Congestive Heart Failure Patients Research Articles

Association of serum Sodium with mortality in patients of Congestive heart failure

  Objectives:  To determine the association of serum Sodium with mortality in patients of Congestive heart failure. Study Design: Prospective observational study Settings and Duration of study: Department of Medicine, Sir Ganga Ram Hospital, Lahore.  ( 22-12-2021 to 22-6-2022 ). Methods:  Sample size of 100 patients; 50 in each group in calculated with 90% power of study, 5% significance level and taking percentage of mortality i.e. 24.75% patients with low serum sodium level and in 4.21% patients with normal serum sodium level. Sample Selection: Inclusion Criteria: Patients aged between 30-70 years, both genders, Patients with congestive heart failure ,Group I: with serum sodium level <135 mEq/L, Group II: with serum sodium level ≥135 mEq/L. Exclusion Criteria: Liver disorders (AST>25IU, ALT>30IU, hepatitis B or C), renal disorders (eGFR ˂ 30 mL/min/1.73 m2 or creatinine >2.0mg/dl or on hemodialysis), any malignancy, anemia (Hb<9 g/dl), due to inherited hemoglobinopathy such as; sickle cell disease, and thalassemia, Patients with recurrent congestive heart failure or already taking treatment for deranged sodium level , valvular heart disease. Results: Patients in exposed group had 52% mortality rate as compared to unexposed group in which mortality rate was only 18% respective. Value of relative risk showed that patients in exposed group had 2.88 times higher chances of mortality as compared to those patients in unexposed group. Similarly, elderly patients (Relative Risk=3.23), Male patients (Relative Risk= 3.37), Overweight patients (Relative Risk=3.54), non-diabetic patients (Relative Risk=3.50), hypertensive patients (Relative Risk=2.95), ischemic heart disease patients (Relative Risk=4.12), Smoker (Relative risk=4.41) and duration of congestive HF as 0.5-3.5 (Relative Risk= 3.03) had higher risk for mortality. Conclusion: Results obtained from this study showed that low serum sodium level had significant impact on patients of congestive HF in terms of mortality. Keeping its prognostic importance, congestive HF patients should be strictly monitored for electrolyte imbalance. Key Words: Serum sodium, Prognostic, Indicator, Mortality,Congestive Heart Failure.

Association of device detected atrial and ventricular tachyarrhythmia with adverse events in patients with an implantable cardioverter-defibrillator.

Heart failure patients with a history of atrial fibrillation (AF) and ventricular tachycardia/ventricular fibrillation (VT/VF) are known to have worse outcomes. However, there are limited data on the temporal relationship between development of these arrhythmias and the risk of subsequent congestive heart failure (CHF) exacerbation and death. The study cohort comprised 5511 patients implanted with an implantable cardioverter-defibrillator (ICD) in landmark clinical trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, and RAID) who were in sinus rhythm at enrollment. Multivariate cox analysis was performed to evaluate the time-dependent association between development of in-trial device detected AF and VT/VF with subsequent CHF exacerbation and death. Multivariate analysis showed that AF occurrence and VT/VF occurrence were both associated with a similar magnitude of risk for subsequent CHF exacerbation (HR = 1.73 and 1.87 respectively, p < .001 for both). In contrast, only in-trial VT/VF was associated with a significant > two-fold increase in the risk of subsequent mortality (HR = 2.13, p < .001) whereas AF occurrence was not associated with a significant mortality increase after adjustment for in-trial VT/VF (HR = 1.36, p = .096). Our findings from a large cohort of ICD recipients enrolled in landmark clinical trials show that device detected AF and VT/VF can be used to identify patients with increased risk for CHF exacerbation and mortality. These findings suggest a need for early intervention in CHF patients who develop device-detected atrial and ventricular tachyarrhythmias.

The Development and Testing of the Hippocratic Heart Failure Self-Care Scale.

The adoption of self-care behaviors among patients with congestive heart failure (CHF) is essential for the management of their health condition. However, there is a lack of tools for estimating self-care in CHF patients. We aim to develop and validate the Greek version of the Hippocratic heart failure self-care scale (HHFSCS). The scale includes 22 items which are reviewed by a committee of experts. Individuals indicate the frequency at which they follow each self-behavior on a five-point Likert scale. Adult patients with CHF (n = 250) from a General Hospital in Athens participated in the study from June 2020 to March 2021. Reliability coefficients and an explanatory factor analysis (EFA), using a Varimax rotation and the principal component method, were used to assess the psychometric measurements. The Cronbach's alpha coefficient of the HHFSCS was 0.807. The exploratory factor analysis identified two domains that accounted for 88.44% of the variance in the scale items; however, each sub-scale could not be used as an independent scale. Finally, the test-retest showed a significant and strong correlation (r = 0.973, p < 0.001). The HHFSCS is a reliable and valid tool for assessing self-behaviors in CHF patients. Health professionals can use it in their clinical practice to improve the management of a patient's health conditions.

Short-Term Mortality in Hospitalized Patients with Congestive Heart Failure: Markers of Thrombo-Inflammation Are Independent Risk Factors and Only Weakly Associated with Renal Insufficiency and Co-Morbidity Burden.

Congestive heart failure (CHF) is associated with significant morbidity and mortality. There has been renewed interest in using thrombo-inflammatory markers as prognostic tools in patients with CHF. To determine if thrombo-inflammatory markers are independent risk factors for 28-day mortality in hospitalized CHF patients, we retrospectively analyzed admission data extracted from 2008 consecutive patients admitted with a diagnosis of CHF to Zigong Fourth People's Hospital. Multivariate Cox proportional hazards analysis demonstrated that the thrombo-inflammatory markers thrombin time, platelet/lymphocyte ratio (PLR), and D-dimer level were independent predictors of mortality. In addition, variables reflecting the severity of CHF (New York Heart Association class > 2), impaired renal function (elevated serum creatinine [SCr]), impaired organ perfusion (elevated BUN), and chronic liver disease were also independent predictors of mortality. Thrombo-inflammatory biomarkers were only weakly associated with SCr and the burden of co-morbidity, suggesting that thrombo-inflammation may in large part be attributable to CHF itself and that, moreover, its presence may confer an increased risk of mortality. Further large-scale prospective studies are needed to determine the existence and the consequences of a thrombo-inflammatory phenotype among patients with CHF.

The epidemiological characteristics of sleep disordered breathing in congestive heart failure: A prospective, single centre study in Southeast Asia.

The presence of sleep-disordered breathing (SDB) in congestive heart failure (CHF) is associated with poor prognosis and is underdiagnosed despite advances in CHF management. The prevalence of SDB in CHF remains understudied in South East Asia. A prospective, observational single-centre study was conducted where 116 consecutive patients in a specialised heart failure clinic underwent level 1, attended polysomnography (PSG). The prevalence of SDB was 78% using the apnoea-hypopnea index (AHI), AHI ⩾ 5/h threshold, and 59% with the AHI ⩾ 15/h threshold. Obstructive sleep apnoea (OSA) was the predominant type of SDB and was associated with increased body mass index and neck circumference. STOP-BANG was predictive of SDB, especially in men. Central sleep apnoea (CSA) patients had worse sleep indexes and lower awake arterial carbon dioxide. SDB was also homogenously present in preserved ejection fraction (EF) CHF. Most of the CHF patients were found to have SDB with the utility of PSG. Local CHF guidelines should include sleep testing for all patients with CHF.The study is registered on ClinicalTrials.gov (NCT05332223) as 'The Epidemiological Characteristics of SDB in Patients with Reduced or Preserved EF CHF'.

U-shaped association between serum calcium and in-hospital mortality in patients with congestive heart failure.

Serum calcium level is widely used for evaluating disease severity, but its impact on clinical outcomes in patients with congestive heart failure (CHF) remains poorly understood. The aim of this study is to investigate the relationship between serum calcium levels and in-hospital mortality in CHF patients. We conducted a retrospective analysis utilizing clinical data from the Medical Information Mart for Intensive Care database, encompassing a cohort of 15983 CHF patients. This cohort was stratified based on their serum calcium levels, with the primary objective being the determination of in-hospital mortality. To assess the impact of admission serum calcium levels on in-hospital mortality, we employed various statistical methodologies, including multivariable logistic regression models, a generalized additive model, a two-piecewise linear regression model, and subgroup analysis. Comparative analysis of the reference group (Q3) revealed increased in-hospital mortality in the first quintile (Q1, the group with the lowest blood calcium level) and the fifth quintile (Q5, the group with the highest blood calcium level), with fully adjusted odds ratios of 1.38 [95% confidence interval (CI): 1.13-1.68, P=0.002] and 1.23 (95% CI: 1.01-1.5, P=0.038), respectively. A U-shaped relationship was observed between serum calcium levels and in-hospital mortality, with the lowest risk occurring at a threshold of 8.35mg/dL. The effect sizes and corresponding CIs below and above this threshold were 0.782 (95% CI: 0.667-0.915, P=0.0023) and 1.147 (95% CI: 1.034-1.273, P=0.0094), respectively. Stratified analyses confirmed the robustness of this correlation. Our study identifies a U-shaped association between serum calcium levels and in-hospital mortality in CHF patients, with a notable inflection point at 8.35mg/dL. Further investigation through prospective, randomized, and controlled studies is warranted to validate the findings presented in this study.

Health-related quality of life among congestive heart failure patients with preserved and reduced ejection fraction

Abstract Objective To determine factors that affect the health-related quality of life (HRQOL) of congestive heart failure (CHF) patients with preserved and reduced ejection fraction. Methods A cross-sectional study design was used for this study. The stratified random sampling was applied for each subgroup. HRQOL was measured with the Minnesota Living with Heart Failure Questionnaire. The data were analyzed using chi-square, Spearman’s correlation analysis, and independent t-test. Results A number of 67 respondents participated in the recent study. The total mean scores of HRQOL were significantly different (P = 0.001) between heart failure (HF) patients with reduced and preserved ejection fractions, 41.07 ± 7.54 and 54.97 ± 4.36, respectively. It related with the physical (mean ± standard deviation [SD] = 10.4 ± 2.14; t = −10.08, 95% CI = −12.46 to −8.34; P-value = 0.001) and psychological (mean ± SD = 3.5 ± 0.5; t = −6.68, 95% CI = −4.55 to −2.45; P-value = 0.001) domain. Strong correlation was found between age (r = −0.898, P &lt; 0.05), NYHA functional classes (r = −0.858, P &lt; 0.01), duration of HF (r = −0.807, P &lt; 0.01), family support (r = 0.927, P &lt; 0.01), and quality of life (QoL). Conclusions HRQOL in HF patients with reduced ejection fraction was higher than in those with preserved ejection fraction. Family support is a further determinant factor that has a positive correlation to the QoL.

On Expert-Machine Partnership to Predict Mortality of Congestive Heart Failure Patients

ABSTRACT This study examines the combined use of machine learning (ML) and expert judgment in predicting 30-day mortality for congestive heart failure (CHF) patients. It compares models using either expert-selected, ML-selected, or integrated features. The integrated model, merging expert and ML insights, outperforms others in predicting mortality risk, underscoring the value of combining human expertise and ML in clinical decision-making.

Preliminary Report of Intravenous Tolvaptan Sodium Phosphate (Samtas®) Treatment in Decompensated Heart Failure

Background: Tolvaptan sodium phosphate (Samtas®; Otsuka Pharmaceutical, Tokyo, Japan) is a novel intravenous aquaretic diuretic aimed at individuals experiencing advanced congestion refractory to conventional diuretics and having difficulty with oral intake. Despite its potential, the true efficacy and practicality of this compound within real-world clinical settings remain obscure. Methods: A retrospective analysis of clinical data was conducted, examining trends among consecutive in-hospital patients diagnosed with congestive heart failure who underwent treatment with tolvaptan sodium phosphate at a prominent academic medical center between June 2022 and June 2023. Results: Twenty-one patients were enrolled (median age: 75 years, serum N-terminal pro B-type natriuretic peptide: 8941 pg/mL). Among them, 14 patients (67%) received non-invasive/invasive positive-pressure ventilation, and 17 patients (81%) concurrently received intravenous inotropes. Subsequent to the initiation of tolvaptan sodium phosphate treatment, a significant increase in urine volume was observed on the following day (p = 0.036). Urine osmolality decreased from 356 (318, 443) at baseline to 247 (176, 333) mOsm/kg after 4 h (p = 0.002). No occurrences of hypernatremia were recorded during the therapeutic period. Notably, two patients transitioned from tolvaptan sodium phosphate treatment to continuous hemodiafiltration due to insufficient efficacy. Conclusions: In routine clinical practice, intravenous tolvaptan sodium phosphate exhibits potential efficacy and practicability in the majority of congestive heart failure patients exhibiting refractory congestion, unstable hemodynamics, and challenges with oral intake.

Relationship Between Pulmonary Artery Pressure and Inflammation Parameters.

Background Inflammation can play a role in the development and progression of pulmonary hypertension (PHT). In this study, inflammatory parameters were compared in congestive heart failure (CHF) patients with and without PHT. The relationship between pulmonary artery pressure (PAP) and inflammatory parameters was investigated. Materials and methods Out of 80 CHF patients,40 had PHT. The patients' age, gender, smoking status, comorbidities such as diabetes mellitus (DM) and hypertension (HT), and mortality rates were recorded. Inflammatory parameters were recorded. Results The mean age of the PHT group was 64.38 ± 9.17 and the mean age of the non-PHT group was 64.70 ± 8.99. There were 23 men and 17 women in the PHT group, and there were 21 men and 19 women in the non-PHT group. There was no significant difference between the two groups in terms of mean age and gender distribution (p = 0.874 and p = 0.653). Accordingly, the C-reactive protein to albumin ratio (CAR) value was statistically significantly higher in PHT patients (p = 0.023). The eosinophil count was found to be significantly higher in non-PHT patients (p = 0.015). Accordingly, a significant correlation was detected between CAR and PAP (r = 0.392 and p < 0.001). Conclusion In this study, the positive correlation between PAP and CAR and the significantly higher CAR value in PHT patients indicate the presence of inflammation in PHT patients. Studies on the relationship between inflammation and mortality in PHT patients may contribute more to the literature in the future.

Impact of mental disorders on unplanned readmissions for congestive heart failure patients: a population-level study.

Reducing preventable hospitalization for congestive heart failure (CHF) patients is a challenge for health systems worldwide. CHF patients who also have a recent or ongoing mental disorder may have worse health outcomes compared with CHF patients with no mental disorders. This study examined the impact of mental disorders on 28day unplanned readmissions of CHF patients. This retrospective cohort study used population-level linked public and private hospitalization and death data of adults aged ≥18years who had a CHF admission in New South Wales, Australia, between 1 January 2014 and 31 December 2020. Individuals' mental disorder diagnosis and Charlson comorbidity and hospital frailty index scores were derived from admission records. Competing risk and cause-specific risk analyses were conducted to examine the impact of having a mental disorder diagnosis on all-cause hospital readmission. Of the 65861 adults with index CHF admission discharged alive (mean age: 78.6±12.1; 48% female), 19.2% (12675) had at least one unplanned readmission within 28days following discharge. Adults with CHF with a mental disorder diagnosis within 12months had a higher risk of 28day all-cause unplanned readmission [hazard ratio (HR): 1.21, 95% confidence interval (CI): 1.15-1.27, P-value<0.001], particularly those with anxiety disorder (HR: 1.49, 95% CI: 1.35-1.65, P-value<0.001). CHF patients aged ≥85years (HR: 1.19, 95% CI: 1.11-1.28), having ≥3 other comorbidities (HR: 1.35, 95% CI: 1.25-1.46), and having an intermediate (HR: 1.34, 95% CI: 1.28-1.40) or high (HR: 1.37, 95% CI: 1.27-1.47) frailty score on admission had a higher risk of unplanned readmission. CHF patients with a mental disorder who have ≥3 other comorbidities and an intermediate frailty score had the highest probability of unplanned readmission (29.84%, 95% CI: 24.68-35.73%) after considering other patient-level factors and competing events. CHF patients who had a mental disorder diagnosis in the past 12months are more likely to be readmitted compared with those without a mental disorder diagnosis. CHF patients with frailty and a mental disorder have the highest probability of readmission. Addressing mental health care services in CHF patient's discharge plan could potentially assist reduce unplanned readmissions.

Plethysmographic assessment of vasomotor response in patients with congestive heart failure before and after heart transplantation.

Sympathetic vasomotor response is the most important part of the autonomic regulation of circulation, which determines the quality of life. It is disrupted in a number of diseases, particularly in patients with congestive heart failure (CHF). However, experimental evaluation of reflex vasoconstriction is still a non-trivial task due to the limited set of available technologies. The aim of this study is to assess the dynamics of vasomotor response of forearm vessels due to both the deactivation of cardiopulmonary baroreceptors and cold stress using a newly designed imaging plethysmograph (IPG) and compare its performance with classical air plethysmograph (APG). In both vasoconstriction tests, vasomotor response was assessed as a change in the blood flow rate due to venous occlusion compared to that at rest. Both tests were carried out in 45 CHF patients both before and after heart transplantation, as well as in 11 age-matched healthy volunteers. Prior to transplantation, both APG and IPG showed a significant decrease in vasomotor response in CHF patients due to both tests as compared to the control group. After heart transplantation, an increase in vasomotor reactivity was revealed in both vasoconstriction tests. We have found that both plethysmographic techniques provide correlated assessment of changes in the vasomotor response. In addition, we have found that IPG is more resistant to artifacts than APG. The new IPG method has the advantage of measuring blood flow in a contactless manner, making it very promising for experimental evaluation of vasomotor response in clinical conditions.

Hand-Held Echocardiography by Advanced Practice Providers in Patients with Congestive Heart Failure.

The performed hand-held echocardiography (HHE) was evaluated and interpreted by trained advanced practice providers (APPs) on hospitalized CHF patients for image quality and interpretation by comparing with expert echocardiographer and SE findings. Congestive heart failure (CHF) is associated with increased hospital admissions and mortality. While a standard echocardiogram (SE) is the gold standard for cardiac assessment, it is not readily available. Hospitalized CHF patients require rapid assessment for expedited treatment. Over 6 months, five trained APPs performed HHE on hospitalized CHF patients and interpreted: (a) left ventricular (LV) size, (b) LV ejection fraction (LVEF), and (c) right atrial pressure (RAP). The study echocardiographer reviewed and blindly interpreted the HHE images and compared them with APPs and SE findings. Kappa statistics determined the degree of agreement between APPs and the study echocardiographer's interpretation of the HHE images and SE. A total of 80 CHF patients (age 73 ± 14 years, 58% males; LVEF (by SE) 45 ± 19%; 36.3% body mass indexes ≥ 30 kg/m2) were enrolled. HHE interpretation by APPs had a good agreement for LVEF (kappa 0.79) with the study echocardiographer and SE (kappa 0.74) and a good agreement for RAP (kappa 0.67) with the study echocardiographer. The correlation between the absolute LVEF interpretation by the study echocardiographer on HHE and SE was r = 0.88 (p < 0.0001). Trained APPs obtained diagnostic-quality HHE images and interpreted the LV function and RAP in CHF patients in good agreement with the study echocardiographer. LVEF by HHE correlated with LVEF by SE. Our study suggests trained APPs can use HHE to evaluate LVEF and RAP in CHF patients, leading to expedited and optimized treatment.

Illness intrusiveness, health locus of control, and anxiety symptoms among veterans with congestive heart failure.

Disease severity, illness intrusiveness, and health locus of control (HLC) each contribute to psychosocial wellbeing in patients with congestive heart failure (CHF). To better understand the relationships between these variables regarding anxiety symptoms, we analyzed data from 116 adult male veterans with comorbid CHF and anxiety. Results suggested that illness intrusiveness significantly mediated the relation of CHF severity to anxiety symptom severity, and that the illness intrusiveness domains of physical well-being/diet, work/finances, and other aspects of life (religious/spirituality, community/civic, self-improvement/expression) were also significant mediators of that relationship. The relation of illness intrusiveness to anxiety was not moderated by internal HLC. Findings highlight the importance of assessing and treating various aspects of illness intrusiveness to manage anxiety symptoms in CHF patients.

Efficacy of Allopurinol in Improving Endothelial Dysfunction: A Systematic Review and Meta-Analysis.

Endothelial dysfunction has been implicated in various cardiovascular disorders as the initial pathology. Allopurinol has been shown to improve endothelial dysfunction in patients with gout, but its effect on cardiovascular patients is unclear. We aim to assess allopurinol efficacy in improving endothelial dysfunction overall and in different disease states including but not limited to heart failure, chronic kidney disease, ischemic heart disease METHODS: We conducted a literature search of PubMed, Cochrane's Central Library, and Scopus until December 2022, including randomized controlled trials and double-arm observational studies. The primary outcome measure was endothelial function assessed by change in flow mediated dilation (FMD) RESULTS: Our meta-analysis included 22 studies with a total of 1472 patients. Our pooled analysis shows that allopurinol significantly improved FMD (WMD=1.46%, 95% CI [0.70, 2.22], p < 0.01) compared to control. However, there was no significant difference between allopurinol and control for endothelial-independent vasodilation measured by forearm blood flow (WMD=0.10%, 95% CI [- 0.89, 0.69], p = 0.80). Subgroup analysis indicated that the effect of allopurinol on FMD was more significant in diabetic and congestive heart failure patients. While allopurinol may improve endothelial function in various patient populations, further high-quality randomized controlled trials are needed to determine its efficacy in preventing cardiovascular disease exacerbation.

Investigating the Smoker's Paradox: Congested Heart Failure Outcomes in Smokers

BackgroundSmoking is a well-established risk factor for cardiovascular diseases, negatively impacting overall health and decreasing life expectancy. Intriguingly, the smoker's paradox suggests that current smokers diagnosed with congestive heart failure (CHF) may experience lower short-term mortality rates than their non-smoking counterparts. In this study, we investigate the effects of smoking on in-hospital outcomes for CHF patients in the United States, aiming to explore the presence and implications of this paradox within this population. MethodsIn this study, we analyzed data from the 2020 National Inpatient Sample (NIS) to identify patients admitted primarily for congestive heart failure (CHF). We then focused on patients with ICD-10 codes indicative of smoking or tobacco use. To investigate the associations, we utilized logistic and linear regression analyses, adjusting for potential confounders. Results with a 2-tailed p-value of 0.05 or lower were deemed statistically significant. ResultsIn 2020, a total of 513,730 hospitalizations were recorded for congestive heart failure (CHF). Among these cases, 247,575 (48.2%) involved patients with a secondary diagnosis of smoking history or use. After adjusting for factors such as age, race, gender, hospital bed size, location, teaching status, insurance coverage, income level, and Elixhauser comorbidities, CHF patients with a secondary smoking diagnosis demonstrated lower rates of in-hospital mortality (aOR 0.55, 95% CI 0.51-0.62), vasopressor initiation (aOR 0.56, 95% CI 0.48-0.65), mechanical circulatory support (aOR 0.33, 95% CI 0.24-0.44), and hemodialysis initiation (aOR 0.44, 95% CI 0.37-0.52). ConclusionOur study revealed that CHF patients with a smoking history exhibited lower odds of in-hospital mortality, vasopressor use, mechanical circulatory support, and hemodialysis initiation in comparison to non-smokers. To gain a comprehensive understanding of the smoker's paradox, it is essential to conduct more extensive, robust investigations that uncover the underlying mechanisms, ultimately informing the development of more effective patient care strategies.

Prevalence of cardiac cachexia among congestive heart failure patients

Cardiac cachexia is a serious, multifaceted condition that is linked to congestive heart failure and can strike at any age or level of ventricular function. For the diagnosis of cardiac cachexia in patients, no particular test is employed. However, specific nutritional screening methods, such as the CASCO (cachexia score), are employed to identify cardiac cachexia in patients with congestive heart failure. A prospective observational study was used. The study was conducted at a tertiary hospital. The study used the CASCO (cachexia score) tool. The objective of the study was to determine the prevalence of cardiac cachexia among congestive heart failure patients. The results of the study showed that individuals with congestive heart failure had a significantly higher prevalence of malnutrition and cardiac cachexia.

Clinical and Socio Demographic Aspects of Congestive Heart Failure Patients

Background: Congestive heart failure (CHF) is a growing issue for healthcare systems throughout the developed world. Many factors have been linked to an increase in mortality in CHF patients. Despite heterogeneity in the research groups, several demographic and clinical variables appear to be consistently associated with a poor prognosis. Objective: To investigate the clinical and sociodemographic aspects of congestive heart failure patients. Materials and Methods: This study was a descriptive observational study conducted by the Department of Medicine at Narsingdi' 100- bed district hospital from July 2021 to June 2022. Purposive sampling was used to select 120 women and men with congestive heart failure from the cardiac center of 100-bed district hospital in Narsingdi, Bangladesh. Daily consecutive admissions were screened to identify eligible patients who arrived in the cardiac emergency room; Department of Cardiology required an admission diagnosis of congestive heart failure and was enrolled in this study on the basis of inclusion and exclusion criteria with a history of at least one well documented hospitalization for congestive heart failure. Results: Rhematic heart disease was identified in 38(31.7%), cardiomyopathy was found in 30(25.0%), hypertension was found in 21(17.5%), pericardial disease was found in 16(13.3%), and ischemaic heart disease was found in 3(2.5%). Factors related with congestive heart failure were 25 (20.8%) inadequate therapy, 25 (20.8%) arrhythmia, 23 (19.2%) respiratory, 17 (14.2%) anaemia, and 23 (19.2%) infective endocarditis. The majority of patients (75.5%) had NYHA class II, 38.7% had class III, and 5.8% had class IV. Conclusion: In conjunction with medical and demographic characteristics, major socio-environmental factors increased the likelihood of readmission due to congestive heart failure.

Multimodal coupling and HRV assessment characterize autonomic functional changes in congestive heart failure patients with sinus rhythm or severe arrhythmia

Autonomic nervous system (ANS) dysfunction is a significant characteristic of patients with congestive heart failure (CHF). Respiratory sinus arrhythmia (RSA) serves as an index of parasympathetic nervous system (PNS) function usually quantified by the high-frequency power of heart rate variability (HRV). However, the high breathing rate of CHF patients results in deviations when estimating RSA by HRV. Multimodal coupling analysis (MMCA) is a novel method of quantifying RSA which decomposes the R-R signal adaptively into intrinsic mode functions (IMFs) followed by identification of the RSA-related IMF. MMCA also calculates the phase synchronization between RSA-related IMF and respiratory signals to exclude the influences that are unrelated to RSA. In this study, we introduced HRV and MMCA-derived parameters to quantify ANS function for CHF patients, along with their comparisons in the clinical efficacy evaluation. Thirty-seven CHF patients were recruited, including 17 with sinus rhythm (SRHF) and 20 with severe arrhythmia (ARHF). Our results showed that all parameters for SRHF patients increased after treatment except for LF/HF. Only LF/HF, α2, and MMCA-derived RSA showed significant differences after treatment for ARHF patients, wherein the MMCA-derived RSA significantly decreased regardless of the left ventricular ejection fraction. The PNS function and ANS balance were recovered in all the CHF patients after treatment. Metrics including MeanRR, SDRR, LF, HF, TPower, SD1, SD2, and MMCA-derived RSA showed more significant improvements in SRHF patients whose New York Heart Association functional class improved after treatment. These metrics can be used to guide prognosis and therapeutic efficacy monitoring.

Association Between Body Temperature and In-Hospital Mortality Among Congestive Heart Failure Patients with Diabetes in Intensive Care Unit: A Retrospective Cohort Study

Association Between Body Temperature and In-Hospital Mortality Among Congestive Heart Failure Patients with Diabetes in Intensive Care Unit: A Retrospective Cohort Study