Diagnosis Of Congestive Heart Failure Research Articles

Abstract 9814: Clinical Characteristics and Outcomes in Patients With Congestive Heart Failure and Low Voltage 12-Lead Ecg

Background: Low voltage ECG (LowV-ECG) pattern is defined as a peak-to-peak QRS amplitude of less than 5mm in the limb leads and/or less than 10mm in the pericardial leads. It can occur in many cardiac conditions associated with congestive heart failure (CHF), such as ischemic cardiomyopathy (ICM), cardiac amyloidosis (CA), hemochromatosis (HC), and hypothyroidism (HT). The clinical significance of LowV-ECG abnormalities in CHF patients has not been well investigated. Methods: Clinical, echocardiographic, and ECG data was collected in 460 consecutive CHF patients with non-V-paced rhythms enrolled over 2 years in the Get With the Guidelines Heart Failure (GWG-HF) registry at a single academic tertiary center. ECGs were reviewed for the presence of low QRS voltage and additional ECG features classically reported in ICM, CA, HC, and HT. Results: LowV-ECG was noted in 8.5% patients (39/460) of the study cohort, and was more common in females, 11.6% (25/216) vs. 5.7% (14/244) in males, p=0.025. LowV-ECG patients had increased BMI (34.9+/-12.8 vs. 31.1+/-9 kg/m2, p=0.016) and more commonly had a history of DM (12.2% vs.5.5%, p=0.01). There were no significant differences in age, GFR, or presence of CAD, hypertension or Afib. Prevalence of HFrEF, HFmrEF, and HFpEF in patients with LowV-ECG was 6.8, 10, and 9.8%, respectively, p=0.506. With regards to the ECG features typically associated with cardiac amyloidosis, poor R-wave progression was more common in LowV-ECG patients, 41% (16/39) vs.13.5% (57/421) in the rest of the cohort, p<0.001, but there was no significant difference in prevalence of pseudo-infarct pattern, 15.4% (6/39) vs. 10.5% (44/421), p=0.344, or in prevalence of LBBB or incomplete LBBB or non-specific IVCD, 15.4% (6/39) vs. 17.3% (73/421), p=0.164. After 70.7+/-25.2 months follow-up, Low-V ECG was not associated with increased mortality (12.8% vs. 20.4%, p=0.253). Rates of 30, 60, and 90-day readmissions were not increased. Conclusions: Among patients admitted with a CHF diagnosis, low voltage ECG pattern was more commonly seen in females, overweight patients, and in patients with diabetes. Low voltage ECG patients did not display additional ECG features typical of cardiac amyloidosis and did not experience adverse short- or long-term outcomes.

Utilization of Palliative Care in Veterans Admitted With Heart Failure Experiencing Homelessness.

Patients experiencing housing insecurity have numerous barriers affecting their utilization of medical care. Determine if housing insecurity is associated with palliative care (PC) encounters and hospice services in patients with heart failure who receive care in United States Veterans Affairs (VA) medical centers. This retrospective study included inpatients in VA hospitals with a primary diagnosis of congestive heart failure from 2010 to 2020. Housing stability was collected from coding and separated into three cohorts: at risk for homelessness, experiencing homelessness, and stably housed. The primary outcome was a PC encounter during admission and the stably housed cohort was used as the analytic reference. Inverse-probability-weighting (IPTW) was calculated to adjust the likelihood of receiving PC during the index admission. Seventy thousand eight hundred fourty nine veterans were identified. Veterans were identified as at risk for homelessness (n=4039, 5.7%), experiencing homelessness (n=1967, 2.8%) and stably housed (n=64,843, 91.5%). PC was delivered to veterans at risk for homelessness (n=484, 12.0%), veterans experiencing homelessness, (n=161, 8.2%) and patients with stable housing (n=6249, 9.6%). Relative to the stably housed and adjusted for IPTW, those at risk for homelessness received PC services similarly (adjusted OR=1.06, 95% CI 0.94,1.19) and those experiencing homelessness were at lower odds of receiving PC services (adjusted OR=0.62, 95% CI 0.52,0.75). Housing stability may be a factor in Veterans receiving PC during hospitalization for heart failure. While the logistical challenges of delivering PC and hospice to people experiencing homelessness are daunting, advocating for these services shows commitment to reducing suffering in life-limiting Illness.

257 Exploring Brain Natriuretic Peptide and Subclinical Heart Disease in Emergency Patients With Asymptomatic Hypertension

257 Exploring Brain Natriuretic Peptide and Subclinical Heart Disease in Emergency Patients With Asymptomatic Hypertension

Chronological Development of Cardiovascular Disease in Times of COVID-19: A Retrospective Analysis of Hospitalized Diseases of the Circulatory System and COVID-19 Patients of a German University Hospital.

This study aims at examining the chronological development of hospitalized cardiovascular and COVID-19 patients and comparing the effects on related sub-disciplines and main diagnoses for pre-pandemic (2017–2019) and pandemic (2020–2021) years in the setting of a German university maximum care provider. Data were retrospectively retrieved from the hospital performance controlling system for patient collectives with main diagnosis of diseases of the circulatory system (nCirculatory) and COVID-19 secondary diagnosis (nCOVID-19). The cardiovascular patient collective (nCirculatory = 25,157) depicts a steady state in terms of relative yearly development of patient numbers (+0.4%, 2019–2020, +0.1%, 2020–2021). Chronological assessment points towards monthly decline during lockdowns and phases of high regional incidence of COVID-19 (i.e., 2019–2020: March −10.2%, April −12.4%, December −14.8%). Main diagnoses of congestive heart failure (+16.1% 2019/2020; +19.2% 2019/2021) and acute myocardial infarction show an increase in case numbers over the course of the whole pandemic (+15.4% 2019/2020; +9.4% 2019/2021). The results confirm negative effects on the cardiovascular care situation during the entire pandemic in the setting of a university maximum care provider. A general increase in cardiac disorders and a worrisome turn in case development of acute myocardial infarction emphasize the feared cardiovascular burden of COVID-19.

The clinical value of hepatojugular reflux on congestive heart failure: A meta-analysis.

Hepatojugular reflux is a cardiac physical examination with a long history of use in heart failure diagnosis across many clinical settings. However, the development of new diagnostic methods has thrown the clinical role of hepatojugular reflux into question. Our meta-analysis aimed to determine the diagnostic accuracy of hepatojugular reflux and assess its usefulness in diagnosing congestive heart failure among at-risk patients. This meta-analysis of studies reporting diagnostic hepatojugular reflux values of patients at risk for congestive heart failure followed PRISMA guidelines. We searched MEDLINE, EMBASE, Web of Science, CENTRAL, and Google Scholar for eligible studies from inception through February 1, 2021. After QUADAS-2 quality assessment, we conducted data synthesis using the random effects model and a hierarchical summary receiver operating characteristic model. As an additional analysis, we sorted the studies by clinical setting and performed synthesis again. We submitted our protocol to PROSPERO (International Prospective Register of Systematic Reviews; ID No. CRD42020215004). The literature search provided 4121 studies for evaluation. Seven studies and their 5195 participants were deemed eligible for synthesis. Clinical diagnosis was the most frequent reference standard. Bivariate random-effects analysis found hepatojugular reflux sensitivity of 0.12, 95% confidence interval (CI) [0.07-0.19], and specificity of 0.96, 95% CI [0.95-0.97]. The DOR was 29.7, 95% CI [18.4-45.3]. The additional analysis of the emergency settings provided a sensitivity of 0.14, 95% CI [0.12-0.17] and specificity of 0.95, 95% CI [0.93-0.96]. Our meta-analysis suggests that hepatojugular reflux has practical value for diagnosis of congestive heart failure with high specificity.

Relationship between Heart Failure Treatment and Self-Management Compliance in Congestive Heart Failure Patients

Self-management has a vital role in treating Congestive Heart Failure (CHF) patients to manage themselves and maintain the ability of body functions. Self-management can be seen in how heart failure patients perform compliance actions in treatment and the patient's ability to know changes in behaviour towards the patient's health status. In addition, it is crucial for people with congestive heart failure to learn about their disease to relieve the signs and symptoms. This study aimed to determine the relationship between knowledge of heart failure care and self-management compliance in CHF patients. This method uses a quantitative correlation research type to determine the relationship between the two variables using an analytical cross-sectional study approach. The sampling technique uses accidental sampling from March to April 2021 at the heart poly Hospital of UNS Surakarta to 100 respondents. Sample criteria: Respondents with a diagnosis of CHF who checked their health at the heart polyclinic of UNS Surakarta Hospital, aged 17 years, patients with NYHA classification 1-3, and willing to be respondents. The research instrument used a demographic questionnaire, knowledge of heart failure care and the Self Care Heart Failure Index (SCHFI) to determine the self-care knowledge of CHF patients and adherence to self-management. The results obtained through the chi-square test showed a p-value of 0.010, meaning there is a relationship between knowledge of heart failure care and self-management compliance. Knowledge of heart failure care can affect the level of compliance of CHF patients because CHF patients need self-management compliance to minimize symptoms of recurrence or worsening of signs and symptoms and reduce the impact of re-hospitalization.

Institutional, therapeutic, and individual factors associated with 30-day mortality after COVID-19 diagnosis in Canadian long-term care facilities.

BackgroundCanadian long‐term care facility (LTCF) residents experienced higher death rates compared to other countries during the first wave of the COVID‐19 pandemic. This cohort study analyzes the individual, therapeutic, and institutional factors associated with death in LTCFs.MethodsInstitutional data for 17 LTCFs in Montreal, Canada were obtained from local administrative registries. Individual data for 1197 residents infected by SARS‐CoV‐2 between February 23 and July 11, 2020 were obtained through chart reviews. A multivariable modified Poisson regression model, which accounted for LTCF clustering, was used to identify resident and facility covariates associated with 30‐day mortality after COVID‐19 diagnosis.ResultsSevere shortage of licensed practical nurses (RR 2.60 95% CI 1.20–5.61) and medium‐sized facilities compared to smaller‐sized facilities (RR 2.73 95% CI 1.23–6.07) were associated with 30‐day mortality. Later COVID‐19 diagnosis (RR 0.98 95% CI 0.97–0.99 per additional day) was associated with survival. Individual risk factors for death included age (RR 1.33 95% CI 1.23–1.45 per additional 10 years), male sex (RR 1.46 95% CI 1.24–1.71), functional impairment (RR 1.08 95% CI 1.04–1.12 per unit increase of SMAF), as well as a diagnosis of congestive heart failure (RR 1.31 95% CI 1.04–1.66) and neurocognitive disorder (RR 1.31 95% CI 1.01–1.70). Among severe cases, anticoagulation was associated with survival (RR 0.70 95% CI 0.51–0.96).ConclusionsThis study identified practical nurse shortages and facility size as institutional risk factors for COVID‐19 death. Anticoagulation was associated with survival among severe cases.

Patient Perspectives on Care Transitions From Hospital to Home

Understanding the patient's perspective of their care transition process from hospital or skilled nursing facility (SNF) to home may highlight gaps in care and inform system improvements. To gather data about patients' care transition experiences and factors associated with follow-up appointment completion. A survey tool was developed with input from patient advisors and organizations participating in a collaborative quality initiative. Seventeen hospitals, 12 practitioner organizations, and 6 SNFs in Michigan collaborated to identify shared patients who were aged 18 years and older, had a working telephone number, recently returned home or to an assisted living facility with a diagnosis of congestive heart failure or chronic obstructive pulmonary disease, or after an SNF stay. Using consecutive sampling, interviewers collected 5 telephone surveys per month. From October 2018 to December 2019, patients or caregivers were surveyed via telephone 8 to 12 days after discharge from a hospital or SNF. Data were analyzed from March 2020 to January 2022. Care transition experiences. The primary outcome was to identify patient-perceived gaps during care transition experiences, including postdischarge follow-up. On the basis of pilot data, the response rate was estimated at 34%, yielding 1257 surveys. Of 1257 survey respondents (mean [SD] age, 70 [12.94] years for 968 patients for whom age data was available), 654 (52%) were female; 829 (74%) were White, 250 (22%) were Black or African American, and 40 (4%) were another race. Eleven percent of patients reported not receiving a telephone number to call for postdischarge questions. Nearly 80% of patients (977 patients) received a follow-up telephone call, and most found it valuable. Twenty percent of patients (255 patients) reported at least 1 social determinant of health issue. Lack of transportation was associated with reduced likelihood of completing a follow-up visit, decreasing the odds of completing a follow-up by nearly 70% (odds ratio [OR], 0.31; 95% CI, 0.18-0.53; P < .001). Compared with other patient groups, Black patients were less likely to report completing a postdischarge follow-up visit (OR, 0.49; 95% CI, 0.36-0.67; P < .001) or to receive prescribed medical equipment (OR, 4.23; 95% CI, 1.30-13.83; P = .02). An examination of patient discharge experiences from a hospital or SNF identified inconsistencies in care transition processes, social determinants of health issues needing to be addressed after discharge, and racial disparities between patients who attend follow-up appointments. Physicians should be aware of these findings and their consequences for patient experiences.

MO763: Clinical Outcomes in Patients on Hemodialysis with Congestive Heart Failure

Abstract BACKGROUND AND AIMS Hemodialysis (HD) is a unique treatment modality that offers a life-sustaining treatment option for patients with end-stage kidney disease (ESKD). However, the mortality of HD patients is still unacceptably high compared with the general population. Cardiovascular diseases (CVDs) (including myocardial infarction, heart failure and stroke) are the leading causes of death in dialysis-dependent ESKD patients, accounting for ∼40% of the mortality. Congestive heart failure (CHF) is a final common clinical pathway for several diseases. HD patients are at 12–36× risk for the development of CHF. In the general population, CHF increases the risk of death. However, there is no well-designed relevant study in the Chinese HD population addressing the risks associated with CHF. The aim of this study was to explore the impact of CHF on the clinical outcomes in HD patients. METHOD The DOPPS is an international prospective cohort study of in-center adult HD patients. China joined DOPPS in 2011. DOPPS China randomly selected an average of 30 patients from 15 dialysis facilities in each city of Beijing, Shanghai and Guangzhou. There were 1427 patients who participated in China DOPPS5 (2012–2015). Of the 1427 patients, 16 patients were excluded from the present analysis as their CHF history information was missing. Demographic data, comorbidity, Lab data and death records were extracted. CHF was defined by the diagnosis records upon study inclusion. Continuous variables were represented as mean ± SD or median (25th, 75th) according to the results of the normality test. Categorical variables were expressed as numbers and percentages. We stratified data by CHF and non-CHF groups. Our primary outcome was associations between CHF and all-cause and cardiovascular (CV) mortality; secondary outcomes were all-cause and cause-specific hospitalization risk. Associations between CHF and outcomes were evaluated using Cox regression models. Cox regression models were with five incremental levels of covariate adjustment. Stepwise multivariate logistic regression was used to identify the related risk factors, and subgroup analyses were carried out. RESULTS Of 1411 patients without missing CHF history information, 24.1% (340) had a CHF diagnosis at enrollment. In this cohort, male patients accounted for 54.9% of the patients. The median age was 60.0 (inter-quartile range, IQR 49.0–71.0) years and the median dialysis vintage was 2.6 (IQR 0.9–5.4, Table 1) years. The median follow-up period was 1.9 (IQR 1.2–2.1) years. Altogether, 203 (14.4%) patients died, where 103 (7.3%) died from CV disease. The CV death constituted half of the patient’s mortality. The overall mortality rates were 21.8% versus 12.0% (P &amp;lt; 0.001) in patients with and without CHF during entire follow-up, respectively. CHF was associated for higher all-cause mortality [adjusted HR 1.72, 95% confidence interval (95% CI) 1.17–2.53; P = 0.006, Fig. 1], and the association with CV death was of similar magnitude (HR 1.60, 95% CI 0.91–2.81; P = 0.105). CHF patients had more episodes of hospitalization due to heart failure (HR 2.93, 95% CI 1. 49– 5.76; P &amp;lt;0.01). However, compared with patients without CHF, the all-cause hospitalization risk was not much higher in CHF patients (HR 1.09, 95% CI 0.90–1.33; P = 0.39). CONCLUSION In this prospective cohort study, the prevalence of CHF was identified to be around one quarter, and all-cause mortality in patients with combined CHF and HD was found to be higher. CHF was associated with an increased risk of all-cause mortality and a cause-specific hospitalization risk in HD patients. The associations were not affected by adjustment for several potential confounding factors. Thus, CHF is found to be an outcome predictor for HD patients, and measures should be adopted to improve care for these patients to improve their survival.

Development of a multivariable clinical prediction model for liposomal doxorubicin-induced cardiotoxicity in adult breast cancer patients: a retrospective multicenter study

BackgroundThe clinical use of anthracyclines is limited by the risk of cardiotoxicity. So, we aim to develop a clinical prediction model for liposomal doxorubicin-induced cardiotoxicity in adult breast cancer patients.MethodsWe designed a multicenter retrospective cohort study. A total of 257 hospitalized breast cancer patients treated with doxorubicin liposomes were finally enrolled in the study, including 58 patients from Beijing Friendship Hospital and 199 from Beijing Cancer Hospital. In all, 32 cases developed cardiotoxicity, including 4 at the Beijing Friendship Hospital and 28 at the Beijing Cancer Hospital. The study involved breast cancer patients with no pre-existing heart disease, whose clinical data were collected from their medical records. All patients underwent electrocardiogram (ECG) and/or left ventricular ejection fraction (LVEF) measurements prior to treatment with doxorubicin liposomes. Patients were clinically assessed after each cycle of treatment, and ECG and/or LVEF measurements were performed at least once after treatment. Liposomal doxorubicin-induced cardiotoxicity was defined when one of the following three conditions was met: (I) a reduction in LVEF of at least 5% from the baseline and the absolute value was less than 55%, accompanied by congestive heart failure (CHF) symptoms or signs; (II) a reduction in LVEF of at least 10% to an absolute value of less than 55%, without CHF symptoms or signs; (III) the definite diagnosis of CHF. Variables associated with cardiotoxicity were identified by univariate and multivariate logistic regression, and the consistency and differentiation of the final model were evaluated.ResultsIn our final model, age [odds ratio (OR): 5.626, 95% confidence interval (CI): 2.321 to 13.639], cancer metastasis (OR: 3.873, 95% CI: 1.220 to 12.299), paclitaxel (OR: 3.601, 95% CI: 1.010 to 12.843), and hypertension (OR: 2.435, 95% CI: 1.046 to 5.671) were significantly associated with cardiotoxicity. The final model was tested for Hosmer-Lemeshow goodness-of-fit, the χ2 was 2.696 and the P value was 0.747, and the resultant predictive model had an area under the receiver operating characteristic (ROC; AUC) curve of 0.781.ConclusionsThis study established a risk prediction model for liposomal doxorubicin-induced cardiotoxicity in breast cancer patients and performed a stratified risk scores

Associations between initial American Board of Internal Medicine certification and maintenance of certification status of attending physicians and in-hospital mortality of patients with acute myocardial infarction or congestive heart failure: a retrospective cohort study of hospitalisations in Pennsylvania, USA

ObjectiveTo determine whether internists’ initial specialty certification and the maintenance of that certification (MOC) is associated with lower in-hospital mortality for their patients with acute myocardial infarction (AMI) or congestive...

Abstract EP26: Impacts Of Social Isolation During The COVID-19 Pandemic On Congestive Heart Failure Disease Management

Background: We investigated the impact of social isolation associated with the COVID-19 pandemic on the severity and frequency of congestive heart failure (CHF) symptoms and the frequency of hospital admissions. Hypothesis: We assessed the hypothesis that the psychosocial impacts of loneliness, as manifested during the COVID19 pandemic, caused potentially worsened congestive heart failure (CHF) symptom frequency and severity as well as the frequency of hospitalizations. Material and methods: This was a single tertiary center cohort study of inpatients admitted with a primary diagnosis of congestive heart failure. Each patient was asked to rate the extent of isolation related to the pandemic and the extent of changes in the severity and frequency of symptoms on a numeric scale during an in-person interview. The number of admission due to CHF since the start of the pandemic and in the two years before the start of the pandemic was also compared. Results: The study cohort included 40 patients, 52.5% females, 69.7+/-13.3 years old. Of these patients, 47.5% reported near-complete pandemic-related isolation and an additional 32.5% reported mild isolation. Symptom worsening was reported in 55% of all patients, which was more common in socially isolated patients (73.7%), while patients who maintained social contacts more commonly reported no change or improvement in symptoms (61.9%, p=0.024). There was also a strong trend in increased symptom frequency associated with social isolation (63.2% in isolated patients vs. 33.3% in the rest of the cohort, p=0.059). The pandemic period was also associated with a significant overall reduction in CHF-related hospital admissions, from 1.9+/-1.3 to 0.7+/-1.4 times (p=0.001), but no significant differences according to the social isolation status. Conclusions: Our findings suggest that the COVID-19 pandemic resulted in a significant symptom increase in patients who reported social isolation. At the same time and despite this symptom increase, a significant reduction in CHF-related hospital admissions suggests reluctance of patients to be treated in the hospital environment. The effects of interventions aimed at reducing social isolation should be investigated.

Chagasic heart failure in a pregnant woman in a non-endemic area: case report and long-term follow-up

Abstract Objectives Chagas disease (CD) is caused by infection with the protozoan Trypanosoma cruzi, a parasite that nests in various tissues, causing irreversible cardiac damage in 30% of patients with chronic disease and neurological or digestive lesions in 10%. CD is now found in areas receiving migrant populations where no vector-borne transmission occurs. Chagasic cardiomyopathy (CC) is the most serious complication of the chronic phase of CD and the major cause of morbidity and mortality among patients with CD. Case presentation Bolivian woman at 38 weeks of gestation was admitted at the emergency room with the diagnosis of congestive heart failure. Cesarean section was performed and maternal hypotension and uterine atony occurred. Dilated myocardiopathy with severe left ventricle dysfunction was diagnosed. The patient referred positive serology for T. cruzi and polymerase chain reaction (PCR) was positive so benznidazole therapy was started. She was discharged due to progressive improvement with cardiological treatment and implantable cardioverter defibrillator was placed 5 years later for the prevention of sudden cardiac death. Conclusions The diagnosis of CC in non-endemic areas requires a high index of suspicion and it is based on serology. Antiparasitic drugs are almost 100% effective in infected newborn babies and highly effective in the treatment of patients in the acute stage of the disease. However, the efficacy of both drugs decreases the longer a person has been infected. Treatment of CC that causes chronic heart failure is similar to that in non-Chagasic etiology.

ECG signals-based automated diagnosis of congestive heart failure using Deep CNN and LSTM architecture

In humans, Congestive Heart Failure (CHF) refers to the chronic progressive condition that drastically influences the pumping potentiality of the heart muscle. This CHF has the possibility of increasing health expenditure, morbidity, mortality and minimized quality of life. In this context, Electrocardiogram (ECG) is considered as the simplest and a non-invasive diagnosis method that aids in detecting and demonstrating the realizable changes in CHF. However, diagnosing CHF based on manual exploration of ECG signals is frequently impacted by errors as duration and small amplitude of the signals either investigated separately or in the integration is determined to neither specific nor sensitive. At this juncture, the reliability and diagnostic objectivity of ECG signals during the CHF detection process may be enhanced through the inclusion of automated computer-aided system. In this paper, Deep CNN and LSTM Architecture (DCNN-LSTM)-based automated diagnosis system is proposed for detecting CHF using ECG signals. In specific, CNN is included for the purpose of extracting deep features and LSTM is used for attaining the objective of CHF detection using the extracted features. This proposed DCNN-LSTM is evolved with minimal pre-processing of ECG signals and does not involve any classification process or manual engineered features during diagnosis. The experimentation of the proposed DCNN-LSTM conducted using the real time ECG signals datasets confirmed an accuracy of 99.52, sensitivity of 99.31%, specificity of 99.28%, F-Score of 98.94% and AUC of 99.9%, respectively.

Smokeless Tobacco Use and Prevalence of Cardiovascular Disease Among Males in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1–4

The purpose of this period prevalence study is to compare the prevalence of cardiovascular disease (CVD) in current/former established smokeless tobacco (SLT) users (ever SLT users who have used the product fairly regularly) to those who were: 1) never established cigarette smokers and SLT users, and 2) current/former established exclusive cigarette smokers (have smoked at least a 100 or more cigarettes in lifetime) only, adjusting for known risk factors for CVD. Analyses included 4,703 men ≥ 40 years of age who participated in the Population Assessment of Tobacco and Health (PATH) Study, Waves: 1–4, conducted between 2013 and 2017. Current users were those using SLT products daily or on some days, whereas former users had not used SLT and/or cigarettes in the past 12 months. CVD prevalence was defined as a self-reported diagnosis of congestive heart failure, stroke, or myocardial infarction. Among current/former established SLT users, years of use defined exposure history, while pack-years defined exposure history for smokers. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported with trend tests to examine dose–response associations. Current/former established exclusive SLT users were not significantly more likely to have had any CVD compared to never established cigarette and SLT users (OR = 1.7 [0.8–3.7]), or current/former established exclusive cigarette smokers (OR = 0.9 [0.5–1.8]). Current/former established exclusive cigarette smokers were more likely to have had any CVD compared to those who were never established cigarette and SLT users (OR = 1.6 [1.1–2.3]).

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock.

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings' mechanisms to improve outcomes in patients with SS and underlying CHF.

The Association between Chronic Myeloid Leukemia and Heart Failure

IntroductionThe first and second leading causes of death in the United States are heart disease and cancer respectively. Chronic myeloid leukemia (CML) is a hematopoietic stem cell malignancy diagnosed at the mean age of 66. The rate of cardiovascular diseases in CML have been increased with the advent of therapies such as tyrosine kinase inhibitors (TKIs) as well as the improved survival rate with the treatments. Heart failure is one the most commonly identified cancer-therapy related cardiovascular adverse events. In this study, we are using national population cohort to study the association between CML and heart failure.MethodsWe conducted a retrospective analysis of 3 years of National inpatient sample (HCUP-NIS) from 2016 to 2018 data base. Patient older than 60 years old and with or without CML was selected using ICD-10 diagnosis code. Principal diagnosis of congestive heart failure and cardiogenic shock were included with the code. Discharge-level weight analysis was used to produce national estimate. Continuous variables were compared by t-test, while chi-square and Fisher's exact test for categorical variables. Finally, multivariate logistic regression was used to calculate odds ratio for inpatient mortality and multivariate linear regression for length of stay using STATA 17 statistical software.ResultsA total of 45,724,104 admissions met for inclusion criteria and 43,505 patients (0.095 %) have CML. Patients with CML are more likely to be of older age (75.2 v 74.9, p <0.002), male (55.2% v 46.8%, p < 0.0001) and white (79.7% v 76.0%, p < 0.0001). They are also associated with lower prevalence of diabetes (16.5% v 20.1%, p < 0.0001) and smoking (0.6% v 0.8%, p <0.0001) but higher prevalence of peripheral arterial diseases (13.7% v 11.6%, p <0.0001). During the study period, a total of 9,339,737 patients were admitted primarily due to CHF and 12,835 of patients (0.14%) have underlying CML. There was no statistical difference in deteriorating to cariogenic shock in CHF patients with and without CML (2.06% v 2.10%, p <0.805). After adjusting for age, sex, race, diabetes, Charlson comorbidity index, there was statistical significance in mortality (OR 1.18, CI 1.09 - 1.27, p < 0.0001) and longer length of stay by 0.28 day (p < 0.0001)DiscussionsThis study describes patient's demographic, in-patient mortality rate and length of stay in patients with CML and heart failure. A comorbid heart failure is associated with higher mortality rate and longer length of stay in hospital. Even though multiple societies have published several guidelines for baseline assessment of the cardiovascular risk factors, there is no standardized assessment tool for risk stratification and management of heart failure in CML patients. Moreover, presence of heart failure can be a limitation on treatments of CML and carry a poor prognosis. Our study emphasizes the importance of assessing cardiovascular diseases and optimizing the care before, during and after the treatment of CML. DisclosuresNo relevant conflicts of interest to declare.

Patient and Physician Preferences for Treatment of Newly Diagnosed Acute Myeloid Leukemia (AML) in Patients Not Candidates for Intensive Chemotherapy

BackgroundThe number of targeted antileukemic therapies for the treatment of AML has increased over the past decade. However, for patients who are not candidates for high intensive chemotherapy (HIC), a better understanding is needed of what treatment attributes patients and physicians value and how their preferences differ to potentially improve treatment satisfaction.ObjectiveTo understand the impact of treatment attributes on treatment selection, we quantified the preferences of: a) patients newly diagnosed with AML who are not candidates for HIC; and, b) the physicians who treat them.MethodsA discrete choice experiment (DCE) was performed to quantify the extent to which treatment attributes impact patients' and physicians' treatment decisions in various scenarios. A literature review was conducted to identify treatment attributes important to patients with AML. Following the review, one-on-one phone interviews were conducted with patients (United States [US], n=3; United Kingdom [UK], n=3) and physicians (US, n=2; UK, n=2) to finalize the attributes and levels included in the DCE. Patients who were eligible to participate in the online survey were adults with a self-confirmed AML diagnosis, who had not relapsed or been refractory to treatment, had not received a stem cell transplant, and had not received HIC or met one of the following criteria: aged ≥75 years, diagnosis of congestive heart failure, chronic kidney disease, or other types of cancer, or ECOG score of 3 or 4. Physicians included hematologists/ oncologists treating >5 patients with AML over the past year. The web-based DCE included choice cards showing 2 hypothetical treatment profiles with 6 attributes (chance of 2-year overall survival [OS], average quality of life [QoL], risk of serious infections, risk of grade 3/4 nausea, chance of achieving transfusion independence, and duration of hospitalization per year) at varying levels. Participants chose a preferred treatment for each choice card. Conditional logit regression models were used to estimate preference weights and to analyze the impact of treatment attributes on participants' choices.ResultsThe DCE was completed by 77 patients newly diagnosed with AML who had not received HIC (US, n=47; UK, n=30) and 145 physicians (US, n=48; UK, n=52; Canada, n=29; Australia, n=16). Mean patient age was 71.4 years; 51.9% were female. Mean (SD) time since AML diagnosis was 8.3 (8.2) months. Most physicians were hematologists (81.4%) and saw a median of 30 AML patients yearly. For patients, duration of hospitalization (decrease from 6 to 2 weeks/year) was the most important attribute followed by average QoL (increase from 50 to 85 on a 100-point QoL scale) and chance of 2-year OS (increase from 15% to 40%; Figure). Based on these findings, we estimated that patients were willing to accept a decrease in 2-year OS (from 40% to 15%) or an increase in risk of serious infections (from 5% to 20%) to decrease time spent hospitalized (from 6 to 2 weeks per year). For physicians, chance of 2-year OS (from 15% to 40%) was the most important attribute followed by average QoL (increase from 50 to 85 on a 100-point scale), risk of serious infections (from 20% to 5%), and risk of grade 3/4 nausea and vomiting (from 20% to 1%; Figure). Based on these findings, we estimated that physicians were willing to accept an increased risk of grade 3/4 nausea and vomiting (from 10% to 20%) in exchange for decreased time in hospital (from 6 to 2 weeks per year) and increased chance of achieving transfusion independence (from 35% to 55%) when other treatment attributes remained stable.ConclusionSignificant differences in treatment attribute importance for patients with newly diagnosed AML who had not received HIC were observed between patients and physicians. Patients most valued treatments that reduced hospitalization duration while physicians most valued treatments that improved chance of 2-year OS. These differences highlight the importance of a shared decision-making process when choosing treatments for patients with AML ineligible for HIC. However, given the variability among individual patients, it may be particularly worthwhile for physicians to initiate a discussion with patients prior to treatment selection to determine what treatment attributes each patient values most. Treatment selection could then be tailored based on attributes most valued by the patient and likely lead to improved treatment satisfaction. [Display omitted] DisclosuresZhou: Astellas Pharma, Inc.: Consultancy. Yang: Astellas Pharma, Inc.: Consultancy. Song: Astellas Pharma, Inc.: Consultancy. Marshall: Astellas Pharma, Inc.: Consultancy; Arthur JE Child Chair: Other: Indirectly related salary support. Griffin: Novartis: Patents & Royalties: Post marketing royalties from midostaurin; Astellas Pharma, Inc.: Consultancy. Saini: Astellas Pharma, Inc.: Consultancy, Honoraria. Shah: Astellas Pharma, Inc.: Current Employment; University of Michigan School of Public Health Department of Health Management and Policy Alumni Board: Other: Chair-Elect.

Bipolar disorder and medical comorbidities: A Portuguese population-based observational retrospective study (2008–2015)

BackgroundThis study aimed to use the Charlson Comorbidity Index (CCI) to assess the prevalence of medical comorbidities among hospitalization episodes with a primary Bipolar Disorder (BD) diagnosis, and to analyze its association with hospitalization outcomes. MethodsA population-based observational retrospective study was conducted using a Portuguese administrative database containing all mainland public hospitalizations. From 2008–2015, hospitalization episodes with a primary diagnosis of BD were analysed. Outcomes included: length of stay (LoS), in-hospital mortality and discharge destination. ResultsOverall, 20807 hospitalization episodes were analysed. Mean±standard deviation age at admission was 47.9±14.3 years, and these episodes mostly refer to women's admissions (66.6%). Median (1st quartile; 3rd quartile) LoS was 16.0 (9.0; 25.0) days. A total of 2145 (10.3%) episodes had ≥1 CCI comorbidities registered, being diabetes the most prevalent. LoS was significantly higher for episodes with secondary diagnoses of congestive heart failure, cerebrovascular disease, dementia, diabetes, renal disease and malignancy (all p<0.05). Episodes with a registry of myocardial infarction, peripheral vascular disease, malignancy and renal disease diagnoses had higher in-hospital mortality. LimitationsLimitations include the use of data registered for administrative reasons rather than research purposes, and the analysis of hospitalization episodes, instead of patients. ConclusionsIn this Portuguese nationwide study, greater comorbidity had a measurable impact on BD hospitalization outcomes. During the study period the prevalence of CCI comorbidities rose from 8.1% to 17.4%, which may reflect the overall increasing quality of hospital-coded data in Portugal throughout the years. The detection and timely management of medical comorbid conditions will likely prevent the high BD medical burden.

Effectiveness of goreisan–jiinkokato combination for an elderly patient with heart failure: A case report

ABSTRACTCaseThe patient was a 93‐year‐old female with a clinical diagnosis of congestive heart failure. Drainage was performed by standard treatment, but pleural effusion and congestive heart failure persisted. In addition, intravascular dehydration occurred. Drainage with standard treatment was considered difficult; hence, goreisan and jiinkokato administration was initiated.OutcomeA decrease in pleural effusion, extracellular water/total body water ratio (63.3% versus 60.8%), and serum B‐type natriuretic peptide level (231.1 versus 194.7 pg/mL) was noted after goreisan and jiinkokato administration. Moreover, serum sodium level and osmolality decreased from 151 to 132 mEq/L and 333 to 288 mOsm/L, respectively. Similarly, body temperature decreased considerably. Conversely, body weight increased from 40.9 to 45.8 kg. Based on the abovementioned facts, we believe that congestive heart failure and intravascular dehydration may have been alleviated, thereby correcting the uneven fluid distribution.ConclusionsGoreisan–jiinkokato combination therapy may be effective for the treatment of elderly patients with heart failure.