge in HFrEF patients. Conclusion: This study showed that hemodynamic congestion assessed with NT-proBNP level and ePCWP at hospital discharge increased 30 day rehospitalization in AHF patients. In HFrEF, improvements in hemodynamic congestion can be achieved by giving the treatment regiment of optimal dose of ACEi/ARB, β-blockers, and diuretics. Keyword: Acute heart failure, hemodynamic congestion, NT-proBNP, ePCWP

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Ana Rita Leite ◽  
João Sérgio Neves ◽  
Marta Borges-Canha ◽  
Catarina Vale ◽  
Madalena von Hafe ◽  
...  

Background. Thyroid hormones (TH) are crucial for cardiovascular homeostasis. Recent evidence suggests that acute cardiovascular conditions, particularly acute heart failure (AHF), significantly impair the thyroid axis. Our aim was to evaluate the association of thyroid function with cardiovascular parameters and short- and long-term clinical outcomes in AHF patients. Methods. We performed a single-centre retrospective cohort study including patients hospitalized for AHF between January 2012 and December 2017. We used linear, logistic, and Cox proportional hazard regression models to analyse the association of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) with inpatient cardiovascular parameters, in-hospital mortality, short-term adverse clinical outcomes, and long-term mortality. Two models were used: (1) unadjusted, and (2) adjusted for age and sex. Results. Of the 235 patients included, 59% were female, and the mean age was 77.5 (SD 10.4) years. In the adjusted model, diastolic blood pressure was positively associated with TSH [β = 2.68 (0.27 to 5.09); p = 0.030 ]; left ventricle ejection fraction (LVEF) was negatively associated with FT4 [β = -24.85 (-47.87 to -1.82); p = 0.035 ]; and a nonsignificant trend for a positive association was found between 30-day all-cause mortality and FT4 [OR = 3.40 (0.90 to 12.83); p = 0.071 ]. Among euthyroid participants, higher FT4 levels were significantly associated with a higher odds of 30-day all-cause death [OR = 4.40 (1.06 to 18.16); p = 0.041 ]. Neither TSH nor FT4 levels were relevant predictors of long-term mortality in the adjusted model. Conclusions. Thyroid function in AHF patients is associated with blood pressure and LVEF during hospitalization. FT4 might be useful as a biomarker of short-term adverse outcomes in these patients.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Melissa E Chinn ◽  
Mary E Roth ◽  
Steven P Dunn ◽  
Kenneth C Bilchick ◽  
Sula Mazimba

Introduction: Gout is a common comorbidity in heart failure (HF) patients, and is often exacerbated by diuretic use. The impact of gout or the treatment of gout on HF outcomes is unknown. The purpose of this study was to assess clinical outcomes in patients being treated for an acute HF exacerbation and receiving colchicine for an acute gout flare. Methods: This was a single center, retrospective cohort study of patients treated for an acute HF exacerbation from March 2011 to February 2020. The gout group included patients receiving colchicine for an acute gout flare during admission. The control group included those who did not receive colchicine for an acute gout flare. The primary outcome was 30-day readmission rate. Secondary outcomes included in-hospital mortality and length of stay. Results: In the cohort of 1,047 patients (68.8 +/- 13.7 years, 38% female), 237 patients received colchicine for acute gout during admission. Length of stay was significantly greater (9.93 days vs. 7.96 days, p < 0.0001) and in-hospital mortality was significantly lower (2.2% vs. 6.6%, p = 0.009) in patients with versus without gout. In a multivariate logistic regression model, in-hospital colchicine given for a gout flare was significantly associated with reduced in-hospital mortality (OR 0.322, 95% CI 0.105-0.779, p = 0.02) after adjustment for home beta blocker use, inotrope use, age, and diabetes mellitus (p < 0.05 for all in the model). The association between colchicine and survival to hospital discharge was only observed in patients who received colchicine during the hospitalization, as opposed to home use only. There was no significant difference in 30-day readmission rate based on gout status for patients surviving to hospital discharge (21.5% vs. 19.5%, p = 0.495). Conclusions: Among patients with an acute HF exacerbation, patients treated for an acute gout flare with colchicine had a greater length of stay and lower in-hospital mortality compared with those not having gout. Future analyses are warranted to identify the relationship between colchicine use and HF outcomes.


2010 ◽  
Vol 25 (3) ◽  
pp. 253 ◽  
Author(s):  
Hyoung-Seob Park ◽  
Hyungseop Kim ◽  
Ji-Hyun Sohn ◽  
Hong-Won Shin ◽  
Yun-Kyeong Cho ◽  
...  

2019 ◽  
Vol 83 (9) ◽  
pp. 1860-1867 ◽  
Author(s):  
Shinya Tanaka ◽  
Kentaro Kamiya ◽  
Nobuaki Hamazaki ◽  
Ryota Matsuzawa ◽  
Kohei Nozaki ◽  
...  

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.F.C Maltes ◽  
A.S.R.P Furtado ◽  
R.F Homem ◽  
R.M Santos ◽  
J Mauricio ◽  
...  

Abstract Background Hospitalization for Acute Heart Failure (AHF) remains an important turning point for patients and families, presenting itself as an index event after which the rate of readmission and mortality are particularly high. Hospitalization for Heart Failure (HF) also has a considerable cost impact on healthcare systems. Strategies that reduce the risk of readmission for HF are, therefore, crucial for patients and healthcare systems. A possible strategy to reduce HF readmissions currently recomended by the European Society of Cardiology is guaranteeing an outpatient follow-up visit carried out by a multidisciplinary HF team (combining specialized medical and nurse care) shortly after discharge. Our goal was to describe and demonstrate the feasibility of an early follow-up visit carried out by a multidisciplinary HF team in the transition care of HF patients, after hospital discharge, and to evaluate its association with early HF readmission and all-cause mortality. Methods This was a retrospective cohort study of acute heart failure (AHF) patients consecutively admitted to an AHF Unit during one year. Exclusion criteria were in-hospital death and transfer to another hospital. We compared patients who were evaluated in a follow-up visit carried out 7 to 14 days after hospital discharge where treatment adjustments could be made, with those who were not. Primary outcomes: AHF readmissions and all-cause mortality at 3 months after discharge were analysed. Cox proportional hazards regression was used. Results Of 181 admissions for AHF, 153 were analysed. Patients were 77±11 years-old; 54% were male and 46% had reduced left ventricular ejection fraction. At hospital discharge median NT-proBNP was 3258 (1429–5995) pg/mL. One-hundred and forty-four (94%) patients were referred to a follow-up visit by the same multidisciplinary HF team with a compliance rate of 81% (n=116). The mortality rate after 3 months was 6.5% (n=10) and the AHF readmission rate was 14.3% (n=22). An early follow-up visit was independently associated with a lower risk of AHF readmission at 3 months after discharge (crude HR 0.35, 95% Confidence Interval (CI): 0.15–0.82, p=0.015; adjusted HR for age and implantable cardiac defibrillator: 0.31, 95% CI: 0.12–0.79, p=0.014) (Figure 1A). and a lower combined risk of all-cause mortality or AHF readmission at 3 months (crude HR 0.37, 95% CI: 0.18–0.78, p=0.009; adjusted HR for age, implantable cardiac defibrillator, pacemaker presence and NYHA &gt;2: 0.29, 95% CI: 0.13–0.67, p=0.004) (Figure 1B). Conclusion Conducting an early specialized follow-up visit after AHF hospitalization is highly feasible and associated with an excelent patient compliance. A multidisciplinary HF team visit in the vulnerable phase after AHF hospitalization was associated with a significantly lower risk of HF readmission and all-cause death at 3 months, mostly due to preventable readmissions. Funding Acknowledgement Type of funding source: None


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sayaki Ishiwata ◽  
Takatoshi Kasai ◽  
Shoko Suda ◽  
Akihiro Sato ◽  
Hiroki Mastumoto ◽  
...  

Introduction: Identifying hospitalized patients at a high risk for worse long-term clinical outcomes following acute heart failure (AHF) is important. However, limited data regarding influence of sleep-disordered breathing (SDB) and its treatment by positive airway pressure (PAP) on post-discharge clinical outcomes in hospitalized patients following AHF are available. Hypothesis: Presence of SDB may be associated with worse long-term clinical outcomes, which may be reversible by PAP therapy in patients with AHF. The aim of this study is to investigate relationship between SDB, its treatment by PAP and long-term clinical outcomes. Methods: After the initial improvement of AHF, overnight polysomnography was performed on consecutive hospitalized patients whose left ventricular (LV) ejection fraction ≤45% between May 2012 and April 2018. In the present study, SDB was defined as an apnea-hypopnea index ≥15. Patients with SDB were subdivided as those with or without PAP treatment. The incidence of deaths and re-hospitalizations due to exacerbation of heart failure until April 2019 were assessed by stepwise multivariable Cox proportional model. Results: Overall, 241 patients were enrolled. Among them, 73% had SDB and 29% were initiated into PAP. At a median follow-up of 1.7 years, 89 patients had clinical events (36.9%). In the stepwise multivariable analysis, SDB was associated with increased risk of clinical events (hazard ratio [HR], 2.20; P=0.007). Among SDB patients, stepwise multivariable analysis showed that PAP treatment was associated with reduced risk of clinical events (HR 0.45; P=0.022). Conclusions: In hospitalized patients following AHF, presence of SDB was associated with worse long-term clinical outcomes, which may be reversible by PAP therapy. Thus, following AHF, hospitalized patients with LV systolic dysfunction should be evaluated whether they have SDB and considered for SDB treatment before discharge.


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