Diagnosis Of Congestive Heart Failure Research Articles

Pregnancy Counseling in a Young Woman With Left Ventricular Non-Compaction.

Left ventricular noncompaction (LVNC) is an uncommon form of cardiomyopathy. Its prevalence in adults is 1:5000. In the differential diagnosis of congestive heart failure, it is rarely the etiology. The etiology of LVNC may be genetic or acquired. There are not guidelines regarding pregnancy planning or outcome in women with this disease. In this presentation, we bring the issue of genetics and pregnancy counseling in women with left ventricular noncompaction.

931. Congestive Heart Failure in Persons Living with HIV: Are we providing standard of care?

BackgroundWith antiretroviral therapy, Human Immunodeficiency Virus (HIV) infection has become a life-long chronic condition. Persons Living with HIV (PLWH) have increased risk of cardiovascular diseases including congestive heart failure (CHF) and increased morbidity and mortality from these diseases due to factors such as HIV-induced chronic inflammation. This study will assess if providers at University Hospital in Newark, NJ are providing standard of care for CHF in PLWH.MethodsThis study was approved by Rutgers IRB (Pro2020000391). A database of 154 charts including all patients with diagnoses of both HIV and CHF was generated using ICD-10 codes for HIV and CHF. After screening, 79 patient charts were eligible. Patients were excluded if their CHF was managed elsewhere, if they were misdiagnosed or deceased. Nine were diagnosed with heart failure with preserved ejection fraction (HFpEF) defined as an ejection fraction above 50%. Seventy were diagnosed with heart failure with reduced ejection fraction (HFrEF) defined as an ejection fraction below 40%. Treatment was assessed using the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines.Recommendations for treatment of HFrEF Recommendations for treatment of HFpEF ResultsFor patients with HFrEF, 10% of eligible patients were not prescribed aldosterone antagonists due to an incorrect contraindication. Thirty eight percent of patients requiring consideration for device therapy were not considered. Fourteen percent of patients did not have NYHA/ACC/AHA class documented. Three additional charts were found to not follow class-based management. Thirty five percent of patients with hypertension did not have guideline-based titrated therapy. In terms of HFpEF, 43% of patients did not have proper hypertension treatment.Heart Failure with Reduced Ejection Fraction Heart Failure with Preserved Ejection Fraction ConclusionAdherence to evidence-based guidelines for CHF in PLWH is important due to their increased risk of mortality and morbidity. Improvements such as documentation of heart failure class, contraindications to medications, and consideration for devices may improve outcomes going forward.Disclosures All Authors: No reported disclosures

Classification of Congestive Heart Failure from ECG Segments with a Multi-Scale Residual Network

Congestive heart failure (CHF) poses a serious threat to human health. Once the diagnosis of CHF is established, clinical experts need to assess the severity of CHF in a timely manner. It is proved that electrocardiogram (ECG) signals are useful for assessing the severity of CHF. However, since the ECG perturbations are subtle, it is difficult for doctors to detect the differences of ECGs. In order to help doctors to make an accurate diagnosis, we proposed a novel multi-scale residual network (ResNet) to automatically classify CHF into four classifications according to the New York Heart Association (NYHA) functional classification system. Furthermore, in order to make the reported results more realistic, we used an inter-patient paradigm to divide the dataset, and segmented the ECG signals into two different intervals. The experimental results show that the proposed multi-scale ResNet-34 has achieved an average positive predictive value, sensitivity and accuracy of 93.49%, 93.44% and 93.60% respectively for two seconds of ECG segments. We have also obtained an average positive predictive value, sensitivity and accuracy of 94.16%, 93.79% and 94.29% respectively for five seconds of ECG segments. The proposed method can be used as an auxiliary tool to help doctors to classify CHF.

Comparison of Time-Varying and Landmark Analysis Methods in Estimating the Association Between Medication Adherence and Outcomes: A Heart Failure Cohort

IntroductionCardiovascular disease (CVD) is a leading contributor to disease burden worldwide. Older people hospitalized with CVD might experience significant decline in physical function and loss of independence.
 Objectives and ApproachThe aim of this study was to investigate the use of community aged care (CAC) and permanent residential aged care (PRAC) services 3 months, 6 months and 12 months after hospital admission for myocardial infarction (MI), stroke and congestive heart failure (CHF). Survey data from the 45 and Up Study (2006-09) for 266,942 people aged 45+ was linked with records for hospital stays (APDC), aged care service use (NACDC), and deaths (RBDM) for 2006-14 through CHeReL and AIHW. Relative risks of using aged care (CAC or PRAC) after MI, stroke or CHF hospitalization were estimated using Cox regression. We described and visualized sequences of health service states (none, re-hospitalization, CAC, PRAC, death) after the index hospitalization.
 ResultsCompared with people without MI, people hospitalized with a principal diagnosis of MI (multivariable-adjusted HR:1.11, 95%CI:1.04-1.18), stroke (HR:1.52, 95%CI:1.43-1.61) and CHF (HR:1.12, 95%CI:1.06-1.19) were more likely to use CAC within 3 months of the hospital discharge. Likewise, people with MI (HR:1.16, 95%CI:1.03-1.29), stroke (HR:2.81, 95%CI:2.58-3.05) and CHF (HR:1.36, 95CI:1.24-1.49) were more likely to enter PRAC within 3 months of discharge. Similar findings were observed for 6 months and 12 months. MI, stroke and CHF patients were more likely to die but less likely to be re-hospitalized after the first 3 months. The number use of CAC and PRAC remains unchanged over 12 months. While this study provides a broadly representative sample of the older population, participants may be healthier than the general population.
 Conclusion / ImplicationsCVD increases use of community and residential care services. Coordination of cardiac and stroke rehabilitation is warranted to maximize ageing in place.

Abstract 16397: Presence of Myocardial Injury on Admission is Associated With an Increase in All-cause Mortality in Patients With COVID-19

Introduction: COVID-19 has emerged as a global health crisis resulting in nearly half a million deaths worldwide to date. Patients with COVID-19 experience significant cardiovascular manifestations including myocardial injury. We sought to determine the risk of myocardial injury within 24 hours of admission on all-cause mortality in patients with COVID-19. Methods: This was a prospective cohort study of patients hospitalized with COVID-19 at a major academic medical center between March 1, 2020-June 1, 2020. The combination of cardiac troponin T (cTnT) elevation (defined as ≥0.01 ng/mL) within 24 hours of admission and an elevated NT-proBNP (defined as >450.0 pg/mL) on admission were used as biomarker surrogates for myocardial injury. Results: There were n = 415 consecutive patients who were hospitalized with COVID-19 with a median age of 68.5 years (IQR 58-81), 44.8% were women, a median BMI of 28.8 (IQR 24.6-35.6), 5.8% of patients had end-stage renal disease on dialysis, 21.6% had a prior diagnosis of coronary artery disease and 21.8% had a prior diagnosis of congestive heart failure. Among patients with at least one positive cTnT level within 24 hours of admission, the median cTnT level was 0.04 ng/mL (IQR 0.01-0.77 ng/mL). Among those with elevated BNP, the median BNP was 1930 pg/mL (IQR 799-5826 pg/mL) on admission. Patients with COVID-19 who had an elevation in both cardiac biomarkers on admission had higher all-cause mortality than patients with COVID-19 who had negative biomarkers (38.2% vs. 7.5%, respectively, p-value < 0.001), with nearly a 5-fold increase in mortality when adjusted for age, gender, BMI and renal dysfunction (adjusted OR 4.9, p-value: 0.003, 95% CI 1.7-13.9, See Figure) Conclusion: Myocardial injury is common in patients with COVID-19 and is associated with a significantly increased risk of death. Cardiac biomarkers on admission can serve as prognostic factors and may guide early management of COVID-19.

Race and Insurance Impact on Hospital Admission From the Emergency Department for Patients Diagnosed With Heart Failure.

The purpose of this study was to analyze if patient race and the presence of insurance predict the odds of admission from the emergency department (ED) for patients diagnosed with congestive heart failure (CHF). Excessive hospital readmissions for patients with CHF are considered a quality-of-care issue. Previous studies have not considered race and insurance in conjunction with quality measures in predicting hospital admission from the ED for these patients. A secondary data analysis was conducted from cross-sectional archival data from the 2015 National Hospital Ambulatory Medical Care Survey using cross-tabulations with χ followed by multiple logistic regression analysis. Race and the presence of insurance were not significant in predicting the odds of admission from the ED for patients with CHF. Being seen in the ED within the last 72 hours and seen by provider types consulting physician and nurse practitioner were significant (P ≤ .05) in predicting the odds of admission related to a diagnosis of CHF.

Study of potentially preventable hospitalisations (PPH) for chronic conditions: what proportion are preventable and what factors are associated with preventable PPH?

IntroductionThe proportion of potentially preventable hospitalisations (PPH) which are actually preventable is unknown, and little is understood about the factors associated with individual preventable PPH. The Diagnosing Potentially Preventable Hospitalisations...

Heart failure in survivors of out-of-hospital cardiac arrest – factors associated with reduced systolic ventricular function at follow-up

Abstract Background Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years but is still only 10%. Little is known about the association between post-resuscitation comorbidity and heart failure after discharge from the initial OHCA-admission. Purpose In OHCA-survivors we aimed to describe predictors of left ventricular (LV) dysfunction, defined as LV ejection fraction (LVEF) <40%, at follow-up. Methods A consecutive cohort of OHCA-patients with cardiac cause from 2007 to 2011 without a pre-OHCA congestive heart failure diagnosis (according to the Danish National Patient Registry, which holds data on all Danish citizens) were retrospectively examined. Logistic regression analyses were used to assess factors associated with LV dysfunction (LVEF <40%) at follow-up after a median of 6 months. Follow-up was not performed systematically in the OHCA-survivors and data from follow-up was assessed by reading of patient charts. Results A total of 365 OHCA-survivors with a mean age of 61 years were discharged alive from hospital. LVEF <40% at hospital discharge was seen in 54% (n=184, 7% missing), and at follow-up after a median of 6 months 19% (n=69) of the total OHCA-cohort of survivors still had LV dysfunction. Factors associated with LV dysfunction at follow-up were chronic ischemic heart disease (IHD) prior to OHCA (odds ratio (OR) = 2.9 (95% CI: 1.2 – 7.1)) and ST-elevation myocardial infarction (STEMI) as cause of OHCA (OR = 2.9 (1.4–6.0)), whereas age, gender, high comorbidity burden prior to OHCA or pre-hospital circumstances (including shockable cardiac arrest rhythm) were not. Conclusion More than half of OHCA-survivors with LVEF <40% at hospital discharge improved LV function and LV dysfunction at follow-up after a median of 6 months after discharge was present in 1 in 5 (19%) of the cohort. Chronic IHD and STEMI were the only factors significantly associated with LV dysfunction at follow-up. A systematic follow-up including echocardiography in the outpatient clinic for OHCA-survivors is recommended especially in patients with reduced LV function at discharge and in STEMI-patients in order to assess the appropriateness of heart failure medication and an implantable cardiac defibrillator. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Danish Foundation Trygfonden

An Observation of Racial and Gender Disparities in Congestive Heart Failure Admissions Using the National Inpatient Sample

BackgroundCongestive heart failure (CHF) is a frequent cause of inpatient admissions in the United States. The purpose of this study was to analyze the racial and gender disparities that occur in CHF admissions and determine the impact of these disparities on medical expenditure.MethodsWe analyzed the National Inpatient Sample (NIS) database from 2009 to 2014 for patients with a primary discharge diagnosis of CHF, and further stratified the cohort on the basis of race and sex. Multivariate analysis was performed to identify the association between CHF and total charges along with other variables such as mortality, length of stay (LOS), and number of procedures.ResultsThere were a total of 5,491,050 admissions with a primary diagnosis of CHF from 977,850 in 2009 to 901,425 in 2014. Females accounted for 49.7%. Total charges for CHF admission were highest in Asians at an average cost of $59,668. African Americans had the lowest mortality rate at 1.75%, however, they also had an average age of admission of 63.47 years, compared to Caucasian at 76.76 (p<0.05). Total charges for males were $42,920 and $36,744 for females (p <0.05). Males also had more procedures at 1.16 vs 0.98 for females (p <0.05). Elixhauser mortality score was higher in males than females at 5.95 vs 5.42 (p <0.05).ConclusionHealthcare disparities exist in CHF admissions in both contexts of race and gender. Further studies are required to pinpoint the source of these differences not only to address mortality but also expenditure costs.

Caracterización Clínica, Terapéutica y Pronóstica En Nefritis Lúpica, A Propósito De Un Caso

Introducción: El lupus eritematoso sistémico, es una enfermedad autoinmune crónica caracterizada por la producción de autoanticuerpos contra un amplio rango de autoantígenos,en la mayoría de pacientes están implicados numerosos tejidos y órganos entre los cuales se destacan los riñones, corazón, cerebro, articulaciones y piel. Una de las complicaciones más severas de la enfermedad es la nefritis lúpica convirtiéndose en causa importante de morbilidad y mortalidad.&#x0D; Objetivo: Describir un caso clínico enfocado en la nefritis lúpica.&#x0D; Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico.&#x0D; Resultados: Paciente femenina de 29 años con diagnóstico previo de Lupus Eritematoso Sistémico quien acudió por presentar edema de miembros inferiores progresivo bilateral, de aproximadamente un mes de evolución sin causa aparente, de predominio matutino que dejó fóvea, en las últimas 48 horas se exacerbó en forma ascendente llegando a región palpebral, es catalogada con Lupus Eritematoso Sistémico con probabilidad de alta actividad por compromiso renal (Síndrome Nefrótico), con diagnósticos diferenciales de Insuficiencia Cardiaca Congestiva y Crisis Hipertensiva tipo Urgencia, recibió tratamiento inmunosupresor con corticoterapia, y se programó biopsia renal para definir diagnóstico, pronóstico y tratamiento de nefritis lúpica.&#x0D; Conclusiones: La presencia de nefropatía lúpica revela un pobre pronóstico, los predictores clínicos como la creatinina sérica, proteinuria y actividad inmunológica influencian el pronóstico a largo plazo.

392 Seasonal Presentation Patterns for Congestive Heart Failure Within a Cohort of Southern Coastal US Emergency Department Patients

Seasonal differences in disease occurrence may inform adjustments to therapeutic regimens. A previous study of emergency department (ED) visits in New Jersey for congestive heart failure (CHF), showed a marked increase in the colder months (35% higher in December compared to August). The authors speculated that this was due in part to increased catecholamine release in response to cold weather. We hypothesized that less harsh winter temperatures in the southern coastal U.S. region might blunt this effect, resulting in a smaller winter-summer difference than the authors observed in New Jersey. We conducted a retrospective cohort study utilizing data from 287 emergency departments within the southern coastal U.S. region. Patients with a primary diagnosis of CHF or pulmonary edema from 01/01/07 to 08/05/19 were included. We aggregated data electronically from medical records and tabulated the number of visits by month, correcting for the length of month. We utilized chi-square to assess for non-uniformity in distribution of visits by month. We calculated the relative difference between the month with the most and least visits along with the 95% confidence interval (CI). There were 285,561 visits for CHF during the study period. Of these, 52% were female and the mean age was 69 +/-16 years. Chi-square rejected uniformity for CHF visits by month (p<0.0001). There were more CHF visits in the colder months. There were 34% more visits in January the peak month versus August the month with the least (95% CI 32% to 36%, p < 0.0001). Contrary to our hypothesis we found a similar winter-summer difference in the southern coastal US region as that in New Jersey. It is unclear why this difference persists despite the fact that winters in the southern coastal region are less harsh than in New Jersey.

Evaluation of serum cardiac troponin I and N-terminal pro-B-type natriuretic peptide levels in patients with alopecia areata.

Alopecia areata (AA) is a recurrent, immune-mediated, hair-loss disorder. It is associated with other autoimmune disorders that carry a high risk of cardiovascular disease (CVD). However, there is a lack of reports on the association of cardiovascular comorbidities and AA. Cardiac troponin I is a biomarker of myocardial ischaemia and inflammation, while N-terminal pro-B-type natriuretic peptide is used in the diagnosis of congestive heart failure. This study was conducted to assess the serum level of both markers by ELISA in 44 patients with AA compared with 44 healthy controls (HCs). None of the participants had CVD, CVD risk factors or other diseases associated with elevation of either marker. The study revealed that serum levels of both markers were significantly higher in patients with AA compared with HCs (P<0.001). The inflammatory milieu encountered in AA may be associated with subtle myocardial inflammation that causes elevation of levels of both of these cardiac markers.

Automatic Detection of Congestive Heart Failure Based on a Hybrid Deep Learning Algorithm in the Internet of Medical Things

Congestive heart failure (CHF) is a chronic heart condition with heart function decline caused by various heart diseases that requires long-term treatment and affects personal life safety. Presently, CHF diagnosis is being conducted by experts, which is a nonspecific mode that is time consuming and depends on experience. Therefore, it is of great clinical value to conduct CHF recognition through automatic detection. This article proposed an automatic CHF detection model based on a hybrid deep learning algorithm that is composed of a convolutional neural network (CNN) and a recursive neural network (RNN). We also classified normal sinus heart rate signals and CHF signals based on electrocardiography (ECG) and time-frequency spectra during the RR interval. The accuracy of this algorithm was 99.93%, the sensitivity was 99.85%, and the specificity was 100% when 5-min ECG signals were analyzed. It showed a certain improvement over previous studies. We also investigated the detection of CHF patients from healthy subjects by ultrashort-term ECG, and good performance was obtained. The hybrid deep learning algorithm can make objective, accurate classifications of CHF signals and serve as an effective auxiliary tool for the clinical detection of CHF patients.

Predictors of return visits to the emergency department among different age groups of older adults.

To identify predictors of 30-day emergency department (ED) return visits in patients age 65-79years and age≥80years. This was a cohort study of older adults who presented to the ED over a 1-year period. A mixed-effects logistic regression model was used to identify predictors for returning to the ED within 30days. We stratified the cohort into those aged 65-79years and aged ≥80years. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) were reported. This study adhered to the STROBE reporting guidelines. A total of 21,460 ED visits representing 14,528 unique patients were included. The overall return rate was 15% (1998/13,300 visits) for age 65-79years, and 16% (1306/8160 visits) for age≥80years. A history of congestive heart failure (CHF), dementia, or prior hospitalization within 2years were associated with increased odds of returning in both age groups (for age 65-79: CHF aOR 1.36 [CI 1.16-1.59], dementia aOR 1.27 [CI 1.07-1.49], prior hospitalization aOR 1.36 [CI 1.19-1.56]; for age≥80: CHF aOR 1.32 [CI 1.13-1.55], dementia aOR 1.22 [CI 1.04-1.42], and prior hospitalization aOR 1.27 [CI 1.09-1.47]). Being admitted from the ED was associated with decreased odds of returning to the ED within 30days (aOR 0.72 [CI 0.64-0.80] for age 65-79years and 0.72 [CI 0.63-0.82] for age≥80). Age alone was not an independent predictor of return visits. Prior hospitalization, dementia and CHF were predictors of 30-day ED return. The identification of predictors of return visits may help to optimize care transition in the ED.

Prognostic role of brain natriuretic peptide in children of the first year of life with congenital heart defects: a prospective cohort study

Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation &gt; 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.

Prognostic role of brain natriuretic peptide in children of the first year of life with congenital heart defects: a prospective cohort study

Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation &gt; 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.

Prognostic role of brain natriuretic peptide in children of the first year of life with congenital heart defects: a prospective cohort study

Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation &gt; 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.

Effects of Pirfenidone on Echocardiographic Parameters of Left Ventricular Structure and Function in Patients with Idiopathic Pulmonary Fibrosis

Abstract Aim: Pirfenidone is a novel anti-fibrotic agent utilized in the treatment of idiopathic pulmonary fibrosis (IPF). It has been implicated in mitigating myocardial fibrosis and left ventricular (LV) systolic and diastolic dysfunction in animal models. However, its impact on LV mechanics in humans remains unknown. The aim of this study was to retrospectively evaluate the effects of pirfenidone on echocardiographic parameters of LV function and structure in patients with IPF. Methods: A total of 124 patients with IPF were included in this study: 64 patients treated with pirfenidone (treatment group) and 60 patients not taking pirfenidone (control group), who had serial pretreatment/baseline and posttreatment/follow-up echocardiograms done within a time frame of four years. Changes in the means of parameters of LV function (systolic, diastolic, and global longitudinal strain) and LV structure (mass and volume indices) were compared between the treatment and control groups. This was followed by a subgroup analysis that included only 88 patients (47 treated, 41 controls) with echocardiographic evidence of myocardial dysfunction at baseline (defined as an ejection fraction of ≤45, or diastolic dysfunction stage 1 or more) in addition to a known clinical diagnosis of congestive heart failure. To account for potential confounders, a secondary adjusted analysis by way of 1:1 propensity score matching (PSM) was carried out. This yielded a sample consisting of 62 patients with 56 patients in the subgroup cohort. Results: Patients in the treatment group were significantly younger (69.4 vs. 77 years, p&lt;0.001) and had relatively lower forced vital capacity (69.9% vs. 80.6%, p = 0.005) in comparison to the control group. However, after PSM, the age demographics were comparable between both groups (72.18 vs. 72.15, p = 0.9). In the primary unadjusted analysis, there was no statistically significant change in any of the mean parameters of LV function and structure after pirfenidone administration when compared to the control group. Furthermore, no significant differences were noted in the subgroup cohort. Such findings were re-demonstrated after a secondary analysis with PSM. Conclusion: From an echocardiographic perspective, pirfenidone had no significant effects on LV structure and function in patients with IPF, even in patients with more overt cardiac dysfunction.

Overall health at diagnosis predicts the risk of complications within the first year after breast cancer diagnosis.

Breast cancer patients with overall poor health are at a greater risk of both complications during treatment and mortality from competing causes. We sought to determine the association of pre-existing comorbidities on treatment-related complications and overall survival. We identified women ages 40-90 years old from our institutional registry with stage I-II invasive breast cancer from 2005 to 2014. Recursive partitioning was used to stratify women based on pre-existing comorbidities as low, moderate, or high risk of treatment-associated complications. Cox proportional hazards model was constructed to estimate the association of risk with overall survival. 2077 women were studied. Mean age was 60 (IQR 51-68). Over half (54%) had ≥ 1 comorbid condition, and 29% experienced at least one adverse medical event within 1 year of diagnosis. Risk categories included low (no comorbidities or hypertension), moderate (combinations of comorbidities excluding congestive heart failure), and high (congestive heart failure in isolation or in combination with other conditions). High-risk women had a lower 10-year OS compared to moderate- or low-risk women (89% vs 90% vs 96%, log-rank p < 0.001). After adjustment, being at moderate (HR 2.20, 95% CI 1.30-3.72, p = 0.003) or high risk (HR 5.07, 95% CI 1.66-15.52, p = 0.004) of adverse sequelae was associated with reduced OS compared to those at low risk of these adverse medical events. Following breast cancer diagnosis, overall poor health was associated with a greater risk of mortality and complications within the first year of treatment, which was driven by a pre-existing diagnosis of congestive heart failure.

CARDIOVASCULAR OUTCOMES FOLLOWING BORTEZOMIB REINITIATION AFTER CONGESTIVE HEART FAILURE DIAGNOSIS IN MULTIPLE MYELOMA

The incidence of congestive heart failure (CHF) in multiple myeloma (MM) patients treated with proteasome inhibitor therapy is reported at 2% - 5%. However, the data are limited regarding safety of resuming proteasome inhibitor therapy after a diagnosis of CHF. A retrospective chart review was