Acute Heart Failure Registry Research Articles

Prevalence, in-hospital course and prognostic value of tricuspid regurgitation in an all-comer population hospitalized for acute heart failure

Abstract Background There are emerging interventional treatment options targeting tricuspid regurgitation (TR) in patients with heart failure. Nevertheless, community-based data regarding tricuspid regurgitation (TR) in patients with acute heart failure (AHF) are scarce. Purpose To determine prevalence, in-hospital course and prognostic value of TR in an all-comer collective of patients hospitalized for AHF. Methods In a university tertiary care center, patients hospitalized for AHF between 2015 and 2020 were included in a prospective AHF registry (n= 1000). We abstracted clinical data and routine transthoracic echocardiography (TTE) results from electronic health records. In patients with more than mild TR, the TTE images were reviewed by an expert sonographer to confirm TR severity according to current guidelines. Patients with TTE entered the current analysis regarding prevalence of TR, a subset of patients receiving serial echocardiography entered the analyses regarding in-hospital course and prognosis of TR severity. We identified potential predictors of severe TR at discharge using binary logistic regression and assessed prognosis using Cox regression adjusted for age and sex. Results Out of n= 934 AHF patients, n= 318 (34%) patients (75 ± 12 years, 44% female) had moderate/severe (m/s) TR at admission. N= 452 patients underwent serial TTE of whom n= 165 (37%) had m/sTR at admission; in n=108 (65%) patients TR remained m/s while TR improved in n= 57 (35%) patients. Patients with persistent m/s TR at discharge had a higher prevalence of peripheral oedema on admission and discharge when compared to those with improved TR (table). Further, patients with improved TR showed a significant reduction in systolic pulmonary artery pressure while sPAP remained unchanged in the group with persistent moderate/severe TR (table). NT-proBNP decreased significantly between admission and discharge in both groups (table). TR at discharge was strongly associated with NT-proBNP (OR= 2.48), E-wave (OR= 3.34) and TR V-max (OR= 4.40). Patients with m/s TR at discharge had a significantly worse prognosis when compared to patients with persistent ≤ mild or improved TR regarding all-cause death or cardiovascular hospitalization (HR 2.15 [95%CI 1.62 – 2.85]) as well as regarding death or rehospitalization for heart failure (HR 2.19 [95%CI 1.59 – 3.03]). Conclusion In an all-comer AHF patient population, prevalence of m/s TR was high. TR severity at discharge was strongly associated with parameters of hypervolemia, thus supporting maximal therapeutic efforts towards recompensation in AHF patients. M/s TR at discharge was associated with a significantly worse prognosis when compared to patients with ≤ mild TR. Confirmation of our results as well as the evaluation of a potentially beneficial effect of TR interventions in AHF patients with significant TR despite maximal recompensation might be subject to future research.

AI derived ECG global longitudinal strain compared to echocardiographic measurements

Left ventricular (LV) global longitudinal strain (LVGLS) is versatile; however, it is difficult to obtain. We evaluated the potential of an artificial intelligence (AI)-generated electrocardiography score for LVGLS estimation (ECG-GLS score) to diagnose LV systolic dysfunction and predict prognosis of patients with heart failure (HF). A convolutional neural network-based deep-learning algorithm was trained to estimate the echocardiography-derived GLS (LVGLS). ECG-GLS score performance was evaluated using data from an acute HF registry at another tertiary hospital (n = 1186). In the validation cohort, the ECG-GLS score could identify patients with impaired LVGLS (≤ 12%) (area under the receiver-operating characteristic curve [AUROC], 0.82; sensitivity, 85%; specificity, 59%). The performance of ECG-GLS in identifying patients with an LV ejection fraction (LVEF) < 40% (AUROC, 0.85) was comparable to that of LVGLS (AUROC, 0.83) (p = 0.08). Five-year outcomes (all-cause death; composite of all-cause death and hospitalization for HF) occurred significantly more frequently in patients with low ECG-GLS scores. Low ECG-GLS score was a significant risk factor for these outcomes after adjustment for other clinical risk factors and LVEF. The ECG-GLS score demonstrated a meaningful correlation with the LVGLS and is effective in risk stratification for long-term prognosis after acute HF, possibly acting as a practical alternative to the LVGLS.

Temporal trends in sudden cardiac death after acute decompensation in HFrEF patients: a 13-year Japanese multicentre registry study

Abstract Background The implementation of guideline-based medical therapy (GBMT) for heart failure with reduced ejection fraction (HFrEF) has significantly contributed to reducing mortality risks. Yet, detailed analyses on temporal trends of sudden cardiac death (SCD) among these patients, especially post-discharge following acute decompensation, remain scarce. Purpose This study aimed to explore changes in the incidence of SCD over the last 13 years in patients with HFrEF discharged after acute decompensation treatment, and to identify clinical factors associated with SCD risk. Methods We analyzed 2,604 consecutive HFrEF (left ventricular ejection fraction [LVEF] ≤40%) patients enrolled in a Japanese multicentre acute heart failure (HF) registry from 2009 to 2021. SCD was defined as an unexpected and otherwise unexplained death in a previously stable patient or death due to documented or presumed cardiac arrhythmia without a clear non-cardiovascular cause. The determination of death cause (SCD, pump failure death, or other) was made by a central adjudicating committee. The Fine and Gray method was employed to analyze factors associated with SCD. The variables submitted to the model included age (≥70 years), gender, LVEF (&amp;lt;30%), ischaemic aetiology and prescription of GBMT (use of renin-angiotensin system inhibitors, β-blockers and mineralocorticoid receptor antagonist) at discharge. Results The mean age of studied patients was 70.9±14.2 years, and 70.0% were male. During the 1-year follow-up period, 262 deaths (10.1%) occurred, including 51 SCDs (2.0%). Older age was associated with an increased risk of SCD (adjusted hazard ratio [HR] 2.81, 95% confidence interval [CI] 1.40-5.64, P=0.004). Further, patients with an ischaemic aetiology had a higher risk of SCD (HR 1.84, 95% CI 1.06-3.22, P=0.032). During the study period, mean age remained constant (71.0 years to 70.7 years, P for trend =0.884). The proportion of ischaemic aetiology also remained constant (from 37.2% to 38.2%, P for trend =0.972). Overall, there were significant decreases in the incidence of all cause death and SCD (from 13.7% to 8.4%, P for trend =0.002; and from 3.5% to 1.0%, P for trend &amp;lt;0.001; Figure A). Notably, there was an increase in the prescription rate of three classes of GBMT at discharge (from 30.9% to 45.6%, P for trend &amp;lt;0.001; Figure B), and the rate of implantable cardioverter-defibrillator (ICD) use in eligible patients (New York Heart Association functional class II-III with LVEF ≤35%) remained constant (from 9.6% to 11.6%, P for trend =0.157; Figure B). Conclusions With the increasing use of GBMT, the incidence of SCD decreased in real-world patients with HFrEF registered in a Japanese acute HF registry over the past decade.

J-shaped relationship between serum creatinine and mortality in Korean patients with acute heart failure.

Cachexia and sarcopenia are common among heart failure (HF) patients and are linked to poor outcomes. As serum creatinine levels are influenced by both renal function and muscle mass, our study aimed to investigate the relationship between serum creatinine levels and mortality in acute HF patients. We enrolled 5198 consecutive acute HF patients from the Korea Acute Heart Failure (KorAHF) registry, excluding those on renal replacement therapy. Patients were categorized into five groups based on their discharge serum creatinine levels: low (< 0.6mg/dL), reference (0.6-0.89mg/dL), upper normal (0.9-1.19mg/dL), high (1.2-1.49mg/dL), and very high (≥ 1.5mg/dL). The primary endpoint was post-discharge all-cause mortality. The mean creatinine level was 1.20 ± 0.88mg/dL. Notably, 335 (6.4%) patients had serum creatinine levels < 0.6mg/dL. These patients were younger (mean age, 67years) and more likely to have a low BMI (< 18.5kg/m2) compared to the reference group (15.3% vs. 6.4%). Over a median follow-up of 975days, 1743 (34.8%) patients died. We observed a J-shaped relationship between serum creatinine levels and mortality, with both low and high levels associated with increased mortality. After adjusting for covariates, including age, sex, body mass index, diabetes, hypertension, smoking, malignancy, atrial fibrillation on electrocardiography, levels of C-reactive protein, sodium, hemoglobin, albumin, brain natriuretic peptide, de novo heart failure, use of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists, patients with serum creatinine levels < 0.6mg/dL had a 33% higher risk of all-cause mortality (HR, 1.33; 95% CI, 1.06 to 1.66) compared to those with levels of 0.6-0.89mg/dL. However, BUN, which is not affected by muscle metabolism, exhibited a linear relationship with mortality. Among acute HF patients, there exists a J-shaped relationship between discharge serum creatinine levels and mortality, highlighting the increased mortality risk in individuals with very low serum creatinine levels.

American registry of ambulatory and acute decompensated heart failure (AMERICCAASS registry): Rationale and design.

Heart failure (HF) is a highly prevalent and progressive condition associated with significant morbidity and mortality rates. Acute decompensated HF precipitates millions of hospitalizations each year. Despite therapeutic advances, the overall prognosis of HF is poor. The varying clinical courses and outcomes of patients with this disease may be due to region-specific gaps and since most HF studies are conducted in developed countries, the participation of Latin American and Caribbean countries is low. Considering this, the American Registry of Ambulatory and Acute Decompensated Heart Failure (AMERICCAASS) aims to characterize the population with ambulatory and acute decompensated HF in the American continent and to determine rehospitalization and survival outcomes during the 12months of follow-up. AMERICCAASS Registry is an observational, prospective, and hospital-based registry recruiting patients with ambulatory or acute decompensated HF. The registry plans to include between two and four institutions per country from at least 20 countries in the Americas, and at least 60 patients recruited from each participant institution regardless of their ambulatory or acutely decompensated condition. Ambulatory patients with confirmed HF diagnosis or inpatients presenting with acute decompensated HF will be included. Follow-up will be performed at 12months in ambulatory patients or 1, 6, and 12months after hospital discharge in acutely decompensated HF patients. This ongoing study began on 1 April 2022, with recruitment scheduled to end on 30 November 2023, and follow-up on 31 January 2025. Ethics approval was obtained from the Biomedical Research Ethics Committee of Fundación Valle del Lili. Data collected in the AMERICCAASS registry is being stored on the electronic platform REDCap (Research Electronic Data Capture), which allows different forms for patient groups to enable unbiased analyses. For quantitative variables comparison, we will use the Student's t-test or non-parametric tests accordingly. Categorical variables will be presented as proportions, and groups will be compared with Fisher's exact test. The significance level will be <0.05 for comparisons. Readmissions and post-discharge mortality will be calculated as proportions at 1, 6, and 12months, with a survival analysis by conditional probability and the Kaplan-Meier method. AMERICCAASS Registry is intended to be the most important registry of the continent for obtaining important information about demographics, aetiology, co-morbidities, and treatment received, either ambulatory or hospitalized. This registry may contribute to the optimization of national and regional evidence and public policies for the diagnosis and treatment of HF disease.

Impact of the method of calculating 30-day readmission rate after hospitalization for heart failure. Data from the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry.

Thirty-day readmission rate after heart failure (HF) hospitalization is widely used to evaluate healthcare quality. Methodology may substantially influence estimated rates. We assessed the impact of different definitions on HF and all-cause readmission rates. Readmission rates were examined in 1835 patients discharged following HF hospitalization using 64 unique definitions derived from five methodological factors: (1) International Classification of Diseases-10 codes (broad vs. narrow), (2) index admission selection (single admission only first-in-year vs. random sample; or multiple admissions in year with vs. without 30-day blanking period), (3) variable denominator (number alive at discharge vs. number alive at 30 days), (4) follow-up period start (discharge date vs. day following discharge), and (5) annual reference period (calendar vs. fiscal). The impact of different factors was assessed using linear regression. The calculated 30-day readmission rate for HF varied more than two-fold depending solely on the methodological approach (6.5-15.0%). All-cause admission rates exhibited similar variation (18.8-29.9%). The highest rates included all consecutive index admissions (HF 11.1-15.0%, all-cause 24.0-29.9%), and the lowest only one index admission per patient per year (HF 6.5-11.3%, all-cause 18.8-22.7%). When including multiple index admissions and compared with blanking the 30-day post-discharge, not blanking was associated with 2.3% higher readmission rates. Selecting a single admission per year with a first-in-year approach lowered readmission rates by 1.5%, while random-sampling admissions lowered estimates further by 5.2% (P<0.001). Calculated 30-day readmission rates varied more than two-fold by altering methods. Transparent and consistent methods are needed to ensure reproducible and comparable reporting.

Eligibility and Cost-Utility Analysis of Dapagliflozin in Patients with Heart Failure Across the Whole Spectrum of Ejection Fraction in South Korea.

The DAPA-HF and DELIVER trials demonstrated the clinical benefits of dapagliflozin in heart failure (HF) patients across the entire ejection fraction (EF) spectrum. However, further investigation is needed for the real-world application of dapagliflozin in HF patients. This study examines the proportion of real-world HF patients eligible for dapagliflozin and evaluates the cost-effectiveness of adding dapagliflozin to current HF therapy. Data from the nationwide prospective registry, the Korean Acute Heart Failure (KorAHF) registry, were used to determine dapagliflozin eligibility based on the enrollment criteria of the DAPA-HF/DELIVER trials. A cost-utility analysis was conducted using a Markov model to assess the cost-effectiveness of dapagliflozin by comparing it to the standard of care. Out of 5178 KorAHF patients, 48.7% met the enrollment criteria of the DAPA-HF/DELIVER trials, while 89.5% met the label criteria (US Food and Drug Administration, European Medicines Agency, and Korean Ministry of Food and Drug Safety). Eligibility was highest among HF patients with preserved EF (55.3% vs. HF with mildly reduced EF and HF with reduced EF 46.4%). Dapagliflozin proved to be cost-effective, with an incremental cost-effectiveness ratio (ICER) of 4557 US dollar (US$) per quality-adjusted life year, which falls below the US$18,182 willingness-to-pay threshold. The cost-effectiveness benefit was more pronounced in patients with a left ventricular EF (LVEF) ≤40% (ICER US$3279 for LVEF ≤ 40% vs. US$8383 for LVEF >40%). Discrepancies in dapagliflozin eligibility were observed between real-world data and clinical trial results. The addition of dapagliflozin to HF therapy proved to be highly cost-effective across the entire EF spectrum.

Prognostic Role of RVGLS/PASP Ratio, a New Echocardiographic Parameter of the Right Ventricle-Pulmonary Artery Coupling, in Patients With Acute Heart Failure.

Few studies have addressed the predictive implications of right ventricular (RV) and pulmonary arterial (PA) coupling as assessed by echocardiography in patients with acute heart failure (AHF). This study aimed to ascertain the prognostic importance of RV-PA coupling in AHF cases and discern any divergence in its prognostic efficacy based on different heart failure (HF) phenotypes. We evaluated RV-PA coupling by measuring the ratio of right ventricular global longitudinal strain (RVGLS) to pulmonary arterial systolic pressure (PASP), termed the RVGLS/PASP ratio, and assessed its prognostic role using the STrain for Risk Assessment and Therapeutic Strategies in Patients with Acute Heart Failure registry. From an AHF registry of 4312 patients, we analyzed the RVGLS/PASP ratio in 2,865 patients (1,449 men; age, 71.1±13.5 years). At a median follow-up of 35.0 months, 1,199 (41.8%) patients died. Remarkably, PASP (hazard ratio [HR], 1.012; p<0.001), RVGLS (HR, 1.019; p<0.001), and the RVGLS/PASP ratio (HR, 2.426; p<0.001) were statistically significant predictors of all-cause mortality in the univariate analysis. The RVGLS/PASP ratio was a significant predictor of all-cause mortality in all the HF phenotypes, including HF with reduced ejection fraction (HR, 2.124; p=0.002), HF with mildly reduced ejection fraction (HR, 2.733; p=0.021), and HF with preserved ejection fraction (HR, 2.134; p=0.006). Multivariate analysis after adjusting for clinical and echocardiographic variables revealed that the RVGLS/PASP ratio ≤0.32 was associated with a 36% increase in all-cause mortality (HR, 1.365; p<0.001). Impaired RV-PA coupling, defined as an RVGLS/PASP ratio (≤0.32) was associated with an increased risk of mortality in patients with AHF across all HF phenotypes. ClinicalTrials.gov Identifier: NCT03513653.

Real-World Eligibility and Cost-Effectiveness Analysis of Empagliflozin for Heart Failure in Korea.

The US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approved empagliflozin for reducing cardiovascular mortality and heart failure (HF) hospitalization in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). However, limited data are available on the generalizability of empagliflozin to clinical practice. Therefore, we evaluated real-world eligibility and potential cost-effectiveness based on a nationwide prospective HF registry. A total of 3,108 HFrEF and 2,070 HFpEF patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. Eligibility was estimated by inclusion and exclusion criteria of EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction (EMPEROR-Reduced) and EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trials and by FDA &amp; EMA label criteria. The cost-utility analysis was done using a Markov model to project the lifetime medical cost and quality-adjusted life year (QALY). Among the KorAHF patients, 91.4% met FDA &amp; EMA label criteria, while 44.7% met the clinical trial criteria. The incremental cost-effectiveness ratio of empagliflozin was calculated at US$6,764 per QALY in the overall population, which is far below a threshold of US$18,182 per QALY. The cost-effectiveness benefit was more evident in patients with HFrEF (US$5,012 per QALY) than HFpEF (US$8,971 per QALY). There is a large discrepancy in real-world eligibility for empagliflozin between FDA &amp; EMA labels and clinical trial criteria. Empagliflozin is cost-effective in HF patients regardless of ejection fraction in South Korea health care setting. The efficacy and safety of empagliflozin in real-world HF patients should be further investigated for a broader range of clinical applications. ClinicalTrials.gov Identifier: NCT01389843.

Differences in the Effects of Beta-Blockers Depending on Heart Rate at Discharge in Patients With Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation.

Beta-blockers (BBs) improve prognosis in heart failure (HF), which is mediated by lowering heart rate (HR). However, HR has no prognostic implication in atrial fibrillation (AF) and also BBs have not been shown to improve prognosis in heart failure with preserved ejection fraction (HFpEF) with AF. This study assessed the prognostic implication of BB in HFpEF with AF according to discharge HR. From the Korean Acute Heart Failure Registry, 687 patients with HFpEF and AF were selected. Study subjects were divided into 4 groups based on 75 beats per minute (bpm) of HR at discharge and whether or not they were treated with BB at discharge. Of the 687 patients with HFpEF and AF, 128 (36.1%) were in low HR group and 121 (36.4%) were in high HR group among those treated with BB at discharge. In high HR group, HR at discharge was significantly faster in BB non-users (85.5±9.1 bpm vs. 89.2±12.5 bpm, p=0.005). In the Cox model, BB did not improve 60-day rehospitalization (hazard ratio, 0.93; 95% confidence interval [95% CI], 0.35-2.47) or mortality (hazard ratio, 0.77; 95% CI, 0.22-2.74) in low HR group. However, in high HR group, BB treatment at discharge was associated with 82% reduced 60-day HF rehospitalization (hazard ratio, 0.18; 95% CI, 0.04-0.81), but not with mortality (hazard ratio, 0.77; 95% CI, 0.20-2.98). In HFpEF with AF, in patients with HR over 75 bpm at discharge, BB treatment at discharge was associated with a reduced 60-day rehospitalization rate.

Prognostic Comparison of Octogenarian vs. Non-Octogenarian With Acute Decompensated Heart Failure ― AURORA Study ―

Acute decompensated heart failure (ADHF) is the main cause of hospitalization and death of octogenarians, but no data on the 1-year post-discharge mortality rate. We evaluated the clinical status and predictors of 1-year mortality in octogenarians with ADHF.Methods and Results: From the AURORA (Acute Heart Failure Registry in Osaka Rosai Hospital) study, we examined 1,246 hospitalized ADHF patients. We compared the in-hospital mortality rate and the proportion of heart failure (HF) with preserved ejection fraction (HFpEF) between octogenarians and non-octogenarians. After discharge we compared the 1-year mortality rate between these groups, and we also evaluated the predictors of death in both groups. The proportion of HFpEF among the in-hospital deaths of octogenarians was significantly higher than in non-octogenarians (46.2% vs. 15.0%, P=0.031). The 1-year mortality rate after discharge was significantly higher in the octogenarians than non-octogenarians (P=0.014). Multivariable Cox regression analysis revealed that albumin ≤3.0 g/dL and antiplatelet agents were useful predictors of 1-year death after discharge of octogenarians whereas chronic kidney disease was a predictor in the non-octogenarians. The proportion of HFpEF among in-hospital deaths of octogenarians with ADHF was high as compared with non-octogenarians. When octogenarians with ADHF have severe hypoalbuminemia and antiplatelet agents, early nutritional and medical interventions after discharge may be important to improve the 1-year prognosis.

Metformin treatment is associated with improved survival in diabetic patients hospitalized with acute heart failure: A prospective observational study using the Korean acute heart failure registry data

AimsAlthough the hypothesis that metformin is beneficial for patients with diabetes and heart failure (HF) has been steadily raised, there is limited data on metformin use in patients with acute HF. We analyzed the association of metformin on all-cause mortality in hospitalized patients with type 2 diabetes and acute HF. MethodsThe Korean Acute Heart Failure registry prospectively enrolled patients hospitalized for acute HF from 2011 to 2014. Among this cohort, we analyzed patients with diabetes with baseline estimated glomerular filtration rate (eGFR) of 30 ml/min/1.73 m2 or more. We analyzed the all-cause mortality and re-hospitalization for HF within 1 year after discharge. Inverse probability treatment weighting method was used to adjust baseline differences on metformin treatment. ResultsThe study analyzed data from 1,309 patients with HF and diabetes (mean age 69 years, 56 % male). Among them, 613 (47 %) patients were on metformin at admission. During the median follow-up period of 11 months, 132 (19 %) and 74 (12 %) patients not receiving and receiving metformin treatment died, respectively. The mortality rate was lower in metformin users than in non-users (hazard ratio 0.616 [0.464–0.819] P<0.001). After adjustment, metformin was significantly associated with a lower risk for the mortality (hazard ratio 0.677 [0.495–0.928] P=0.015). In subgroup analyses, this association remains significant irrespective of baseline kidney function (eGFR <60 or ≥60 ml/min/1.73 m2, P-for-interaction=0.176) or left ventricular ejection fraction (<40 %, 40–49 %, or ≥50 %, P-for-interaction=0.224). ConclusionsMetformin treatment at the time of admission was associated with a lower risk for 1-year mortality in patients with diabetes, hospitalized for acute HF.

Morbidity and mortality of acute heart failure patients stratified by mitral regurgitation in the Arabian Gulf: Observations from the Gulf acute heart failure registry (Gulf CARE)

This study aimed to evaluate the clinical outcomes of patients with acute heart failure (AHF) stratified by mitral regurgitation (MR) in the Arabian Gulf. Patients from the Gulf CARE registry were identified from 47 hospitals in seven Arabian Gulf countries (Yemen, Oman, Kuwait, Qatar, Bahrain, the United Arab Emirates, and Saudi Arabia) from February to November 2012. The cohort was stratified into two groups based on the presence of MR. Univariable and multivariable statistical analyses were performed. The population cohort included 5005 consecutive patients presenting with AHF, of whom 1491 (29.8 %) had concomitant MR. The mean age of patients with AHF and concomitant MR was 59.2 ± 14.9 years, and 63.1 % (n = 2886) were male. A total of 58.6 % (n = 2683) had heart failure (HF) with reduced ejection fraction (EF) (HFrEF), 21.0 % (n = 961) had HF with mildly reduced EF (HFmrEF), and 20.4 % (n = 932) had HF with preserved EF (HFpEF). Patients with MR had a lower haemoglobin (Hb) level (12.4 vs. 12.7 g/dL; p < 0.001), and a higher prevalence of left atrial enlargement (80.2 % vs. 55.1 %; p < 0.001), cardiogenic shock (9.7 % vs. 7.3 %; p = 0.006) and atrial fibrillation (7.6 % vs. 5.6 %; p = 0.006), and HFrEF (71.0 % vs. 52.6 %; P < 0.001). Multivariable analysis demonstrated that MR was independently associated with increased all-cause mortality at 1-year and 3-month HF rehospitalization [1-year all-cause mortality, adjusted odds ratio (aOR), 1.40; 95 % confidence interval (Cl): 1.13–1.74; p = 0.002; 3-month HF rehospitalization, aOR, 1.26; 95 % Cl: 1.06–1.49; p = 0.009]. In an Arabian Gulf cohort with AHF, concomitant MR was associated with an increased risk of 1-year mortality and 3-months HF rehospitalization.

Abstract 16307: Does the Method of Calculating the 30-day Readmission Rate After Hospitalization for Heart Failure Matter? Data From the VancOuver CoastAL Acute Heart Failure Registry

Introduction: The 30-day readmission rate after a heart failure (HF) hospitalization is widely used for assessing healthcare quality and system performance. However, there are different methodological approaches which may influence estimated rates, and no single accepted approach. The combined impact of these methods is unknown. Goals: We calculated 30-day HF readmission rates (RRs) of hospitalized patients using different published approaches to sampling and measurement. Methods: We included 1,849 patients discharged following unplanned hospitalization with a primary diagnosis of HF between 2016 to 2018 from the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry. We combined five distinct methodological factors (Table 1) to create 64 unique definitions and associated HF RRs. The readmission rates were averaged over 3-years. Multiple linear regression was used to determine the impact of different factors on estimated readmission rates. Results: The calculated 30-day RR for HF varied more than twofold depending solely on the methodological approach (6.4% to 15.0%, 8.6% absolute difference, 134% relative difference). The rates were highest when including all consecutive index admissions (11.1% to 15.0%), and lowest including only one index admission per patient per year (6.4% to 11.4%). The regression model ranked variables affecting RR as: index selection method, reference period, ICD-10 codes, 30-day survival, and index day (Table 2, p&lt;0.001 in all). Conclusions: Our findings have important implications for policy and reporting. Transparent and consistent methods are needed to calculate 30-day RRs to ensure reproducible and comparable reporting.

Abstract 13434: Prognostic Impact of Functional Limitations in Acute Decompensated Heart Failure Patients With Reduced &amp; Preserved Left Ventricular Ejection Fraction

Background: Although functional limitations (FL) could predict clinical status in patients with heart failure (HF), these clinical significances have not been fully elucidated. Hypothesis: Severe FL would be associated with poor prognosis both in patients with HFrEF and HFpEF. Aims: The purpose of this study was to examine the prognostic significance of FL in patients with acute decompensated heart failure (ADHF), relating to left ventricular ejection fraction (LVEF). Methods: We studied 340 patients admitted for ADHF in our prospective cohort study (Osaka Prefectural Acute heart failure Registry: OPAR study)(HFrEF[LVEF≤50%]:n=175 and HFpEF[LVEF&gt;50%]:n=165). Clinical data, echocardiography and venous blood sampling were performed just before discharge. FL were evaluated using the Performance Measure for Activities of Daily Living-8 (PMADL-8 ranges 8-32, and higher scores indicate worse FL). The endpoint was the composite of worsening heart failure rehospitalization and cardiac death. Results: During a follow up period of 3.0±1.9 years, 123 patients (64 patients in HFrEF and 59 patients in HFpEF) reached the primary endpoint. PMADL-8 was significantly smaller in patients with HFrEF than HFpEF (18.9±7.1 vs 21.0±6.1, p=0.004). On multivariate Cox analysis, PMADL-8 score was an independent risk factor for the primary endpoint both in HFrEF and HFpEF after adjustment for major confounders (age, sex, systolic blood pressure, and plasma brain natriuretic peptide level). Patients with high PMADL-8 scores had a higher risk of the primary endpoint than those with low PMADL-8 scores both in HFrEF (≥16 defined by ROC analysis, AUC 0.590[0.503-0.676]; adjusted hazard ratio: 2.20 [95%CI 1.08-4.48], 43% vs 25%, p=0.03) and HFpEF (≥25 defined by ROC analysis, AUC 0.617 [0.528-0.707]; adjusted hazard ratio: 1.95 [95%CI 1.04-3.66], 50% vs 29%, p=0.04). Conclusion: FL evaluated based on PMADL-8 was associated with poor prognosis in ADHF patients with both HFrEF and HFpEF.

Timing of decongestion and its impact on acute heart failure prognosis.

The risk of unfavourable outcomes after an acute heart failure (AHF) episode remains high. Effective decongestion, reflected by haemoconcentration (HC), may guide therapy. Optimal timing of HC remains unspecified. We analysed the AHF registry to evaluate the prognostic differences of various timing of HC. Subjects were divided into 3 groups by time of reaching HC. The groups differed in terms of 1-year occurrence of a composite of the mortality and AHF hospitalization (26% vs. 46% vs. 40%, early vs. late vs. no HC, p = 0.016). Patients reaching HC earlier seem to present the best prognosis regarding the analysed composite endpoint.

Clinical characteristics, treatment and outcomes of acute heart failure patients over 65 years of age (analysis from the OP-AHF registry)

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant from the Institute of Medical Sciences, University of Opole, Poland. Introduction Acute heart failure (AHF) is one of the most common causes of hospitalizations and deaths in the developed countries. Advances in the diagnosis and treatment of heart diseases and the increase of life expectancy have resulted in the fact that we are increasingly hospitalizing elderly patients, often with multi-diseases, which is a significant challenge for health care. Purpose The aim of the study was to analyze the clinical characteristics, treatment and outcomes of patients with AHF over 65 years of age compared to the younger ones. Methods As part of the prospective Acute Heart Failure Registry (OP-AHF), data from 122 patients hospitalized in ICCU were collected from June 2019. Inclusion criteria were hospitalization for AHF and the use of at least one of: intravenous diuretics, catecholamines or mechanical circulatory support. All patients were then followed for 12 months. Results Patients older than 65 years constituted 64% of patients with AHF (78 out of 122 people). Compared to younger ones, they were more often males (36% vs 14%, p = 0.01), smokers (85% vs 55%, p &amp;lt;0.01) and had a significantly lower BMI (29 vs 32 kg / m2, p = 0.02). Older patients had more often history of renal failure (54% vs 44%, p &amp;lt;0.01), diabetes (58% vs 42%, p = 0.07) and arterial hypertension (47% vs 53%), p = 0, 02). Dyspnea was the dominant symptom in both groups (79% vs 94%, p = 0.04). Left ventricular ejection fraction LVEF was insignificantly lower in the elderly (40% vs 44%, p = 0.18). In both groups, NTpro-BNP was increased on admission (9722 vs 8221 pg / ml, p = 0.08) and then decreased on discharge (8057 vs 5377 pg / ml, p = 0.11). Significantly lower hemoglobin values were noted on admission in the group of patients over 65 years of age (12.5 vs 13.8 g%, p &amp;lt;0.01). Elderly patients had higher 12-month mortality (29% vs 14% in younger patients, p = 0.06; HR = 2.34 [95% CI = 0.95-5.76]; adjusted for age, sex, LVEF and NTpro-BNP HR = 2.64 [0.99-7.01], p = 0.05. There was no statistically significant difference in the rates of rehospitalizations within 12 months after hospital discharge (27% in both groups, corrected HR = 0.95 [0.45-1.99]). Conclusions Elderly patients &amp;gt;65 years of age have higher risk of death within 12 months after an episode of acute heart failure than younger ones. However, despite greater burden of comorbidities, they are not more often rehospitalized due to cardiovascular reasons. Fig. Actual and adjusted for age, sex, LVEF and NT-pro BNP 12- month survival of patient over 65 years of age

Comparative analysis of ischemic and non-ischemic etiology of acute heart failure - analysis from the "OP-AHF" registry

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by a grant from the Institute of Medical Sciences, University of Opole, Poland. ROCHE Diagnostics Poland. Introduction Current guidelines of the European Society of Cardiology define acute heart failure as the rapid onset of symptoms and/or signs of heart failure, severe enough for the patient to seek urgent medical attention, leading to an unplanned hospital admission or an emergency department visit. Purpose The aim of this study was to compare clinical characteristics, treatment, and 12-month outcomes of patients with ischemic(I-AHF) and non-ischemic acute heart failure(NI-AHF). Materials and Methods As a part of the open prospective Acute Heart Failure Registry (OP-AHF),data 122 patients hospitalized in the Intensive Cardiac Care Unit were collected in the period from June 2019. The inclusion criteria were hospitalization for acute heart failure and the need to use at least one of: intravenous diuretics, catecholamines or mechanical circulatory support. The project was approved by the Bioethical Committee. Results Patients with ischemic etiology of acute heart failure (I-AHF) constituted 43% of the study group (53 of 122 patients). Compared to patients with non-ischemic etiology of acute heart failure (NI-AHF), patients with I-AHF were older (69 vs. 64 years, p = 0.04) and slightly more frequently male (79% vs. 67%, p=0.12). BMI was similar in both groups (29 vs. 30, p=0.21). On admission, they reported more frequently chest pain (49% vs. 33%, p = 0.08), and less frequently than NI-AHF patients, edema (40% vs. 54%, p = 0.12) and dyspnoea (91% vs. 97%, p =0.25). History of diabetes (60% vs. 20%, p&amp;lt;0.01) and chronic kidney disease (38% vs. 20%, p =0.03) were predominant in I-AHF patients,but atrial fibrillation (36% vs 57%, p=0.02) was less common than in NI-AHF patients. Laboratory results on admission showed significantly higher NT-proBNP levels in the I-AHF patients (11078 vs 7785 pg/ml, p &amp;lt; 0.004). Left ventricle ejection fraction (LVEF) was lower on admission (29% vs 35%, p= 0.02) and at discharge (34% vs 39%, p = 0.19) in I-AHF patients. At 12-month follow-up, there was no improvement of LVEF in I-AHF patients in contrast to NI-AHF patients (34% vs 47%, p &amp;lt;0.001). Death during hospitalization occurred more frequently in the I-AHF patients group (15% vs 3%, p=0.01). The rates of cardiovascular rehospitalisations within 12 months was 23% in patients with I-AHF patients compared to 32% in NI-AHF patients, p=0.3;HR=0.70 (95% CI = 0.35-1.38). The risk of death from any cause within 12 months was lower in patients with I-AHF (17% vs. 32%, p=0.056; HR = 0.49 (95% CI = 0.23-1.02)), nevertheless, after adjustment for age, sex, LVEF and NT-proBNP, mortality was essentially identical in both groups, 24% inI-AHF and 23% in NI-AHF, p=0.99; HR=1.00 (0.45-2.24). Conclusions Despite a worse in-hospital outcomes, ischemic etiology of acute heart failure was not associated with a higher risk of cardiovascular rehospitalization and death at 12-month follow-up than non-ischemic etiology.

COVID-19 incidence and vaccination against SARS-Cov-2, influenza, and pneumococcal disease in patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The risk of a severe course of COVID-19 infection increases with age and body weight, is higher in men and in the chronically ill. Patients with cardiovascular diseases, including heart failure (HF), are at risk of severe (various) infections with a higher risk of complications leading to death. The current guidelines of the European Society of Cardiology recommend prophylactic vaccinations in this group of patients against both SARS-COV-2 and other pathogens. Purpose The aim of the study was to analyze the vaccination coverage against pneumococcus, influenza and COVID-19, as well as to assess the incidence and course of COVID-19 infections in the population of patients with HF hospitalized after an episode of acute heart failure (AHF) between 03.2021 and 03.2022. Methods As a part of the prospective Acute Heart Failure Registry (OP-AHF), in the period from 06.2019, data were obtained from 122 patients hospitalized in the ICCU. Inclusion criteria were hospitalization for AHF and the need to use at least one of: intravenous diuretics, catecholamines or mechanical circulatory support. Data on vaccinations against COVID-19 (a/C19), influenza (a/I) and pneumococcus (a/P), as well as COVID-19 incidence, were collected in a 12-month follow-up from 90 patients. Results COVID-19 infection occurred in 27% of patients (24 of 90 patients). In the studied population, fewer cases of the disease occurred in patients over 65 years of age compared to the younger ones (20% vs 36%, p = 0.08) and a significant proportion of them were male (96% vs 4% women).Among patients with a history of COVID-19 infection [C19(+)] compared to patients without infection [C19(-)], slightly more patients were active smokers (42% vs 39%, p = 0.85), more had diabetes (42% vs 27%, p = 0.19) and hypertriglyceridemia (25% vs 8%, p = 0.03). Patients C19(+) had a higher BMI (34 vs 29 in C19(-), p = 0.01) and lower left ventricle ejection fraction at discharge (33 vs 40, p = 0.18). The most common etiologies of HF in C19(+) patients were ischemic (10 of 24 patients, 42%) and valvular (10 of 24 patients, 42%). The vaccination coverage a/C19 in the whole group of patients was 69% (62 out of 90), of which a higher percentage of vaccinations was in patients over 65 years of age (75% vs 62%, p = 0.19). The a/I vaccination rate was 11%, with a slightly lower percentage in patients over 65 years of age (10% vs 13%, p = 0.65). Among the studied patients, 58% (52 of 90) were vaccinated with both a/C19 and a/I. However, all patients vaccinated a/I were also vaccinated a/C19. None of the examined patients was vaccinated a/P. Conclusion The COVID-19 pandemic and the widely available information on cardiovascular complications resulted in an increase in vaccination among a group of patients at high risk for complications. However, there is still unsufficient awareness of the need for influenza and pneumococcal vaccination as a prevention of serious post-infection complications.

Usefulness of the Klotho protein, FGF-23 and GDF-15 in assessment of the new onset Acute Heart Failure

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by a grant from the Institute of Medical Sciences, University of Opole, Poland. Background Acute heart failure (AHF) is a life-threatening multifaceted clinical condition requiring intensive and expensive treatment. Earlier studies highlighted the difference in characteristics and prognosis of new onset AHF (NO- AHF) and acute decompensated heart failure (ADHF). Protein Klotho and FGF23 could be attractive tools in the evaluation of patients with AHF. GDF-15 is a recognized marker of the risk of death and complications, including bleeding in many cardiovascular diseases. Aim The aim of the study was to compare selected biomarkers (Protein Klotho, FGF-23, GDF-15) with clinical characteristics and 12-month outcomes of patients with NO-AHF and ADHF. Methods As part of the prospective Acute Heart Failure Registry (OP-AHF), data from 112 patients hospitalized in Intensive Cardiac Care Unit (ICCU) were collected from June 2019. Inclusion criteria were: hospitalization for AHF and the use of at least one of: intravenous diuretics, catecholamines or mechanical circulatory support. Blood samples were collected on admission, at discharge as well as at the 30-day. Patients were than follow-up for one year. Results Patients with NO-AHF constituted 46% of the study group (52 out of 112) and compared to patients with ADHF they were more often aged under 65 years (44% vs. 30%, p=0.12), better educated (25% vs. 8%, p=0.03), less frequently with diabetes (31% vs. 43%, p=0.17), hypertension (58% vs. 83%, p=0.03), and prior myocardial infarction (19% vs. 45%, p=0.004). In both groups there were more men (69% vs. 80%,p=0.19) and ischemic etiology of heart failure were more frequent (33% vs. 51%, p=0.42) in NO-AHF and ADHF, respectively. Left ventricular ejection fraction (LVEF) was insignificantly higher in patients with NO-AHF on admission (30% vs. 26%, p=0.6) and at discharge (35% vs. 30%, p=0.27).Only patient with NO-AHF improved LVEF at the 12- month follow–up (50% vs. 35%, p=0,003).It was no signifcant differences between median value of Klotho protein in both groups at admission, discharge and 30–day follow up visit. We observed significant reduction in FGF-23 and GDF-16 at tree time points (Table 1). 12-month mortality in patients with NO-AHF was insignificantly lower (17% vs. 28% in ADHF HR=1,7 (95% Cl=0.25-1.18)),also after correction for age, sex and ,LVEF- 20% vs. 25%, respectively, p=0.58; HR=1,26 (0.3-1.8). In the Cox multivariate model, the risk of death was presented as hazard ratio (HR) and was highest for GDF-15 in both groups (Table2). Conclusion Patients with the NO- AHF have different clinical profile than patients with acute decompensated heart failure with a tendency to lower 12-month mortality. There were no significant differences in the median value of Klotho protein in both groups. Reduction of the FGF-23 during hospitalization can serve as a marker of AHF compensation, thus FGF-23 could be a valuable tool for assessing response to treatment. GDF-15 seems to be the strongest predictor of death in both groups of AHF.