Acute Decompensated Heart Failure Patients Research Articles

Prognostic impact of plasma volume status during hospital admission in patients with acute decompensated heart failure.

Plasma volume status (PVS), a measure of plasma volume, has been evaluated as a prognostic marker for chronic heart failure. Although the prognostic value of PVS has been reported, its significance in patients with acute decompensated heart failure (ADHF) admitted to the cardiovascular intensive care unit (CICU) remains unclear. In this study, we examined the relationship between PVS and long-term mortality in patients with ADHF admitted to the CICU. Between January 2018 and December 2020, 363 consecutive patients with ADHF were admitted to the Nippon Medical School Hospital CICU. Of the 363 patients, 206 (mean age, 74.9±12.9years; men, 64.6%) were enrolled in this study. Patients who received red blood cell transfusions, underwent dialysis, were discharged from the CICU or died in the hospital were excluded from the study. We measured the PVS of the patients at admission, transfer to the general ward (GW) and discharge using the Kaplan-Hakim formula. The patients were assigned to four groups according to the quartiles of their PVS measured at each of the three abovementioned timepoints. We examined the association between PVS and all-cause mortality during the observation period (1134days). The primary endpoint of this study was all-cause mortality. The Kaplan-Meier analysis showed that the high PVS group had a significantly higher mortality rate at admission, transfer to the GW and discharge than the other groups (log-rank test: P=0.016, P=0.005 and P<0.001, respectively). Univariate Cox regression analysis showed that age, body mass index, history of heart failure, use of beta-blockers, albumin level, blood urea nitrogen level, N-terminal pro-brain natriuretic peptide level and left ventricular ejection fraction were significantly different among the PVS groups and thus were not significant prognostic factors for ADHF. Furthermore, the multivariate analysis revealed that PVS at discharge [hazard ratio (HR)=1.06 (1.00-1.12), P=0.048] was an independent poor prognostic factor for ADHF. This study highlights the effect of PVS measured at different timepoints on the prognoses of ADHF patients. Regular assessment of PVS, particularly at discharge, is crucial for optimising patient management and achieving favourable outcomes in cases of ADHF.

Sex and Age Differences in Atypical Chief Complaints for Acute Decompensated Heart Failure in Emergency Department Visits.

Around one million United States emergency department (ED) visits annually are due to acute decompensated heart failure (ADHF) symptoms. Characterizing ED symptom presentation of ADHF patients may improve clinical care, yet sex and age differences in ED chief complaints have not been thoroughly investigated. This paper aims to describe differences in chief complaints and comorbid conditions for ED patients with a ADHF diagnosis, stratified by sex and age. Retrospective analysis of adults presenting to North Carolina EDs in NC DETECT, a statewide syndromic surveillance system, between 2010 and 2016 with a diagnosis of ADHF. Frequencies of chief complaint categories for ED visits and comorbid conditions, stratified by sex and age, were evaluated and standardized differences computed. Top chief complaints were dyspnea (19.1%), chest pain (13.5%), and other respiratory complaints (13.4%). In the 18-44 age group, females when compared to males reported more nausea/vomiting (6.7% versus 4.1%) and headache (4.2% versus 2.0%). In those 45-64 and 65+ years old, complaints were similar by sex. When stratified by age group alone, the 18-44 and 45-64 age groups had more complaints of chest pain, whereas balance issues, weakness, and confusion were more common in the 65+ age group. Sex and age differences in atypical ADHF symptoms were seen in in ED patients with ADHF. Characterizing variation of ADHF symptoms in ED patients can inform the identification of ED patients with ADHF and the management of ADHF-related symptoms.

Establishment of in-hospital nutrition support program for middle-aged and elderly patients with acute decompendated heart failure

ObjectiveTo construct a nutrition support program for middle-aged and elderly patients with acute decompensated heart failure (ADHF) during hospitalization.MethodsBased on the JBI Evidence-Based Health Care Model as the theoretical framework, the best evidence was extracted through literature analysis and a preliminary nutrition support plan for middle-aged and elderly ADHF patients during hospitalization was formed. Two rounds of expert opinion consultation were conducted using the Delphi method. The indicators were modified, supplemented and reduced according to the expert’s scoring and feedback, and the expert scoring was calculated.ResultsThe response rates of the experts in the two rounds of consultation were 86.7% and 100%, respectively, and the coefficient of variation (CV) for each round was between 0.00% and 29.67% (all < 0.25). In the first round of expert consultation, 4 items were modified, 3 items were deleted, and 3 items were added. In the second round of the expert consultation, one item was deleted and one item was modified. Through two rounds of expert consultation, expert consensus was reached and a nutrition support plan for ADHF patients was finally formed, including 4 first-level indicators, 7 s-level indicators, and 24 third-level indicators.ConclusionThe nutrition support program constructed in this study for middle-aged and elderly ADHF patients during hospitalization is authoritative, scientific and practical, and provides a theoretical basis for clinical development of nutrition support program for middle-aged and elderly ADHF patients during hospitalization.

EARLY USE OF SACUBITRIL/VALSARTAN FOLLOWING ACUTE DECOMPENSATED HEART FAILURE WITH REDUCED EJECTION FRACTION: FEASIBILITY AND UNVEILING FACTORS

Abstract Introduction Sacubitril/Valsartan plays a pivotal role in treating heart failure with reduced ejection fraction (HFrEF), reducing cardiovascular mortality and hospitalizations. Despite its effectiveness, real-world data indicate persistent underprescription due to management complexity, modest tolerability, therapeutic inertia and regulatory constraints. The TRANSITION study in acute decompensated heart failure (ADHF) demonstrated the feasibility of initiating Sacubitril/Valsartan in hospitalized patients with HFrEF. Our study aims to establish the safety and tolerability of early Sacubitril/Valsartan prescription during ADHF hospitalization and investigate reasons of its underprescription. We present preliminary data from 20 consecutive ADHF patients admitted to our department between August and October 2023. Methods We collected data from patients with HFrEF diagnosis according to current guidelines. Patient data were documented during hospitalizations, and therapeutic regimens at admission were compared with those at discharge. We also reported systolic arterial pressure, creatinine levels, glomerular filtration rate and kaliemia values. Results Patients had a mean age of 75±12.8, and 80% were men. The mean ejection fraction was 30.7% ± 5.6. BMI was 26.9±4.3, and 40% of the patients had diabetes. The mean hospital stay was 5.4 ± 4.1 days. The utilization of Sacubitril/Valsartan at admission was 25% up to 75% at discharge (p = 0.001). Concurrently, beta-blocker usage increased from 55% to 90% (p = 0.013), SGLT2 inhibitors from 55% to 75% (p = 0.001), and MRAs from 30% to 80% (p = 0.001). Systolic arterial pressure decreased not significantly (p = 0.189) as well as the glomerular filtration rate (p = 0.51). Kaliemia remained stable from 4.09±0.45 mEq/l to 4.14±0.45 mEq/l (p = 0.72). The prescribed dosage of Sacubitril/Valsartan was 50 mg bid in 80% of patients, 100 mg bid in 13,3% and 200 mg in 6,6%. Among patients who didn’t receive Sacubitril/Valsartan, four patients had an absolute contraindication represented by a GFR &amp;lt; 30 ml/min and one patient didn’t receive the drug due to an episode of cardiogenic shock. Discussion Our analysis highlights the underutilization of ARNi in HFrEF and the feasibility of early Sacubitril/Valsartan use in ADHF. The optimization of the therapy during hospitalization had no significant impact on key parameters. Advanced renal dysfunction represents the major limitation of Sacubitril/Valsartan prescription.

Acute heart failure in patients with valvular infective endocarditis: a one-year consecutive cohort from a Spanish tertiary centre

Abstract Funding Acknowledgements None. Background Infective endocarditis (IE) is associated with substantial morbidity and mortality. Acute decompensated heart failure (AHF) is a frequent complication of IE and it is often an indication for urgent cardiac surgery. Purpose The aim of this study was to describe clinical data and short term outcomes of patients admitted for valvular IE complicated with AHF. Methods We collected data from all the patients with IE admitted or referred to our Spanish tertiary centre from September 1st, 2022 to August 31st, 2023. Patients with non-valvular IE were not included. Results Two patients did not consent to participate in the study. 87 consenting patients were included. Of them, 38 (44%) presented with AHF, of whom 14 (16.1%) had acute pulmonary oedema, and 6 (6.9%) suffered cardiogenic shock. Mean age was 67.4 years old in the AHF group vs 64.0 in patients without AHF (non significant), 74% of male sex in both groups, Charlson Comorbidity Index of 4.9 vs 5.6 points (n.s.); prosthetic-valve endocarditis was more frequent in the AHF group compared to patients without AHF (42% vs 28%, p &amp;lt; 0.05). Urgent cardiac surgery was indicated in 91% of patients with AHF vs 44% of patients without heart failure (p &amp;lt; 0.01); when indicated, surgery was eventually performed in 65% vs 57% of the patients (n.s.). In AHF patients with surgical indication, in-hospital mortality rate was significantly higher in those that did not undergo surgery (64% vs 16%, p &amp;lt; 0.01). Compared to native-valve IE, prosthetic-valve IE was associated with higher rates of AHF (42% vs 28%, p &amp;lt; 0.05). In-hospital mortality rate was significantly higher in AHF patients (33.3% vs 3.0%, p &amp;lt; 0.01). Acute pulmonary oedema and cardiogenic shock patients had the highest in-hospital mortality (respectively, 43% and 67%). Similarly, mortality rate 30 days after hospital discharge was higher in the AHF group (16.0% vs 6.3%, p &amp;lt; 0.05). Conclusions In this population, presentation with AHF was associated with worse short-term outcomes. Surgery was indicated in the majority of AHF patients, and not performing it was associated with worse outcome.

Low irisin levels predict acutely decompensated heart failure in type 2 diabetes mellitus patients

Abstract Funding Acknowledgements None. Background Acutely decompensated heart failure (ADHF) continues to be associated with unacceptably increasing in-hospital mortality rates and one-year mortality rates. Distinct scenarios of the natural course of ADHF relate to clinical heterogeneity among patients admitted to hospitals, cardiac dysfunction etiology, precipitating factors contributing to heart failure (HF) decompensation including type 2 diabetes mellitus (T2DM). The aim of this study was to determine the discriminative value of irisin for ADHF in T2DM patients with hemodynamically stable chronic HF. Methods A total of 738 patients with T2DM were prescreened using the local database of "Vita Center" (Ukraine). Using criteria of inclusion (male/female with age of ≥18 years, established T2DM with hemodynamically stable chronic HF, glycosylated hemoglobin &amp;lt; 6.9%, informed consent to participate in the study), we enrolled 489 patients with T2DM with concomitant chronic HF I-IV New York Heart Association (NYHA) functional classes. We enrolled 480 T2DM patients with any phenotype of HF and followed them for 52 weeks. Hemodynamic performances and the serum levels of biomarkers were detected at the study entry. The primary clinical end-point was ADHF that led to urgent hospitalization. Results We found that the serum levels of N-terminal natriuretic pro-peptide (NT-proBNP) were higher (1719 [980-2457] pmol/mL vs. 1057 [570-2607] pmol/mL, respectively) and the levels of irisin were lower (4.96 [3.14-6.85] ng/mL vs. 7.95 [5.73-9.16] ng/mL) in ADHF patients than in those without ADHF. The ROC curve analysis showed that the estimated cut-off point for serum irisin levels (ADHF versus non-ADHF) was 7.85 ng/mL (area under curve [AUC] = 0.869 (95% CI = 0.800-0.937), sensitivity = 82.7%, specificity = 73.5%; p = 0.0001). The multivariate logistic regression yielded that the serum levels of irisin &amp;lt; 7.85 ng/mL (OR = 1.20; p = 0.001) and NT-proBNP &amp;gt; 1215 pmol/mL (OR = 1.18; p = 0.001) retained the predictors for ADHF. Kaplan-Meier plots (Figure) showed a significant difference of clinical end-point accumulations in patients with HF depending on irisin levels (&amp;lt;7.85 ng/mL versus ≥7.85 ng/mL). The intra-class correlation coefficient for inter-observer reproducibility of LV dimensions was 0.88 (95% CI = 0.83–0.92), of LVEF was 0.93 (95% CI = 0.90–0.97), of LAVI was 0.92 (95% CI = 0.89–0.94), and of E/e’ was 0.90 (95% CI = 0.87–0.94). Along with it, the intra-class correlation coefficient for the intra-observer reproducibility of LV dimensions was 0.91 (95% CI = 0.88–0.95), of LVEF was 0.94 (95% CI = 0.90–0.98), of LAVI was 0.95 (95% CI = 0.93–0.97), and of E/e’ was 0.92 (95% CI = 0.90–0.95). In conclusion, we established that decreased levels of irisin were associated with ADHF presentation in chronic HF patients with T2DM independently from NT-proBNP.Flow chart of the study designThe Kaplan–Meier analysis of ADHF

Validation of a New Scoring Method to Assess the Efficacy of Rapid Initiation and Titration of Combination Pharmacotherapy for Patients Hospitalized with Acute Decompensated Heart Failure with Reduced and Mildly Reduced Ejection Fraction.

Background: Despite the encouragement of early initiation and titration of guideline-directed medical therapy (GDMT) for the treatment of heart failure (HF), most patients do not receive an adequate type and dose of pharmacotherapy in the real world. Objectives: This study aimed to determine the efficacy of titrating composite GDMT in patients with HF with reduced and mildly reduced ejection fraction and to identify patient conditions that may benefit from titration of GDMT. Methods: This was a two-center, retrospective study of consecutive patients hospitalized with acute decompensated heart failure (ADHF). Patients were classified into two groups according to a scoring scale determined by combination and doses of four types of HF agents (ACEis/ARBs/ARNis, BBs, MRAs, and SGLT2is) at discharge. A score of 5 or greater was defined as titrated GDMT, and a score of 4 or less was regarded as sub-optimal medical therapy (MT). Results: A total of 979 ADHF patients were screened. After 553 patients were excluded based on exclusion criteria, 426 patients (90 patients in the titrated GDMT group and 336 patients in the sub-optimal MT group) were enrolled for the analysis. The median follow-up period was 612 (453-798) days. Following statistical adjustment using the propensity score weighting method, the 2-year composite endpoint (composite of cardiac death and HF rehospitalization) rate was significantly lower in the titrated GDMT group, at 19%, compared with the sub-optimal MT group: 31% (score 3-4 points) and 43% (score 0-2 points). Subgroup analysis indicated a marked benefit of titrated GDMT in particular patient subgroups: age < 80 years, BMI 19.0-24.9, eGFR > 20 mL/min/1.73 m2, and serum potassium level ≤ 5.5 mmol/L. Conclusions: Prompt initiation and dose adjustment of multiple HF medications, with careful monitoring of the patient's physiologic and laboratory values, is a prerequisite for improving the prognosis of patients with heart failure.

Clinical efficacy of tolvaptan in acute decompensated heart failure patients with severe aortic stenosis and atrial fibrillation: a sub-analysis from the LOHAS registry.

Severe aortic valve stenosis (AS) and atrial fibrillation (AF) are risk factors of hemodynamic instability in heart failure (HF) management due to low cardiac output, respectively. Therefore, the treatment of HF due to severe AS complicated with AF is anticipated to be difficult. Tolvaptan, a vasopressin V2 receptor inhibitor, is effective in controlling acute decompensated heart failure (ADHF) with hemodynamic stability. However, its clinical efficacy against ADHF caused by AS with AF remains to be determined. Clinical information (from September 2014 to December 2017) of 59 patients diagnosed with ADHF due to severe AS (20 patients with AF; 39 patients with sinus rhythm [SR]) was obtained from the LOHAS registry. The registry collected data from seven hospitals and assessed the short-term effects of tolvaptan in patients hospitalized for ADHF with severe AS. We attempted to identify clinical differences from baseline up to 4days, comparing patients with AF (AF group) versus those with SR (SR group). There were no significant differences between the groups in age (83.7 ± 4.5 vs. 85.8 ± 6.9years, respectively; p = 0.11) and aortic valve area (0.60 [0.46-0.73] vs. 0.56 [0.37-0.70] cm2, respectively; p = 0.50). However, left atrial volume was larger (104 [85-126] vs. 87 [64-103] mL, respectively; p < 0.01), whereas stroke volume was lower (51.6 ± 14.8 vs. 59.0 ± 18.7mL, respectively; p = 0.08) in the AF group versus the SR group. Body weight decreased daily from baseline up to day 4 in both groups (from 55.4 to 53.2kg [p < 0.01] and from 53.5 to 51.0kg [p < 0.01], respectively) without change in heart rate. Notably, the systolic blood pressure decreased slightly in the AF group after 2days of treatment with tolvaptan. Short-term treatment with tolvaptan improved HF in patients hospitalized for severe AS, regardless of the presence of AF or SR. After achieving sufficient diuresis, a slight decrease in blood pressure was observed in the AF group, suggesting an appropriate timeframe for safe and effective use of tolvaptan.

Clinical Outcomes in Acute Decompensated Heart Failure Patients with Reduced Ejection Fraction and Impaired Renal Function–A Study Comparing Levosimendan and Dobutamine

Background: Cardiorenal syndrome is a disorder in which renal function is affected by heart failure (HF) or vice versa. It occurs in 20% of HF patients. The most common reason for hospitalization is acute decompensation (ADHF). Diuretics and inodilators are the standard of treatment in the management. Our objective was to demonstrate that levosimendan is more effective than dobutamine in improving the outcome of ADHF patients with a low ejection fraction (EF) and impaired kidney function. Material and methods: The study was carried out between January to December 2022. Patients with ADHF, a low EF (&lt;40%) on echocardiography, and decreased renal function (estimated glomerular filtration rate [eGFR] &gt;15 and &lt;60 mL/min/m 2 ) were included. All patients have given consent. The study was approved by the institutional ethical committee. The estimated study sample size was 18 in each group, and as the study continued, we enrolled 60 patients, who were divided into two equal groups (30 in each). The patients were assigned either levosimendan or dobutamine based on preassigned numbers in the software. The clinical characteristics (serum creatinine, eGFR, EF, cardiac output, and cardiac index) were measured on the first, seventh, and at one month (30 days). Results: Of the 60 patients, 40 were men and 20 were women. The mean age was (50 ± 8.9 vs 50.8 ± 11.2) years. Of the comorbidities, hypertension was seen in 83.3% followed by diabetes (56.7%). Serum creatinine levels in both groups at admission and 30 days were (2.2 ± 0.3 vs. 2.5 ± 0.7, P = 0.1) and (1.6 ± 0.4 vs. 2.4 ± 0.8, P = 0.05). The eGFR of both groups at admission and 30 days follow up was (32.6 ± 9.1 vs. 28.2 ± 11.4, P = 0.2) and (40 ± 15.5 vs. 29.4 ± 12.6, P = 0.05). At 30 days, the predetermined outcomes in terms of improvement in EF, cardiac output, improved eGFR and cardiac index were better in the levosimendan compared to dobutamine group significantly. Conclusion: In ADHF patients with decreased EF and poor renal function, levosimendan improved renal and cardiac indices more than dobutamine at 30 days of follow up.

Predictive value of the prognostic nutritional index combined with serum chloride levels for the prognosis of patients with acute decompensated heart failure.

The prognostic nutritional index (PNI) and serum chloride level are related to adverse outcomes in patients with heart failure. However, little is known about the relationship between the PNI and serum chloride level in predicting the poor prognosis of patients with acute decompensated heart failure (ADHF). We reviewed 1221 consecutive patients with ADHF admitted to the First Affiliated Hospital of Kunming Medical University from January 2017 to October 2021. After excluding patients with in hospital death, missing follow-up data, missing chloride data, missing lymphocyte (LYM) count data, or missing serum albumin data, 805 patients were included. PNI was calculated using the formula: serum albumin (ALB) (g/L) + 5 × LYM count (10^9/L). Patients were divided into 4 groups according to the quartiles of the PNI, and the highest PNI quartile (PNI Q4: PNI ≥ 47.3) was set as the reference group. The patients in the lowest PNI quartile (PNI Q1: PNI < 40.8) had the lowest cumulative survival rate, and mortality risk decreased progressively through the quartiles (log-rank χ2 142.283, P < 0.0001). Patients with ADHF were divided into 8 groups by quartiles of PNI and median levels of serum chloride. After adjustment, the hazard ratio (HR) for all-cause mortality in ADHF patients in Group 1 was 8.7 times higher than that in the reference Group 8. Furthermore, the addition of serum chloride level and PNI quartile to the Cox model increased the area under the Receiver operating characteristic (ROC) curve by 0.05, and the area under the ROC curve of the new model was higher than that of the original model with traditional risk factors. Both the lowest PNI quartiles and low chloride level indicate a higher risk of all-cause death in patients with ADHF.

The Prognostic Impact of Follow-up Cardiac MIBG Imaging on LV trajectory After Acute Decompensation.

Cardiac metaiodobenzylguanidine (MIBG) imaging provides prognostic information in patients with heart failure. Recently, the trajectory of left ventricular ejection fraction (LVEF) has been a focus in patients with reduced LVEF admitted for acute decompensated heart failure (ADHF). We sought to investigate the prognostic value of follow-up cardiac MIBG imaging in ADHF patients with reduced LVEF in relation to LVEF trajectory. We prospectively studied 145 ADHF patients with reduced LVEF<40%. The cardiac MIBG heart-to-mediastinum ratio (late HMR) was measured on the delayed image at discharge and at the 6-month follow-up (6FUP). At 6 months after discharge, 54 (37%) patients had complete recovery of LVEF≥50% (HFcorEF), and 43 (30%) patients had partial recovery of LVEF: 40%-50% (HFparEF), while the remaining 48 (33%) patients had no functional recovery of LVEF (HFnorEF). The late HMR at 6 FUP in HFcorEF patients was significantly greater than that in HFparEF and HFnorEF patients. During a follow-up period of 4.3 ± 2.6 years, 43 patients had cardiac events, defined as the composite of readmission for worsening HF and cardiac death. Patients with lower late HMR at 6 FUP had a greater risk of cardiac events than those with higher late HMR at 6 FUP in the group with recovered LVEF, especially HFparEF, which was not observed in the HFnorEF subgroup. Follow-up MIBG imaging after discharge could provide additional prognostic information in ADHF patients with recovered left ventricular function.

Differential Mortality Among Heart Failure Patients Across Different COVID-19 Surges in New York City.

Learning from the healthcare system's response to the COVID-19 pandemic is essential to better prepare for potential future crises. We sought to assess mortality rates for patients admitted for acute decompensated heart failure (HF) and to analyze which factors demonstrated a statistically significant correlation with this primary endpoint. We performed a retrospective analysis of patients hospitalized with a primary diagnosis of acute decompensated HF within the New York City Health and Hospitals 11-hospital system across the different COVID surge periods. Mortality information was collected in 4,405 participants (mean [SD] age 70.54 [14.44] years, 1885 [42.87%] female).The highest mortality existed in the first surge (9.02%), then improved to near prepandemic levels (3.65%) in the second (3.91%) and third surges (5.94%, p < 0.0001). In-hospital mortality inversely correlated with receipt of a COVID-19 vaccination, but had no correlation with left ventricular ejection fraction or the number of vaccination doses. Mortality for acute decompensated HF patients improved after the first surge, suggesting that hospitals adequately adapted to provide quality care. As future infectious outbreaks may occur, emergency preparedness must ensure that adequate focus and resources remain for other clinical entities, such as HF, to ensure optimal care is delivered across all areas of illness.

Association of Hypoalbuminemia within Hospital Mortality in Patients with Acute Decompensated Heart Failure

Background: Acute decompensated heart failure (ADHF) remains a leading cause of hospitalization with significant morbidity and mortality. Hypoalbuminemia has been identified as a potential prognostic factor in various medical conditions, including heart failure. Understanding its association with in-hospital mortality in ADHF patients could enhance risk assessment and management strategies. Objective: This study aimed to investigate the association of hypoalbuminemia with in-hospital mortality in patients admitted with ADHF. Methods: This was a retrospective observational study conducted at a tertiary cardiac care center in Rawalpindi between July and November 2023. A total of 480 patients with a confirmed diagnosis of ADHF were included. Inclusion criteria were age ≥ 18 years, confirmed ADHF diagnosis, and available serum albumin levels upon admission. Exclusion criteria included incomplete medical records, end-stage renal disease, active malignancies, acute liver disease, and acute infectious diseases. Data on demographics, clinical characteristics, and serum albumin levels were collected. Logistic regression analysis was used to assess the association between hypoalbuminemia (defined as serum albumin &lt;3.0 g/dL) and in-hospital mortality, adjusting for confounders like age, sex, and comorbidities. Results: The cohort comprised 60% males and 40% females, with a mean age of 68 years. Hypertension (78%), diabetes (42%), and chronic kidney disease (36%) were the most prevalent comorbidities. The mean serum albumin level was 3.2 g/dL (SD = 0.4). Hypoalbuminemia was observed in 42% of patients. In-hospital mortality was 15%. Patients with hypoalbuminemia had a 2.5-fold increased risk of in-hospital mortality (unadjusted HR = 2.5, p &lt; 0.001). The adjusted HR was 2.0 (p &lt; 0.01), indicating hypoalbuminemia as an independent predictor of in-hospital mortality. Conclusion: Hypoalbuminemia is significantly associated with increased in-hospital mortality in patients with ADHF, serving as an independent prognostic indicator. This finding highlights the importance of serum albumin in the risk assessment and management of ADHF patients.

Clinical Profile and Prognosis of Dementia in Patients With Acute Decompensated Heart Failure - From the CURE-HF Registry.

Acute decompensated heart failure (ADHF) has a poor prognosis and common comorbidities may be contributory. However, evidence for the association between dementia and clinical outcomes in patients with is sparse and it requires further investigation into risk reduction.Methods and Results: We assessed the clinical profiles and outcomes of 1,026 patients (mean age 77.8 years, 43.2% female) with ADHF enrolled in the CURE-HF registry to evaluate the relationship between investigator-reported dementia status and clinical outcomes (all-cause death, cardiovascular (CV) death, non-CV death, and HF hospitalization) over a median follow-up of 2.7 years. In total, dementia was present in 118 (11.5%) patients, who experienced more drug interruptions and HF admissions due to infection than those without dementia (23.8% vs. 13.1%, P<0.01; 11.0% vs. 6.0%, P<0.01, respectively). Kaplan-Meier analysis revealed that dementia patients had higher mortality rates than those without dementia (log-rank P<0.001). After multivariable adjustment for demographics and comorbidities, dementia was significantly associated with an increased risk of death (adjusted hazard ratio, 1.43; 95% confidence interval, 1.06-1.93, P=0.02) and non-CV death (adjusted hazard ratio, 1.65; 95% confidence interval, 1.04-2.62, P=0.03), but no significant associations between dementia and CV death or HF hospitalization were observed (both, P>0.1). In ADHF patients dementia was associated with aggravating factors for HF admission and elevated risk of death, primarily non-CV death.

Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5.

Despite historical differences in cardiogenic shock (CS) outcomes by etiology, outcomes by CS etiology have yet to be described in patients supported by temporary mechanical circulatory support (MCS) with Impella 5.5. This study aims to identify differences in survival and post-support destination for these patients in acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) CS at a high-volume, tertiary, transplant center. A retrospective review of patients who received Impella 5.5 at our center from November 2020 to June 2022 was conducted. Sixty-seven patients underwent Impella 5.5 implantation for CS; 23 (34%) for AMI and 44 (66%) for ADHF. AMI patients presented with higher SCAI stage, pre-implant lactate, and rate of prior MCS devices, and fewer days from admission to implantation. Survival was lower for AMI patients at 30 days, 90 days, and discharge. No difference in time to all-cause mortality was found when excluding patients receiving transplant. There was no significant difference in complication rates between groups. ADHF-CS patients with Impella 5.5 support have a significantly higher rate of survival than patients with AMI-CS. ADHF patients were successfully bridged to heart transplant more often than AMI patients, contributing to increased survival.

Red Cell Distribution Width Is an Independent Predictor of 1-Year Mortality in a Turkish Patient Population with Acute Decompensated Heart Failure

Objective: Heart failure (HF) is a significant public health issue in Turkey. The goal of this study was to look into how red cell distribution width (RDW) affected patients with acute decompensated HF (ADHF) patients' prognoses. Methods: A total of 101 ADHF patients under the age of 18 were enrolled in the study. Venous blood was drawn to measure the serum rdw. After a year of follow-up, the patients' survival status was determined. Results: The patients' mean age was 72. Forty-nine patients had heart failure (HF) with a reduced ejection fraction (EF), 8 had HF with a mildly reduced EF, and 44 had HF with a preserved EF. The median RDW value was 15.9%. In the hospital, nine patients passed away, and 92 others were discharged. 14 patients were lost to follow-up after one year, 87 patients completed the trial, and 40 patients passed away. Inotropic medication use, and serum RDW value were identified as independent predictors of 1-year death in ADHF patients by multivariate logistic regression analysis. According to this data, there was a 44% increase in 1-year mortality for every 1% increase in RDW. Conclusion: In Turkish patients hospitalized for ADHF, red cell distribution width represents an independent prognostic predictor for 1-year mortality.

The correlation between heart rate variability index and vulnerability prognosis in patients with acute decompensated heart failure.

To explore the correlation between Heart Rate Variability Index (HRV) and poor prognosis in patients with acute decompensated heart failure (ADHF). A retrospective compilation of clinical data encompassed 128 cases of patients afflicted with acute decompensated heart failure (ADHF) who were admitted to and discharged from our hospital between April 2019 and July 2022. Subsequent to assessing their follow-up progress during the tracking period, the subjects were categorized into two cohorts: the poor prognosis group (n = 31) and the good prognosis group (n = 97). Comparative analysis of clinical data and Heart Rate Variability (HRV) parameters was executed between these two groups. Moreover, a multiple linear regression analysis was employed to identify the contributing factors associated with adverse prognoses in ADHF patients. Furthermore, the receiver operating characteristic (ROC) curve was employed to evaluate the prognostic predictive capability of HRV parameters among ADHF patients. The levels of SDNN (t = 3.924, P < 0.001), SDANN (t = 4.520, P < 0.001) and LF (t = 2.676, P = 0.018) in the poor prognosis group were significantly higher than those in the good prognosis group, and the differences were statistically significant (P < 0.05). The levels of PNN50 (t = 2.132, P = 0.035), HF (t = 11.781, P < 0.001) and LF/HF (t = 11.056, P < 0.001) in the poor prognosis group were significantly lower than those in the good prognosis group (P < 0.05). The results of multiple linear regression analysis indicated that SDNN, SDANN, LF, PNN50, and HF were factors influencing poor prognosis in ADHF patients (P < 0.05). The results of the ROC curve analysis indicate that the area under the curve (AUC) for predicting poor prognosis in ADHF patients using HRV parameters were as follows: SDNN (AUC = 0.818, 95% CI [0.722-0.914]), SDANN (AUC = 0.684, 95% CI [0.551-0.816]), PNN50 (AUC = 0.754, 95% CI [0.611-0.841]), LF/HF (AUC = 0.787, 95% CI [0.679-0.896]), and combined diagnosis (AUC = 0.901, 95% CI [0.832-0.970]). Among these, the combined diagnosis exhibited the highest AUC, sensitivity, and specificity for predicting poor prognosis in ADHF patients (P < 0.001). The HRV parameters of SDNN, SDANN, PNN50 and LF/HF are closely related to the prognosis of ADHF patients. The combined detection of the above HRV parameters can improve the efficacy of predicting the poor prognosis of ADHF patients. This suggests that clinical staff can identify ADHF patients at risk of poor prognosis by long-term monitoring of HRV in the future.

Prognostic impact of acute decompensated heart failure in patients with heart failure with mildly reduced ejection fraction.

This study sought to determine the prognostic impact of acute decompensated heart failure (ADHF) in patients with heart failure with mildly reduced ejection fraction (HFmrEF). ADHF is a major complication in patients with heart failure (HF). However, the prognostic impact of ADHF in patients with HFmrEF has not yet been clarified. Consecutive patients hospitalized with HFmrEF (i.e. left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. The prognosis of patients with ADHF was compared with those without (i.e. non-ADHF). The primary endpoint was long-term all-cause mortality. Secondary endpoints included in-hospital all-cause mortality and long-term HF-related re-hospitalization. Kaplan-Meier, multivariable Cox proportional regression, and propensity score matched analyses were performed for statistics. Long-term follow-up was set at 30 months. A total of 2184 patients with HFmrEF were included, ADHF was present in 22%. The primary endpoint was higher in ADHF compared to non-ADHF patients with HFmrEF [50% vs. 26%; hazard ratio (HR) = 2.269; 95% confidence interval (CI) 1.939-2.656; P = 0.001]. Accordingly, the secondary endpoint of long-term HF-related re-hospitalization was significantly higher (27% vs. 10%; HR = 3.250; 95% CI 2.565-4.118; P = 0.001). A history of previous ADHF before the index hospitalization was associated with higher rates of long-term HF-related re-hospitalization (42% vs. 23%; HR = 2.073; 95% CI 1.420-3.027; P = 0.001), but not with long-term all-cause mortality (P = 0.264). ADHF is a common finding in patients with HFmrEF associated with an adverse impact on long-term prognosis.

The prognostic impact of cardio-renal anaemia syndrome in Japanese acute decompensated heart failure patients stratified by left ventricular ejection fraction

Abstract Background Cardio-renal anaemia syndrome (CRAS) has been reported to be an important prognostic factor for events in heart failure (HF) patients. Previous reports have shown that it has relatively little prognostic impact in patients with preserved left ventricular ejection fraction (LVEF), which remains controversial. We therefore investigated the prognostic impact of CRAS in Japanese acute decompensated heart failure (ADHF) patients according to LVEF. Methods We combined two registry studies of ADHF patients in Japan and examined HF events and their associated factors over a 2-year observation period. The prognostic impact of CRAS was also analysed by LVEF. The primary endpoint was defined as all-cause mortality or HF hospitalisation. Renal dysfunction was defined as eGFR &amp;lt;60 mL/min/1.73 m2 and anaemia as haemoglobin &amp;lt;13 g/dl in men and &amp;lt;12g/dl in women. CRAS was defined as the presence of both renal dysfunction and anaemia. Three groups were also created by LVEF (&amp;gt;50%, 40-49% and &amp;lt;40%) and analysed separately. Results A total of 2142 patients were enrolled. Mean age was 78.7 years and 49% of the patients was male. Previous coronary artery disease and atrial fibrillation were present in 31% and 44% of the patients, respectively. Medications included beta-blockers in 61% and renin-angiotensin system inhibitors in 53% of the patients. Renal dysfunction was present in 1676 (74%) and anaemia was seen in 1523 (67%) patients. CRAS was present in 1190 (53%) patients. During the mean follow-up period of 623±244 days, the primary endpoint was observed in 1015 patients, with 563 deaths and 737 HF hospitalisations. Multivariate analysis in a Cox proportional hazards model showed that CRAS was an independent prognostic factor in all patients (hazard ratio [HR]1.488;95% confidence interval [CI] 1.292-1.715, p&amp;lt;0.001). Multivariate analysis was also performed in three groups of patients with LVEF &amp;gt;50%, 40-49% and &amp;lt;40%. As with all patients, CRAS was an independent predictor of the primary endpoint in the three groups. (LVEF &amp;gt;50% [1273 patients]: HR1.313[95%CI 1.089-1.583], p = 0.004; LVEF 40-49% [381 patients]:HR,1.907[95%CI 1.323-2.750], p&amp;lt;0.001; LVEF &amp;lt;40% [651 patients]:HR: 1.446[95%CI 1.117-1.872]; p = 0.005) Conclusion In the present registry study of Japanese patients with ADHF, CRAS was a important prognostic factor. The results also confirmed a similar trend in patients with any LVEF.

The prognostic impact of follow-up cardiac Metaiodobenzylguanidine imaging: relation to differential trajectories in left ventricular ejection fraction after acute decompensation

Abstract Background Cardiac metaiodobenzylguanidine (MIBG) imaging provides prognostic information in patients with heart failure (HF). Recently, the trajectory of left ventricular ejection fraction (LVEF) has been focused in patients with reduced LVEF admitted for acute decompensated heart failure (ADHF). We sought to prospectively investigate the prognostic value of the follow-up cardiac MIBG imaging in ADHF patients with reduced LVEF, in relation to LVEF trajectory. Methods We prospectively studied 145 ADHF patients with reduced LVEF&amp;lt;40%. The cardiac MIBG heart-to-mediastinum ratio (late HMR) was measured on the delayed image at the discharge and 6 months’ follow-up (6FUP). HF recovered LVEF (HFrecEF) was defined as those with a second measurement of LVEF at 6FUP of ≥ 40% with a 10-point increase from baseline LVEF, according to the previous report. Furthermore, in the present study, HFrecEF was classified into the two groups; patients with partial recovery of LVEF (≥40%, &amp;lt;50%) (HFparEF) and complete recovery of LVEF (≥50%) (HFcorEF). The endpoint was a cardiac event (CE) defined as a composite of cardiac death and unplanned hospitalization for worsening HF. Results At 6 months after the discharge, HFrecEF was observed in 97 (67%) of 145 study patients and the remaining 48 (33%) patients did not have HFrecEF (HFnorEF). In the subgroup of HFrecEF, 43 (30%) patients had HFparEF and 54 (37%) patients had HFcorEF. Late HMR at 6FUP in HFcorEF patients was significantly greater than those in HFparEF and HFnorEF patients, which was also observed at the discharge with non-significant difference. The change of late HMR significantly correlated with the improvement in LVEF (r=0.33, p&amp;lt;0.001). During a follow-up period of 4.3 ± 2.6 years, 28 patients in HFnorEF, 11 patients in HFparEF and 4 patients in HFcorEF had CEs, respectively. Kaplan-Meier analysis revealed that HFnorEF patients had a significantly higher risk of cardiac events than those with HFparEF and HFcorEF. (58.3% vs 25.6% vs 7.4% P &amp;lt; 0.0001). Patients with lower late HMR at 6FUP had a greater risk of CEs than those with higher late HR at 6FUP in HFrecEF, especially in HFparEF, which was not observed in HFnorEF subgroup. Conclusion The follow-up MIBG imaging after the discharge could provide the additional prognostic information in ADHF patients with recovered LV function.