scholarly journals Diabetes in Patients With Heart Failure With Reduced Ejection Fraction During Hospitalization: A Retrospective Observational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yiling Zhou ◽  
Miye Wang ◽  
Si Wang ◽  
Nan Li ◽  
Shengzhao Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Cardiogenic Shock ◽  
Hospital Stay ◽  
Reduced Ejection Fraction ◽  
Icu Admission ◽  
Patients With Heart Failure ◽  
Patients With Diabetes ◽  
Subgroup Effects

BackgroundDiabetes is prevalent worldwide including hospitalized patients with heart failure with reduced ejection fraction (HFrEF). This retrospective study investigated the association of diabetes with in-hospital adverse events in patients with HFrEF.MethodsWe analyzed data from electronic medical records of patients hospitalized with HFrEF in West China Hospital of Sichuan University from January 1, 2011, to September 30, 2018. Propensity score matching balances the baseline characteristics between patients with and without diabetes. Logistic and Poisson regressions investigated the association of diabetes with risks of intubation, cardiogenic shock, acute kidney injury (AKI), intensive care unit (ICU) admission and death during hospitalization, and length of ICU and hospital stay in the matched cases.ResultsAmong 6,022 eligible patients (including 1,998 with diabetes), 1,930 patient pairs with and without diabetes were included by propensity score matching. Patients with diabetes had a significantly increased risk of intubation (odds ratio [OR], 2.69; 95% confidence interval [CI], 2.25–3.22; P<0.001), cardiogenic shock (OR, 2.01; 95% CI, 1.72–2.35; P<0.001), AKI at any stage (OR, 1.67; 95% CI, 1.44–1.94; P<0.001), ICU admission (OR, 1.89; 95% CI, 1.65–2.15; P<0.001), and death (OR, 4.25; 95% CI, 3.06–6.02; P<0.001) during hospitalization. Patients with diabetes had longer ICU (median difference, 1.47 days; 95% CI, 0.96–2.08; P<0.001) and hospital stay (2.20 days; 95% CI, 1.43–2.86; P<0.001) than those without diabetes. There were potential subgroup effects by age and by hypertension, and CKD status on the association of diabetes with risk of AKI at any stage; and subgroup effects by sex and CKD status on the association of diabetes with risk of intubation. The increase in length of hospital stay was larger in patients without hypertension than those with hypertension.ConclusionsAmong patients with HFrEF, those with diabetes have a worse prognosis, including a higher risk of in-hospital intubation, cardiogenic shock, AKI, ICU admission and death during hospitalization, and longer ICU and hospital stay.

Association of Body Mass Index With Clinical Outcomes in Patients With Heart Failure With Reduced Ejection Fraction Treated With Sacubitril/Valsartan

2021 ◽  
pp. 107424842110244
Author(s):  
Kazuhiko Kido ◽  
Christopher Bianco ◽  
Marco Caccamo ◽  
Wei Fang ◽  
George Sokos
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Normal Weight ◽  
Reduced Ejection Fraction ◽  
Propensity Score Weighting ◽  
Patients With Heart Failure

Background: Only limited data are available that address the association between body mass index (BMI) and clinical outcomes in patients with heart failure with reduced ejection fraction who are receiving sacubitril/valsartan. Methods: We performed a retrospective multi-center cohort study in which we compared 3 body mass index groups (normal, overweight and obese groups) in patients with heart failure with reduced ejection fraction receiving sacubitril/valsartan. The follow-up period was at least 1 year. Propensity score weighting was performed. The primary outcomes were hospitalization for heart failure and all-cause mortality. Results: Of the 721 patients in the original cohort, propensity score weighting generated a cohort of 540 patients in 3 groups: normal weight (n = 78), overweight (n = 181), and obese (n = 281). All baseline characteristics were well-balanced between 3 groups after propensity score weighting. Among our results, we found no significant differences in hospitalization for heart failure (normal weight versus overweight: average hazard ratio [AHR] 1.29, 95% confidence interval [CI] = 0.76-2.20, P = 0.35; normal weight versus obese: AHR 1.04, 95% CI = 0.63-1.70, P = 0.88; overweight versus obese groups: AHR 0.81, 95% CI = 0.54-1.20, P = 0.29) or all-cause mortality (normal weight versus overweight: AHR 0.99, 95% CI = 0.59-1.67, P = 0.97; normal weight versus obese: AHR 0.87, 95% CI = 0.53-1.42, P = 0.57; overweight versus obese: AHR 0.87, 95% CI = 0.58-1.32, P = 0.52). Conclusion: We identified no significant associations between BMI and clinical outcomes in patients diagnosed with heart failure with a reduced ejection fraction who were treated with sacubitril/valsartan. A large-scale study should be performed to verify these results.

Abstract 17005: Early Goal Directed Fluid Therapy for Patients With Heart Failure and Septic Shock

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Pedro Torres ◽  
Baher Al Abassi ◽  
Mohamed Abdul Qader ◽  
Riya Job ◽  
Kai Chen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Pulmonary Edema ◽  
Fluid Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Cardiovascular Center

Introduction: The use of aggressive fluid therapy in patients with heart failure and reduced ejection fraction (HFrEF) who develop septic shock is controversial. Methods: This is a retrospective cohort study of 334 patients with heart failure (HF) and septic shock admitted to a tertiary cardiovascular center between 01/2015 and 06/2018. For this study, ejection fraction (EF) was dichotomized into <45% (HFrEF) and ≥45% (HF with preserved EF). The evaluated outcomes included in-hospital mortality, development of pulmonary edema, cardiogenic shock, and 30-day readmission rate. Results: A total of 133(40%) patients had HFrEF, and 201(60%) patients had HFpEF (see Table 1, baseline characteristics). Early goal direct fluid therapy and vasopressors were equally implemented in all patients with HF that developed septic shock. Outcomes: There was no difference in in-hospital mortality for patients with HFrEF that developed septic shock when compared to patients with HFpEF, 64(48%) vs 102(51%) p=0.6542. Patients with HFrEF had a higher incidence of cardiogenic shock 25(19%) vs 9(4.5%) p<0.0001 and 30-day HF-related readmission 25(36%) vs 17(17%) p=0.0096. However, pulmonary edema requiring urgent intravenous diuresis 82(62%) vs 113(56%) p=0.4186 or mechanical ventilation 70(53%) vs 110(55%) p= 0.6543 was similar between groups. Conclusions: Once patients with HF develop septic shock, the mortality is similar for both HFrEF and HFpEF. However, complications such as cardiogenic shock and 30-day readmission are more common in patients with HFrEF. A more individualized treatment approach is needed for this population.

Sign in / Sign up

Export Citation Format

Share Document