Acute Heart Failure Patients Research Articles

Prognostic value of Growth differentiation factors 15 in Acute heart failure patients with preserved ejection fraction.

There is an increasing proportion of hospitalized heart failure (HF) patients classified as HF with preserved ejection fraction (HFpEF) around the world. Growth differentiation factor 15 (GDF-15) is a promising biomarker in HFpEF prognostication; however, the majority of the existing data has been derived from the research on undifferentiated HF, whereas the studies focusing on HFpEF are still limited. This study aimed to determine the prognostic power of GDF-15 in the hospitalized patients with HFpEF in a Chinese cohort. We analysed the levels of serum GDF-15 in 380 patients hospitalized for acute onset of HFpEF measured by heart ultrasound at admission in a prospective cohort. The associations of GDF-15 with 1year risk of all-cause death and 1year HF readmission were assessed by the Cox proportional hazards model. Area under the receiver operating characteristic curves was used to compare predictive accuracy. GDF-15 was strongly correlated with 1year HF readmission and 1year all-cause death, with event rates of 24.8%, 40.0%, and 50.0% for 1year HF readmission (P<0.001), respectively, and with 11.2%, 13.6%, and 24.6% for 1year all-cause death (P=0.004) in the corresponding tertile, respectively. In the multivariate linear regression model, GDF-15 had a significantly negative correlation with haemoglobin (P=0.01) and a positive correlation with creatinine (P=0.01), alanine transaminase (P=0.001), and therapy of aldosterone antagonist (P=0.018). The univariate Cox regression model of GDF-15 showed that c-statistic was 0.632 for 1year HF readmission and 0.644 for 1year all-cause death, which were superior to the N-terminal pro-brain natriuretic peptide (NT-proBNP) model with c-statistics of 0.595 and 0.610, respectively. In the multivariable Cox regression model, GDF-15 tertiles independently predicted 1year HF readmission (hazard ratio 2.25, 95% confidence interval: 1.43-3.54, P<0.001) after adjusting for baseline Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) risk score, history of HF, NT-proBNP, and high-sensitivity cardiac troponin T. Compared with the model including all the adjusted variables, the model with the addition of GDF-15 improved predictive power, with c-statistic increasing from 0.643 to 0.657 for 1year HF readmission and from 0.638 to 0.660 for 1year all-cause death. In hospitalized patients with HFpEF, GDF-15 measured within 48h of admission is a strong independent biomarker for 1year HF readmission and even better than NT-proBNP. GDF-15 combined with the traditional indicators provided incremental prognostic value in this population.

Comparison of the red blood cell indices based on accuracy, sensitivity, and specificity to predict one-year mortality in heart failure patients

BackgroundVarious investigations have specified the role of each RBC indices separately [including hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red blood cell distribution width (RDW)] to predict the prognosis of acute heart failure (AHF) patients. However, in the current study, these variables were compared based on accuracy, sensitivity, and specificity to determine the best prognostic factor.MethodsOf 734 heart failure patients referred to the emergency department, 400 cases were enrolled based on the inclusion and exclusion criteria. Data of them were documented, and patients were followed for one year. Eventually, the association of clinical variables and RBC indices with one-year mortality was explored.ResultsThe study included 226 (56%) men and 174 (44%) women with a median age of 66 years. Body Mass Index (HR 1.098, p = 0.016), Hb (HR 0.728, p = 0.024), HTC (HR 0.875, p = 0.066), MCHC (HR 0.795, p = 0.037), and RDW-CV (HR 1.174, p = 0.006) were confirmed as predictors of long-term mortality. Despite confirming the predictive role of these variables by ROC curves, their sensitivity and specificity were reported as follows: [72% and 50% for Hb], [75% and 52% for HCT], [88% and 27% for MCHC], and [49% and 81% for RDW]. In addition, stratified groups of patients, based on normal cut-off values obtained from scientific literature, had significantly different survival in Kaplan–Meier analyses.ConclusionWhilst proving the predictive role of Hb, HCT, MCHC, and RDW in AHF patients, the most sensitive measurement was MCHC and the most specific one was RDW; therefore, these variables should be considered for risk stratification purposes of AHF patients in daily clinical practice.

Pragmatic trial of messaging to providers about treatment of acute heart failure: The PROMPT-AHF trial

Acute Heart failure (AHF) is among the most frequent causes of hospitalization in the United States, contributing to substantial health care costs, morbidity, and mortality. Inpatient initiation of guideline-directed medical therapy (GDMT) is recommended for patients with heart failure with reduced ejection fraction (HFrEF) to reduce the risk of cardiovascular death or HF hospitalization. However, underutilization of GDMT prior to discharge is pervasive, representing a valuable missed opportunity to optimize evidence-based care. The PRagmatic Trial Of Messaging to Providers about Treatment of Acute Heart Failure tests the effectiveness of an electronic health record embedded clinical decision support system that informs providers during hospital management about indicated but not yet prescribed GDMT for eligible AHF patients with HFrEF. PRagmatic Trial Of Messaging to Providers about Treatment of Acute Heart Failureis an open-label, multicenter, pragmatic randomized controlled trial of 1,012 patients hospitalized with HFrEF. Eligible patients randomized to the intervention group are exposed to a tailored best practice advisory embedded within the electronic health record that alerts providers to prescribe omitted GDMT. The primary outcome is an increase in the proportion of additional GDMT medication classes prescribed at the time of discharge compared to those in the usual care arm.

Optimizing exercise testing-based risk stratification to predict poor prognosis after acute heart failure.

The timely selection of severe heart failure (HF) patients for cardiac transplantation and advanced HF therapy is challenging. Peak oxygen consumption (VO2 ) values obtained by the cardiopulmonary exercise testing are used to determine the transplant recipient list. This study reassessed the prognostic predictability of peak VO2 and compared it with the Heart Failure Survival Score (HFSS) in the modern optimized guideline-directed medical therapy (GDMT) era. We retrospectively selected 377 acute HF patients discharged from the hospital. The primary outcome was a composite of all-cause mortality, or urgent cardiac transplantation. We divided these patients into the more GDMT (two or more types of GDMT) and less GDMT groups (fewer than two types of GDMT) and compared the performance of their peak VO2 and HFSS in predicting primary outcomes. The median follow-up period was 3.3years. The primary outcome occurred in 57 participants. Peak VO2 outperformed HFSS when predicting 1year (0.81 vs. 0.61; P=0.017) and 2year (0.78 vs. 0.58; P<0.001) major outcomes. The cutoff peak VO2 for predicting a 20% risk of a major outcome within 2years was 10.2 (11.8-7.0) for the total cohort. Multivariate Cox regression analyses showed that peak VO2 , sodium, previous implantable cardioverter defibrillator (ICD) implantation, and estimated glomerular filtration rate were significant predictors of major outcomes. Optimizing the cutoff value of peak VO2 is required in the current GDMT era for advanced HF therapy. Other clinical factors such as ICD use, hyponatraemia, and chronic kidney disease could also be used to predict poor prognosis. The improvement of resource allocation and patient outcomes could be achieved by careful selection of appropriate patients for advanced HF therapies, such as cardiac transplantation.

Arterial Embolic Complications in a Patient with Acute Heart Failure

Abstract Introduction: In acute heart failure patients, the prothrombotic state is likely due to arterial and venous endothelial dysfunction. Decompensated heart failure appears to also be associated with increased levels of prothrombotic molecules, such as fibrinogen and von Willebrand factor, which also contribute to the prothrombotic state. Case presentation: We present the case of a 72-year-old male patient, admitted for signs of acute heart failure with bilateral ankle edema. Laboratory data showed D-dimer level &gt;5 µg/mL, which raised the suspicion of pulmonary embolism secondary to deep vein thrombosis. Doppler ultrasound performed to exclude a deep vein thrombosis revealed a total occlusion of the superficial femoral artery on the lower left limb and an abdominal aorta with a lumen diameter of 35 mm and a true lumen of 18.6 mm with circular isoechoic material on the aortic wall. The computed tomography angiography described an aneurysm of the abdominal aorta with mural thrombosis extending to the bifurcation level. Conclusion: In patients with acute heart failure, a comprehensive vascular assessment is also needed. The therapeutic management of these patients varies from conservative to endovascular or surgical therapy, but revascularization therapy should be considered based on the patient’s medical condition.

A Rising Star of the Multimarker Panel: Growth Differentiation Factor-15 Levels Are an Independent Predictor of Mortality in Acute Heart Failure Patients Admitted to an Emergency Clinical Hospital from Eastern Europe.

(1) Background: Acute heart failure (HF) represents one of the most common yet extremely severe presentations in emergency services worldwide, requiring prompt diagnosis, followed by an adequate therapeutic approach, and a thorough risk stratification. Natriuretic peptides (NPs) are currently the most widely implemented biomarkers in acute HF, but due to their lack of specificity, they are mainly used as ruling-out criteria. Growth differentiation factor-15 (GDF-15) is a novel molecule expressing different pathophysiological pathways in HF, such as fibrosis, remodeling, and oxidative stress. It is also considered a very promising predictor of mortality and poor outcome. In this study, we aimed to investigate the GDF-15's expression and particularities in patients with acute HF, focusing mainly on its role as a prognosis biomarker, either per se or as part of a multimarker panel. (2) Methods: This unicentric prospective study included a total of 173 subjects, divided into 2 subgroups: 120 patients presented in emergency with acute HF, while 53 were ambulatory-evaluated controls with chronic HF. At admission, all patients were evaluated according to standard clinical echocardiography and laboratory panel, including the assessment of GDF-15. (3) Results: The levels of GDF-15 were significantly higher in patients with acute HF, compared to controls [596 (305-904) vs. 216 (139-305) ng/L, p &lt; 0.01]. GDF-15 also exhibited an adequate diagnostic performance in acute HF, expressed as an area under the curve (AUC) of 0.883 [confidence interval (CI) 95%: 0.828-0.938], similar to that of NT-proBNP (AUC: 0.976, CI 95%: 0.952-1.000), or troponin (AUC: 0.839, CI 95%: 0.733-0.944). High concentrations of GDF-15 were significantly correlated with mortality risk. In a multivariate regression model, GDF-15 was the most important predictor of a poor outcome, superior to NT-proBNP or troponin. (4) Conclusions: GDF-15 proved to be a reliable tool in the multimarker assessment of patients with acute HF. Compared to the gold standard NT-proBNP, GDF-15 presented a similar diagnostic performance, doubled by a significantly superior prognostic value, making it worth being included in a standardized multimarker panel.

Treatment of Acute Decompensated Chronic Heart Failure: Furosemide vs Furosemide and Metolazone: A Cross-Sectional Comparative Study

Background: Heart failure is a leading cause of hospital admissions each year. In Nepal also the incidence of heart failure is increasing. Acute decompensated heart failure carries a poor prognosis. Most patients respond to intravenous loop diuretics but a substantial proportion of patients are resistant to them and may need additional diuretic agents like metolazone by the principle of “sequential nephron blockade”.&#x0D; Methods: In a hospital-based cross-sectional comparative study, we assigned 68 patients with acute decompensated chronic heart failure patients to receive furosemide at 1 mg/kg twice daily or furosemide at 1 mg/kg twice daily plus metolazone 5mg/day. The primary end-points were daily weight loss, negative water balance (difference between urine output and fluid intake) and symptomatic improvement on NYHA grading.&#x0D; Results: There were 55% males and 45% females in total. There was a significant difference (p-value =0.003) in mean weight loss observed between the two groups on day three, i.e., 0.971±0.6 kg and 1.5±0.78 kg in furosemide group and furosemide plus metolazone group respectively. Mean negative water significantly more in the combination group on day two (450±230.94 ml vs 750.59±416.92 ml) with p-value &lt;0.001 and day three (780.88±352.48 ml vs 504.38±292.46 ml) with p-value 0.001. There was no significant change in symptoms on the basis of NYHA grading between the two groups, duration of hospital stay and adverse events like hypotension, acute kidney injury and dyselectrolytemia.&#x0D; Conclusion: Among patients with acute decompensated chronic heart failure, treatment with combination of furosemide and metolazone was found to be more effective than furosemide alone without significant increase in adverse effects.

Predictive Value of Arterial Blood Lactic Acid Concentration on the Risk of in-Hospital All-Cause Death in Patients with Acute Heart Failure.

The study aims to examine the predictive value of arterial blood lactic acid concentration for in-hospital all-cause mortality in the intensive care unit (ICU) for patients with acute heart failure (AHF). We retrospectively analyzed the clinical data of 7558 AHF patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The exposure variable of the present study was arterial blood lactic acid concentration and the outcome variable was in-hospital all-cause death. The patients were divided into those who survived (n = 6792) and those who died (n = 766). The multivariate logistic regression model, restricted cubic spline (RCS) plot, and subgroup analysis were used to evaluate the association between lactic acid and in-hospital all-cause mortality. In addition, receiver operating curve (ROC) analysis also was performed. Finally, we further explore the association between NT-proBNP and lactic acid and in-hospital all-cause mortality. Compared with the lowest quartiles, the odds ratios with 95% confidence intervals for in-hospital all-cause mortality across the quartiles were 1.46 (1.07-2.00), 1.48 (1.09-2.00), and 2.36 (1.73-3.22) for lactic acid, and in-hospital all-cause mortality was gradually increased with lactic acid levels increasing (P for trend <0.05). The RCS plot revealed a positive and linear connection between lactic acid and in-hospital all-cause mortality. A combination of lactic acid concentration and the Simplified Acute Physiology Score (SAPS) II may improve the predictive value of in-hospital all-cause mortality in patients with AHF (AUC = 0.696). Among subgroups, respiratory failure interacted with an association between lactic acid and in-hospital all-cause mortality (P for interaction <0.05). The correlation heatmap revealed that NT-proBNP was positively correlated with lactic acid (r = 0.07) and positively correlated with in-hospital all-cause mortality (r = 0.18). There was an inverse L-shaped curve relationship between NT-proBNP and in-hospital all-cause mortality, respectively. Mediation analysis suggested that a positive relationship between lactic acid and in-hospital all-cause death was mediated by NT-proBNP. For AHF patients in the ICU, the arterial blood lactic acid concentration during hospitalization was a significant independent predictor of in-hospital all-cause mortality. The combination of lactic acid and SAPS II can improve the predictive value of the risk of in-hospital all-cause mortality in patients with AHF.

Defining Multimorbidity in Older Patients Hospitalized with Medical Conditions.

The term "multimorbidity" identifies high-risk, complex patients and is conventionally defined as ≥2 comorbidities. However, this labels almost all older patients as multimorbid, making this definition less useful for physicians, hospitals, and policymakers. Develop new medical condition-specific multimorbidity definitions for patients admitted with acute myocardial infarction (AMI), heart failure (HF), and pneumonia patients. We developed three medical condition-specific multimorbidity definitions as the presence of single, double, or triple combinations of comorbidities - called Qualifying Comorbidity Sets (QCSs) - associated with at least doubling the risk of 30-day mortality for AMI and pneumonia, or one-and-a-half times for HF patients, compared to typical patients with these conditions. Cohort-based matching study PARTICIPANTS: One hundred percent Medicare Fee-for-Service beneficiaries with inpatient admissions between 2016 and 2019 for AMI, HF, and pneumonia. Thirty-day all-location mortality KEY RESULTS: We defined multimorbidity as the presence of ≥1 QCS. The new definitions labeled fewer patients as multimorbid with a much higher risk of death compared to the conventional definition (≥2 comorbidities). The proportions of patients labeled as multimorbid using the new definition versus the conventional definition were: for AMI 47% versus 87% (p value<0.0001), HF 53% versus 98% (p value<0.0001), and pneumonia 57% versus 91% (p value<0.0001). Thirty-day mortality was higher among patients with ≥1 QCS compared to ≥2 comorbidities: for AMI 15.0% versus 9.5% (p<0.0001), HF 9.9% versus 7.0% (p <0.0001), and pneumonia 18.4% versus 13.2% (p <0.0001). The presence of ≥2 comorbidities identified almost all patients as multimorbid. In contrast, our new QCS-based definitions selected more specific combinations of comorbidities associated with substantial excess risk in older patients admitted for AMI, HF, and pneumonia. Thus, our new definitions offer a better approach to identifying multimorbid patients, allowing physicians, hospitals, and policymakers to more effectively use such information to consider focused interventions for these vulnerable patients.

Short Report Risk factors for elderly acute decompensated heart failure patients with diabetic nephropathy: A retrospective study.

Risk factors that contribute to the development of heart failure include chronic kidney disease and diabetes. Elderly patients with diabetic nephropathy are more likely to develop heart failure. We analysed laboratory data and clinical characteristics of elderly patients with diabetic nephropathy to explore the risk factors for therapeutic effect of acute decompensated heart failure (ADHF). One hundred and five elderly patients with diabetic nephropathy, admitted in the Nephrology Ward of Baoding No1 Central Hospital Baoding, China, between June 2018 and June 2020, were enrolled in this study. They were classified as biochemically unaltered group (21 cases) and biochemically recovering group (84 cases). The clinical data, laboratory examination, therapy, and outcome of the participants were collected for analysis retrospectively. Low-density lipoprotein (LDL), C-reactive protein (CRP) and 24-hour urine protein are independent risk factors for the therapeutic efficacy of ADHF in elderly patients with diabetic nephropathy.

Abstract 11912: Pregabalin Use Increases the Risk of Acute Heart Failure in Patients With Heart Failure: A Population-Based Study

Introduction: Pregabalin, a structural analog to λ-aminobutyric acid, is prescribed for neurological disorders. Through actions to cause sodium/water retention, the agent may increase the risk of acute heart failure (AHF). Methods: We performed a retrospective cohort study using a repository of healthcare records obtained from a large U.S. academic healthcare system. HF patients were identified between 1/1/2016-12/31/2020. Patients who had initiated treatment with pregabalin were compared to patients with no post-HF pregabalin over a 365-day post-pregabalin period or post-HF period. Study outcomes were per-patient per-year (PPPY) emergency department (ED) admissions or PPPY hospitalizations, time-to first ED admission, and time-to hospitalizations. Outcomes encounters were adjudicated by a HF diagnosis (ICD-10, I50.x) at any position. We tested the association between the pregabalin exposure and outcomes using generalized linear regression and Cox-proportional hazard regression approach. Results: The study cohort included 483 pregabalin-HF patients and 21,150 pregabalin-naïve HF patients. The pregabalin-HF patients age was (mean±SEM: 62.2±0.7 vs. 66.2±0.1 years, p &lt;0.0001) and more females (54.9% vs, 44.4%, p &lt;0.0001) than pregabalin-naïve HF patients. Charleston comorbidity score was 3.66±0.14 vs. 3.23±0.02 ( p =0.007). Pregabalin use was associated with a 13% increase in PPPY AHF hospitalizations ( p &lt;0.036). A 15% increase in the PPPY ED pregabalin admissions was noted ( p =0.1142). Pregabalin ED admission or AHF hospitalization were 1.492 (95% CI: 1.204 ̶ 1.850 [ p =0.0003]) and 1.112 (95% CI: 0.922 ̶ 1.340 [ p =0.2663]). Conclusion: This retrospective cohort study shows pregabalin is associated with an increased risk of AHF in patients with existing HF. Pregabalin prescribing in HF should be considered with caution. Further signal evaluation to test the robust association between pregabalin and AHF is warranted.

Abstract 12075: Extracellular Vesicle Cargo Long-Noncoding RNAs Are Dynamic Biomarkers in Acute Decompensated Heart Failure

Introduction: Acute decompensation is associated with increased long-term mortality in patients with heart failure (HF). Biomarkers of acute HF that are dynamic during decongestion may provide physiologic insight for this observation. We hypothesized that long-noncoding RNAs (lncRNAs) and mRNAs in extracellular vesicles (EVs) not only mark different types of HF, but also may be dynamically altered with decongestion across physiologically important pathways. Methods: RNA sequencing was performed on plasma-derived EVs in acute HF patients (7 HFpEF; 7 HFrEF) at hospital admission (V1) and at discharge (V2) along with 9 controls without HF. Differential expression analysis was performed using DESeq2 across groups and time-points. Transcripts were prioritized by fold change (±1.5) and statistical significance (&lt;5% FDR). We subsequently validated targets in EVs from 182 additional patients (24 control; 86 HFpEF; 72 HFrEF). Results: Between HF and control patients, 138 lncRNAs and 147 mRNAs were different (Fig a,b). LncRNAs were confirmed to be exclusively present in EVs. Of 13 targets investigated in our validation cohort, 5 lncRNAs and 6 mRNAs were significantly different between control and HF (age, sex-adjusted; Fig c). Pairwise comparisons between EV RNAs at hospital admission versus decongestion revealed a significant change in 4 lncRNAs (Fig d,e ) that was independent of weight change during hospitalization. Notably, distinct fragments derived from these transcripts were noted in HF versus control groups. Conclusions: The plasma EV transcriptome is significantly altered in patients with acute HF. Plasma EV-derived lncRNA fragments demarcate congestion and decongestion better than mRNAs, may be markers for pathophysiologically relevant pathways independent of volume status, and may provide additional prognostic information.

Abstract 11115: Impella Preserves Systemic, Coronary, and Cerebral Blood Flows During Ventricular Fibrillation by Establishing the Acute Fontan Circulation

Introduction: The ventricular fibrillation (VF) often occurs in acute heart failure patients with Impella support, percutaneous transvalvular left ventricular assist device. Although Impella can preserve blood pressure in some VF patients, the hemodynamic mechanism of Impella during VF remains unclear. Aim: In this study, we examined the impact of Impella on hemodynamics and cerebral and coronary blood flows in a goat model of VF. We also addressed the optimal blood volume status to maintain the Impella circulation during VF. Methods: In six goats, we inserted Impella CP via the left carotid artery. We simultaneously recorded right (RAP) and left atrial pressure (LAP), central blood pressure at ascending aorta (CBP), and the blood flows of pulmonary artery (PA), left coronary circumflex artery (LCX), and right carotid artery (CA). The VF was induced by direct current. We compared the impact of Impella support level (P0, P4 and P8) on hemodynamics and each blood flow. Under P8-Impella supported VF condition, we withdrew blood continuously and observed the left ventricular (LV) suction point at which a frequent negative LV pressure occurred. Results: As shown in Fig. 1 and 2, Impella maintained hemodynamics flow-dependently, indicating the establishment of acute Fontan circulation. In P8-Impella support, systemic (PA flow), LCX and CA blood flows were preserved by 50.1±27.7, 50.7±12.5 and 67.3±5.6%. from baseline, respectively. The blood volume reduction induced the suction of Impella (Fig. 3) at RAP below 9.9±1.9 mmHg. Conclusions: Impella establishes the acute Fontan circulation and preserves hemodynamics including coronary and cerebral blood flows during VF. The optimal blood volume status should be considered to maintain the Impella operation during VF.

Abstract 13692: Gender, Process of Care and Mortality in Heart Failure Patients in India: Findings From the National Heart Failure Registry India

Introduction: HF mortality rate vary by gender in high income countries. Process of care is often associated with differences in HF mortality. Hypothesis: We hypothesized that, HF process of care is associated with differential mortality in men and women. Methods: National Heart Failure Registry is a nationwide registry . Data from 10851 consecutive acute decompensated heart failure patients (ESC2016) criteria was analysed. At baseline we examined sociodemographic characteristics, clinical features , disease etiology and co-morbid conditions of patients. We assessed both in-hospital and 90-day mortality. Results: The mean age of study population was 59.9 (SD=13.5). More than two third (69%) participants were men. Sixty-five percent (Women = 58.6%, Men =68.2%, p value = p&lt;0.001) and 13%( Women = 19.5%, Men =9.6%, p value = p&lt;0.001) of patients had HF with reduced ejection fraction and HF with preserved ejection fraction, respectively. In this study, 71.2%(Women =74.2 %, Men = 69.8%, p value = p&lt;0.001) of patients had New York Heart Association (NYHA) Class III or Class IV. In-hospital and 90-day mortality rate were 6.7%(Women = 7.6%, Men = 6.3%, p value = 0.010) and 14.2%(Women = 14.9%, Men = 13.9%, p value =0.160), respectively(Fig:1). Beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA) were prescribed in 75.7% (Women=74.2%, Men=76.4%, p value = 0.015), 61.2% (Women=60.6%, Men=61.4%, p value = 0.405) and 64.7% (Women=66.4%, Men=64.0%, p value = 0.016), respectively. The study population had very low usage of devices like the automatic implantable cardioverter-defibrillator 0.9% (Women=0.4%, Men=1.1%, p value =p&lt;0.001), cardiac resynchronization therapy defibrillator 1.0% (Women=1.1%, Men=1.0%, p value =0.75). Conclusion: The HF process of care differences may partially explains the differences in mortality in men and women.

Abstract 14520: Paradoxical Increase in Myeloperoxidase Inhibitory Capacity Associated With Poorer Outcomes in Acute Cardio-Renal Syndrome

Introduction: While implicated in both cardiac and renal dysfunction, it remains unclear if myeloperoxidase (MPO) plays a role in the development of acute cardiorenal syndrome (CRS). We developed an assay to quantify MPO inhibitory capacity (MIC) to assess a plasma sample’s capacity to inhibit MPO activity. Hypothesis: We hypothesized that unopposed MPO activity (less inhibition) contributes to development of acute CRS and greater MPO inhibition leads to improved clinical outcomes. Methods: 90 paired samples of acute heart failure (AHF) patients were collected at enrollment and between 24-96 hours follow-up. Diluted samples were supplemented with 100 ng/mL exogenous MPO and allowed to equilibrate for 1 hour at room temperature. Equal parts sample and Amplex UltraRed Reagent were incubated for 30 minutes, and fluorescence was read. 59 patients had long-term follow-up data for time to readmission survival analysis, censored for loss to follow up, death, or transplantation. Results: Patients with CRS have higher rather than lower MIC compared to that in uncomplicated patients (50% vs 34%, p=0.048). Serial MIC measurements during hospitalization revealed that patients with persistently low MIC experienced better outcomes (median time to readmission 575 days vs 104 days, p=0.023, Figure). Conclusions: Contrary to our original hypothesis, we observed acute CRS patients had higher rather than lower MIC, and that persistently low MIC experienced better long-term outcomes. These results imply that in patients experiencing acute CRS, there is a circulating MPO inhibitory component that has not been previously accounted for, and that unopposed MPO activity was not associated with CRS or poor outcomes.

Abstract 11074: A Model for Predicting Cardiovascular Events in Acute Decompensated Heart Failure Patients With Decreased Renal Function

Background: The models for predicting cardiovascular events, including medication data such as dosage and the number of medications, have not been well studied. This study aimed to develop a model, including medication data, for predicting cardiovascular events within one year after discharge in acute decompensated heart failure (ADHF) patients with decreased renal function. Methods This study included 443 first-time admitted ADHF patients with decreased renal function in the Showa University Fujigaoka Hospital between January 2015 and December 2019. Decreased renal function was defined as an eGFR &lt; 60 mL/min/1.73 m 2 at discharge. The primary outcome was cardiovascular events (cardiovascular death and first heart failure rehospitalization) within one year after discharge. The model for predicting events was developed using predictive factors extracted by multivariate analysis. The cardiovascular events curves were visualized using the Kaplan-Meier method and estimated using a log-rank test. Results The incidence of cardiovascular events was 20.1%. By multivariate analysis, atrial fibrillation (AF), weight loss &lt; 5% during admission, brain natriuretic peptide (BNP) ≥ 200 pg/mL at discharge, polypharmacy (≥ 10 drugs), and beta-blockers use below the maintenance dosage were significantly associated with an increased risk of cardiovascular events. The hazard ratios of the five factors for the cardiovascular events were scored (AF, weight loss, polypharmacy, and beta-blockers dosage = 1 point; BNP = 2 points) and patients divided into three groups. The cardiovascular events rate in the high-risk (≥ 4 points) group was four times as high as the rate in the low-risk (≤ 2 point) group (one-year events rate: 41.0% vs 9.2%, p &lt; 0.001, Figure). Conclusions The developed model for cardiovascular events, including polypharmacy and beta-blockers dosage, will be useful for planning more aggressive and earlier management in ADHF patients with decreased renal function.

Abstract 9825: Trajectories of Pharmacotherapy After Acute Cardiac Decompensation - Impact of Heart Failure Phenotype

Background &amp; Aim: Longitudinal data on prescription rates (PR) of guideline-directed medical therapy (GDMT) in patients with acute heart failure (HF) are scarce. We investigated GDMT patterns in patients with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction (EF) and determined mortality risk. Patients &amp; Methods: 943 acute HF patients, consecutively recruited between 2015 and 2019, with EF measured while in hospital. PR of betablockers (BB), renin angiotensin system inhibitors (RASi), mineralocorticoid receptor antagonists (MRA), and diuretics were recorded on admission, at discharge, and 6-month follow-up. Results: Little more than one third of patients had HFrEF ( Table ). Patients with HFpEF were older and more often female. Irrespective of EF, comorbidity burden was high ( Table ). Mortality at 12 months was similar across HF phenotypes. The Figure shows that PR of all disease-modifying drug classes increased from admission to discharge irrespective of HF phenotype. PR of MRA were highest in HFrEF. After 6-months, in HFrEF patients, PR of BB (-9%), RASi (-8%), and diuretics (-10%) had decreased again to admission levels. Similar patterns were apparent in HFmrEF and HFpEF including PR of diuretics ( Figure ). Treatment discontinuation of one or more disease modifying drug classes after discharge was frequent (38% in HFrEF, 29% in HFmrEF, 39% in HFpEF). Post-discharge discontinuation was associated with an age-adjusted increase of 12-month mortality risk (OR 10.9, 95%CI 7.6–15.7): for BB 24.5 (16.0–37.5); for RASi 17.6 (11.1–28.0); for MRA 12.3 (6.9–22.1); for diuretics 27.7 (18.3–42.1), with comparable impact across HF phenotypes. Conclusion: In this cohort of patients with AHF, prescription patterns of GDMT were often changed along the HF trajectory, yet similar across HF phenotypes and time. Irrespective of HF phenotype, stopping GDMT was associated with a consistently increased mortality risk.

Implications of worsening renal function before hospitalization for acute heart failure.

Kidney function changes dynamically during AHF treatment, but risk factors for and consequences of worsening renal function (WRF) at hospital admission are uncertain. We aimed to determine the significance of WRF at admission for acute heart failure (AHF). We evaluated a subgroup of 406 patients from The Acute Kidney Injury Neutrophil gelatinase-associated lipocalin Evaluation of Symptomatic heart failure Study (AKINESIS) who had serum creatinine measurements available within 3months before and at the time of admission. Admission WRF was primarily defined as a 0.3mg/dL or 50% creatinine increase from preadmission. Alternative definitions evaluated were a ≥0.5mg/dL creatinine increase, ≥25% glomerular filtration rate decrease, and an overall change in creatinine. Predictors of admission WRF were evaluated. Outcomes evaluated were length of hospitalization, a composite of adverse in-hospital events, and the composite of death or HF readmission at 30, 90, and 365days. Biomarkers' prognostic ability for these outcomes were evaluated in patients with admission WRF. One-hundred six patients (26%) had admission WRF. These patients had features of more severe AHF with lower blood pressure, higher BUN, and lower serum sodium concentrations at admission. Higher BNP (odds ratio [OR] per doubling 1.16-1.28, 95% confidence interval [CI] 1.00-1.55) and lower diastolic blood pressure (OR 0.97-0.98, 95% CI 0.96-0.99) were associated with a higher odds for the three definitions of admission WRF. The primary WRF definition was not associated with a longer hospitalization, but alternative WRF definitions were (1.3 to 1.6days longer, 95% CI 1.0-2.2). WRF across definitions was not associated with a higher odds of adverse in-hospital events or a higher risk of death or HF readmission. In the subset of patients with WRF, biomarkers were not prognostic for any outcome. Admission WRF is common in AHF patients and is associated with an increased length of hospitalization, but not adverse in-hospital events, death, or HF readmission. Among those with admission WRF, biomarkers did not risk stratify for adverse events.

Remote dielectric sensing to detect acute heart failure in patients with dyspnoea: a prospective observational study in the emergency department.

Remote dielectric sensing (ReDS) enables quick estimation of lung fluid content. To examine if ReDS is superior to other methods in detecting acute heart failure. We included consecutive patients with dyspnoea from the emergency departments at Bispebjerg Hospital, Copenhagen, and performed ReDS, low-dose chest computed tomography (CT), echocardiogram, lung ultrasound, NT-Pro-brain natriuretic peptide (NT-proBNP), and a Boston score evaluation (chest X-ray and clinical signs). ReDS values >35% were used as a cut-off to diagnose pulmonary congestion. Acute heart failure was adjudicated by experts' review of health records but independently of ReDS values. Sub-analyses investigated ReDS in acute heart failure patients with congestion on CT. We included 97 patients within a median of 4.8 h from admittance: 25 patients (26%) were ReDS-positive and 39 (40%) had adjudicated acute heart failure (21 with and 18 without CT congestion). Heart failure patients had median ReDS 33%, left ventricular ejection fraction 48%, and NT-proBNP 2935 ng/L. A positive ReDS detected heart failure with 46% sensitivity, 88% specificity, and 71% accuracy. The AUC for ReDS was like the Boston score (P = 0.88) and the lung ultrasound score (P = 0.74). CT-congested heart failure patients had higher ReDS values than patients without heart failure (median 38 vs. 28%, P < 0.001). Heart failure patients without CT-congestion had ReDS values like patients without heart failure (mean 30 vs. 28%, P = 0.07). ReDS detects acute heart failure similarly to the Boston score and lung ultrasound score, and ReDS primarily identifies the acute heart failure patients who have congestion on a chest CT.

Machine Learning Approach to Understand Worsening Renal Function in Acute Heart Failure

Acute heart failure (AHF) is a common and severe condition with a poor prognosis. Its course is often complicated by worsening renal function (WRF), exacerbating the outcome. The population of AHF patients experiencing WRF is heterogenous, and some novel possibilities for its analysis have recently emerged. Clustering is a machine learning (ML) technique that divides the population into distinct subgroups based on the similarity of cases (patients). Given that, we decided to use clustering to find subgroups inside the AHF population that differ in terms of WRF occurrence. We evaluated data from the three hundred and twelve AHF patients hospitalized in our institution who had creatinine assessed four times during hospitalization. Eighty-six variables evaluated at admission were included in the analysis. The k-medoids algorithm was used for clustering, and the quality of the procedure was judged by the Davies-Bouldin index. Three clinically and prognostically different clusters were distinguished. The groups had significantly (p = 0.004) different incidences of WRF. Inside the AHF population, we successfully discovered that three groups varied in renal prognosis. Our results provide novel insight into the AHF and WRF interplay and can be valuable for future trial construction and more tailored treatment.