1-year Rehospitalization Research Articles

High-risk admission prior to transcatheter aortic valve implantation and subsequent outcomes

Abstract Background Severe symptomatic aortic stenosis may cause heart failure, acute myocardial infarction, or syncope; however, limited data exist on the occurrence of such events before transcatheter aortic valve implantation (TAVI) and their impact on subsequent outcomes. Purpose To investigate the association between a preceding event (hospitalization for heart failure, acute myocardial infarction, or syncope) and outcomes after TAVI. Methods Using nationwide registries, all Danish patients undergoing TAVI from 2014 through 2021 were identified. Preceding events up to 180 days before TAVI were identified. Patients were then stratified into two groups: 1) patients with a preceding event. 2) patients without a preceding event. The primary outcome of interest was 1-year risk of all-cause death estimated with Kaplan-Meier for patients with a preceding event compared with patients without. The secondary outcome of interest was 1-year cardiovascular rehospitalization amongst patients discharged alive. Here, we used Aalen-Johansen with the competing risk of death among patients alive at discharge. Finally, adjusted analyses were performed with Cox regression analyses. Results The main findings are summarized in Figure 1. The study population comprised 5,851 patients. Of these, 759 (13.0%) had a preceding event. Median age was 81 years in both groups. Frailty and male sex were more prevalent among patients with a preceding event (males: 64.7%, intermediate/high frailty: 49.6%) compared with patients without a preceding event (males: 55.2%, intermediate/high frailty 40.6%). A hospitalization for heart failure was the most common preceding event (n=524). The risk of 1-year all-cause death was 11.7% (95% CI: 9.4%–14.1%) for patients with a preceding event compared with 8.0% (95%CI: 7.2%–8-7%) for patients without a preceding event (Figure 2). This resulted in an adjusted hazard ratio of 1.29 (95%CI: 1.01–1.64). Moreover, the 1-year risk of cardiovascular rehospitalization was 15.0% (95 CI: 12.4%–17.6%) versus 8.2% (95 CI: 7.4%–8.9%) for patients with and without a preceding event (adjusted hazard ratio 1.60 [95%CI: 1.29–1.99]) (Figure 2). Conclusion A hospitalization for heart failure, acute myocardial infarction, or syncope prior to TAVI is associated with a higher risk of mortality and cardiovascular rehospitalization. These patients should be carefully evaluated prior to and after TAVI to improve outcomes.

In-hospital and 1-year mortality associated with percutaneous coronary intervention use in patients with acute myocardial infarction older than 90 years

Abstract Background Patients older than 90 years are less likely to receive percutaneous coronary intervention (PCI) for treatment of acute myocardial infarction (AMI). This is due to the lack of evidence derived from randomized trials, multimorbidity, and possible futility. We investigated the prognostic impact of PCI in a large population of patients hospitalized with AMI in the period 2003-2018, by using the Lombardy Health Database (Italy). Methods We analyzed data of all patients >90 years hospitalized with AMI (both STEMI and NSTEMI) in Lombardy. Patients were grouped according to whether they were treated or not with PCI during index hospitalization. The primary outcome was in-hospital mortality. One-year mortality and 1-year re-hospitalization for acute heart failure (AHF) or AMI were considered as secondary endpoints. Results During the study period, 15,954 patients (median age 92 [91-94] years); 50% STEMI) were hospitalized with a primary diagnosis of AMI. Twelve percent of them (n=1,954) were treated with PCI. The in-hospital mortality rate in the entire cohort was 22% (29% in STEMI and 15% in NSTEMI). It was significantly lower in patients treated with PCI than in those not treated with PCI (15% vs. 23%; P<0.0001). In the overall population, 1-year mortality was 56% and 1-year re-hospitalization for AHF/AMI was 19%. Both these endpoints were less frequent in PCI-treated (37% vs. 58% and 16% vs. 21%, respectively; P<0.0001). The adjusted risk of the study endpoints was significantly lower in patients treated with PCI: OR 0.61 (95% CI 0.54-0.69) for in-hospital mortality; HR 0.53 (95% CI 0.49-0.57) for 1-year mortality; HR 0.68 (95% CI 0.66-0.70) for 1-year re-hospitalization for AHF/AMI. The figure shows the 1-year survival curves of AMI patients treated or not treated with PCI. Similar results were found in STEMI and NSTEMI patients considered separately. Conclusions Our real-world data showed that in patients with AMI older than 90 years of age, PCI use is associated with a significant in-hospital and 1-year clinical benefit.

Recurrence of acute coronary syndrome in the elderly: predictors and prognosis - insights from a multicentre national registry

Abstract The burden of cardiovascular (CV) disease remains at the top of society's health problems, with acute coronary syndromes (ACS) undoubtedly being one of the major causes. Patients with a known history of CVD are at increased risk of recurrent events. However, this recurrence's incidence rate and clinical impact vary between populations. Elderly patients represent a large proportion of patients admitted for a second ACS. The decision on its management lacks support in clinical guidelines, as studies generally exclude patients with significant comorbidities and tend to underrepresent this group. This study aimed to analyse the characteristics and outcomes of elderly patients admitted with ACS with a previous history of myocardial infarction (MI) versus those who did not. The authors performed a retrospective analysis of patients older than 75 years included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between 2010 and 2022. Comparison tests were performed. A COX proportional hazard regression method was applied to generate the proposed risk models. A p-value less than 0.05 was considered statistically significant. A total of 8658 patients older than 75 years admitted for ACS were analysed, 6630 (76.6%) without a history of MI (group 1) and 2028 (23.4%) with a previous MI. Table 1 shows the most important baseline characteristics and differences between groups. Table 2 demonstrates the group differences regarding admission diagnosis, complementary study results and treatment. Table 3 represents in-hospital complications. At discharge, 16.5% of group 1 and 21.2% of group 2 had a planned cardiac rehabilitation program (CRP) (p-value=0.01). At 1-year follow-up, 15,6% of patients with more than 75 years admitted for ACS died and 17.4% were re-hospitalized by a CV cause. COX-regression analysis identified the history of MI as a predictor factor of CV re-hospitalization (HR 1,43; 95%CI [1.10;1.86], p-value<0.01) and of the composite of mortality and CV re-hospitalization (HR 1,37; 95%CI [1.10;1.71], p-value<0.01). In conclusion, the elderly with a second episode of ACS tends to have more CV risk factors and comorbidities than those without a MI history. Furthermore, the recurrence of MI seems to be an independent predictor of 1-year re-hospitalization and the composite of mortality and CV re-hospitalization. Then, these results should increase the awareness of this group of patients.Table 1Table 2 (incomplete) and Table 3

New onset heart failure with reduced ejection fraction management: single center, real-life Tunisian experience

BackgroundHeart failure (HF) is a serious and frequent pathology. It represents a major public health problem. We have few data about this pathology in our country. The aim of our study is to determine the epidemiological, clinical, therapeutic, and prognostic characteristics of new-onset HF with reduced left ventricular ejection fraction (HFrEF) and to study the degree of conformity of the management of HF with international recommendations.ResultsOur study population includes 210 patients hospitalized for HFrEF newly diagnosed. The average age of our patients was 64 ± 12 years. A male predominance was noted with a sex ratio of 2.8. The main etiology of HF was ischemic heart disease noted in 97 patients (46.2%). The average LVEF is 33 ± 6%. The triple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists) was prescribed in 75 patients (35.7%). The quadruple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists + Sodium-Glucose Co-Transporter 2 inhibitors) was prescribed in 17 patients (8.1%). Myocardial revascularization was indicated in 97 patients (46.6%) and valve surgery was indicated in 49 patients (23.3%). Hospital mortality was 3.8% and at 1 year 18.1%. Among the 192 patients followed during the first year after discharge from hospital, 81 patients had to be re-hospitalized, i.e., a 1-year rehospitalization rate of 42.2%.ConclusionsOur study highlighted the epidemiological and clinical features of HF in a Tunisian care center, revealing our patient management deficiency. This pushes us to have a new Tunisian register to enable a better statistical analysis and lead to more relevant conclusions.

New York Heart Association Class and Kansas City Cardiomyopathy Questionnaire in Acute Heart Failure

Sparse data exist regarding how clinician-assigned New York Heart Association (NYHA) class compares with heart failure (HF)-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) in acute HF. To compare concordance between NYHA class and KCCQ overall summary score (KCCQ-OS) in acute HF and investigate associations of changes in NYHA class and KCCQ-OS with long-term outcomes. In this cohort study, patients with HF were enrolled from 52 hospitals in China between August 2016 and May 2018. Among patients with NYHA class and KCCQ-OS at admission and 1 month, levels of each scale were categorized into 4 groups from worst to best. Mild and moderate to severe discordance were defined as NYHA class and KCCQ-OS differing by 1 level or 2 or more levels, respectively. Multivariable models evaluated associations between improvements in the 2 measures and outcomes. Analysis was conducted from January to March 2023. Changes in NYHA class and KCCQ-OS from admission to 1 month. All-cause mortality, cardiovascular death, or first HF rehospitalization. A total of 2683 patients (1709 [63.7%] male; median [IQR] age, 66 [56-75] years) were included. NYHA class II, III, and IV were presented in 374 patients (13.9%), 1179 patients (44.0%), and 1130 patients (42.1%), respectively, and the median (IQR) KCCQ-OS was 44.4 (28.3-61.9). Concordance, mild discordance, and moderate to severe discordance between admission NYHA class and KCCQ-OS occurred in 954 patients (35.6%), 1203 patients (44.8%), and 526 patients (19.6%), respectively. For KCCQ-OS, kernel density overlaps were 73.6% between NYHA II and III, 63.8% between NYHA II and IV, and 88.3% between NYHA III and IV. Most patients experienced improvements in NYHA and KCCQ-OS from admission to 1 month. After adjustment, there was no significant association between improvements in NYHA class and 4-year all-cause mortality, whereas 5 or more point improvements in KCCQ-OS were independently associated with a lower risk of 4-year mortality (hazard ratio, 0.84; 95% CI, 0.74-0.96; P = .01). NYHA class and KCCQ-OS improvements were both associated with decreased risk of 1-year composite cardiovascular death or HF rehospitalization. In this cohort study of acute HF, discordance between NYHA class and KCCQ was common, and KCCQ was more relevant to subsequent mortality than NYHA class.

Exploring the efficacy of Shexiang Tongxin extract pills in severe heart failure

The clinical efficacy of Shexiang Tongxin pills (STP) on cardiac function, inflammation, and prognosis was investigated in patients with severe heart failure. A total of 140 patients with severe heart failure, diagnosed and treated at the Shaoxing Central Hospital and its affiliates, were divided into control and experimental groups. Patients in the control group received conventional treatment, while those in the experimental group were given STP plus conventional treatment. The cardiac functions, levels of inflammatory factors, and outcomes of 6-minute walk distance (6MWD) were assessed and compared after 12 weeks of intervention. Besides, the rehospitalization and mortality proportions were also determined during a 1-year follow-up. In addition, oxygen-glucose deprivation and reperfusion (OGD/R) were conducted to mimic the injury of H9c2 cells in heart failure; cell survival, cytotoxicity, apoptosis, and inflammatory factors were also evaluated. Post-intervention, patients in the experiment group demonstrated greater improvement in cardiac functions, especially regarding left ventricular end-diastolic diameter and N-terminal pro-B-type natriuretic peptide, which were significantly decreased, while left ventricular ejection fraction was significantly increased (P < 0.05). Further, the levels of inflammatory factors, including tumor necrosis factor-α, hypersensitive C-reactive-protein, and interleukin 6, were significantly lower (P < 0.05), and a superior 6MWD outcome was observed in patients from the experimental group, compared to the control group (P < 0.05). After 1-year follow-up, both rehospitalization rate and mortality were significantly decreased in the experimental group, compared to the control group (rehospitalization, 38.57% vs. 55.71%, and mortality, 12.86% vs. 27.14%, respectively; P < 0.05). Furthermore, STP increased cell survival and reduced cell apoptosis, cytotoxicity, and inflammatory response in cardiomyocytes induced by OGD/R. Shexiang Tongxin pill demonstrated significant and promising clinical effects in treating severe heart failure by ameliorating cardiac functions, reducing inflammatory factor levels, and improving patients’ prognosis. In addition, STP ameliorated cellular damage and inflammation at cellular level. Thus, STP demonstrated important clinical values.

Cardiogenic Shock in Idiopathic Dilated Cardiomyopathy Patients: Red Flag for Myocardial Decline

Idiopathic dilated cardiomyopathy (IDCM) is one of the most common forms of nonischemic cardiomyopathy worldwide, possibly leading to cardiogenic shock (CS). Despite this heavy burden, the outcomes of CS in IDCM are poorly reported. Based on a large registry of unselected CS, our aim was to shed light on the 1-year outcomes after CS in patients with and without IDCM. FRENSHOCK was a prospective registry including 772 patients with CS from 49 centers. The 1-year outcomes (rehospitalizations, mortality, heart transplantation [HTx], ventricular assist devices [VAD]) were analyzed and adjusted on independent predictive factors. Within 772 CS included, 78 occurred in IDCM (10.1%). Patients with IDCM had more frequent history of chronic kidney failure and implantable cardioverter-defibrillator implantation. No difference was found in 1-month all-cause mortality between groups (28.2 vs 25.8%for IDCM and others, respectively; adjusted hazard ratio 1.14 [0.73 to 1.77], p=0.57). Patients without IDCM were more frequently treated with noninvasive ventilation and intra-aortic balloon pump. At 1 year, IDCM led to higher rates of death or cardiovascular rehospitalizations (adjusted odds ratio 4.77 [95% confidence interval 1.13 to 20.1], p=0.03) and higher rates of HTx or VAD for patients aged <65 years (adjusted odds ratio 2.68 [1.21 to 5.91], p=0.02). In conclusion, CS in IDCM is a very common scenario and is associated with a higher rate of 1-year death or cardiovascular rehospitalizations and a more frequent recourse to HTx or VAD for patients aged <65 years, encouraging the consideration of it as a red flag for myocardial decline and urging for a closer follow-up and earlier evaluation for advanced heart failure therapies.

One-year outcomes in cardiogenic shock triggered by supraventricular tachycardia: an analysis of the FRENSHOCK multicenter prospective registry.

Cardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, we aimed to compare 1-year outcomes between SVT-triggered and non-SVT-triggered CS. FRENSHOCK is a French prospective registry including 772 CS patients from 49 centers. For each patient, the investigator could report 1-3 CS triggers from a pre-established list (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance, and others). In this study, 1-year outcomes [rehospitalizations, mortality, heart transplantation (HTx), ventricular assist devices (VAD)] were analyzed and adjusted for independent predictive factors. Among 769 CS patients included, 100 were SVT-triggered (13%), of which 65 had SVT as an exclusive trigger (8.5%). SVT-triggered CS patients exhibited a higher proportion of male individuals with a more frequent history of cardiomyopathy or chronic kidney disease and more profound CS (biventricular failure and multiorgan failure). At 1 year, there was no difference in all-cause mortality (43% vs. 45.3%, adjusted HR 0.9 (95% CI 0.59-1.39), p = 0.64), need for HTx or VAD [10% vs. 10%, aOR 0.88 (0.41-1.88), p = 0.74], or rehospitalizations [49.4% vs. 44.4%, aOR 1.24 (0.78-1.98), p = 0.36]. Patients with SVT as an exclusive trigger presented more 1-year rehospitalizations [52.8% vs. 43.3%, aOR 3.74 (1.05-10.5), p = 0.01]. SVT is a frequent trigger of CS alone or in association in more than 10% of miscellaneous CS cases. Although SVT-triggered CS patients were more comorbid with more pre-existing cardiomyopathies and HF incidences, they presented similar rates of mortality, HTx, and VAD at 1 year, arguing for a better overall prognosis. https://clinicaltrials.gov, identifier: NCT02703038.

Prognostic Impact of Percutaneous Coronary Intervention in Older Patients Hospitalized with Acute Myocardial Infarction: Real-World Findings from the Lombardy Health Database.

Older patients are less likely to receive percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) compared to younger patients. We investigated the prognostic impact of PCI in a large population of patients hospitalized with AMI in the period 2003-2018 by using the administrative Lombardy Health Database (Italy). We considered all patients aged ≥75 years hospitalized with AMI (either STEMI or NSTEMI) from 2003 to 2018 in Lombardy. Patients were grouped according to whether they were treated or not with PCI during the index hospitalization. The primary outcome was in-hospital mortality. The secondary endpoints were 1-year mortality and 1-year re-hospitalization for acute heart failure (AHF) or AMI. 116,063 patients aged ≥75 years (mean age 83 ± 6; 48% males; 46% STEMI) were hospitalized with a primary diagnosis of AMI. Thirty-seven percent of them (n = 42,912) underwent PCI. The in-hospital mortality rate was significantly lower in PCI-treated patients (6% vs. 15%; p < 0.0001). One-year mortality and 1-year re-hospitalization for AHF/AMI were less frequent in PCI-treated patients (16% vs. 41% and 15% vs. 21%, respectively; p < 0.0001). The adjusted risks of the study endpoints were lower in PCI-treated patients: OR 0.37 (95% CI 0.36-0.39) for in-hospital mortality; HR 0.37 (95% CI 0.36-0.38) for 1-year mortality; HR 0.74 (95% CI 0.71-0.77) for 1-year re-hospitalization for AHF/AMI. Similar results were found in STEMI and NSTEMI patients considered separately. Our real-world data showed that in patients with AMI ≥ 75 years of age, PCI use is associated with lower in-hospital and 1-year mortality.

Intraprocedural Residual Mitral Regurgitation and Survival After Transcatheter Edge-to-Edge Repair: Prospective German Multicenter Registry (MITRA-PRO)

BackgroundResidual mitral regurgitation (MR) is thought to be an important predictor of long-term survival following transcatheter edge-to-edge repair (TEER). Intraprocedural MR assessment using transesophageal echocardiography could be limited by image quality, hemodynamics, and patient sedation. The MitraScore is a validated multimodal approach for intraprocedural MR assessment during TEER. ObjectivesThis study aimed to assess the impact of residual MR using the MitraScore on 1-year mortality. MethodsPatients undergoing mitral TEER were eligible for inclusion in the prospective, multicenter MITRA-PRO registry (A Prospective Registry Study on 1-Year Mortality and the Prognostic Significance of MitraScore After MitraClip Implantation in Patients With Mitral Regurgitation). Patients with a MitraScore ≤3 were defined as patients with mild residual MR after mitral TEER, whereas a MitraScore ≥4 was considered as relevant residual MR. Mortality, rehospitalization, and major adverse events were assessed 1 year after TEER. ResultsA MitraScore ≤3 was found in 1,059 patients (71.0%), whereas 432 patients revealed a MitraScore ≥4 (29.0%). One-year mortality was significantly lower in patients with nonrelevant residual MR (MitraScore ≤3 14.6% vs MitraScore≥4 22.1%). An almost linear relationship between intraprocedural MitraScore after TEER and mortality was observed. The combined clinical endpoint of mortality and rehospitalization within the 1-year follow-up was also significantly lower in the MitraScore ≤3 group (31.5%) than in the MitraScore ≥4 group (40.8%). A subgroup analysis confirmed the predictive value of the MitraScore in patients with primary, secondary, or mixed MR etiologies. ConclusionsResidual MR assessed by intraprocedural MitraScore after TEER predicts 1-year mortality and rehospitalization. Therefore, the multimodal MitraScore improves MR assessment during mitral TEER and might improve patient survival.(A Prospective Registry Study on 1-Year Mortality and the Prognostic Significance of MitraScore After MitraClip Implantation in Patients With Mitral Regurgitation [MITRA-PRO]; DRKS00012288)

Abstract P327: Device-Measured Sedentary Behavior and Risk of 1-Year Hospital Readmission After Suspected Acute Coronary Syndrome

Background: Patients hospitalized with acute coronary syndrome (ACS) have an increased risk of a readmission during the first year after discharge; necessitating a need to identify modifiable therapeutic targets to improve outcomes. While moderate to vigorous physical activity (MVPA) has been a hallmark of secondary prevention efforts to prevent hospital readmission, sedentary behavior (SB) has emerged as a potentially unique and clinically important aspect of the physical activity profile. Yet, little is known regarding whether SB is associated with hospital readmission in ACS patients independent from or in addition to MVPA levels. Purpose: To examine the association between device-measured SB and risk of 1-year hospital readmission among patients evaluated for ACS, independent of MVPA. Methods: Patients (n=603, 47.8% female, 62.5±13.0 yrs) evaluated in the emergency department for ACS were fitted with a GENEActiv accelerometer in-hospital and were instructed to wear the device on their non-dominant wrist continuously in-hospital and for 30 days post-discharge. Hospital readmissions were ascertained by proactively searching medical records for any possible hospitalizations and by contacting participants or their closest contacts at 1- and 12-months follow-up; with supporting documentation secured from hospital medical records. Results: Over 1-year follow-up, 281 (46.6%) patients were readmitted. SB was associated with increased risk of 1-year hospital readmission after adjusting for socio-demographic factors, comorbidities, and disease severity indicators [HR per 1-hour per day increase in SB= 1.09, 95% CI: 1.01, 1.18]. The association remained significant after further adjusting for MVPA [HR per 1-hour per day increase in SB= 1.11, 95% CI: 1.02, 1.22]. In joint association analyses, high sedentary time in combination with low MVPA was associated with the greatest risk of 1-year hospital readmission in a fully adjusted model (HR: 2.18; 95%: CI: 1.44, 3.31) compared to the referent group (low SB/high MVPA). However, even among participants with higher levels of MVPA; high sedentary time was associated with a greater risk of 1-year re-hospitalization (HR: 1.54; 95% CI: 1.05, 2.27). For participants with low MVPA and low sedentary time, no significant association was observed (HR: 1.37; 95% CI: 0.84, 2.21). Conclusions: SB was associated with an increased risk of 1-year hospital readmission among patients evaluated for ACS. This increased risk was independent of MVPA and was not eliminated by high levels of MVPA. Implications of this study suggest that reducing SB should be considered as a modifiable therapeutic target in addition to MVPA to improve outcomes in ACS survivors.

Determinants of 1-Year Adverse Event Requiring Re-Hospitalization in COVID-19 Oldest Old Survivors.

The incidence of "Long COVID" syndrome appears to be increasing, particularly in the geriatric population. At present, there are few data regarding the relationship between long COVID and the risk of re-hospitalization in the oldest old survivors. Patients older than 80 years consecutively hospitalized for COVID-19 in our tertiary care hospital were enrolled and followed after discharge in a 12-month ambulatory program. A comprehensive geriatric assessment (CGA), including functional capabilities and physical and cognitive performances, was performed at 6-month follow-up. Frailty degree was assessed using a 30-item frailty index. The re-hospitalization rate was assessed at 12-month follow-up through a computerized archive and phone interviews. Out of 100 patients discharged after hospitalization for COVID-19 (mean [SD] age 85 [4.0] years), 24 reported serious adverse events requiring re-hospitalization within 12 months. The most frequent causes of re-hospitalization were acute heart failure (HF), pneumonia and bone fracture (15.3% each). By multivariate logistic analysis, after adjustment for potential confounders, history of chronic HF [aOR: 3.00 (CI 95%: 1.10-8.16), p = 0.031] or chronic renal failure [aOR: 3.83 (CI 95%: 1.09-13.43), p = 0.036], the burden of comorbidity [(CIRSc) aOR: 1.95 (CI 95%: 1.28-2.97), p = 0.002] and frailty [aOR: 7.77 (CI 95%: 2.13-28.27), p = 0.002] resulted as independent predictors of re-hospitalization. One-fourth of the oldest old patients previously hospitalized for COVID-19 suffered from adverse events requiring re-hospitalization, two-thirds of them within three months after discharge. Frailty, the burden of comorbidity, history of chronic HF or chronic renal failure, but not COVID-19 disease severity, independently predicted re-hospitalization.

What Is the Impact of Liver Function to Predict Mortality in Patients with Severe Aortic Stenosis and Reduced Ejection Fraction?

Liver is one of the target organs in patients with symptomatic severe aortic stenosis and reduced ejection fraction. We aimed to evaluate the prognostic impact of liver function reserve as assessed by albumin-bilirubin score on 30-day and 1-year mortality and rehospitalization at 1 year in patients with severe symptomatic aortic stenosis and reduced ejection fraction undergoing transcatheter aortic valve implantation. The patients with severe symptomatic aortic stenosis and reduced ejection fraction who were hospitalized between 2013 and 2021 were included in this single-center retrospective study. Preoperative bilirubin and albumin levels were used for albumin-bilirubin score calculation as in the original report. The total primary outcomes were defined as 30-day and 1-year all-cause mortality and hospitalization for decompensated heart failure within 1 year. Two groups were generated based on albumin-bilirubin score scores: high (>-2.25) and low (≤-2.25) albumin-bilirubin score groups. A total of 77 patients (49 male) were included in the study. and 29 (37.7%) patients died within 1 year of follow-up with 17 corresponding to 30-day mortality. There was no difference between high and low albumin-bilirubin score groups in terms of length of hospital stay, postprocedural complications, and re-hospitalization within 1 year, while 30-day mortality (50.0% vs. 4.3%, P < 0.0001) and 1-year mortality (80.0% vs. 10.6%, P < 0.0001) were significantly higher in the high albumin-bilirubin score group. Hence, total primary outcomes (86.7% vs. 44.7%, P < 0.0001) were significantly higher in the high albumin-bilirubin score group. High albumin-bilirubin score (> -2.25) was found as an independent risk factor associated with 30-day and 1-year mortality and total primary outcomes. The results of this study suggest that preprocedural assessment of the albumin-bilirubin score gives additional information to stratify of patients with severe symptomatic aortic stenosis with reduced ejection fraction.

Blood volume and chronic kidney disease in heart failure - Can volume expansion help balance the Cardio-Renal Axis for better clinical outcomes?

Intravascular volume is largely regulated by the kidneys but how differences in intravascular volume profiles interact with chronic kidney disease (CKD) to influence outcomes in chronic heart failure (HF) has not been explored. Our hypothesis was that a greater degree of volume expansion (VE) would moderate the impact of CKD on HF-related clinical outcomes. Quantitative blood volume (BV) data were available in 137 patients at the time of hospital discharge using a nuclear medicine radiolabeled albumin indicator-dilution technique. The study patients were stratified by the cohort median glomerular filtration rate (GFR, 44 ml/min/1.73 m2 ). An a priori cut-point of ≥+25% above normal BV was then used to further stratify the two GFR subgroups and prospectively analyzed for 1-year HF-related mortality or 1st re-hospitalization. Persistent BV expansions ≥+25% were present in 51% of the cohort. In the subgroup with GFR above the median (N=68) greater or lesser BV expansion from +25% did not differentiate outcomes. However, in the subgroup with GFR below the median (N=69), BV expansion-stratified risk (log-rank p=0.022) with <+25% VE associated with poorer outcomes, while VE ≥ + 25% was associated with lower risk and comparable to GFR above the median. In patients with chronic HF, significant intravascular VE and CKD are common co-existing conditions. The presence of larger VE, however, appears to be a factor mitigating the impact of declining renal function on clinical outcomes, and as an element of volume pathophysiology warrants further study.

The effect of SGLT-2i administration on red blood cell distribution width in patients with heart failure and type 2 diabetes mellitus: A randomized study.

BackgroundRecent studies suggest that the pivotal mechanism of sodium glucose co-transporter-2 inhibitors (SGLT-2i) favorable action in patients with heart failure (HF) and type 2 diabetes mellitus (DM) is the stimulation of erythropoiesis via an early increase in erythropoietin (EPO) production which leads to hematocrit rise. Red blood cell distribution width (RDW) is a simple hematological parameter which reflects the heterogeneity of the red blood cell size (anisocytosis). Since, EPO has been also implicated in the pathophysiology of RDW increase, the current mechanistic study examined the effect of SGLT-2i administration on red blood cells size (RDW) in patients with HF and DM.MethodsThe present was a prospective single-center study. Patients (N=110) were randomly assigned to dapagliflozin (10 mg a day on top of antidiabetic treatment) or the control group. Inclusion criteria were: (a) age > 18 years, (b) history of type 2 DM and hospitalization for HF exacerbation within 6 months. The evaluation of patients (at baseline, 6 and 12 months) included clinical assessment, laboratory blood tests, and echocardiography. Data were modeled using mixed linear models with dependent variable the RDW index. In order to find factors independently associated with prognosis (1-year death or HF rehospitalization), multiple logistic regression was conducted with death or HF rehospitalization as dependent variable.ResultsAn RDW increase both after 6 and after 12 months was observed in the SGLT-2i (dapagliflozin) group (p < 0.001 for all time comparisons), whereas RDW didn't change significantly in the control group. The increase in RDW was positively correlated with EPO, while negatively correlated with ferritin and folic acid (p < 0.005 for all). Baseline RDW was significantly associated with 1-year death or rehospitalization, after adjusting for group (SGLT-2i vs. control), age, gender, smoking and BMI at baseline.ConclusionRDW increased with time in patients with HF and DM who received SGLT-2i (dapagliflozin). The increased RDW rates in these patients may stem from the induction of hemopoiesis from dapagliflozin. Baseline RDW was found to be independently associated with outcome in patients with HF and DM.

Already low drug dose antagonism of the renin-angiotensin aldosterone system decreases 1-year mortality and rehospitalization in old heart failure patients

AimsHospitalization for heart failure treatment (HHF) is an incisive event in the course of HF. Today, the large majority of HHF patients is ≥ 65 years and discharge HF drugs are most often not applied at dose levels acknowledged to provide prognostic benefit. This study therefore aims to investigate the treatment effect size of discharge HF drugs in old HHF patients. MethodsDrugs are analyzed according to pharmacological class. Individual discharge HF drug dose is reported as percentage of guidelines-recommended target dose. Primary endpoint was 1-year all-cause mortality (ACM) after discharge; the secondary endpoint combined 1-year ACM and first cardiovascular hospitalization within 1 year after discharge. Comparison between 65–80 years and > 80 years old study participants tested the relative treatment effect size as a function of respective age group. ResultsThe 875 consecutive HHF patients had a median age of 82 years [76–87 years]; 48.6 % were females. Betablocker and diuretic treatment did not change the incidence of endpoints. Inhibition of the renin-angiotensin system (RASi), when compared to no treatment, decreased the incidence of endpoints both at the 1–25 % and the > 25 % target dose level. Antagonists of the mineralocorticoid receptor (MRA), when compared to no treatment, decreased the secondary endpoint at the 1–25 % target dose level but not at the > 25 % target dose level. The relative treatment effect size of RASi or MRA corresponded between the age strata for both endpoints. ConclusionLow-dose RASi and MRA had beneficial effects in these old HHF patients.

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients With Three Vessel Coronary Artery Disease: A Comparison of Centers in the Same Jurisdiction With Differing Multidisciplinary Heart Team Approaches.

Referral patterns and outcomes of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were compared between 2 centers within 1 jurisdiction wherein only 1 center utilizes multidisciplinary review for all patients. Management of advanced coronary artery disease often involves PCI and CABG for improvements in quality of life and survival. Indications exist for PCI and CABG, with CABG demonstrating benefit in three-vessel disease (TVD). A total of 27,961 patients underwent cardiac catheterization in 2 centers within the same single-payer health jurisdiction (Center A and B) from 2017 to 2018. Rates of PCI, CABG, and outcomes of 1-year mortality, rehospitalization, myocardial infarction, and stroke were compared. More patients in Center A received PCI and less received CABG compared with Center B even among patients with TVD ( P <0.001). Multivariable logistic regression identified Center B as protective for mortality for TVD patients ( P <0.001) and those undergoing PCI ( P =0.004), but not CABG ( P =0.06). Center A's 1-year mortality was increased for all patients ( P =0.004) and those with TVD ( P =0.011). Discordant outcomes exist between these 2 centers. While patients in Center A were more likely to undergo PCI than Center B and experienced decreased 1-year survival, the difference was not significant for CABG. In part, the differences are attributable to contrasting referral practices and the discrepant rates of PCI and CABG between centers. Review of all coronary artery disease patients with a multidisciplinary Heart Team including a surgical opinion may lead to a more evidence-based referral practice aligned with current clinical guidelines.

Patient profiles on outcomes in patients hospitalized for heart failure: a 10-year history of the Malaysian population.

AimsHeart failure (HF) affects an estimated 38 million people worldwide and is the leading cause of hospitalization among adults and the elderly. Evidence suggests that there may be regional and ethnic differences in the prevalence, outcomes and management of HF. The aim of this study was to understand the disease burden and treatment patterns of patients hospitalized for HF in multi‐ethnic Malaysia.Methods and resultsA retrospective, non‐interventional study was conducted utilizing 10 years of medical records from the National Heart Institute Malaysia (IJN) from 1 January 2009 to 31 December 2018. Of the 4739 patients in the IJN database, 3923 were eligible and were included in this analysis. The study recorded a high male prevalence (72.3%) with a mean age of 62.0 (±13.26) years. The 30‐day and 1‐year rehospitalization rate was 6.8% and 24.7%, respectively. In‐hospital mortality was 7.2% with 27.0% due to cardiovascular causes and 14.2% non‐cardiovascular causes. The 30‐day and 1‐year rehospitalization rates were significantly higher in patients with lower systolic blood pressure (SBP, P < 0.001 and P = 0.002), diastolic blood pressure (DBP, P < 0.001 and P = 0.017), sodium (P < 0.001 and P = 0.029) and estimated glomerular filtration rate (eGFR, P < 0.001 and P = 0.002) and higher urea (P < 0.001 for both), serum creatinine (P < 0.001 and P = 0.003), and uric acid (P < 0.001 for both), respectively. Risk of hospitalization within 1 year varied significantly by ethnicity and was relatively higher in Indian (28.3%), followed by Malay (24.4%) and Chinese (21.9%; P = 0.008). In‐hospital mortality within 1‐year post‐index date was higher in patients with lower weight (P = 0.002), body mass index (P = 0.009), SBP (P < 0.001), DBP (P < 0.001), sodium (P < 0.001), eGFR (P < 0.001) and higher heart rate (P = 0.039), urea (P < 0.001), serum potassium (P = 0.038), serum creatinine (P < 0.001), and uric acid (P < 0.001). In‐hospital mortality within 1‐year post‐index date was also higher in patients with severe or end‐stage chronic kidney disease (CKD) compared with mild/moderate CKD (P < 0.001) and in patients with HF with reduced ejection fraction (HFrEF) compared with those with mid‐range or preserved ejection fraction (P < 0.001). The most commonly prescribed HF medications at discharge were loop diuretics (89.2%), β‐blockers (68.5%), mineralocorticoid receptor antagonists (56.2%), angiotensin‐converting enzyme inhibitors (31.5%), and angiotensin receptor blockers (20.8%).ConclusionsThis study provides a greater understanding of the characteristics, treatment patterns, and outcome of hospitalized HF patients in a leading referral centre in Malaysia and will aid the implementation of meaningful interventions to improve patient outcome for HF patients.

Innovative medical technologies in the percutaneous treatment of tricuspid regurgitation in Poland.

Tricuspid regurgitation (TR) usually develops secondarily to left-sided heart diseases, whereas primary lesions to the valve apparatus is less common. Untreated severe TR has a poor prognosis and surgical treatment, i.e., valve repair or replacement, is the only treatment option with class I recommendation. However, cardiac surgical procedures may be associated with a high risk of complications. Recent advances in percutaneous approaches to managing structural heart diseases, especially mitral valve diseases, have enabled the implementation of this therapeutic strategy in the population of patients with TR. This paper presents data on the clinical efficacy, cost-effectiveness and expected population size for one of these procedures, namely the TriClip TTVr System procedure. Its efficacy was assessed in the TRILUMINATE study involving 85 patients with co-morbidities and at high surgical risk. After 1 year of follow-up, the reduction in the TR grade was reported in 71% of patients. Clinical improvement in New York Heart Association functional class, a 6-minute walk test, and the quality of life were also observed. A published analysis comparing percutaneous treatment modalities with a drug therapy based on data from medical registers was utilized, and propensity score matching was also employed. Percutaneous treatment reduced 1-year mortality and rehospitalization risk. The economic analysis showed the use of TriClip TTVr System is cost-effective: the cost of an additional quality-adjusted life year ranged from approximately PLN 85,000 to PLN 100,000, which is below the official threshold in Poland. The potential annual number of candidates for this treatment modality in Poland is estimated at 265.

The Association of Nutritional Risk Screening 2002 With 1-Year Re-hospitalization and the Length of Initial Hospital Stay in Patients With Heart Failure.

Backgrounds and AimsNutritional Risk Screening 2002 (NRS-2002) has been widely recommended for identifying the nutritional risk. However, the association between NRS-2002 and the prognosis of heart failure has not been fully addressed. This study aimed to explore the association of NRS-2002 with 1-year re-hospitalization and the length of initial hospital stay in heart failure patients.MethodsThis retrospective study included 2,830 heart failure patients. The primary endpoint was 1-year re-hospitalization for heart failure. The secondary endpoint was the length of initial hospital stay. The Log-binomial regression analysis was performed to determine the association between NRS-2002 and re-hospitalization. The Cox regression model was fitted to estimate hazard of discharge. The cumulative incidence curves of discharge were plotted using Kaplan–Meier method and log-rank test was performed. Exploratory analysis was also conducted according to the classification of heart failure and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) fold-elevation.ResultsAmong 2,830 heart failure patients, the mean age was 64.3 years and 66.4% were male. A total of 122 (4.3%) patients were considered at high nutritional risk. Log-binomial regression analysis demonstrated that higher NRS-2002 score was an independent risk factor of re-hospitalization ([1 vs. 0]: relative risks [RR] = 1.383, 95% CI = 1.152 to 1.660; [2 vs. 0]: RR = 1.425, 95% CI = 1.108 to 1.832; [3–7 vs. 0]: RR = 1.770, 95% CI = 1.310 to 2.393). Kaplan–Meier curve showed that the cumulative incidence of discharge was lower in high nutritional risk group (Log rank p < 0.001). Cox regression analysis also found that higher NRS-2002 score (2 or ≥3) was strongly associated with longer length of initial hospital stay ([2 vs. 0]: Hazard ratios [HR] = 0.854, 95% CI = 0.748 to 0.976; [3–7 vs. 0]: HR = 0.609, 95% CI = 0.503 to 0.737). Exploratory analysis showed that such association still remained irrespective of NT-proBNP fold-elevation, but only existed in patients with heart failure with preserved ejection fraction (HFpEF).ConclusionIn patients with heart failure, high NRS-2002 score was strongly and independently associated with the incidence of 1-year re-hospitalization and the length of initial hospital stay.