Ambulatory Heart Failure Patients Research Articles

Prevalence and predictors of poor self-care behaviors in patients with chronic heart failure

Despite the indispensable role of self-care behavior in managing heart failure, the practice of self-care behavior remains poor, especially in developing countries. There is a scarcity of research focusing on poor self-care behavior and its determinants within our specific context. Therefore, the objective of this study was to investigate the prevalence and predictors of poor self-care behavior among ambulatory heart failure patients. A facility-based cross-sectional study was conducted at a tertiary care hospital in Ethiopia, involving patients with heart failure. We utilized the European Heart Failure Self-Care Behavior Scale (EHFScBS-9) to evaluate adherence to self-care behaviors. Data were gathered through patient interviews and a review of medical records. A binary logistic regression analysis was performed to identify predictors of poor self-care behavior in heart failure patients. We included a total of 343 participants in the final analysis of this study. The findings revealed that a majority of the patients (73.8%) demonstrated poor overall self-care behavior. Specifically, the majority of patients did not engage in regular exercise (76.1%), failed to consult doctors in case of rapid weight gain (75.6%), did not monitor weight daily (71.5%), did not restrict fluid intake (69.9%), and did not contact doctors in case of experiencing fatigue (68.6%). Additionally, 32.4% of patients did not reach out to doctors when experiencing shortness of breath, 30% did not restrict salt intake, 29% did not adhere to prescribed medication, and only 7% did not consult doctors if edema occurred. Our findings indicated that rural residence (AOR: 5.76, 95% CI: 2.47–13.43), illiteracy (AOR: 2.64, 95% CI: 1.52–6.31), prior hospitalization (AOR: 2.09, 95% CI: 1.21–3.61), and taking five or more medications (AOR: 1.83, 1.01–3.33) were significant predictors of poor self-care behavior. In conclusion, a majority of the participants in our study demonstrated poor self-care behavior. Risk factors for this behavior included rural residence, illiteracy, prior hospitalization, and taking five or more medications. Therefore, it is crucial to prioritize these high-risk patients and implement interventional programs aimed at improving self-care behaviors and overall treatment outcomes in heart failure patients.

Effect of Albumin-Bilirubin Score on Prognosis in Ambulatory Heart Failure Patients with Reduced Ejection Fraction.

Heart failure (HF) often impacts liver function due to reduced cardiac output and increased venous congestion. The Albumin-Bilirubin (ALBI) score has recently been shown to possess prognostic value in patients hospitalized with HF. In this study, we aimed to evaluate the association of the ALBI score with long-term mortality in ambulatory HF patients with reduced ejection fraction (HFrEF). Consecutive patients with HFrEF were included between 2014 and 2019. The ALBI score was calculated using the following formula: (log10 total bilirubin [mg/dL] × 0.66) + (albumin [g/dL] × -0.085). Patients were categorized into two groups: low ALBI (≤ -2.60) and high ALBI score (> -2.60). The endpoint was all-cause mortality. Patients were followed up for a median of 55 (42.6-68.4) months. A total of 417 patients were included in the study. The mean age of the group was 51.5 ± 11.9 years, and 74.8% of the patients were male. 36.5% (n = 152) of the patients were in the high ALBI score group. Patients with a high ALBI score were more likely to be in the New York Heart Association functional class III/IV. These patients had significantly higher N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, systolic pulmonary arterial pressure, and inferior vena cava diameter, along with worse right ventricular systolic function than patients with a low ALBI score. All-cause mortality was significantly increased in the high ALBI score group (41.4% vs. 27.2%, P = 0.003). Multivariate analysis revealed the ALBI score (HR 1.53, 95% CI 1.09-2.15, P = 0.02) as an independent predictor of long-term mortality. The ALBI score is associated with increased long-term mortality in outpatients with HFrEF. It can easily be evaluated and utilized as a liver dysfunction score in this patient group, providing prognostic information.

Better Respiratory Function in Heart Failure Patients With Use of Central-Acting Therapeutics

BackgroundDiaphragm atrophy can contribute to dyspnea in patients with heart failure (HF) with its link to central neurohormonal overactivation. HF medications that cross the blood-brain barrier could act centrally and improve respiratory function, potentially alleviating diaphragmatic atrophy. Therefore, we compared the benefit of central- vs peripheral-acting HF drugs on respiratory function, as assessed by a single cardiopulmonary exercise test (CPET) and outcomes in HF patients. MethodsA retrospective study was conducted of 624 ambulatory adult HF patients (80% male) with reduced left ventricular ejection fraction ≤ 40% and a complete CPET, followed at a single institution between 2001 and 2017. CPET parameters, and the outcomes all-cause death, a composite endpoint (all-cause death, need for left ventricular assist device, heart transplantation), and all-cause and/or HF hospitalizations, were compared in patients receiving central-acting (n = 550) vs peripheral-acting (n = 74) drugs. ResultsCompared to patients who receive peripheral-acting drugs, patients who receive central-acting drugs had better respiratory function (peak breath-by breath oxygen uptake [VO2], P = 0.020; forced expiratory volume in 1 second [FEV1], P = 0.007), and ventilatory efficiency (minute ventilation / carbon dioxide production [VE/VCO2], P < 0.001; end-tidal carbon dioxide tension [PETCO2], P = 0.015; and trend for forced vital capacity [FVC], P = 0.056). Many of the associations between the CPET parameters and drug type remained significant after multivariate adjustment. Moreover, patients receiving central-acting drugs had fewer composite events (P = 0.023), and HF hospitalizations (P = 0.044), although significance after multivariant correction was not achieved, despite the hazard ratio being 0.664 and 0.757, respectively. ConclusionsCentral-acting drugs were associated with better respiratory function as measured by CPET parameters in HF patients. This could extend to clinically meaningful composite outcomes and hospitalizations but required more power to be definitive in linking to drug effect. Central-acting HF drugs show a role in mitigating diaphragm weakness.

Multicenter registry and test bed for extended outpatient hemodynamic monitoring: the hemodynamic frontiers in heart failure (HF2) initiative

BackgroundHemodynamic Frontiers in Heart Failure (HF2) is a multicenter academic research consortium comprised of 14 US institutions with mature remote monitoring programs for ambulatory patients with heart failure (HF). The consortium developed a retrospective and prospective registry of patients implanted with a wireless pulmonary artery pressure (PAP) sensor.Goals/aimsHF2 registry collects demographic, clinical, laboratory, echocardiographic (ECHO), and hemodynamic data from patients with PAP sensors. The aims of HF2 are to advance understanding of HF and to accelerate development of novel diagnostic and therapeutic innovations.MethodsHF2 includes adult patients implanted with a PAP sensor as per FDA indications (New York Heart Association (NYHA) Class III HF functional class with a prior hospitalization, or patients with NYHA Class II or brain natriuretic peptide (BNP) elevation without hospitalization) at a HF2 member site between 1/1/19 to present. HF2 registry is maintained at University of Kansas Medical Center (KUMC). The registry was approved by the institutional review board (IRB) at all participating institutions with required data use agreements. Institutions report data into the electronic registry database using REDCap, housed at KUMC.ResultsThis initial data set includes 254 patients implanted from the start of 2019 until May 2023. At time of device implant, the cohort average age is 73 years old, 59.8% are male, 72% have NYHA Class III HF, 40% have left ventricular ejection fraction (LVEF) &amp;lt; 40%, 35% have LVEF &amp;gt; 50%, mean BNP is 560 pg/ml, mean N-Terminal pro-BNP (NTproBNP) is 5,490 pg/ml, mean creatinine is 1.65 mg/dl. Average baseline hemodynamics at device implant are right atrial pressure (RAP) of 11 mmHg, pulmonary artery systolic pressure (PASP) of 47 mmHg, pulmonary artery diastolic pressure (PADP) 21 mmHg, mean pulmonary artery pressure (mPAP) of 20 mmHg, pulmonary capillary wedge pressure (PCWP) of 19 mmHg, cardiac output (CO) of 5.3 L/min, and cardiac index (CI) of 2.5 L/min/m2.ConclusionA real-world registry of patients implanted with a PAP sensor enables long-term evaluation of hemodynamic and clinic outcomes in highly-phenotyped ambulatory HF patients, and creates a unique opportunity to validate and test novel diagnostic and therapeutic approaches to HF.

Non-adherence to prescribed medications in ambulatory patients with heart failure assessed using liquid chromatography tandem mass spectrometry

Abstract Background Reported rates of medication non-adherence in patients with heart failure (HF) vary widely, ranging between 5-60%, depending on the method of assessment. Very few studies have assessed non-adherence objectively by measuring the plasma level of medications or metabolites; the true prevalence of medication non-adherence in HF patients is unknown. Objectives To report prevalence and clinical associates of medication non-adherence in a cohort of ambulatory HF patients assessed using liquid chromatography–tandem mass spectrometry analysis of plasma levels of prescribed, evidence-based treatments. Methods We assessed adherence in 172 consecutive patients with HF attending a routine clinic follow-up visit. We used liquid chromatography-tandem mass spectrometry to measure the presence of prescribed medications (angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blocker (ARB), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), diuretics and digoxin) in plasma samples collected during the visit. No patient knew in advance that the blood test would be used to assess adherence. Results 69% were male; median (IQR) age 76 (67-82) years; median NTproBNP 1036 (433-2340) ng/L; 62% HF with reduced ejection fraction (HFrEF, LVEF &amp;lt;40%). 1 in 5 patients had severe symptoms (NYHA III/IV) and 38% patients had Clinical Frailty Scale ≥ 5. 120 (70%) had all prescribed medications of interest detectable in plasma; in 52 (30%) patients, at least one prescribed medication was not detected. In none of the patients were no prescribed medications detected (Figure 1). Among the 125 patients prescribed diuretics, 18 (14%) were non-adherent. Among the 106 patients with HFrEF, 25 (24%) were at least partially non-adherent to a disease modifying medication (ACEi/ ARB/BB/MRA). Amongst medication groups studied, the highest non-adherence rate was with ACEi/ARB and diuretics (14% for each) (Figure 2). Comparing non-adherent patients to those who were adherent, there was no significant difference in age, sex or number of medications prescribed. Frailty was more common in the non-adherent compared to adherent group (46% vs 34%). Systolic/ diastolic blood pressure and heart rate were higher in non-adherent patients [median (IQR) SBP: 150 (137-174) vs 140 (125-164) mmHg; median (IQR) DBP 80 (69-89) vs 75 (64-83) mmHg; median (IQR) HR 76 (67-85) vs 69 (60-77) mmHg, each p&amp;lt;0.05]. NTproBNP tended to be higher in those who were non-adherent [median (IQR): 1309 (673-2302) vs 891 (353-2391) ng/L]. Conclusion Medication non-adherence, assessed using a single spot plasma measurement of medication levels, appears to be common in ambulatory patients with HF. 1 in 3 patients were at least partially non adherent to prescribed medications. Our observations have implications for the assessment and management of patients with HF.

Abstract 13587: Hemoglobin Levels Can Predict Early Rehospitalization in Advanced Heart Failure Patients Listed for Heart Transplantation Without Inotropes or Mechanical Circulatory Support

Background: Anemia is a common comorbidity which often coexists in patients with heart failure (HF), and is associated with poor clinical outcome. However, it is unclear whether hemoglobin value has clinical impact in advanced HF patients. Hypothesis: Hemoglobin value influence the clinical outcome of patients with advanced HF. Methods: We retrospectively reviewed clinical data of ambulatory advanced HF patients who were listed for heart transplantation at our institute without intravenous inotropes or mechanical circulatory support (MCS) between 2011 and 2022. We divided the patients with a hemoglobin of lower or higher than the median value, and compared a composite of all-cause death and rehospitalization for HF within 1 year. Results: We enrolled consecutive 38 HF patients (28 males, 49±11 years old). All patients had New York Heart Association III or IV symptoms. The median hemoglobin value at the time of listing for heart transplantation was 12.9 g/dL, 42% met the criteria of anemia, and 67% had iron deficiency. Patients in the lower hemoglobin group were characterized by lower body mass index (19.7±3.0 vs. 21.7±3.1 kg/m 2 , P=0.049), lower systolic blood pressure (84.0±7.6 vs. 88.9±6.2 mmHg, P=0.034) and lower albumin (4.0±0.4 vs. 4.3±0.3 g/dL, P=0.031) than those in the higher hemoglobin group. Age, prevalence of male, left ventricular ejection fraction and brain natriuretic peptide were comparable between the two groups. No patient died in either group at 1 year. The HF rehospitalization-free survival rate was significantly lower in the lower hemoglobin group (41% vs. 82% at 1 year, P=0.020). By multivariate Cox regression analyses, hemoglobin as a continuous variable was an independent predictor for early HF rehospitalization (odds ratio 0.70, 95% confidence interval 0.49-0.97, P=0.030). Conclusion: Lower hemoglobin was a predictor of early HF rehospitalization in ambulatory advanced HF patients listed for heart transplantation without inotropes or MCS.

Abstract 12982: Underutilization of Intravenous Iron in a Contemporary Population of Ambulatory Heart Failure Patients in Canada

Background: Intravenous iron has been shown to improve quality of life and exercise capacity in patients with heart failure and reduced ejection fraction (HFrEF) with iron deficiency anemia. We undertook this study to understand the utilization rates of IV iron in a Canadian heart function clinic. Methods: This retrospective analysis was carried out on all heart failure (HF) patients referred to a tertiary care Heart Function Clinic (HFC) who would have been eligible for intravenous iron therapy from January 2020 until December 2022. Our inclusion and exclusion criteria were based on the FAIR HF trial. Inclusion criteria was left ventricular ejection fraction (LVEF) of ≤40% for patients with New York Heart Association (NYHA) class II or ≤45% for NYHA class III, hemoglobin level of 95 to 135 g/L and iron deficiency. The data and decision to recommend IV iron was based on initial HFC consultation and pre-appointment investigations. Results: Out of 1360 charts reviewed, 920 patients had a complete data set in order to determine eligibility. Of those, 127 (13.8%) met IV iron eligibility criteria as per the FAIR HF trial. Of those eligible, 64.6% were male, 98.4% had HFrEF and 1.6% had heart failure with mildly reduced ejection fraction (HFmrEF) (p&lt;0.001). The mean LVEF for those meeting criteria for IV iron was 28.3±7.6% vs 36.1±13.7% for those ineligible (p&lt;0.001). Mean NYHA class for those meeting criteria for IV iron was 2.3±0.5 vs 2.1±0.7 for those ineligible (p&lt;0.001). Only 3 (2.4%) of the eligible patients were recommended or received IV iron, while 2 (1.6%) others had received IV iron prior to HFC visit (Fig). There were no significant differences in the proportion of patients receiving optimal quadruple therapy HF management between both cohorts (p=0.07). Conclusion: Our study demonstrates a significant underutilization of IV iron administration in eligible HFC patients, presenting many missed opportunities to improve patient quality of life.

Combined telemonitoring and telecoaching for heart failure improves outcome

Telemedicine has been shown to improve the outcome of heart failure (HF) patients in addition to medical and device therapy. We investigate the effectiveness of a comprehensive telehealth programme in patients with recent hospitalisation for HF on subsequent HF hospitalisations and mortality compared to usual care in a real-world setting. The telehealth programme consists of daily remote telemonitoring of HF signs/symptoms and regular individualised telecoaching sessions. Between January 2018 and September 2020, 119,715 patients of a German health insurer were hospitalised for HF and were eligible for participation in the programme. Finally, 6065 HF patients at high risk for re-hospitalisation were enroled. Participants were retrospectively compared to a propensity score matched usual care group (n = 6065). Median follow-up was 442 days (IQR 309–681). Data from the health insurer was used to evaluate outcomes. After one year, the number of hospitalisations for HF (17.9 vs. 21.8 per 100 patient years, p < 0.001), all-cause hospitalisations (129.0 vs. 133.2 per 100 patient years, p = 0.015), and the respective days spent in hospital (2.0 vs. 2.6 days per year, p < 0.001, and 12.0 vs. 13.4, p < 0.001, respectively) were significantly lower in the telehealth than in the usual care group. Moreover, participation in the telehealth programme was related to a significant reduction in all-cause mortality compared to usual care (5.8 vs. 11.0 %, p < 0.001). In a real-life setting of ambulatory HF patients at high risk for re-hospitalisation, participation in a comprehensive telehealth programme was related to a reduction of HF hospitalisations and all-cause mortality compared to usual care.

Orthostatic variation of pulmonary artery pressure in ambulatory heart failure patients

AimTo study effect of change in position (supine and standing) on pulmonary artery pressure (PAP) in ambulatory heart failure (HF) patients.MethodsSeventeen patients with CardioMEMS® sensor and stable heart failure were consented and included in this single center study. Supine and standing measurements were obtained with at least 5 min interval between the two positions. These measurements included PAP readings utilizing the manufacturer handheld interrogator obtaining 10 s data in addition to the systemic blood pressure and heart rate recordings.ResultsMean supine and standing readings and their difference (Δ) were as follows respectively: Systolic PAP were 33.4 (± 11.19), 23.6 (± 10) and Δ was 9.9 mmHg (p = 0.0001), diastolic PAP were 14.2 (± 5.6), 7.9 (± 5.7) and Δ was 6.3 mmHg (p = 0.0001) and mean PAP were 21.8 (± 7.8), 14 (± 7.2) and Δ was 7.4 mmHg (p = 0.0001) while the systemic blood pressure did not vary significantly.ConclusionThere is orthostatic variation of PAP in ambulatory HF patients demonstrating a mean decline with standing in diastolic PAP by 6.3 mmHg, systolic PAP by 9.9 mmHg and mean PAP by 7.4 mmHg in absence of significant orthostatic variation in systemic blood pressure or heart rate. These findings have significant clinical implications and inform that PAP in each patient should always be measured in the same position. Since initial readings at the time of implant were taken in supine position, it may be best to use supine position or to obtain a baseline standing PAP reading if standing PAP is planned on being used.

Patient phenotype profiling using echocardiography and natriuretic peptides to personalise heart failure therapy.

Heart failure (HF) is a progressive condition with a clinical picture resulting from reduced cardiac output (CO) and/or elevated left ventricular (LV) filling pressures (LVFP). The original Diamond-Forrester classification, based on haemodynamic data reflecting CO and pulmonary congestion, was introduced to grade severity, manage, and risk stratify advanced HF patients, providing evidence that survival progressively worsened for those classified as warm/dry, cold/dry, warm/wet, and cold/wet. Invasive haemodynamic evaluation in critically ill patients has been replaced by non-invasive haemodynamicphenotype profiling using echocardiography. Decreased CO is not infrequent among ambulatory HF patients with reduced ejection fraction, ranging from 23 to 45%. The Diamond-Forrester classification may be used in combination with the evaluation of natriuretic peptides (NPs) in ambulatory HF patients to pursue the goal of early identification of those at high risk of adverse events and personalise therapy to antagonise neurohormonal systems, reduce congestion, and preserve tissue/renal perfusion. The most benefit of the Guideline-directed medical treatment is to be expected in stable patients with the warm/dry profile, who more often respond with LV reverse remodelling, while more selective individualised treatments guided by echocardiography and NPs are necessary for patients with persisting congestion and/or tissue/renal hypoperfusion(cold/dry, warm/wet, and cold/wet phenotypes) to achieve stabilizationandto avoid further neurohormonal activation, as a result of inappropriate use of vasodilating or negative chronotropic drugs, thuspursuing the therapeutic objectives. Therefore, tracking the haemodynamic status over time by clinical, imaging, and laboratory indicators helps implement therapy by individualising drug regimens and interventionsaccording to patients'phenotypes even in an ambulatory setting.

Prevalencia y perfil clínico de la enfermedad renal en pacientes con insuficiencia cardiaca crónica. Datos del Registro cardiorrenal español

Introduction and objectivesPatients with combined heart failure (HF) and chronic kidney disease (CKD) have been underrepresented in clinical trials. The prevalence of CKD in these patients and their clinical profile require constant evaluation. This study aimed to analyze the prevalence of CKD, its clinical profile, and patterns of use of evidence-based medical therapies in HF across CKD stages in a contemporary cohort of ambulatory patients with HF. MethodsFrom October 2021 to February 2022, the CARDIOREN registry included 1107 ambulatory HF patients from 13 HF clinics in Spain. ResultsThe median age was 75 years, 63% were male, and 48% had heart failure with reduced left ventricular ejection fraction (HFrEF). A total of 654 (59.1%) had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, and 122 (11%) patients with eGFR ≥ 60 mL/min/1.73 m2 had a urine albumin-creatinin ratio ≥ 30 mg/g. The most important variables associated with lower eGFR were age (R2=61%) and furosemide dose (R2=21%). The proportion of patients receiving an angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blockers (ARB), an angiotensin receptor-neprilysin inhibitor (ARNi), a sodium-glucose cotransporter 2 inhibitor (SGLT2i), or a mineralocorticoid receptor antagonist (MRA) progressively decreased with lower eGFR categories. Notably, 32% of the patients with HFrEF and an eGFR <30 mL/min/1.73 m2 received the combination of ACEI/ARB/ARNi+beta-blockers+MRA+SGLT2i. ConclusionsIn this contemporary HF registry, 70% of patients had kidney disease. Although this population is less likely to receive evidence-based therapies, structured and specialized follow-up approaches within HF clinics may facilitate the adoption of these life-saving drugs.

Transthyretin amyloid cardiomyopathy among patients hospitalized for heart failure and performance of an adapted wild-type ATTR-CM machine learning model: Findings from GWTG-HF

An 11-factor random forest model has been previously developed among ambulatory heart failure (HF) patients for identifying potential wild-type amyloidogenic TTR cardiomyopathy (wtATTR-CM), but model performance in a large sample of patients hospitalized for HF has not been evaluated. This study included Medicare beneficiaries aged ≥65 years hospitalized for HF in the Get With The Guidelines-HF® Registry from 2008-2019. Patients with and without a diagnosis of ATTR-CM were compared, as defined by inpatient and outpatient claims data within 6 months pre- or post- index hospitalization. Within a cohort matched 1:1 by age and sex, univariable logistic regression was used to evaluate relationships between ATTR-CM and each of the 11 factors of the established ATTR-CM model. Discrimination and calibration of the 11-factor model were assessed. Among 205,545 patients (median age 81 years) hospitalized for HF across 608 US hospitals, 627 patients (0.31%) had a diagnosis code for ATTR-CM. ATTR-CM patients were more likely to be male (69% vs 47%), Black race (23% vs 9%), and had lower systolic blood pressure (median 124 vs 139 mmHg). Univariable analysis within the 1:1 matched cohort of each of the 11-factors in the ATTR-CM model found pericardial effusion, carpal tunnel syndrome, lumbar spinal stenosis, and elevated serum enzymes (e.g., troponin elevation) to be strongly associated with ATTR-CM. The 11-factor model showed modest discrimination with c-statistic of 0.65 and good calibration within the matched cohort. Among patients hospitalized for HF in US practice, the number of patients with ATTR-CM as defined by diagnosis codes on an inpatient/outpatient claim within +/- 6 months of admission was low. Patients with a diagnosis of ATTR-CM have a distinct clinical profile, and most factors within the prior 11-factor model were associated with greater odds of ATTR-CM diagnosis. In this population, the ATTR-CM model demonstrated modest discrimination.

Sex differences in Cardiorenal Syndrome: Insights from CARDIOREN Registry.

Although sex-specific differences in heart failure (HF) or kidney disease (KD) have been analyzed separately, the predominant cardiorenal phenotype by sex has not been described. This study aims to explore the sex-related differences in cardiorenal syndrome (CRS) in a contemporary cohort of outpatients with HF. An analysis of the Cardiorenal Spanish registry (CARDIOREN) was performed. CARDIOREN Registry is a prospective multicenter observational registry including 1107 chronic ambulatory HF patients (37% females) from 13 Spanish HF clinics. Estimated Glomerular Filtration Rate (eGFR) < 60ml/min/1.73 m2 was present in 59.1% of the overall HF population, being this prevalence higher in the female population (63.2% vs. 56.6%, p = 0.032, median age: 81years old, IQR:74-86). Among those with kidney dysfunction, women displayed higher odds of showing HF with preserved ejection fraction (HFpEF) (odds ratio [OR] = 4.07; confidence interval [CI] 95%: 2.65-6.25, p < 0.001), prior valvular heart disease (OR = 1.76; CI 95%:1.13-2.75, p = 0.014), anemia (OR: 2.02; CI 95%:1.30-3.14, p = 0.002), more advanced kidney disease (OR for CKD stage 3: 1.81; CI 95%:1.04-3.13, p = 0.034; OR for CKD stage 4: 2.49, CI 95%:1.31-4.70, p = 0.004) and clinical features of congestion (OR:1.51; CI 95%: 1.02-2.25, p = 0.039). On the contrary, males with cardiorenal disease showed higher odds of presenting HF with reduced ejection fraction (HFrEF) (OR:3.13; CI 95%: 1.90-5.16, p < 0.005), ischemic cardiomyopathy (OR:2.17; CI 95%: 1.31-3.61, p = 0.003), hypertension (OR = 2.11; CI 95%:1.18-3.78, p = 0.009), atrial fibrillation (OR:1.71; CI 95%: 1.06-2.75, p = 0.025), and hyperkalemia (OR:2.43, CI 95%: 1.31-4.50, p = 0.005). In this contemporary registry of chronic ambulatory HF patients, we observed sex-related differences in patients with combined heart and kidney disease. The emerging cardiorenal phenotype characterized by advanced CKD, congestion, and HFpEF was predominantly observed in women, whereas HFrEF, ischemic etiology, hypertension, hyperkalemia, and atrial fibrillation were more frequently observed in men.

Prevalence and clinical profile of kidney disease in patients with chronic heart failure. Insights from the Spanish cardiorenal registry

Introduction and objectivesPatients with combined heart failure (HF) and chronic kidney disease (CKD) have been underrepresented in clinical trials. The prevalence of CKD in these patients and their clinical profile require constant evaluation. This study aimed to analyze the prevalence of CKD, its clinical profile, and patterns of use of evidence-based medical therapies in HF across CKD stages in a contemporary cohort of ambulatory patients with HF. MethodsFrom October 2021 to February 2022, the CARDIOREN registry included 1107 ambulatory HF patients from 13 HF clinics in Spain. ResultsThe median age was 75 years, 63% were male, and 48% had heart failure with reduced left ventricular ejection fraction (HFrEF). A total of 654 (59.1%) had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, and 122 (11%) patients with eGFR ≥ 60 mL/min/1.73 m2 had a urine albumin-creatinin ratio ≥ 30 mg/g. The most important variables associated with lower eGFR were age (R2=61%) and furosemide dose (R2=21%). The proportion of patients receiving an angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blockers (ARB), an angiotensin receptor-neprilysin inhibitor (ARNi), a sodium-glucose cotransporter 2 inhibitor (SGLT2i), or a mineralocorticoid receptor antagonist (MRA) progressively decreased with lower eGFR categories. Notably, 32% of the patients with HFrEF and an eGFR <30 mL/min/1.73 m2 received the combination of ACEI/ARB/ARNi+beta-blockers+MRA+SGLT2i. ConclusionsIn this contemporary HF registry, 70% of patients had kidney disease. Although this population is less likely to receive evidence-based therapies, structured and specialized follow-up approaches within HF clinics may facilitate the adoption of these life-saving drugs.

Benzodiazepine use and mortality in chronic heart failure.

The prognostic implications of using benzodiazepines (BZD) in heart failure (HF) patients are still unknown. This study aimed to assess the association of BZD use with all‑cause death in ambulatory, chronic HF patients. We investigated a retrospective cohort of ambulatory HF patients with left ventricular systolic dysfunction (LVSD). The patients were followed up from their first medical appointment until January 2021 and all‑cause mortality was the primary end point. The Cox regression analysis was used to assess the association between BZD use and all‑cause mortality. Subgroup analyses were performed considering age, sex, body mass index (BMI), respiratory disease, chronic kidney disease (CKD), and New York Heart Association (NYHA) class. Multivariable models were built to account for confounders. We studied 854 patients (69% men), of mean (SD) age 71 (13) years, of whom 51% had severe LSVD, and 242 (28.3%) regularly used BZD. During a median follow‑up of 46 months, 443 patients (51.9%) died. BZD use predicted no crude survival disadvantage in the entire investigated group and in the subgroup analysis according to sex, respiratory disease, BMI, and NYHA class. BZD use was not mortality‑associated among patients aged 75 years and younger. However, in those older than 75 years the hazard ratio (HR) of all‑cause death was 1.3 (95% CI, 0.99-1.69; P = 0.06). BZD use seemed safe in the patients without CKD, but in those with CKD it was associated with worse survival (HR, 1.33; 95% CI, 1.02-1.73). In a multivariable‑adjusted analysis, the use of BZD was independently associated with increased death risk (HR, 1.36; 95% CI, 1.06-1.75). The patients medicated with BZD presented a 36% higher risk of dying. BZD should probably be used with caution, particularly in older HF patients and in those with CKD.

Use of the Impella device in ambulatory heart failure and pre-heart transplant patients - one medical center’s experience

Background and objective: The prevalence of heart failure (HF) in the US has increased over several years. The American Heart Association (AHA) documents that HF has a prevalence of 6 million cases among Americans aged 20 years and older. HF is a complex syndrome that results from the structural or functional impairment of ventricular filling or ejection of blood, leading to symptoms including poor exercise tolerance, shortness of breath, and signs of HF such as edema and rales. The aim of the study was to add to the knowledge base from one medical center's experience using Impella device in ambulatory heart failure and pre-heart transplant patients.Results: The axillary Impella enables HF patients to ambulate inside the CICU while waiting for destination therapy. RNs in our medical center's CICU can take care of these patients effectively and competently because of extensive prior experiences with the AxIABP. Nursing staff have adapted existing nursing procedures, protocols, and lessons learned from experiences with the AxIABP to manage this new patient population.Discussion: Impella is one treatment option in advanced HF and pre-heart transplant patients. The development of an alternative insertion technique that allows patients to ambulate instead of being on bedrest continues to evolve. Our medical center’s experiences with taking care of ambulatory HF and pre-heart transplant Impella patients have shown that this is a safe and effective treatment.

Treatment outcomes and associated factors among chronic ambulatory heart failure patients at Jimma Medical Center, South West Ethiopia: prospective observational study

BackgroundHeart failure has been one of the major causes of hospitalization across the world. Focusing on the treatment outcomes of ambulatory heart failure patients will reduce the burden of heart failure such as hospitalization and improve patient quality of life. Even if research is conducted on acute heart failure patients, there is limited data about treatment outcomes of chronic ambulatory heart failure patients. Therefore, this study aimed to assess treatment outcomes and associated factors of chronic ambulatory heart failure patients at Jimma Medical Center, South West Ethiopia.MethodsA hospital-based prospective observational study was conducted on 242 chronic ambulatory heart failure patients at Jimma Medical Center from November 2020 to June 2021. The data were collected with pretested data collection format, and analyzed with Statistical Package for Social Sciences version 23. Both univariate and multivariate logistic regression model were used to identify factors associated with treatment outcomes of outpatient heart failure, and with a reported p value < 0.05, 95% confidence interval (CI) was considered statistical significance.ResultFrom 242 patients, 126 (52.1%) were males and 121 (50.0%) patients were aged between 45 and 65 years. Regarding treatment outcomes, 51 (21.1%) of patients were hospitalized, and 58 (24.0%) and 28 (11.6%) of patients had worsened and improved clinical states respectively. Clinical inertia [AOR = 2.820; 95% CI (1.301, 6.110), p = 0.009], out-of-pocket payment [AOR = 2.790; 95% CI (1.261, 6.172), p = 0.011] and New York Heart Association class II [AOR = 2.534; 95% CI (1.170, 5.488), p = 0.018] were independent predictors of hospitalization.ConclusionHospitalization of ambulatory heart failure patients was relatively high. More than half of the patients had clinical inertia. And also, this study showed most ambulatory HF patients had inadequate self-care. Clinical inertia, out-of-pocket payment, and New York Heart Association class II were independent predictors of hospitalization in ambulatory heart failure patients. Therefore, it is better to give more attention to ambulatory heart failure patients to prevent hospitalization and the burden of heart failure.

Clinical characteristics and outcomes of adults with a history of heart failure in ambulatory patients with COVID-19

Clinical characteristics and outcomes of adults with a history of heart failure in ambulatory patients with COVID-19

Telemedical monitoring and coaching improves survival and hospitalisation rates in heart failure

Abstract Aims To investigate the effectiveness of a combined telemonitoring and telecoaching programme for chronic heart failure patients at high risk for hospitalisation compared to usual care in a real life setting. The applied telehealth programme consisted of regular individualised telecoaching sessions as well as daily remote telemonitoring of heart failure signs and symptoms. Methods Between January 2018 and September 2020, 6,065 heart failure patients were enrolled in a combined telehealth programme and retrospectively compared to a propensity matched usual care group (n=6,065). All participants were members of a statutory health insurance. Median follow-up was 442 days (IQR 309–681). Endpoints were all cause mortality, number and duration of hospitalisations. Results After 1 year the combined telecoaching and telemonitoring programme significantly reduced all-cause mortality probability compared to usual care (11.0 vs. 5.8%, p&amp;lt;0.001). The corresponding number-needed to treat to prevent one death in one year was 19.3. In addition, the number of hospitalisations for heart failure (17.9 vs. 21.8 per 100 patient years, p&amp;lt;0.001) and all cause hospitalisations (129.0 vs. 133.2, p=0.015), as well as their duration (2.0 vs. 2.6 days per year p&amp;lt;0.001, and 12.0 vs. 13.4 days per year p&amp;gt;0.001, respectivel y) were significantly lower in the telehealth group than in the usual care group. Conclusion In ambulatory heart failure patients at high risk for hospitalisation, a combined telemonitoring and telecoaching programme led to a reduction of heart failure hospitalisations and all-cause mortality compared to standard care. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Health Care Systems GmbH (HCSG), Pullach i. Isartal

Endocrine hormone imbalance in heart failure with reduced ejection fraction: A cross-sectional study.

Sustained neurohormonal activation plays a central role in the progression of heart failure (HF). Other endocrine axes may also be affected. It was the aim of this study to examine the endocrine profile (thyroid, parathyroid, glucocorticoid, and sex hormones) in a contemporary sample of patients with HF and reduced ejection fraction (EF) on established disease-modifying therapy. This study prospectively measured morning fasting hormones in 52 ambulatory and stable HF patients with EF < 50% on disease-modifying therapy (mean age 63 ± 11 years, 29% female, mean LVEF 32 ± 9.6%) and compared them to 54 patients at elevated risk for HF (61 ± 12 years, 28% female) and 62 healthy controls (HC; 61 ± 13 years, 27% female). Main comparisons were performed using one-way analysis of variance. Associations with biomarkers were studied with linear regression. HF patients showed a reduced free triiodothyronine (fT3)/free thyroxine (fT4) ratio compared to HC (0.30 ± 0.06 vs. 0.33 ± 0.05, p = 0.046). Parathyroid hormone (PTH) and cortisol were increased in HF compared to both HC (median [IQR] 59 [50-84] vs. 46 [37-52] ng/L,p < 0.001 and 497 ± 150 vs. 436 ± 108 nmol/L, p = 0.03, respectively) and patients at risk (both p < 0.001). Total testosterone was reduced in male HF compared to HC (14.4 ± 6.6 vs. 18.6 ± 5.3 nmol/L; p = 0.01). No differences in TSH, estradiol, progesterone, and prolactin were found. Lower fT3 levels were found in HF with EF < 40% versus EF 40%-49% (4.6 ± 0.3 vs. 5.2 ± 0.7 pmol/L, p = 0.009). In HF patients, fT3 was an independent predictor of NT-proBNP and high-sensitivity troponin T in multiple regression analysis. PTH was positively associated with NT-proBNP. There is evidence of endocrine hormonal imbalance in HF with reduced EF beyond principal neurohormones and despite the use of disease-modifying therapy.