Acute Heart Failure Exacerbation Research Articles

Role of Gastroesophageal Reflux Disease in Morbidity and Mortality for Patients Admitted With Pulmonary Hypertension.

The association between gastroesophageal reflux disease (GERD) and morbidity and mortality in patients with pulmonary arterial hypertension (PH) is unknown. Our objective was to examine the difference in socio-demographics, comorbidities, and morbidity/mortality in PH patients also diagnosed with GERD, compared to PH patients without GERD. We performed a retrospective cross-sectional study of the large U.S. National Inpatient Sample identifying patients with a primary diagnosis of primary pulmonary hypertension (PH). All patients ≥ 18 years old that were admitted with a primary diagnosis of PH from January 1, 2001, to December 31, 2013, in the NIS database were included. We analyzed the socio-demographic and clinical comorbidities in PH patients with and without GERD. We investigated the predictors for complications of PH and differences in hospital utilization in this population. PH patients with GERD were more likely to be older than 18-29 years. They were more likely to be Caucasian and female and less likely to be part of the top 75% median income compared to the bottom 25%. Patients with GERD were more likely insured with Medicare or private insurance but less likely to have Medicaid or be uninsured. Patients were more likely to be obese, and have asthma, chronic bronchitis, obstructive sleep apnea, hypertension, and hypothyroidism but were less likely to have diabetes or a history of alcohol use. PH Patients with GERD were less likely to have myocardial infarctions, cardiac arrests, pulmonary embolisms, pulmonary hemorrhages, cardiac interventions, acute respiratory failure, acute renal failure, or urinary tract infections compared to those without GERD. Patients with GERD were, however, more likely to have acute heart failure exacerbations and aspiration pneumonia. Patients with a diagnosis of GERD had lower mortality, length of stay (LOS), and hospital costs compared to their counterparts. The concomitant presence of GERD is associated with fewer adverse outcomes in patients with PH. Though it is well understood that treatment of GERD is beneficial for lung disease, the exact role of GERD in PH has not been identified. This study helps characterize the important role appropriately treated GERD may play in preventing morbidity and mortality due to PH.

Association of atrial fibrillation and outcomes in patients undergoing bone marrow transplantation.

Haematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for several malignant and non-malignant haematologic conditions. Patients undergoing HSCT are at an increased risk of developing atrial fibrillation (AF). We hypothesized that a diagnosis of AF would be associated with poor outcomes in patients undergoing HSCT. The National Inpatient Sample (2016-19) was queried with ICD-10 codes to identify patients aged >50 years undergoing HSCT. Clinical outcomes were compared between patients with and without AF. A multivariable regression model adjusting for demographics and comorbidities was used to calculate the adjusted odds ratio (aOR) and regression coefficients with corresponding 95% confidence intervals and P-values. A total of 50 570 weighted hospitalizations for HSCT were identified, out of which 5820 (11.5%) had AF. Atrial fibrillation was found to be independently associated with higher inpatient mortality (aOR 2.75; 1.9-3.98; P < 0.001), cardiac arrest (aOR 2.86; 1.55-5.26; P = 0.001), acute kidney injury (aOR 1.89; 1.6-2.23; P < 0.001), acute heart failure exacerbation (aOR 5.01; 3.54-7.1; P < 0.001), cardiogenic shock (aOR 7.73; 3.17-18.8; P < 0.001), and acute respiratory failure (aOR 3.24; 2.56-4.1; P < 0.001) as well as higher mean length of stay (LOS) (+2.67; 1.79-3.55; P < 0.001) and cost of care (+67 529; 36 630-98 427; P < 0.001). Among patients undergoing HSCT, AF was independently associated with poor in-hospital outcomes, higher LOS, and cost of care.

Abstract #1395486: Uncontrolled Acromegaly Resulting in the Need for LVAD as Bridge to Heart Transplant

Acromegaly is an uncommon pituitary disorder with an incidence of six per million persons. While hypertension is often encountered in these patients, heart failure rarely is seen with an incidence rate under 10%. We describe a case of an individual who was diagnosed with acromegaly after an acute exacerbation of heart failure with subsequent management requiring an LVAD to perform Transsphenoidal Surgery (TSS). 37-year-old male otherwise healthy initially presented to an emergency room and was found to be in acute heart failure exacerbation. Concerning acromegaly features included macrognathia, enlarged hands and feet, swollen phalanges, widened spacing of teeth, and frontal bossing. IGF-1 level was found 455 ng/mL. MRI showed a 10mm macroadenoma. A right heart catheterization showed elevated filling pressures. Cardiac MRI showed no defects or enhancement. Endomyocardial biopsy showed no inflammatory infiltrates or evidence of infiltrative diseases. Patient had an ejection fraction of 15% corroborated by cardiac MRI along with the presence of aortic root dilatation and mitral regurgitation. The patient started on 0.5mg of Cabergoline twice weekly and 120mg weekly Lanreotide injections. Patient stabilized with plans for further close monitoring and outpatient neurosurgical evaluation. The COVID-19 pandemic and insurance gaps led the patient to spend two years off his medicines and he was unable to be seen by his medical team. Patient was seen by our system after recurrent hospitalizations for heart failure at our sister hospital, AICD was unable to be placed due to the patient’s anatomy, he was placed on wearable cardiac defibrillator and required milrinone infusion for progression to end-stage heart failure with cardiac cachexia. At our institution, the patient was evaluated for Orthotopic Heart Transplant (OHT) but due to active GH secreting macroadenoma there was concern for OHT failure without TSS. Decision was made to utilize LVAD as Bridge-to-Transplant for OHT so the patient could be stabilized and safely undergo TSS. The patient tolerated surgeries well and is currently on the active transplant list. Heart failure is an uncommon presentation of severe acromegaly requiring multidisciplinary management. We describe a case of a patient who initially presented with heart failure too unstable for surgery. Due to the COVID-19 pandemic the patient’s disease progressed resulting in end-stage heart failure requiring LVAD placement for further treatment. We would like to draw attention to the use of LVAD placement in acromegalic patients who develop severe cardiovascular disease who are not candidates for OHT.

E-27 | Comparison of In-Hospital Outcomes Between Ischemic and Non-Ischemic Cardiomyopathy Among Patients Admitted With Acute Heart Failure Exacerbation: A Nationwide Analysis

E-27 | Comparison of In-Hospital Outcomes Between Ischemic and Non-Ischemic Cardiomyopathy Among Patients Admitted With Acute Heart Failure Exacerbation: A Nationwide Analysis

Abstract #1404146: The Ups and Downs of Diagnosing Insulinoma

Insulinomas are rare neuroendocrine tumors of the pancreas. The diagnosis of an insulinoma may be delayed in the geriatric population, as older individuals often have comorbid conditions making evaluation more difficult. The case described here involves an exceptionally rare presentation of insulinoma in a 78-year-old male with underlying type 2 diabetes mellitus and heart failure. A 78-year-old man with a past medical history of type 2 diabetes, heart failure, and chronic kidney disease presented to the hospital with bilateral lower extremity edema and shortness of breath. He had been hospitalized four times during the previous six months for acute heart failure exacerbations accompanied by recurrent episodes of hypoglycemia. Of note, his diabetes was well-controlled with glimepiride and dapagliflozin only. The patient reported symptomatic hypoglycemia, primarily during fasting episodes, with nadir serum glucose values between 40 and 50 mg/dL. During hospitalizations, total insulin (range 22-68 uU/mL), and C peptide (range 6.9-16.4 ng/mL) concentrations were inappropriately elevated when glucose was low, indicative of endogenous hyperinsulinemia. However, this hypoglycemia was thought to be secondary to recent sulfonylurea use in the setting of poor diet and acute renal insufficiency related to heart failure. Both glimepiride and dapagliflozin were held, though he inadvertently continued to take glimepiride until his fourth hospitalization. During his fourth admission, the patient continued to have symptomatic hypoglycemia. As his sulfonylurea screen was negative, he underwent an Octreoscan that revealed radiotracer uptake in the distal pancreas. An endoscopic ultrasound with biopsy revealed a well-differentiated neuroendocrine tumor of the pancreas. His heart failure made agents such as diazoxide, verapamil, and phenytoin undesirable, and he was discharged on subcutaneous octreotide three times daily with a plan to follow up in the surgery clinic. The presentation of insulinomas in the geriatric population can be variable and nonspecific, increasing the risk of misdiagnosis or delay of diagnosis. Missing the diagnosis can lead to increased morbidity and mortality via cognitive impairment and falls. Our patient experienced a delay in diagnosis of insulinoma of over one year despite satisfying the criteria of Whipple’s triad during his first admission. The patient had been asked to stop all anti-diabetic medications during his third admission. However, he misunderstood and continued glimepiride. Further, his acute renal insufficiency, heart failure, and decreased appetite provided alternative causes for his hypoglycemia. Insulinomas are extremely rare pancreatic neuroendocrine tumors that typically present in patients between 40 and 60 years of age. However, there have been reports of these rare tumors in older individuals, who often have comorbid conditions making their diagnosis more difficult. This case report highlights the importance of including insulinoma as a cause of persistent endogenous hypoglycemia among the geriatric population.

PO-05-172 EPIDEMIOLOGY OF TAKOTSUBO CARDIOMYOPATHY WITH ARRHYTHMIAS AND THEIR COMPLICATIONS- AN UPDATED ANALYSIS

Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy that is usually readily reversible. However, it has been associated with many life-threatening arrhythmias. Prolonged QT, changes in cardiac cellular signaling due to catecholamine excess along with certain gender and genetic causes are considered to be the potential causes. We sought to assess the arrhythmia burden and associated complications in patients with Takotsubo cardiomyopathy. National Inpatient sample 2018-2020 was queried for adult patients (age> 18 years) with TCM. These patients were compared to the rest of the adults and analysed for underlying arrhythmias. Further, patients with TCM with and without underlying arrhythmias were studied to look for complications. A total of 200040 adult patients with TCM were admitted from 2018-2020 with a mean age of 67 years. 82.61% of them were females. Caucasians comprised 82.38%; African- Americans comprised 8.2% while the remaining 9.42% of patients with TCM belonged to other race categories (Hispanics, Native- Americans, etc). Patients with TCM were associated with a higher prevalence of arrhythmias as compared to patients without TCM (27.87% vs 16.98%; P<0.0001). Bradyarrhythmias including atrioventricular blocks (AV blocks) as well as tachyarrhythmias including supraventricular tachycardias and ventricular tachycardias were significantly more in the patients admitted with TCM (Table 1). Long QT syndrome and sick sinus syndrome were more prevalent in this patient subgroup as well. (Table 1) On comparing complications in a cohort of TCM, it was observed that mortality, cardiogenic shock, and cardiac tamponade were more commonly seen in patients with an underlying arrhythmia (complete heart block, ventricular tachycardia, ventricular fibrillation, and atrial fibrillation) than in patients without arrhythmias. Incidence of acute heart failure exacerbations was however not statistically different in these two groups. (Table 2) This study substantiates the fact that although TCM is reversible it is not free of complications. These patients are at significant risk of arrhythmias and subsequently further complications. It is advisable to monitor patients with TCM before discharge and warrants close outpatient monitoring as well.

Billing &amp; Coding

Billing &amp; Coding

Sodium-Glucose Cotransporter 2 Inhibitors: A Scoping Review of the Positive Implications on Cardiovascular and Renal Health and Dynamics for Clinical Practice.

Cardiorenal benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2is) have been demonstrated in patients with type 2 diabetes in multiple trials. We aim toprovide a comprehensive review of the role of SGLT2i in cardiovascular disease.Reducing blood glucose to provide more effective vascular function, lowering the circulating volume, reducing cardiac stress, and preventing pathological cardiac re-modeling and function are the mechanisms implicated in the beneficial cardiovascular effects of SGLT2 inhibitors.Treatment with SGLT2i was associated with a decrease in cardiovascular and all-cause mortality, acute heart failure exacerbation hospitalization, and composite adverse renal outcomes. Improved symptoms, better functional status, and quality of life were also seen in heart failure with reduced ejection fraction (HFrEF), heart failure and mildly reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF) patients.Recent trials have shown a notable therapeutic benefit of SGLT2is in acute heart failureand also suggest that SGLT2is have the potential to strengthen recovery after acute myocardial infarction (AMI) in percutaneous coronary Intervention (PCI) patients.The mechanism behind the cardio-metabolic and renal-protective effects of SGLT2i is multifactorial. Adverse events may occur with their usage including increased risk of genital infections, diabetic ketoacidosis, and perhaps limited amputations; however, all of them are preventable. Overall, SGLT2i clearly has many beneficial effects, and the benefits of using SGLT2i by far outweigh the risks.

COVID-19 and Heart Failure with Preserved and Reduced Ejection Fraction Clinical Outcomes among Hospitalized Patients in the United States

Heart failure exacerbations impart significant morbidity and mortality, however, large- scale studies assessing outcomes in the setting of concurrent coronavirus disease-19 (COVID-19) are limited. We utilized National Inpatient Sample (NIS) database to compare clinical outcomes in patients admitted with acute congestive heart failure exacerbation (CHF) with and without COVID-19 infection. A total of 2,101,980 patients (Acute CHF without COVID-19 (n = 2,026,765 (96.4%) and acute CHF with COVID-19 (n = 75,215, 3.6%)) were identified. Multivariate logistic regression analysis was utilized to compared outcomes and were adjusted for age, sex, race, income level, insurance status, discharge quarter, Elixhauser co-morbidities, hospital location, teaching status and bed size. Patients with acute CHF and COVID-19 had higher in-hospital mortality compared to patients with acute CHF alone (25.78% vs. 5.47%, adjust OR (aOR) 6.3 (95% CI 6.05-6.62, p < 0.001)) and higher rates of vasopressor use (4.87% vs. 2.54%, aOR 2.06 (95% CI 1.86-2.27, p < 0.001), mechanical ventilation (31.26% vs. 17.14%, aOR 2.3 (95% CI 2.25-2.44, p < 0.001)), sudden cardiac arrest (5.73% vs. 2.88%, aOR 1.95 (95% CI 1.79-2.12, p < 0.001)), and acute kidney injury requiring hemodialysis (5.56% vs. 2.94%, aOR 1.92 (95% CI 1.77-2.09, p < 0.001)). Moreover, patients with heart failure with reduced ejection fraction had higher rates of in-hospital mortality (26.87% vs. 24.5%, adjusted OR 1.26 (95% CI 1.16-1.36, p < 0.001)) with increased incidence of vasopressor use, sudden cardiac arrest, and cardiogenic shock as compared to patients with heart failure with preserved ejection fraction. Furthermore, elderly patients and patients with African-American and Hispanic descents had higher in-hospital mortality. Acute CHF with COVID-19 is associated with higher in-hospital mortality, vasopressor use, mechanical ventilation, and end organ dysfunction such as kidney failure and cardiac arrest.

Association of 48-h net fluid status with change in renal function and dyspnea among patients with decompensated heart failure: A pooled cohort analysis of three acute heart failure trials.

Acute heart failure (AHF) exacerbations are a leading cause of hospitalization in the United States. Despite the frequency of AHF hospitalizations, there are inadequate data or practice guidelines on how quickly diuresis should be achieved. To study the association of 48-h net fluid change and (A) 72-h change in creatinine and (B) 72-h change in dyspnea among patients with acute heart failure. This is a retrospective, pooled cohort analysis of patients from the DOSE, ROSE, and ATHENA-HF trials. The primary exposure was 48-h net fluid status. The co-primary outcomes were 72-h change in creatinine and 72-h change in dyspnea. The secondary outcome was risk of 60-day mortality or rehospitalization. Eight hundred and seven patients were included. The mean 48-h net fluid status was -2.9 L. A nonlinear association was observed with net fluid status and creatinine change, such that creatinine improved with each liter net negative up to 3.5 L (-0.03 mg/dL per liter negative [95% confidence interval [CI]: -0.06 to -0.01) and remained stable beyond 3.5 L (-0.01 [95% CI: -0.02 to 0.001], p = .17). Net fluid loss was associated with a monotonic improvement of dyspnea (1.4-point improvement per liter negative [95% CI: 0.7-2.2], p = .0002). Each liter net negative by 48 h was also associated with 12% decreased odds of 60-day rehospitalization or death (odds ratio: 0.88; 95% CI: 0.82-0.95; p = .002). Aggressive net fluid targets within the first 48 h are associated with effective relief of patient self-reported dyspnea and improved long-term outcomes without adversely affecting renal function.

Development and Validation of a Nomogram to Predict the Future Risk of Cardiovascular Disease

Background: Early identification of individuals at a high risk of cardiovascular disease (CVD) is crucial. This study aimed to construct a nomogram for CVD risk prediction in the general population. Methods: This retrospective study analyzed the data between January 2012 and September 2020 at the Physical Examination Center of the Second Affiliated Hospital of Nanjing Medical University (randomized 7:3 to the training and validation cohorts). The outcome was the occurrence of CVD events, which were defined as sudden cardiac death or any death related to myocardial infarction, acute exacerbation of heart failure, or stroke. The least absolute shrinkage and selection operator (LASSO) method and multivariate logistic regression were applied to screen the significant variables related to CVD. Results: Among the 537 patients, 54 had CVD (10.1%). The median cardiac myosin-binding protein-C (cMyBP-C) level in the CVD group was higher than in the no-CVD group (42.25 pg/mL VS 25.00 pg/mL, p = 0.001). After LASSO selection and multivariable analysis, cMyBP-C (Odds ratio [OR] = 1.004, 95% CI [CI, confidence interval]: 1.000–1.008, p = 0.035), age (OR = 1.023, 95% CI: 0.999–1.048, p = 0.062), diastolic blood pressure (OR = 1.025, 95% CI: 0.995–1.058, p = 0.103), cigarettes per day (OR = 1.066, 95% CI: 1.021–1.113, p = 0.003), and family history of CVD (OR = 2.219, 95% CI: 1.003–4.893, p = 0.047) were associated with future CVD events (p &lt; 0.200). The model, including cMyBP-C, age, diastolic blood pressure, cigarettes per day, and family history of CVD, displayed a high predictive ability with an area under the curve (AUC) of 0.816 (95% CI: 0.714–0.918) in the training cohort (specificity and negative predictive value of 0.92 and 0.96) and 0.774 (95% CI: 0.703–0.845) in the validation cohort. Conclusions: A nomogram based on cMyBP-C, age, diastolic blood pressure, cigarettes per day, and family history of CVD was constructed. The model displayed a high predictive ability.

Angiotensin Receptor Neprilysin Inhibitor Use and Blood Pressure Lowering in Patients With Heart Failure With Reduced Ejection Fraction Across the Spectrum of Kidney Function: An Analysis of the Veterans Administrative Health System

A substantial proportion of patients with HF and kidney disease have poorly controlled blood pressures. This study aimed to evaluate patterns of blood pressure after initiation of angiotensin receptor neprilysin inhibitor (ARNI) or angiotensin-converting enzyme inhibitor (ACEI) /angiotensin receptor blocker (ARB) across the spectrum of kidney function. Between 2016 and 2020, we evaluated 26,091 patients admitted to a Veterans Affairs hospital for an acute heart failure exacerbation with reduced ejection fraction. We assessed patterns of systolic and diastolic blood pressure among those started on ARNI or ACEI/ARB over 6 months, overall and across estimated glomerular filtration rate. To account for differential treatment factors, we applied 1:1 propensity score matching using 15 known baseline covariates. There were 13,781 individuals treated with an ACEI or ARB, and 2,589 individuals with an ARNI prescription. After propensity score matching, 839 patients were matched in each of the ARNI and ACEI/ARB groups. Mean baseline eGFR was 63.8 (standard deviation 21.6) and 10% had stage 4 or 5 CKD. Patients in the ARNI group experienced greater SBP reduction at month 3 (-5.2 mmHg vs. -2.2 mmHg, ARNI vs. ACEI/ARB; p<0.001), and month 6 (-4.7 mmHg vs. -1.85 mmHg, ARNI vs. ACEI/ARB; p < 0.001). These differences in SBP by 6 months did not vary by eGFR above and below 60 ml/min/1.73m2 or continuously across a wide range of eGFR (Pinteraction>0.10 for both). The use of ARNI was associated with significant BP reduction as compared with the ACEI/ARB group overall and across the eGFR spectrum, including in advanced CKD.

Association of Redox State of Human Serum Albumin with Severity in Patients with Heart Failure

Oxidative stress plays a crucial role in the progression of heart failure (HF). We surveyed the fraction of human mercaptalbumin [f (HMA) ], an indicator of the redox state of human serum albumin (HSA), in patients with HF and examined whether f (HMA) is associated with the severity of HF.We enrolled consecutive elderly patients hospitalized for acute HF or exacerbation of HF. The redox state of HSA was measured by the high-performance liquid chromatography with postcolumn bromocresol green method using serum samples collected close to discharge. First, the distribution of f (HMA) in HF was compared to that in community-dwelling elderly individuals (n = 125; median age, 80 years) as a control group analyzed in a previous study. Overall, 133 patients (median age, 81 years; 75 men) were included. Patients with HF showed a lower level of f (HMA) than those of the control group (55.0% [IQR 47.7-61.3] versus 66.3% [IQR 62.8-70.0], P < 0.001]. Multiple regression analysis showed a negative correlation between f (HMA) and log-transformed B-type natriuretic peptide (standardized beta = -0.19).Patients with HF showed lower f (HMA) than those in the control group. Additionally, f (HMA) was related to HF independently with log-transformed B-type natriuretic peptide in the multivariate regression analysis, suggesting that f (HMA) is a biomarker that reflects the redox state in HF patients.

Abstract 13604: Sodium-Glucose-Cotransporter-2 Inhibitor (SGLT2i) Exposure in the Immediate Post-Acute Kidney Injury Period in Patients Hospitalized With Acute Heart Failure is Associated With Improved Outcomes

Introduction: Sodium-Glucose Cotransporter-2 inhibitor (SGLT2i) use during or immediately following Acute Heart Failure (AHF) exacerbation has shown clinical benefit including improved symptoms, lower frequencies of re-hospitalization for heart failure and death. However, effects of SGLT2i use immediately following acute kidney injury (AKI) on mortality and renal recovery in this setting are unknown. Hypothesis: Among patients admitted with AHF who sustain in-hospital AKI, exposure to SGLT2i in the immediate post-AKI period would be associated with better outcomes. Methods: Adult patients admitted across 5 hospitals between January, 2020 and April, 2022 with acute heart failure (NT-pro-BNP &gt;500ng/L and receipt of IV diuretic within 24 hours of admission) and KDIGO-defined AKI during hospitalization were included. Advanced CKD (eGFR ≤15 ml/min/1.72m2) and those prescribed SGLT2i &gt; 10 days after AKI were excluded. AKI recovery and death were compared between the exposed and unexposed cohorts using a time-varying Cox-regression analysis after adjusting for potential confounders. Results: In this retrospective cohort of 3599 individuals admitted with AHF that developed AKI during hospitalization, 293 patients received SGLT2i within the 10 days post-AKI. The median (IQR) time to AKI after admission was 24 (1.41-64.48) hours. 36.52% of the SGLT2i exposed had renal recovery pre-SGLT2i exposure. For the SGLT2i-exposed (pre-renal recovery) vs. unexposed groups, rates of 14-day renal recovery were not significantly different (adj. HR 0.99, 95% CI 0.82-1.19, p=0.90). However, the post-AKI SGLT2i-exposed group had a lower risk of death at 30 days (adj. HR 0.39, 95% CI 0.19-0.79, p=0.009) after adjustment for potential confounders. Conclusion: In a retrospective cohort of patients hospitalized with AHF with in-hospital AKI, exposure to SGLT2i within 10 days post-AKI was associated with decreased mortality and no significant delay in renal recovery.

Abstract 11850: Association Between SGLT2 Inhibitor Use and Risk of Clinical Events in Patients With Antineoplastic Therapy Associated Cardiomyopathy and Heart Failure

Background: Antineoplastic therapies can be cardiotoxic and increase the risk of cardiomyopathy and heart failure (HF). SGLT2i are shown to be efficaceous in patients across the spectrums of HF regardless of ejection fraction and presence of type 2 diabetes. However, the impact of these agents on outcomes in patients with antineoplastic therapy associated cardiomyopathy and HF has not been well established. Methods: A retrospective cohort analysis was performed on de-identified, aggregate patient data from the TriNetX research network. Patients ≥18 years of age with a history of exposure to potentially cardiotoxic antineoplastic therapy between Jan 1, 2013 and Apr 30, 2020 who subsequently developed cardiomyopathy or HF and treated with guideline directed medical therapy (GDMT) were identified. Patients with ischemic heart disease were excluded. Patients were divided into two groups based on SGLT2i use. Propensity score matching was performed to match the baseline characteristics. Odds ratio and log-rank test were used to compare the outcomes over a 2-year follow-up period. Results: In well matched cohorts (640 patients in each cohort with antineoplastic therapy associated cardiomyopathy/HF; mean age 67.6 years, women 41.6%, White 68%), patients on SGLT2i in addition to conventional GDMT faced lower risk of acute HF exacerbation (85 vs 154, OR 0.48, 95% CI: 0.36 - 0.65, p&lt;0.001) and all-cause mortality (73 vs 194, OR 0.30, 95% CI: 0.22 - 0.40, p=0.001). Secondary outcomes of all-cause hospitalization or ER visit (OR 0.479, 95% CI: 0.383-0.599, p&lt;0.001), atrial fibrillation/flutter (OR 0.397, 95% CI: 0.213-0.737, p=0.003), acute kidney injury (OR 0.486, 95% CI: 0.382-0.619, p&lt;0.001), and renal replacement therapy (OR 0.398, 95% CI: 0.189-0.839, p=0.012) were also less frequent in patients on SGLT2i. Conclusions: SGLT2i use is associated with lower risk of clinical events in patients with antineoplastic therapy associated cardiomyopathy or HF.

Abstract 11693: Improving Angiotensin Receptor-Neprilysin Inhibitor Utilization for Veterans Admitted With Acute Decompensated Heart Failure: A Single-Center Experience

Objective: Improve angiotensin receptor-neprilysin inhibitor (ARNI) utilization among patients admitted with acute decompensated heart failure (HF) through a multidisciplinary quality improvement (QI) intervention. Background: ARNIs reduce mortality and hospitalizations for patients with HF and abnormal systolic function; current guidelines recommend them as first-line agents for Stage C HF. Inpatient initiation of ARNIs during an acute exacerbation is cost-effective and safe. Despite this, ARNI utilization remains low nationally and at our center. Methods: We implemented a multidisciplinary QI intervention at a large urban Veterans Affairs (VA) medical center. The intervention included electronic health record system redesign to provide clinical decision support, a new pharmacy-led screening process and recommendation system to the primary inpatient team, and an educational campaign. Our primary outcome metric was monthly ARNI initiation rate, defined as the number of new ARNI initiations divided by the number of eligible patients admitted for an acute HF exacerbation. We used a statistical process control (XmR) chart to measure change. Results: We observed a statistically significant, non-random improvement in mean monthly ARNI initiation rate from 8.4% pre-intervention to 35.7% post-intervention. An XmR chart is shown in Figure 1. Split limits analysis showed variation post-intervention was within statistical control, suggesting sustainable change. Conclusions: Our outcomes demonstrate successful implementation of a multidisciplinary intervention to improve ARNI utilization among patients admitted with acute decompensated HF at a large VA medical center. ARNI initiation rate increased significantly post-intervention, and the split limits analysis suggests that our results represent sustainable change. A longer period of data collection will be useful to assess HF readmission and mortality rates in response to this intervention.

Abstract 14084: Safety and Outcomes of Percutaneous Coronary Intervention in Patients Presenting With Acute Coronary Syndrome With Prior Liver Transplantation

Background: There is a paucity of data about the outcomes of performing Percutaneous coronary intervention (PCI) for Liver transplant (LT) patients presenting with acute coronary syndrome (ACS). Methods: We queried the national readmission database for patients who underwent PCI hospitalized between 2016 and 2019, patient were classified into two groups based on prior LT status. International classification of disease codes (ICD-10) were used for diagnosis and procedures codes. Our outcomes were In-hospital mortality and 90-day readmission rate. A multivariate adjusted regression model was performed to risk adjust for predictors of 90-day readmission (all-cause). Results: A total of 1400,861 patients underwent PCI between the years 2016 and 2019 for ACS and underwent PCI. 1,532 patients had a history of LT (0.1%). Hospitalized patients with prior LT were of similar age (65.2 ±0.31 vs 65.3 ±0.04 years, p=0.9), and less likely to be women (20.8.6% vs. 32.5%, p&lt;0.01) compared with those without prior LT history. Hospitalized patients with prior LT had similar In-hospital mortality rate (3.9% vs 2.9%, p=0.3), shock (5.3% vs 4.5%, p=0.34), and Mechanical circulatory support utilization rate (4.9% vs 4.3%, p=0.452) but longer length of stay (5.8±0.3 vs 4.1±0.02, P&lt;0.001) compared to the cohort that had no prior LT. Patients with prior LT had a higher readmission rate within 90 days 29.6% vs 19.4%, p= 0.001), and were less likely to have repeat PCI in the readmission (7.9% vs 12.3%, p&lt;0.001), however more likely and acute kidney injury. Both cohorts had similar rates of acute heart failure exacerbation, bleeding complications, or in-hospital mortality in the readmission. Conclusion: There was no significant difference in mortality between both cohorts, however, readmission rate was higher in the LT cohort, Further studies exploring these differences may help to mitigate these readmissions.

Lung ultrasound predicts left-sided filling pressures in patients with cardiogenic shock admitted to the cardiac intensive care unit

Abstract Background Left and right filling pressures, as well as cardiac output, are key targets in optimising treatment of cardiogenic shock (CS). Invasive pulmonary artery catheters can provide these data but are associated with complications and are not available in all hospital settings. Lung ultrasound (LUS) can detect pulmonary congestion in patients with heart failure (HF) and may be an alternative to invasive monitoring. We assessed the correlation between LUS score and invasive haemodynamic parameters in patients with CS admitted to the cardiac intensive care unit (CICU) of a North American cardiac centre. Methods We prospectively evaluated consecutive patients who underwent pulmonary artery catheter insertion in the CICU. Haemodynamic parameters including right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were measured and cardiac output (CO) was calculated using the thermodilution method. This was immediately followed by an 8-zones LUS done by a critical care cardiologist who was blinded to the invasive hemodynamic measurements. The LUS score was calculated by counting the total number of B-lines in all 8 zones, with a higher score indicating greater congestion. Correlations between LUS score and hemodynamic parameters were evaluated using Pearson's correlation. Results Ninety-six measurements from 60 patients were included, aged 58±14 years with 27% female. The most common diagnosis at admission was cardiogenic shock, followed by acute myocardial infarction and HF exacerbation. Most patients were at SCAI stages C and D at the time of assessment. The mean number of B-lines at LUS was 10.1±8.2. Mean RAP was 8.5±4.6 mmHg, PCWP 16.2±6.3 mmHg and CO of 5.0±1.8 L/min. The total number of B-lines was correlated with PCWP (r=0.66, P&amp;lt;0.001, see Figure 1), RAP (r=0.26, P&amp;lt;0.001) and cardiac output (r=−0.23, p=0.02). Due to the correlation of B-lines in LUS with PCWP, we then evaluated the area under the ROC of the LUS to identify patients with PCWP ≥15 mmHg. The number of positive zones (≥3 B-lines) showed an AUC of 0.81 (0.72–0.89), P&amp;lt;0.001. In 36 patients, we had repeated measurement with more than 12 hours apart. The delta change in PCWP was correlated with delta change in the number of B-lines (r=0.59, P&amp;lt;0.001). Conclusion Elevated LUS score in patients with CS is associated with worse invasively-measured LV filling pressures, but less so with RAP or CO. LUS can serve as a useful adjunct to the clinical assessment of patients with CS who do not receive invasive hemodynamic monitoring, either at a single timepoint or to detect changes in clinical status over time, to guide ongoing management. Funding Acknowledgement Type of funding sources: None.

Effect of Dapagliflozin on Indicators of Myocardial Fibrosis and Levels of Inflammatory Factors in Heart Failure Patients.

Objective To explore the effect of dapagliflozin on the myocardial fibrosis and the levels of inflammatory factors in heart failure patients. Methods 60 patients with T2DM who were diagnosed as acute left heart failure or acute exacerbation of chronic left heart failure in the Department of Cardiology of our hospital from November 1, 2020, to December 31, 2021, during hospitalization were the study subjects. According to the treatment regimen, they were divided into the experimental group (EG) which received dapagliflozin and conventional drugs and the control group (CG) which received conventional drugs, with 30 cases in each group to compare and analyze the clinical indicators such as myocardial fibrosis and inflammatory factors. Results The levels of TNF-α, IL-1β, IL-6, and hs-CRP in the two groups were decreased gradually after treatment, and the levels of TNF-α, IL-1β, IL-6, and hs-CRP in the EG were visibly lower compared with those in the CG at week 4 of treatment (P < 0.05). The cardiac function evaluation of patients showed that the levels of LVEF and LVEDD in both groups were gradually improved after treatment, with a significant difference from the fourth week. In other words, compared with the CG, the LVEF level in the EG was obviously higher (P < 0.05), the LVEDD level was distinctly lower (P < 0.05), and the levels of ST2, BNP, and MCP-1 in the EG were clearly lower at week 4 of treatment (P < 0.05) with a statistical significance in difference. Conclusion Dapagliflozin has a definite curative effect in heart failure patients with type 2 diabetes mellitus, which can effectively reduce the inflammatory response of patients and inhibit the myocardial fibrosis, and has a potential value in improving cardiac function and promoting prognosis.

71-Year-Old Man With a New Heart Murmur

71-Year-Old Man With a New Heart Murmur