Stages Of Congestive Heart Failure Research Articles

Unveiling the future of cardiac care: advances in mechanical circulatory support

Congestive heart failure (CHF) is a multifaceted clinical syndrome characterized by the inability of the heart to pump blood effectively, leading to inadequate oxygen and nutrient delivery to the body tissues. Despite advancements in treatment strategies, including guideline-directed medical treatment (GDMT), end-stage CHF remains a significant cause of morbidity and mortality worldwide. Heart transplantation is considered to be the gold standard treatment of end stage CHF but constrained by the lack of organ donors, lengthening waitlists, and the negative side effects of lifelong immunosuppressive medications. Mechanical circulatory support (MCS) has emerged as a pivotal intervention for patients with end-stage CHF, serving as a bridge to recovery, transplantation, or destination therapy. The aim of this narrative review is to highlight the historical development of MCS, to assess the recent status of MCS device technology and discuss current challenges associated with complications of MCS that need to be solved in the future by device development. The history of MCS dates back to pioneering efforts in the 1960s, with significant progress in device development and utilization over decades. MCS devices, including left ventricular assist devices (LVADs), extracorporeal membrane oxygenation (ECMO), and artificial hearts, play a crucial role in providing circulatory support to patients with end-stage CHF. Recent advancements in MCS technology aim to decrease the device size, enhance blood compatibility, reduce thrombo-embolic complications, and prolong device durability and battery life and improve physiological performance of MCS. Continued research and innovation are essential to address these challenges and improve outcomes in patients with end-stage CHF. Artificial intelligence (AI) has emerged as a valuable tool in cardiovascular medicine to facilitate risk prediction, patient selection, and treatment optimization for MCS and heart transplantation. Despite these advancements, challenges persist in MCS device selection, resource allocation, and integration of AI into clinical practice. Continued research and innovation are essential to address these challenges and improve outcomes in patients with advanced heart failure.

Thoracoscopic Radiofrequency Fragmentation of the Left Atrium as a Bridge to Decision Before Heart Transplant.

Atrial fibrillation and congestive heart failure can provoke and aggravate each other. Often the boundaries between those diseases are ambiguous, and successful diagnosis is initially elusive. However, the last stage of congestive heart failure can lead the patient to heart transplant. We suggested that restoration and stabilization of sinus rhythm could be used as a differential diagnostic criterion to distinguish dilated cardiomyopathy from atrial fibrillation. We investigated the possibility that thoracoscopic radiofrequency fragmentation of the left atrium could be a valid a bridge to decision before heart transplant in patients with the combination of atrial fibrillation and congestive heart failure with reduced left ventricular ejection fraction. The pilot study included 3 men who consecutively received thoracoscopic radiofrequency fragmentation of the left atrium from November 2021 to May 2022. All 3 patients had a combination of atrial fibrillation and congestive heart failure with a reduced ejection fraction and left ventricle dilatation (echocardiography, Simpson method: 31%, 33%, and 30%, respectively) despite receiving as highly as possible drug therapy and normalization of heart rate. The patients were 42, 38, and 55 years old, with rates of N-terminal pro-B-type natriuretic peptide of 3047, 2548, and 2542 pg/mL, respectively. The follow-up examination was performed every month. The total durations of the follow-up were 12, 9, and 7 months, respectively. By month 3 after the surgery, the left ventricular ejection fraction began to increase. By month 6 of follow-up, the left ventricular ejection fraction reached its maximum value and stabilized. All patients reported cessation of congestive heart failure symptoms. Thoracoscopic radiofrequency fragmentation of the left atrium can be considered a bridge to decision before heart transplant in patients with a combination of atrial fibrillation and congestive heart failure with reduced left ventricular ejection fraction.

P90: Silverlon: A Weapon Against Driveline Infections in LVAD Patients

Heart disease is the leading cause of death in the western world. Approximately five million people in the United States have congestive heart failure (CHF), with two hundred fifty thousand of those people in the most advanced stages of CHF. Left ventricular assist devices (LVAD) are currently the state-of-the-art treatment for patients with end stage cardiac failure who are not a candidate for heart transplant. LVADs are powered by external power sources that connect to the pump via a percutaneous lead (driveline). The driveline exits the body, typically from the right quadrant, creating a chronic wound that renders that site prone to infection. Infectious complications are a leading cause of mortality in the LVAD patient population. The driveline site is often the entry point of infection which can lead to blood stream and pump pocket infections. LVAD driveline infection rates, on average, are around 13%. At Lehigh Valley Hospital (LVH), our infection rate from 2013-2020 was 19%. In November 2020, the LVAD program here at LVH placed Silverlon patches in all dressing kits for all newly implanted LVAD patients. The addition of Silverlon was the only intervention done to the driveline dressing kits. From November 2020 to September 2022, the driveline infection rate went from 19% to 0%. This innovative plan of care has allowed our team to implement a simple, cost-effective method to decrease infectious complications and improve patient outcomes. A secondary finding was a decrease in the readmission rates. In 2021, 30% of all readmissions were directly related to driveline site infections. So far in 2022, we have had “0” readmissions related to driveline site infections. This is a 100% reduction in readmissions related to driveline site infections. This decreased our total readmissions by 34%. Based on the results of our “best practice” change, a treatment regime involving the use of Silverlon on drivelines has demonstrated significant reduction of driveline related bloodstream and pocket infections, as well as decreased readmissions.Figure 1. Data graphs depicting the decrease in driveline site infections and readmission rates

THE USE OF POPLITEAL AND FEMORAL BLOCKS FOR PEDIS AMPUTATION IN PATIENT WITH CONGESTIVE HEART FAILURE STAGE III

The choice of peripheral nerve blocks for lower extremity operation are popliteal and femoral block. But at the special condition, the patient could not be performed with general anesthesia, subarachnoid block or epidural block anesthesia because various of reasons. In consequense, it is needed the other anesthesia technique by different way for lower extremity operation using peripheral nerve block. There are some recognized peripheral nerve blocks with or without ultrasonography guidance. Some of them are femoral block, sciatik/popliteal block, ankle block and psoas block. In this case report, the patient with congestive heart failure stage III and history of pulmonary edema with ejection fraction 23% was performed by lateral popliteal and femoral block usg guided for pedis amputation.

Sauna Bathing as an Alternative Adjunct Therapy in the Prevention and Treatment of Chronic Health Conditions Including Cardiovascular Disease, Neurodegenerative Disease, Metabolic Disease, and Mental Health Disorders

Sauna bathing is a time-efficient, cost-effective health modality that has the potential to mimic the heat thermogenesis and cardiovascular effects of exercise. In recent years, researchers have been able to measure the benefits of sauna on human performance, endurance, and cardiovascular health. While many studies have investigated sauna use and its effect on athletic performance, fewer studies have investigated the use of sauna as a medical treatment for chronic health conditions. This review compiles the proven effects of sauna on human physiology and investigates its applications in the treatment of patients with chronic disease. Sauna use appears to be safe in most patient populations and is shown to be both tolerable and effective in patient populations with cardiovascular disease and late stages of congestive heart failure. Multiple cardiovascular benefits were demonstrated in the review including improved perfusion in peripheral arterial disease, decreased ventricular arrhythmias, 51% reduced annual cardiovascular mortality and 47% reduced annual risk of developing hypertension in men using the sauna 4-7 times per week. Finnish cohort studies have additionally exhibited reductions in lifetime annual risk of dementia by 66% in men using the sauna 4-7 times per week. It is suggested that increased heat shock protein expression through heat exposure may be responsible for the neuroprotective benefits of lifetime sauna use. Sauna has also displayed benefits in metabolic disease by reducing hemoglobin A1C and aiding heat acclimation in diabetics through improved thermoregulation. In mental health research, sauna use has shown potential in the treatment of depression by improving objective depression scores. Another study exhibited that sauna use was able to increase appetite in patients with severe depression and coexisting appetite suppression. Additionally, in cohort studies sauna is shown to be correlated to reduced annual risk of developing psychosis across the lifespan. By compiling and reviewing the current research on sauna bathing, education and guidance are provided to medical providers regarding the potential use of sauna as a treatment adjunct for patients with various conditions including cardiovascular disease, neurodegenerative disease, metabolic disease, and mental health disorders.

CARDIAC CACHEXIA AND CLINICAL OUTCOME OF CHRONIC HEART FAILURE DUE TO RHEUMATIC HEART DISEASE

Background: Rheumatic Heart Disease (RHD) is still a significant cause of cardiovascular morbidity and death in developing countries like Indonesia. However, despite being one of the most preventable chronic diseases, RHD still receives less attention, especially in Southeast Asia. PJR that is not treated immediately can develop into chronic heart failure. When heart failure has entered the stage of congestive heart failure, there is activation of a complex network of metabolic, immune, and characteristic neurohormonal factors that can result in cachexia. Cachexia can be an indicator of decreased survival in patients with chronic heart failure due to RHD. Objective: To determine the relationship between cachexia and clinical outcomes of chronic heart failure due to RHD at RSUD Dr. Soetomo. Methods: This study was an analytic observational study using a retrospective cohort design. Data were collected by taking secondary data in the form of patient medical records. There were 106 patients who were taken by non-probability sampling technique. Correlation was determined using Mann-Whitney test and Chi-square test. Result: A total of 106 patients consisted of 53 people with cachexia and 53 people without cachexia, represented both groups dominated by female (57.6%), with largest age range was late adulthood (36-45 years) in both groups (32.1%). Education level data mostly came from secondary schools with a total of 71 people (66.9%) in both groups. The most common type of valve lesion in both groups was mitral stenosis (53.7%). The frequency of hospitalization in patients with cachexia was more frequent with an average of 1.25 times compared to patients without cachexia with an average of 1.02 times. Mortality was higher in patients with cachexia as many as 7 per 53 people (0.13%) compared to patients without cachexia as many as 3 per 53 people (0.06%). With Mann-Whitney and chi-square tests, it was found that cachexia had no effect on the hospitalization frequency (p=0.453) and mortality (p=0.319). Conclusion: Clinical outcomes in chronic heart failure patients due to RHD with cachexia are found to be higher in hospitalization frequency and mortality compared to patients with no cachexia.

The long-term clinical course of moderate tricuspid regurgitation

Abstract Background Moderate TR is a frequent condition, worsening mid and long-term survival, particularly in patients >75 years old, and in those suffering from left ventricular systolic dysfunction. As TR is often clinically unsuspected until an advanced stage of congestive heart failure (HF), there is a great need of early diagnosis and long-term appropriate follow-up. However, data focusing on the clinical and echocardiographic course of a cohort of patients with moderate TR is lacking, and the most appropriate type and time of management of these patients is still heavily debated. Purpose To evaluate the evolution and the long-term clinical outcome of a cohort of patients suffering from moderate and moderate to severe TR, regardless of its etiology. Methods Clinical outcome and echocardiographic follow-up were assessed in 212 patients diagnosed with moderate and moderate to severe TR in our centre between January 2014 and December 2019. TR progression at follow-up was defined as TR grade increase to at least severe. The primary endpoint was all-cause death; secondary endpoints were cardiovascular (CV) death and HF hospitalization. Results After a median follow-up of 4.2 years, TR progression occurred in 76 patients (36%): patients with TR progression presented with more history of coronary artery disease (p=0.042), atrial fibrillation (AF, p=0.007) and chronic kidney disease (CKD, p=0.007) and with baseline larger right ventricle end-diastolic diameter (RVEDD, p<0.001) and worse left ventricular ejection fraction (LVEF, p=0.048). After univariate and multivariate analyses, a history of AF (HR 2.3, CI 1.2–4.5, p=0.011) and RVEDD (HR 2.4, CI 1.3–4.4, p=0.003) were independent predictors of TR progression. The primary endpoint occurred in 57 patients (27%) and was significantly more frequent (p=0.015) in the group of patients with TR progression compared to those without TR progression; multivariate analyses showed TR grade progression (HR 4.3, CI 2.1–9.1, p<0.001), CKD (HR 3.2, CI 1.5–7.1, p=0.002) and LVEF (HR 0.9, CI 0.93–0.99, p=0.007) as being independently associated with the primary outcome. Moreover, both CV death (p=0.003) and HF hospitalization (p=0.0139) were significantly more frequent in patients with TR progression. Conclusions Our results showed that moderate TR, by progressing in a relevant proportion of patients over a long-term follow-up, significantly increases the risk of mortality and HF hospitalization. We identified specific risk factors associated with TR progression, which could help to identify patients at risk before an advanced stage of this disease. We believe that this cohort of patients should be appropriately managed and closely followed-up to avoid adverse clinical events related to the natural course of this valvulopathy. Funding Acknowledgement Type of funding sources: None.

Asistencia de larga duración en pacientes pediátricos: 15 años de experiencia

Background and aimThe aim is to analyse clinical and survival results after the implant of a long-term mechanical assist device in pediatric patients in the end stages of heart failure. MethodsBetween January 2006 and November 2021 34 Berlin Heart EXCOR® devices were implanted in pediatric patients. We analysed preoperative and intraoperative characteristics, together with complications after implant. Outcomes were also evaluated (transplant vs. death). Statistical analysis with STATAIC15. ResultsThe mean age was 51±53 months (1-180), mean weight 17±16kg (2.2-65). Underlying heart disease was myocardiopathy in 68% and congenital heart disease in 32%. The Berlin Heart EXCOR® device was univentricular in 64% of the patients. Surgical indication was bridge to transplant in 97%. Mean duration of mechanical support was 92±105 days (1-511). Postoperative complications were common: 62% infectious and 44% neurological (29% ischaemic and 15% haemorrhagic). Mortality of haemorrhagic strokes 80%, ischaemic 20%. Since 2019, when heparin was changed to bivalirudin, no mortal strokes were observed. 71% of the patients has been transplanted, 29% has died. ConclusionsAs a response to the increasing number of paediatric patients in end stages of congestive heart failure, the use of the Berlin Heart EXCOR® device has spread, especially if the intention is to use it as bridge to transplant. Neurological events, mostly haemorrhagic, are the most feared because of high mortality. Nevertheless, it is an encouraging alternative as a long-term mechanical assist device in children, allowing them to reach the transplant in 71% of the cases.

445 The long-term natural course of moderate tricuspid regurgitation

Abstract Aims The epidemiological and clinical burden of tricuspid regurgitation (TR) has lately gained much attention from the scientific community. In fact, recent epidemiological studies report a prevalence of moderate and severe TR in population over the age of 65 screened for valve disease ranging from 2.7% to 4%, with an independent prognostic role clearly worsening long-term survival along with the increasing severity of TR grade. Particularly, as TR is often clinically unsuspected until an advanced stage of congestive heart failure (HF), there is a great need of early diagnosis and long-term appropriate follow-up and management. Nonetheless, data focusing on the clinical and echocardiographic course of a cohort of patients suffering from moderate TR, although eagerly awaited, are lacking. To evaluate and clarify the evolution and the long-term independent clinical outcome of a cohort of patients suffering from moderate functional or organic TR. Methods We electronically searched for ambulatory and in-patients who underwent transthoracic and/or transesophageal echocardiography with a diagnosis of moderate TR, along with a complete clinical evaluation, in our centre between January 2014 and December 2019. Patients were considered eligible if a second echocardiographic examination including a careful evaluation of the severity of TR and clinical information were available for a minimum follow-up of 6 months. The primary endpoint was all-cause mortality; secondary endpoints were hospitalization for HF and TV intervention, either surgical or percutaneous. Results We enrolled 130 patients, predominantly female with multiple comorbidities, cardiovascular risk factors and history of atrial fibrillation; TR aetiology was functional in most cases (93 patients, 72%). Over a mean follow-up of 5 years, TR grade progressed to at least severe in 55 patients (42%): at multivariate analyses, diabetes mellitus (P=0.003), anaemia (P=0.03) and at least moderate mitral regurgitation or aortic stenosis (P=0.039) were all predictors of TR severity progression. The primary endpoint occurred in 41(32%) of patients and was significantly more frequent (P<0.0001) in patients with severe TR at follow-up compared to those without TR severity progression. HF hospitalization and TV intervention occurred in 47 (36%) and 20 (14%) of patients: again, both were significantly more frequent in patients with severe TR (P=0.0008 and P=0.02, respectively) in comparison to those without worsened TR severity at follow-up. Conclusions Our results show that moderate TR, over a long-term follow-up period, worsens to at least severe grade in a relevant proportion of patients, conveying a significant independent risk of hard events such as all-cause death, HF hospitalization and TV intervention. Therefore, this cohort of patients should be appropriately managed and closely followed-up in order to avoid adverse clinical events related to the natural course of this valvulopathy.

Inflammation and its association with oxidative stress in dogs with heart failure

BackgroundInflammation and oxidative stress can contribute to the development and progression of heart failure. This study aimed to investigate the association between inflammatory and oxidative stress markers in dogs with congestive heart failure (CHF). Associations between the disease severity marker N-terminal pro-B-type natriuretic peptide (NT-proBNP) and markers of inflammation and oxidative stress were also determined.ResultsThirty-seven dogs with cardiovascular diseases (dilated cardiomyopathy, DCM (16 dogs), myxomatous mitral valve disease, MMVD (21 dogs)) and ten healthy dogs were included in this prospective study. The patients were further divided into groups with (26) and without CHF (11). We found a significantly higher serum concentration of C-reactive protein (P = 0.012), white blood cell (P = 0.001), neutrophil (P = 0.001) and monocyte counts (P = 0.001) in patients with CHF compared to control dogs. The concentration of tumor necrosis factor-alpha (TNF-α) was significantly higher in patients with CHF compared to patients without CHF (P = 0.030). No significant difference was found in most of the measured parameters between MMVD and DCM patients, except for glutathione peroxidase (GPX) and NT-proBNP. In patients with CHF, TNF-α correlated positively with malondialdehyde (P = 0.014, r = 0.474) and negatively with GPX (P = 0.026, r = − 0.453), and interleukin-6 correlated negatively with GPX (P = 0.046, r = − 0.412). NT-proBNP correlated positively with malondialdehyde (P = 0.011, r = 0.493). In patients without CHF none of the inflammatory and oxidative stress markers correlated significantly. Furthermore, in the group of all cardiac patients, GPX activity significantly negatively correlated with NT-proBNP (P = 0.050, r = − 0.339) and several markers of inflammation, including TNF-α (P = 0.010, r = − 0.436), interleukin-6 (P = 0.026, r = − 0.382), white blood cell (P = 0.032, r = − 0.369), neutrophil (P = 0.027, r = − 0.379) and monocyte counts (P = 0.024, r = − 0.386).ConclusionInflammatory and oxidative stress markers are linked in canine CHF patients, but not in patients without CHF. These results suggest complex cross communication between the two biological pathways in advanced stages of CHF.

Early-Term Complications after Carotid Endarterectomy and Their Risk Factors: Eight-Year Employment of Local Treatment Protocol of a Russian High-Volume Center

Background: More than 20,000 carotid endarterectomies are performed annually in the Russian Federation. Until now, no studies based on the national carotid data set have been published. The objectives of this study were to evaluate early outcomes after carotid endarterectomy and to identify potential risk factors for major adverse cardiovascular events. Materials and Methods: The retrospective analysis was based on data recorded in a single-center registry, including all carotid endarterectomies performed between 2010 and 2017. A univariate analysis was used to identify the risk factors for perioperative mortality, and predictors of stroke were determined using a multivariate logistic regression model. Results: Data from 1,832 patients with a mean age of 64.1 ± 7.6 years were analyzed. The combined in-hospital mortality was 0.65% (12/1,832). The rate of stroke was 0.7% (13/1,832), and the rate of myocardial infarction was 1.1% (20/1,832). The 30-day stroke-free survival was 99%. A history of stroke (p = 0.02) and chronic obstructive pulmonary disease (COPD; p = 0.0001) were found to be predictive of a lethal stroke. Previous myocardial infarction (p = 0.0001), an advanced stage of congestive heart failure (p = 0.0001), and angina pectoris (p = 0.01) were associated with cardiac-related mortality. Moreover, diabetes mellitus (p = 0.03), COPD (p = 0.0001), and carotid calcinosis (p = 0.006) increased the risk of poor survival due to myocardial infarction. The mean duration of clamping was found to be an independent predictor of any perioperative stroke (OR = 1.109; 95% CI 1.052–1.129; p < 0.0001). Conclusions: The present retrospective analysis of the local carotid surgery register showed appropriate outcomes after CEA regarding the cumulative incidence of MACE, which is comparable to previously published international register data. A previous history of stroke, myocardial infarction, COPD, a prolonged clamping time during CEA, and diabetes mellitus were found to be factors of high-risk for cardiovascular mortality. A prolonged clamping was identified as an independent predictor of any stroke.

P1186PRELIMINARY RESULTS OF THE FIRST PHASE II CLINICAL TRIAL ON THE USE OF AN INNOVATIVE GLUCOSE-SPARING PD SOLUTION (FIRST)

Abstract Background and Aims High amounts of glucose as the main osmotic agent for peritoneal dialysis (PD) could be harmful, as it may significantly increase cardiovascular morbidity and mortality. Glucose has long-term detrimental effects on the peritoneum, which ultimately may result in ultrafiltration failure, worsening fluid overload and cardiovascular disease. The absorption of glucose from the dialysate accentuates the disturbances of the carbohydrate metabolism, which is already impaired in the uremic state, leading to insulin resistance. XyloCore (Iperboreal Pharma, Pescara, Italy), is a low glucose containing PD solution (PDS) proposed as an alternative to glucose PDS only regimen. It has been formulated replacing most of the glucose with two crystalloid agents, D-xylitol and L-carnitine. PDS containing osmolar agents like xylitol and L-Carnitine added to glucose, used for the nocturnal exchange, may lead to a significant reduction of glucose level in PDS during the night dwell, while preserving or even improving the depurative efficacy of the standard PDS containing 2.5% glucose. The reduction of glucose level could be further enhanced if the PDS with xylitol and carnitine will be used for the diurnal exchanges and a PDS with icodextrin will substitute the standard PDS containing glucose 2.5% for the nocturnal dwell. The aims of the study are to evaluate the effects of (I) the XyloCore PDS IPX15 [containing glucose (0.5%), xylitol (1.5%) and L-carnitine (0.02%) as osmotic agents, as compared to the standard 2.5% glucose PDS] for the nocturnal exchange, and (II) the XyloCore PDS IPX07 [containing glucose (0.5%), xylitol (0.7%) and L-carnitine (0.02%), as compared to the standard 1.5% glucose PDS] for the diurnal (short dwell) exchanges. Method Prospective, randomized, controlled clinical trial in stable ESRD patients treated by CAPD (study protocol registered as NCT 04001036). Key inclusion criteria are: ESRD treated for at least three months with CAPD, stable clinical condition within the four weeks before the screening, hemoglobin ≥ 9g/dL, absence of acute peritonitis and/or peritoneal catheter infection in the three months before. Key exclusion criteria are: androgen therapy, active infections, congestive heart failure stage III and IV NYHA; major cardiovascular events in the last 3 months, clinically relevant cardiac arrhythmia; clinically relevant abnormal hepatic tests; treatment with L-carnitine in the previous three months, pregnancy, life expectancy of less than one year, allergy to L-carnitine or xylitol. The sample size is 40 patients. Treatment duration is 4 weeks plus a 4 weeks safety follow up with no treatment. Primary end-point is the daily peritoneal ultrafiltration volume. Secondary end-points are the peritoneal equilibration test (D/P creatinine, D/P glucose), weekly total Kt/V urea, weekly total creatinine clearance, Adverse Events. Results Two centers participate in the study. One center has so far recruited 10 patients, 6 in the IPX15 group and 4 in the IXP07 group. The six patients in the IXP15 group were 4 males and 2 males, aged 69.5 ±5.1 years. The four patients in the IXP07 were all male, mean age 56 ± 12 years. One patient already completed the study period. Results for Kt/V, creatinine clearance, D/P creatinine, D/P glucose, ultrafiltration volume, at time (T) 0 are 1.17, 85.6, 0.75, 0.18, 400 ml, respectively; at T28 (days) are 3.1, 80, 0.82, 0.23, 400 ml respectively, and at T56 are 3.5, 80, 0.77, 023, 450 ml, respectively. D/P glucose results indicate that this patient is a high transporter and D/P creatinine that the patient was an average/ high transporter. There were no adverse events reported and tolerability has been excellent so far. Conclusion In the first 10 ESRD patients included in the study, XyloCore PDS used for 4 weeks has been well tolerated without significant adverse events. The study is in progress.

Epidemiological aspects of nephrolithiasis and chronic diseases of the cardiovascular system combination

Purpose of the study. To analyze prevalence and characteristics of the cardiovascular diseases (CVD) in patients with urolithiasis, revealed for the first timeMaterials and methods. In a period between 2009 and 2018, was made a retrospective analysis of medical histories of 2311 patients with urolithiasis, which were treated in in the urology departments of the branch No. 1 of the MCHG named after N.N. Burdenko (n=1487) and GBUZ MO Krasnogorsk City Hospital No. 1 (n=824). In 67,6% of the cases (1562 patients) the diagnosis of urolithiasis was diagnosed for the first time on admission. Isolated urolithiasis was recorded in 676 cases (43,3%), in other 154 cases (9,8%) nephrolithiasis was combined with different variants of cardiovascular diseases (CVD) and diabetes. From 732 respondents with urolithiasis and associated cardiovascular diseases (CVD), were formed 3 groups, in the first group (I) were included patients (n=363) with hypertension and arterial hypertension: the second group (II; n=79) was formed from patients with isolated coronary heart disease. In the third group (III) were included 290 patients which had urolithiasis combined with hypertension, arterial hypertension and coronary heart disease. The stages of hypertension and degree of expression of arterial hypertension were given according to the recommendations of Russian science society of cardiology (2004). Stages of congestive heart failure were defined according to c NYHA (New York Heart Association) classification. Functional class of stable angina was defined according to Canadian Cardiovascular Society classification (1970,1976). The obtained data was analyzed using descriptive statistics methods.Results. Average age of patients was 65,4 +– 3,27; 78% of the patients were men. On an emergency basis were hospitalized 30,9% from group I, 27,6% from group 2, and 31,3% from group III. In group I more often were recorded hypertension I + arterial hypertension I (32,5%) and hypertension II + arterial hypertension II (40,2%). In group II effort angina was recorded in 30 cases (38%). Congestive heart failure occurred among 153 patients (20,9%); most often it occurred among patients from III – in 102 cases (35,2%). In the whole sample, congestive heart failure of I and II degrees prevailed – in 88 (12%) and 57 (7,9%) patients. Kidney stones were found in 59,4% of patients, in the ureters – in 30,9% of patients, in kidneys and in the ureters – in 9,9% of patients. Share of the patients with kidney stones in the shape of corals is 3,4% of the whole sample. Average sizes of kidney stones of the patients with congestive heart failure are 9,2–11,8 mm which is different from the sizes in whole sample – 6,9–9,5 mm.Conclusion. During the observation period, share of the patients with first time revealed urolithiasis, complicated with the cardiovascular diseases (CVD) increased in 1,9 times (16,7 versus 31,7%). Congestive heart failure, which was registered in 20,9% of patients, was charged with I and II degrees. The presence chronic cardiovascular diseases (CVD), especially complicated by congestive heart failure in patients with first time revealed nephrolithiasis, implies changes in the algorithms of metaphylactic of nephrolithiasis (regime of water loads, selection of diuretics and anticoagulants).

Hospital Transfer Rates Among US Nursing Home Residents With Advanced Illness Before and After Initiatives to Reduce Hospitalizations

Hospital transfers among nursing home residents in the United States who have been diagnosed with advanced illnesses and have limited life expectancy are often burdensome, costly, and of little clinical benefit. National initiatives, introduced since 2012, have focused on reducing such hospitalizations, but little is known about the consequences of these initiatives in this population. To investigate the change in hospital transfer rates among nursing home residents with advanced illnesses, such as dementia, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD), from 2011 to 2017-before and after the introduction of national initiatives to reduce hospitalizations. In this cross-sectional study, nationwide Minimum Data Set (MDS) assessments from January 1, 2011, to December 31, 2016 (with the follow-up for transfer rates until December 31, 2017), were used to identify annual inception cohorts of long-stay (>100 days) nursing home residents who had recently progressed to the advanced stages of dementia, CHF, or COPD. The data were analyzed from October 24, 2018, to October 3, 2019. The number of hospital transfers (hospitalizations, observation stays, and emergency department visits) per person-year alive was calculated from the MDS assessment from the date when residents first met the criteria for advanced illness up to 12 months afterward using Medicare claims from 2011 to 2017. Transfer rates for all causes, potentially avoidable conditions (sepsis, pneumonia, dehydration, urinary tract infections, CHF, and COPD), and serious bone fractures (pelvis, hip, wrist, ankle, and long bones of arms or legs) were investigated. Hospice enrollment and mortality were also ascertained. The proportions of residents in the 2011 and 2016 cohorts who underwent any hospital transfer were 56.1% and 45.4% of those with advanced dementia, 77.6% and 69.5% of those with CHF, and 76.2% and 67.2% of those with COPD. The mean (SD) number of transfers per person-year alive for potentially avoidable conditions was higher in the 2011 cohort vs 2016 cohort: advanced dementia, 2.4 (14.0) vs 1.6 (11.2) (adjusted risk ratio [aRR], 0.73; 95% CI, 0.65-0.81); CHF, 8.5 (32.0) vs 6.7 (26.8) (aRR, 0.72; 95% CI, 0.65-0.81); and COPD, 7.8 (30.9) vs 5.5 (24.8) (aRR, 0.64; 95% CI, 0.57-0.72). Transfers for bone fractures remained unchanged, and mortality did not increase. Hospice enrollment was low across all illness groups and years (range, 23%-30%). The findings of this study suggest that concurrent with new initiatives aimed at reducing hospitalizations, hospital transfers declined between 2011 and 2017 among nursing home residents with advanced illnesses without increased mortality rates. Opportunities remain to further reduce unnecessary hospital transfers in this population and improve goal-directed care for those residents who opt to forgo hospitalization.

Serum uric acid levels in patients of acute myocardial infarction

Background: Following Myocardial Infarction some proteins and enzymes, CPK-MB/ Troponin-I, T, are released into the blood from the necrotic heart muscle. Serum Uric Acid (SUA) may be a risk factor and negative prognostic marker for cardiovascular diseases. Aim of the study was to study serum uric acid levels in patients of acute Myocardial infarction with congestive heart failure, its relation with stages of congestive heart failure as per Killip classification and the role of serum uric acid levels as a marker of mortality.Methods: The case control study was conducted on 120 patients divided into two groups. Group A included 60 patients of acute Myocardial infarction. Group A was further divided into two categories. One includes 30 patients of with congestive heart failure and another includes 30 patients without congestive heart failure. Group B consists of 60 control patients. Serum uric acid levels were measured in Group A on 1st, 3rd and 7th day of hospital admission and in Group B on 1st day.Results: The study showed females have higher degree of hyperuricemia than males. SUA was significantly higher in patients of acute myocardial infarction than control group patients. SUA were also higher in patients with history of IHD, in patients with BNP &gt;100 and it correlates with Killip class and mortality rates. Patients of acute myocardial infarction with diabetes mellitus had higher degree of hyperuricemia than nondiabetic and control group. No significant difference in SUA levels were observed with regard to age, alcohol intake, lipid profile, ejection fraction and hypertension.Conclusions: In acute myocardial infarction, patients with hyperuricemia had higher mortality and may be considered as poor prognostic biomarker.

Vasopressin &amp; Oxytocin in Control of the Cardiovascular System: An Updated Review

Since the discovery of vasopressin (VP) and oxytocin (OT) in 1953, considerable knowledge has been gathered about their roles in cardiovascular homeostasis. Unraveling VP vasoconstrictor properties and V1a receptors in blood vessels generated powerful hemostatic drugs and drugs effective in the treatment of certain forms of circulatory collapse (shock). Recognition of the key role of VP in water balance via renal V2 receptors gave birth to aquaretic drugs found to be useful in advanced stages of congestive heart failure. There are still unexplored actions of VP and OT on the cardiovascular system, both at the periphery and in the brain that may open new venues in treatment of cardiovascular diseases. After a brief overview on VP, OT and their peripheral action on the cardiovascular system, this review focuses on newly discovered hypothalamic mechanisms involved in neurogenic control of the circulation in stress and disease.

Role of electrolyte concentrations and renin-angiotensin-aldosterone activation in the staging of canine heart disease.

BackgroundRefractory congestive heart failure (CHF) and associated diuretic resistance are not well defined.ObjectivesTo characterize renal function, electrolyte concentrations, indices of diuretic efficacy, and renin‐angiotensin‐aldosterone system (RAAS) activation in dogs with naturally occurring heart disease (HD) in American College of Veterinary Internal Medicine stages B1, B2, C, and D and to determine their usefulness in defining HD stages.AnimalsGroup 1:149 dogs with HD stages B1, B2, C, and D. Group 2:22 dogs with HD stages C and D.MethodsGroup 1: Renal parameters, serum and urine electrolyte and diuretic concentrations, and urine aldosterone concentrations were measured. Medication dosages and measured variables were compared among stages. Correlation of furosemide dosages to serum concentrations was explored. Group 2: Angiotensin‐converting enzyme activity and RAAS components were measured and compared among CHF stages.ResultsSerum chloride concentration was the best differentiator of HD stage. Furosemide PO dosages (≤6 mg/kg/day) were weakly correlated with serum furosemide concentrations, whereas higher dosages were not significantly correlated. Angiotensin‐converting enzyme inhibitor dosage and RAAS inhibition were greater in stage D, compared to stage C dogs.Conclusions and Clinical ImportanceHypochloremia is a useful marker for stage D HD in dogs. Poor furosemide dosage correlation to serum concentration may indicate variable and poor absorption, especially at higher dosages, advanced disease, or both. A small number of stage D dogs met proposed criteria for diuretic resistance. Greater RAAS inhibition in stage D versus stage C indicates effectiveness of RAAS‐suppressive treatments in this group of dogs with refractory CHF.

HUBUNGAN DERAJAT KLASIFIKASI GAGAL JANTUNG KONGESTIF TERHADAP KEPATUHAN TERAPI MEDIS DAN TINGKAT KEPUASAN PASIEN DI RUMAH SAKIT FATMAWATI JAKARTA SELATAN

Heart failure classified in four stages which includes first stage, second stage, third stage, and fourth stage. Congestive heart failure patients are often re-hospitalized in hospital because of the reccurence. This research purposed to know the correlation between classifaction congestive heart failure to medical therapy compliance and patient satisfaction level in Fatmawati Hospital South Jakarta. This research used correlative descriptive design with quantitative research and cross sectional approach. The sampling technique in this research used a total sampling with 38 patients. Based on the research results that prove with p value = 0,000 < 0,05 which mean there’s significant correlation between classification stages of congestive heart failure to medical therapy compliance, with the value of r = 0,796 which show that there’s an intense correlation. This is proven with p value = 0,000 < 0,05 which mean there’s significant correlation between classification stages of congestive heart failure to medical therapy compliance, with the value of r = 0,796 which show that there’s an intense correlation. This is proven with p value = 0,000 < 0,05 which mean there’s significant correlation between classifaction stages of congestive heart failure to patient satisfaction level with the value of r = 0,606 which show that there’s an intense correlation. Rom the research result is expected that the patients can improve their medical therapy compliance to avoid the risk of reccurence for the re-hospitalized patients. Keywords: Classifaction stages of congestive heart failure, compliance level, satisfaction level.

Sympathetic neural overdrive in congestive heart failure and its correlates: systematic reviews and meta-analysis.

Sympathetic neural activation occurs in congestive heart failure (CHF). However, the small sample size of the microneurographic studies, heterogeneity of the patients examined, presence of comorbidities as well as confounders (including treatment) represented major weaknesses not allowing to identify the major features of the phoenomenon, particularly in mild CHF. This meta-analysis evaluated 2530 heart failure (CHF) patients recruited in 106 microneurographic studies. It was based on muscle sympathetic nerve activity (MSNA) quantification in CHF of different clinical severity, but data from less widely addressed conditions, such as ischemic vs. idiopathic, were also considered. Assessment was extended to the relationships of MSNA with venous plasma norepinephrine, heart rate (HR) and echocardiographic parameters of cardiac morphology [left ventricular (LV) end-diastolic diameter] and function (LV ejection fraction) as well. MSNA was significantly greater (1.9 times, P < 0.001) in CHF patients as compared with healthy controls, a progressive significant increase being observed from New York Heart Association classes I-IV in unadjusted and adjusted analyses. MSNA was significantly greater in both untreated and treated CHF (P < 0.001 for both), related to left ventricular (LV) end-diastolic diameter and to a lesser extent to LV ejection fraction (r = 0.24 and -0.05, P < 0.001 and <0.01, respectively), and closely associated with HR (r = 0.66, P < 0.001) and plasma norepinephrine (r = 0.68, P < 0.001). CHF is characterized by sympathetic overactivity which mirrors the degree of LV dysfunction independently of the stage of CHF, its cause and presence of confounders or pharmacological treatment. plasma norepinephrine and HR represent potentially valuable surrogate markers of sympathetic activation in the clinical setting.

Serum Sodium Profile of Congestive Heart Failure Patients and its Impact on Their Outcome at Discharge.

IntroductionPatients with congestive heart failure (CHF) readily present with electrolyte imbalance which commonly includes deficiencies of sodium, potassium, and magnesium. Hyponatremia occurs in advanced stages of CHF and is associated with adverse disease outcome-longer hospital stay, severity of CHF, and increased risk of mortality.MethodsIn this observational, single-center, prospective, case-control study adult patients admitted with clinical diagnosis of CHF were included after informed consent. Their demographic, clinical, and biochemical profile was attained. Patients with low serum sodium (hyponatremia) were grouped as "cases" and patients with normal serum sodium profile (normonatremia) were grouped as "controls". Factors associated with both groups and their hospital outcome were compared. SPSS for Windows version 16 (SPSS Inc., Chicago, IL, USA) was utilized.ResultsHyponatremia (serum sodium <135 mmol/L) was present in 58/189 (30.7%) patients admitted with CHF. Younger patients with non-ischemic CHF, and history of previous diagnosis, treatment, and hospitalization due to CHF were more likely to be affected. Diabetic nephropathy, chronic kidney disease, salt-restricted diet, drugs including furosemide, spironolactone, and angiotensin-converting enzyme inhibitors, low serum potassium, and reduced GFR were also related to hyponatremia. Hyponatremic CHF patients showed adverse hospital outcome on all parameters including higher death rate (12% vs. 0.8%), longer duration of hospital day, and deranged blood pressures and severe CHF at the time of discharge.ConclusionHyponatremic CHF patients are associated with prolonged hospital stay, more severe form of CHF, and deranged blood pressures. Overall, hyponatremia is an indirect clinical indicator of circulatory dysfunction and should guide a clinician for closer observation as outcomes could be poor. These patients also have higher in-hospital mortality risk.