Discharge In Heart Failure Patients Research Articles

The Relationship Between Self-Efficacy and Functional Capacity Among Discharged Heart Failure Patients in Jordan.

Self-efficacy is an important factor associated with healthy lifestyle changes in heart failure treatment. Functional capacity testing of heart failure patients (HFPs) can stratify prognosis. Reduced functional capacities in HFPs are linked to a poor heart failure prognosis. Limited research has examined the potential relationship between self-efficacy and functional capacity. The aims of this study were to assess self-efficacy level and functional capacity among HFPs after hospitalization, and examine whether there is a relationship between them. A descriptive correlational design was used. A convenience sample of 220 HFPs was recruited from 2 hospitals in Jordan. The Arabic version of Cardiac Self-Efficacy Questionnaire was used to assess self-efficacy, the 6-Minute Walking Test (6-MWT) was used to assess functional capacity, and the Borg rating of perceived exertion scale (Borg Scale) was used to assess exertion during 6-MWT. The sample included 46.8% male (n = 103) and 53.2% female (n = 117). The mean age was 52.66 ± 8.91 years. Most of the HFPs were categorized based on New York Heart Association classification as class I, 35.9% (n = 79), and class II, 41.4% (n = 91). The mean ejection fraction was 41.46 ± 9.44. The global self-efficacy was moderate (32.98 ± 9.92), and the mean score for the 6-MWT was 494.35 ± 143.37. The Borg Scale mean was 10.94 ± 3.34. In addition, there was a positive relationship between self-efficacy and 6-MWT (r = 0.63, n = 220, P = .01). This study provides baseline data for further research on treatment of HFPs, and the development of evidence-based tailored health interventions to maintain and improve self-efficacy and functional capacity among these service users. Moreover, replicated researches can test the study results considering different methodologies, such as using objective functional capacity tool and longer follow-up periods.

Heart Failure Emergency Readmission Prediction Using Stacking Machine Learning Model.

Heart failure is a devastating disease that has high mortality rates and a negative impact on quality of life. Heart failure patients often experience emergency readmission after an initial episode, often due to inadequate management. A timely diagnosis and treatment of underlying issues can significantly reduce the risk of emergency readmissions. The purpose of this project was to predict emergency readmissions of discharged heart failure patients using classical machine learning (ML) models based on Electronic Health Record (EHR) data. The dataset used for this study consisted of 166 clinical biomarkers from 2008 patient records. Three feature selection techniques were studied along with 13 classical ML models using five-fold cross-validation. A stacking ML model was trained using the predictions of the three best-performing models for final classification. The stacking ML model provided an accuracy, precision, recall, specificity, F1-score, and area under the curve (AUC) of 89.41%, 90.10%, 89.41%, 87.83%, 89.28%, and 0.881, respectively. This indicates the effectiveness of the proposed model in predicting emergency readmissions. The healthcare providers can intervene pro-actively to reduce emergency hospital readmission risk and improve patient outcomes and decrease healthcare costs using the proposed model.

Association of ivabradin use with ventricular arrhythmias in heart failure patients

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Heart failure patients with reduced left ventricular function are at high risk for ventricular arrhythmias and sudden cardiac death. Ivabradine, a specific inhibitor of the If current in the sinoatrial node, provides heart rate reduction in sinus rhythm and angina control in chronic coronary syndromes. Purpose The effect of ivabradine on ventricular arrhythmias in heart failure patients has not been fully elucidated. In this study, we aimed to investigate the effect of ivabradine use on life-threatening arrhythmias and long-term mortality in heart failure patients. Methods In this retrospective study, 1639 patients with heart failure were included. Patients were divided into two groups as ivabradine users and non-users. Patients presenting with ventricular tachycardia, presence of ventricular extra systole and ventricular tachycardia in 24-hour rhythm monitoring, appropriate ICD shocks and long-term mortality outcomes were evaluated according to ivabradine use. Results After adjustment for clinical variables, admission with ventricular tachycardia had 3.0 higher rates in ivabradine non-users (95% CI: 1.5 – 10.2). According to the adjusted model for all variables, approximately 4.1 times more appropriate ICD shocks were observed in the ivabradine non-users than the users (95% CI: 1.8 – 9.6). Long-term mortality did not differ between these groups after adjustment for all covariates. Conclusion The use of ivabradine reduced the appropriate ICD discharge in heart failure patients with low ejection fraction. Ivabradine has a potential in the treatment of ventricular arrhythmias in heart failure patients.

Effect of different blood pressure levels on short-term outcomes in hospitalized heart failure patients

BackgroundTo investigate the influence of blood pressure (BP) level on short-term prognosis of heart failure (HF), the effect of the BP level on clinical end point events 3 months after discharge was observed. MethodsA retrospective cohort study was performed on 1492 hospitalized HF patients. All patients were divided according to systolic blood pressure (SBP) per 20 mmHg and diastolic blood pressure (DBP) per 10 mmHg. Logistic regression analysis was used to analyze the relationship between BP level and heart failure rehospitalization, cardiac death, all-cause death and a composite end point of heart failure rehospitalization/all-cause death at 3 month follow-up after discharge. ResultsAfter multivariable adjustment, the relationship between SBP and DBP levels and outcomes followed an inverted J curve relationship. Compared with the reference group (110 < SBP≤130 mmHg), the risk of all end point events significantly increased in the SBP≤90 mmHg group included heart failure rehospitalization (OR 8.16, 95%CI 2.88–23.11, P < 0.001), cardiac death (OR 5.43, 95%CI 1.97–14.96, P = 0.001), all-cause death (OR 4.85, 95%CI 1.76–13.36, P = 0.002), and composite end point (OR 2.76, 95%CI 1.03–7.41, P = 0.044). SBP>150 mmHg significantly increased the risk of heart failure rehospitalization (OR 2.67, 95%CI 1.15–6.18, P = 0.022). Compared with.the reference group (65 < DBP≤75 mmHg), cardiac death (OR 2.64, 95%CI 1.15–6.05, P = 0.022) and all-cause death (OR 2.67, 95%CI 1.20–5.93, P = 0.016) was significantly increased in DBP≤55 mmHg group. There was no significant difference among subgroups according to left ventricular ejection fraction (P > 0.05). ConclusionsThere is a significant difference in the short-term prognosis 3 months after discharge in HF patients with different BP levels at discharge. There was an inverted J curve relationship between BP levels and prognosis.

The Changes in Frailty and Death within Six Months of Discharge in Heart Failure Patients 80 Years and Older

The Changes in Frailty and Death within Six Months of Discharge in Heart Failure Patients 80 Years and Older

Social and therapeutic decline earlier than physical and psychological domains after discharge in heart failure patients: A patient-reported outcome measurements of latent transition analysis.

BackgroundAmong patients with chronic heart failure (CHF), response shifts are common in assessing treatment effects. However, few studies focused on potential response shifts in these patients.Materials and methodsData of CHF patient-reported outcome measures (PROMs) were obtained from three hospitals in Shanxi, China, from 2017 to 2019. A total of 497 patients were enrolled and followed up at 1 month and 6 months after discharge. Latent transition analysis (LTA) was employed to determine the longitudinal transition trajectories of latent subtypes in CHF patients in the physiological, psychological, social, and therapeutic domains.ResultsThe patients were divided into high- and low-level groups in the four domains according to the LTA. One month after discharge, the physiological and psychological domains improved, while the social and therapeutic domains remained unchanged. Six months after discharge, the former remained stable, but the latter deteriorated. The factors affecting the state transition in four domains were as follows. The influencing factor of the physiological domains are gender, age, tea consumption, smoking, alcohol consumption, physical activity, and light diet; those of the psychological domain are gender, occupation, smoking, alcohol consumption, and physical activity; those of the social domains are age; those of the therapeutic domains are education and income.ConclusionThe disease status of CHF patients has shifted over time. Risk factors accelerate the deterioration of patients’ condition. Furthermore, the risk factors of social and therapeutic domains deteriorate patients’ condition faster than those of physiological and psychological domains. Therefore, individualized intervention programs should be given for CHF patients who may be transferred to the low-level groups to maintain the treatment effect and improve the prognosis.

Incremental prognostic value of lung ultrasound on contemporary heart failure risk scores.

Introduction: Over the last decades, several scores have been developed to aid clinicians in assessing prognosis in patients with heart failure (HF) based on clinical data, medications and, ultimately, biomarkers. Lung ultrasound (LUS) has emerged as a promising prognostic tool for patients when assessed at discharge after a HF hospitalization. We hypothesized that contemporary HF risk scores can be improved upon by the inclusion of the number of B-lines detected by LUS at discharge to predict death, urgent visit, or HF readmission at 6- month follow-up. Methods: We evaluated the discrimination improvement of adding the number of B-lines to 4 contemporary HF risk scores (Get with the Guidelines -GWTG-, MAGGIC, Redin-SCORE, and BCN Bio-HF) by comparing the change in the area under the receiver operating curve (AUC), the net reclassification index (NRI), and the integrated discrimination improvement (IDI). The population of the study was constituted by the 123 patients enrolled in the LUS-HF trial, adjusting the analyses by the intervention. Results: The AUC of the GWTG score increased from 0.682 to 0.789 (p = 0.02), resulting in a NRI of 0.608 and an IDI of 0.136 (p < 0.05). Similar results were observed when adding the number of B-lines to the MAGGIC score, with an AUC that increased from 0.705 to 0.787 (p < 0.05). This increase translated into a NRI of 0.608 and an IDI of 0.038 (p < 0.05). Regarding Redin-SCORE at 1-month and 1-year, the AUC increased from 0.714 to 0.773 and from 0.681 to 0.757, although it did not reach statistical significance (p = 0.08 and p = 0.06 respectively). Both IDI and NRI were significantly improved (0.093 and 0.509 in the 1-month score, p < 0.05; 0.056 and 0.111 in the 1-year score, p < 0.05). Lastly, the AUC for the BCN Bio-HF score increased from 0.733 to 0.772, which was statistically non-significant, with a NRI value of 0.363 (p = 0.06) and an IDI of 0.092 (p < 0.05). Conclusion: Adding the results of LUS evaluated at discharge improved the predictive value of most of the contemporary HF risk scores. As it is a simple, fast, and non-invasive test it may be recommended to assess prognosis at discharge in HF patients.

Prognostic values of B-lines combined with clinical congestion assessment at discharge in heart failure patients.

We aim to investigate the additive effect of B-lines on lung ultrasound (LUS) for predicting outcome in patients with heart failure (HF) when combined with conventional assessment of clinical congestion. This study prospectively enrolled 117 hospitalized HF patients (61±16years, 70.1% males) who underwent congestion assessment by the 'wet/dry' status, clinical congestion score (CCS), and B-lines on LUS. The primary endpoint was all-cause mortality or hospitalization for HF during the 180-day follow-up after discharge. The 'Wet', CCS≥3, and B-lines >5, indicators of congestion positive (+), were observed in 83.8%, 76.1%, and 70.1% of the patients on admission, respectively; and the numbers significantly decreased to 41.9%, 41.9%, and 35.9% at discharge, respectively. The agreement between the 'wet/dry' status and B-lines (58.1%) or between CCS and B-lines (56.4%) was moderate at discharge, in terms of both positive and both negative. By incorporating the B-lines with assessment of clinical congestion, the patients at discharge were divided into three phenotypes as clinical congestion (+), clinical congestion (-) with B-lines (+), and clinical congestion (-) with B-lines (-). The Kaplan-Meier analysis showed a better survival in the both (-) group ('wet/dry' with B-lines: Chi-square 10.591, P=0.005; CCS with B-lines: χ2 6.239, P=0.031). When the 'wet' patients (n=49) being taken as the reference, the 'dry' patients with B-lines (+) (n=21) had an identical risk of the composite endpoint (hazard ratio [HR] adjusted for clinical covariates 1.021, 95% confidence interval [CI] 0.480-2.134, P=0.974), while the 'dry' patients with B-lines (-) (n=47) had a lower risk (HR 0.264, 95% CI 0.113-0.617, P=0.002). When the CCS (+) patients (n=49) being regarded as the reference, similar results were obtained in the patients with CCS (-) but B-lines (+) (n=22) (HR 1.348, 95% CI 0.627-2.896, P=0.444) as well as in those with both CCS (-) and B-lines (-) (n=46) (HR 0.447, 95% CI 0.202-0.992, P=0.048). The combination of B-lines on LUS and conventional assessment helped to identify new phenotypes of congestion that aid in the risk stratification of discharged HF patients. Further investigation is warranted to determine whether this strategy could be adopted as a guide for decongestion therapy.

Impact of B-lines-guided intensive heart failure management on outcome of discharged heart failure patients with residual B-lines.

AimsPulmonary congestion (PC) expressed by residual lung ultrasound B‐lines (LUS‐BL) could exist in some discharged heart failure (HF) patients, which is a known determinant of poor outcomes. Detection efficacy for PC is suboptimal with widely used imaging modalities, like X‐ray or echocardiography, while lung ultrasound (LUS) can sufficiently detect PC by visualizing LUS‐BL. In this trial, we sought to evaluate the impact LUS‐BL‐guided intensive HF management post‐discharge on outcome of HF patients discharged with residual LUS‐BL up to 1 year after discharge. IMP‐OUTCOME is a prospective, single‐centre, single‐blinded, randomized cohort study, which is designed to investigate if LUS‐BL‐guided intensive HF management post‐discharge in patients with residual LUS‐BL could improve the clinical outcome up to 1 year after discharge or not.Methods and resultsAfter receiving the standardized treatment of HF according to current guidelines, 318 patients with ≥3 LUS‐BL assessed by LUS within 48 h before discharge will be randomly divided into the conventional HF management group and the LUS‐BL‐guided intensive HF management group at 1:1 ratio. Patient‐related basic clinical data including sex, age, blood chemistry, imaging examination, and drug utilization will be obtained and analysed. LUS‐BL will be assessed at 2 month interval post‐discharge in both groups, but LUS‐BL results will be enveloped in the conventional HF management group, and diuretics will be adjusted based on symptom and physical examination results with or without knowing the LUS‐BL results. Echocardiography examination will be performed for all patients at 12 month post‐discharge. The primary endpoint is consisted of the composite of readmission for worsening HF and all‐cause death during follow up as indicated. The secondary endpoints consisted of the change in the New York Heart Association classification, Duke Activity Status Index, N terminal pro brain natriuretic peptide value, malignant arrhythmia event and 6 min walk distance at each designed follow up, echocardiography‐derived left ventricular ejection fraction, and number of LUS‐BL at 12 month post‐discharge. Safety profile will be recorded and managed accordingly for all patients.ConclusionsThis trial will explore the impact of LUS‐BL‐guided intensive HF management on the outcome of discharged HF patients with residual LUS‐BL up to 1 year after discharge in the era of sodium‐glucose cotransporter‐2 inhibitors and angiotensin receptor blocker‐neprilysin inhibitor.Trial Registration: ClinicalTrials.gov: NCT05035459

Beta-blocker could show the prognostic impact in heart failure patients even on the regular hemodialysis

Abstract Background β-blockers are recommended as standard medications for patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). However, this favorable prognostic effect of β-blockers has not been fully validated in patients receiving regular hemodialysis. Indeed, prior clinical trials have generally excluded such very high-risk population for adverse cardiovascular events. Main reasons for that are the limited number of regular hemodialysis patients in the Western nations, and too high rates of clinical events. Purpose This study aimed to clarify the prognostic benefit of β-blocker in patients on regular hemodialysis who were hospitalized due to HF. Methods This observational study included 1,930 consecutive patients who were hospitalized for worsening of HF and discharged alive from 2013 to 2019. Of them, 151 patients who underwent regular hemodialysis were ultimately analyzed. They were divided into 2 groups depending on the prescription of β-blocker at the discharge; β-blocker group (n=115) and No-β-blocker group (n=36). The primary endpoint of this study was a composite of death from any cause and rehospitalization due to HF. Results During the observation period with 501 days of median follow-up (IQR: 197–954 days), the primary endpoint was occurred in 45 patients (39%) who were receiving β-blockers, while in 24 patients (67%) who were not. Kaplan-Meier analysis showed a significantly lower rate of the primary endpoint in patients in the β-blocker group (Log-rank, p&amp;lt;0.001, Figure). After the adjustment for age, sex, LVEF, systolic blood pressure, heart rate and atrial fibrillation, the administration of β-blocker was still an independent predictor for the primary endpoint in patients who underwent regular hemodialysis (hazard ratio; 0.46, 95% confidence interval; 0.26–0.82). Further analysis each for the population with reduced LVEF (&amp;lt;45%) and preserved LVEF (&amp;gt;45%) showed that the main result of the current study was consistent with that in the reduced LVEF group (Log-rank, p=0.005), but was diminished in the preserved LVEF group (p=0.13). Conclusion The prescription of β-blocker at discharge in HF patients with regular hemodialysis was associated with lower risk of adverse cardiovascular events, mainly in the patients with reduced LVEF. From the findings of our study, we should consider the administration of β-blockers in HF patients, even they are on the regular hemodialysis. Funding Acknowledgement Type of funding sources: None. Figure 1

Prognostic impact of hyponatraemia and hypernatraemia at admission and discharge in heart failure patients with preserved, mid-range and reduced ejection fraction.

Hyponatraemia is common in patients with acute heart failure (HF). To determine the impact of sodium disturbances on mortality and readmissions in HF with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF) and mid-range ejection fraction (HFmrEF). This study was a prospective multicentre consecutive registry in 20 hospitals, including patients admitted due to acute HF in cardiology departments. Sodium <135 mmol/L was considered hyponatraemia, >145 mmol/L hypernatraemia and 135-145 mmol/L normal. A total of 1309 patients was included. Mean age was 72.0 ± 11.9 years, and 810 (61.9%) were male. Mean serum sodium level was 138.6 ± 4.7 mmol/L at hospital admission and 138.1 ± 4.1 mmol/L at discharge. The evolution of sodium levels was: normal-at-admission/normal-at-discharge 941 (71.9%), abnormal-at-admission/normal-at-discharge 127 (9.7%), normal-at-admission/abnormal-at-discharge 155 (11.8%) and abnormal-at-admission/abnormal-at-discharge 86 (6.6%). Hyponatraemia at discharge was more common in HFrEF (109 (20.7%)) than in HFpEF (79 (13.9%)) and HFmrEF (27 (12%)), P=0.003. The prevalence of hypernatraemia at discharge was similar in the three groups: HFrEF (10 (1.9%)), HFpEF (12 (2.1%)) and HFmrEF (4 (1.9%)), P=0.96. In multivariate analysis, abnormal sodium concentrations at hospital admission (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.15-1.76, P=0.001) and discharge (HR 1.33, 95% CI 1.08-1.64, P=0.007) were both independently associated with increased mortality and readmissions at 12 months. Hyponatraemia and hypernatraemia at admission and discharge predict a poor outcome in patients with acute HF regardless of left ventricular ejection fraction. Hyponatraemia at discharge is more frequent in HFrEF than in the other groups.

Spironolactone and Eplerenone Use at Discharge in Heart Failure Patients With Reduced Ejection Fraction at 3 Large Hospital Systems.

Spironolactone and Eplerenone Use at Discharge in Heart Failure Patients With Reduced Ejection Fraction at 3 Large Hospital Systems.

Abstract 16345: Increase in Serum Chloride Level During Hospitalization Leads to Improved Clinical Outcomes in Patients With Heart Failure

Introduction: Serum chloride levels both at admission and at discharge in patients with heart failure (HF) are independently associated with the incidence of adverse clinical outcomes. However, there has been few reports focusing on the prognostic impact of the change in serum chloride level during the hospitalization on the long-term prognosis after discharge. Hypothesis: We thus hypothesized that changes in serum chloride during the hospitalization is an independent prognostic predictor after discharge in HF patients. Methods: This observational study included 1,913 consecutive patients who admitted to hospital due to worsening of HF and discharged alive in a single university hospital. After excluding patients who received regular hemodialysis, 1,762 patients were ultimately analyzed. The primary endpoint of this study was death from any cause. Result: Overall serum chloride level was significantly decreased from the admission to discharge (103 [100-106] mEq/L to 102 [99-105] mEq/L, P&lt;0.001). During the observation period with 512 days of median follow-up, 286 patients (16.2%) died. Multivariate Cox regression analysis revealed that increase in serum chloride level during the index hospitalization was independently associated with lower rates of mortality, even after the adjustment of diverse covariates including serum chloride level at admission (hazard ratio (HR): 0.94, 95% confidence interval: 0.90-0.98). When dividing the study population into tertiles by chloride levels at admission, patients with the lower baseline chloride level had the greater reduction in HR of the primary endpoint by the increase of chloride level during the hospitalization (Figure). Conclusion: Increase in serum chloride level during hospitalization may be associated with better post-discharge prognosis in HF patients. This could be a new therapeutic target for heart failure to improve long-term prognosis.

Six-Month Predictive Value of Diuretic Resistance Formulas in Discharged Heart Failure Patients after an Acute Decompensation.

Background. The diuretic response has been shown to be a robust independent marker of cardiovascular outcomes in acute heart failure patients. The objectives of this clinical research are to analyze two different formulas (diuretic response (DR) or response to diuretic (R-to-D)) in predicting 6-month clinical outcomes. Methods: Consecutive patients discharged alive after an acute decompensated heart failure (ADHF) were enrolled. All patients underwent N-terminal-pro hormone BNP (NT-proBNP) and an echocardiogram together with DR and R-to-D calculation during diuretic administration. Death by any cause, cardiac transplantation and worsening heart failure (HF) requiring readmission to hospital were considered cardiovascular events. Results: 263 patients (62% male, age 78 years) were analyzed at 6-month follow-up. During the follow-up 58 (22.05%) events were scheduled. Patients who experienced CV-event had a worse renal function (p = 0.001), a higher NT-proBNP (p = 0.001), a lower left ventricular ejection fraction (p = 0.01), DR (p = 0.02) and R-to-D (p = 0.03). Spearman rho’s correlation coefficient showed a strong direct correlation between DR and R to D in all patients (r = 0.93; p < 0.001) and both in heart failure with reduced ejection fraction (HFrEF) (r = 0.94; p < 0.001) and HF preserved ejection fraction (HFpEF) (r = 0.91; p < 0.001). At multivariate analysis, a value of R-to-D <1.69 kg/40 mg, but only <0.67 kg/40 mg for DR were significantly related to poor 6-month outcome (p = 0.04 and p = 0.05, respectively). Receiver operating characteristic (ROC) curve analyses demonstrated that DR and R-to-D are equivalent in predicting prognosis (area under curve (AUC): 0.39 and 0.40, respectively). Only R-to-D was inversely related to in-hospital stay (r = −0.23; p = 0.01). Conclusion: Adding diuresis to DR seemed to provide a better risk assessment in alive HF patients discharged after an acute decompensation.

The role of the clinical pharmacist in the prevention of potential drug interactions in geriatric heart failure patients.

Background The treatment of heart failure patients is very complex and includes lifestyle modification as well as different pharmacological therapies. Polypharmacy is very common in such patients and they are at increased risk of potential drug-drug interactions and associated effects such as poor adherence, compliance and adverse events. Objective The aim of the present study is to investigate retrospectively the prescribed pharmacotherapy of the hospital discharged heart failure patients for possible drug interactions. Settings Clinic for Cardiology of the "Saint Marina" University Hospital in Varna, Bulgaria. Method Lexicomp® Drug interaction software was used for screening potential drug-drug interactions. Logistic regression was applied to determine the odds ratio for the association between the age and number of drugs taken and the number of potential drug-drug interactions. Main outcome measure Incidence and type of pDDIs in geriatric heart failure patients. Results A retrospective study was conducted by reviewing the medical records of 248 selected heart failure patients for the prescribed medicines for a 1-year period (January 2015-December 2015). The total number of potential drug-drug interactions was 1532, or approximately 6.28 (± 4.72 SD) per one person. The range of prescribed drugs was between three and fourteen, 92% of them have been taking more than five medicines, an average of 7.12 (± 2.07 SD) per patient. The average age was 72.35 (± 10.16 SD). The results have shown stronger association between the number of drugs taken (more than 7) and the occurrence of potential drug-drug interactions (more than 10)-37.84 (95% CI 9.012-158.896, P ≤ 0.001). No statistically significant differences were found between age and occurrence of potential drug-drug interactions (more than 10)-1.008 (95% CI 0.441-2.308, P = 0.848). Conclusion The incidence of drug-drug interactions in heart failure patients is high. The clinical pharmacist, as a part of the multidisciplinary team, could reduce medication-related problems, such as drug interactions, and to optimize drug therapy by checking the treatment prescribed at the discharge of these patients.

Effectiveness of telemonitoring-enhanced support over structured telephone support in reducing heart failure-related healthcare utilization in a multi-ethnic Asian setting

Aims Our study aimed to compare the effectiveness of telemonitoring over structured telephone support in reducing heart failure-related healthcare utilization. Methods This was a non-randomised controlled study comparing 150 recently discharged heart failure patients enrolled into telemonitoring and 55 patients who only received structured telephone support after rejecting telemonitoring. Patient activation, knowledge and self-management levels were measured at baseline and the one year upon programme completion using the Patient Activation Measure, the Dutch Heart Failure Knowledge Scale and the Self-Care of Heart Failure Index respectively. Differences in heart failure-related and all-cause hospitalization rates, total bed days and mortality rates at 180 days and at one year, knowledge and self-management scores and total cost of care between groups at one year were analysed. Results Average age of telemonitoring was 57.9 years and 63.9 years for structured telephone support. Significant difference in adjusted 180-day all-cause bed days (telemonitoring: five days versus structured telephone support: 9.8 days), heart failure-related bed days (telemonitoring: 1.2 days versus structured telephone support: six days) and adjusted one-year heart failure-related bed days (telemonitoring: 2.2 days versus structured telephone support: 6.6 days) were observed. Telemonitoring was associated with reduced all-cause one-year mortality (hazard ratio 0.32, p = 0.02). Estimated mean maintenance and confidence scores were significantly higher in the telemonitoring group at one year. No differences in all-cause and HF-related readmission rates and knowledge levels were observed. The one-year total cost of care was predicted to be Singapore dollars (SG$) 2774.4 lower (p = 0.07) in telemonitoring. Conclusion In conclusion, telemonitoring was associated with lower all-cause and heart failure-related total bed days at 180 days, lower heart failure-related total bed days and total cost of care at one year as compared with structured telephone support.

Role of Response-to-Diuretic in Predicting Prognosis in Discharged Heart Failure Patients After an Acute Decompensation

The diuretic response has been shown to be a robust independent marker of cardiovascular outcomes in acute heart failure (ADHF) patients. The objectives of this clinical research, will aim are to: a) include diuresis in the formula for diuretic response (R-to-D); b) add to R-to-D the value of a pre-discharged determination of galectin-3 and BNP in predicting mid-term clinical outcome. Consecutive patients discharged alive after an ADHF were enrolled. All patients underwent BNP and galectin-3, a 6min walk test and an echocardiogram together with diuresis and body weight during diuretic administration. Death by any cause, cardiac transplantation and worsening HF requiring readmission to the hospital were considered cardiovascular events. 141 patients (98 males, age 73.8) were analysed (follow-up 17months). During the follow-up 45 (31.9%) events were scheduled (19 cardiac deaths, 26 re-hospitalisation for HF). Patients who experienced CV-event had a worst renal function (p=0.003), an higher BNP (p=0.006) and galectin-3 (p=0.008). At multivariate analysis, only R-to-D, galectin-3 and BNP showed a significant correlation with worst clinical prognosis (respectively p=0.043; OR 6.01; p=0.01; OR 8.9; p=0.02 OR 10.38), independently of age and renal function. Kaplan-Meier curves depicted a powerful stratification using an R-to-D <1.2kg/40mg furosemide (log rank 10.96; p=0.0009). Adding R-to-D<1.2mg/40mg furosemide to galectin-3>17.6 pg/mL and BNP>500 pg/mL the predictive value improved (log rank 23.59; p=0.0001). Adding R-to-D to Gal-3 and BNP, a single pre-discharge strategy testing seemed to obtain a satisfactorily predictive value in alive HF patients discharged after an ADHF episode.

The role of diuretic response in prognosis prediction in discharged heart failure patients: the inclusion of diuresis.

The role of diuretic response in prognosis prediction in discharged heart failure patients: the inclusion of diuresis.

Abstract 13478: Increased Changes in Calculated Plasma Volume Predict Poor Prognosis in Heart Failure

Introduction: Plasma volume (PV) is contracted in stable patients with heart failure (HF) due to the effects of therapy aimed at reducing congestion, while increased PV can complicate the progression of HF. We sought to determine the prognostic implications of calculated PV in patients with HF. Hypothesis: Increased changes in PV predict mortality after hospital discharge in HF patients. Methods: We used data from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial for our analysis. The outcome in our study was all-cause mortality after hospital discharge. We used the hemoglobin and 1-hematocrit method to calculate the percentage change in PV (%ΔPV) between baseline and hospital discharge. We used Kaplan-Meier curves to compare 180-day (6-month) survival for patients that had increased %ΔPV to patients that had reduced or no %ΔPV. We used Cox proportional hazard regression analysis to adjust for age and gender, and obtained adjusted hazard ratios (AHR) and 95% confidence intervals (CI) of the association between mortality and %ΔPV. Results: There were 315 patients with complete data on PV that were included, of which 231 (73.3%) were men. The mean age was 56 years (range: 22-88 years). Of these 315 patients, 59 (18.7%) died after discharge during 4365.3 person days (PDs) of observation from baseline; mortality incidence rate was 1.4 deaths/100 PDs. Patients with reduced or no %ΔPV were more likely to survive than those with increased %ΔPV at the end of follow-up (Log rank test p=0.0042). Patients with increased %ΔPV had a statistically significant increased risk of mortality compared to patients with reduced or no %ΔPV (AHR 1.9, 95% CI: 1.1-3.2). Conclusions: Increased changes in calculated plasma volume predicted 6-month mortality in HF patients enrolled in the ESCAPE trial. Plasma volume changes during hospitalization for acute decompensated HF could guide risk stratification and prognosis in HF patients.

The predictive value of non-invasive cardiac output at rest in discharged heart failure patients

Risk stratification in patients suffering from chronic congestive heart failure (CHF) is based on a variety of clinical and laboratory variables. Indeed, several prognostic parameters have been identified, including age, New York Heart Association (NYHA) class, renal function, comorbidity such as atrial fibrillation, diabetes mellitus and ischemic heart disease [ [1] Swedberg K. Cleland J. Dargie H. et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): the Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur. Heart J. 2005; 26: 1115-1140 Crossref PubMed Scopus (246) Google Scholar ]. In acute decompensated heart failure (ADHF) episodes, the degree of renal dysfunction and arterial hypotension easily stratified patients with worst clinical outcome [ [2] Fonarow G.C. Adams K.F. Abraham W.T. Yancy C.W. Boscardin W.J. for the ADHERE Scientific Advisory Committee Risk stratification for in-hospital mortality in acutely decompensated heart failure. JAMA. 2005; 293: 572-580 Crossref PubMed Scopus (1308) Google Scholar ]. A single determination of Brain Natriuretic Peptide (BNP) plasma level represents a reliable risk stratification procedure and its increase is considered a sensitive diagnostic marker of left ventricular dysfunction [ 3 Boland D.G. Abraham W.T. Natriuretic peptides in heart failure. Congest. Heart Fail. 1998; 4: 23-33 Google Scholar , 4 McDonagh T.A. Robb S.D. Murdoch D.R. et al. Biochemical detection of left-ventricular systolic dysfunction. Lancet. 1998; 351: 9-13 Abstract Full Text Full Text PDF PubMed Scopus (909) Google Scholar ] having a clear prognostic relevance in predicting cardiovascular events in congestive heart failure (CHF) patients [ 5 Maisel A.S. Krishnaswamy P. Nowak R.M. et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N. Engl. J. Med. 2002; 347: 161-167 Crossref PubMed Scopus (2785) Google Scholar , 6 Berger R. Huelsman M. Strecker K. et al. B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. Circulation. 2002; 105: 2392-2397 Crossref PubMed Scopus (616) Google Scholar , 7 Feola M. Aspromonte N. Canali C. et al. Prognostic value of plasma brain natriuretic peptide, urea nitrogen and creatinine in outpatients >70 years of age with heart failure. Am. J. Cardiol. 2005; 96: 705-709 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar ]. In discharged HF patients both right or left ventricular function proved to play a prognostic role [ 8 Kamath S.A. Drazner M.H. Tasissa G. Rogers J.G. Stevenson L.W. Yancy C.W. Correlation of impedance cardiography with invasive hemodynamic measurements in patients with advanced heart failure: the Bioimpedance CardioGraphy (BIG) Substudy of the ESCAPE Trial. Am. Heart J. 2009; 158: 217-223 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 9 Zornoff L.A.M. Skali H. Pfeffer M.A. et al. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J. Am. Coll. Cardiol. 2002; 39: 1450-1455 Abstract Full Text Full Text PDF PubMed Scopus (366) Google Scholar ]. In particular, in HF patients developed after an MI each reduction of 5% in right ventricular function correlated with a 16% increased in mortality [ [9] Zornoff L.A.M. Skali H. Pfeffer M.A. et al. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J. Am. Coll. Cardiol. 2002; 39: 1450-1455 Abstract Full Text Full Text PDF PubMed Scopus (366) Google Scholar ]. In the substudy of the ESCAPE trial, the invasive measurement of pulmonary wedge pressure was significantly associated with death at 6-month follow-up [ [8] Kamath S.A. Drazner M.H. Tasissa G. Rogers J.G. Stevenson L.W. Yancy C.W. Correlation of impedance cardiography with invasive hemodynamic measurements in patients with advanced heart failure: the Bioimpedance CardioGraphy (BIG) Substudy of the ESCAPE Trial. Am. Heart J. 2009; 158: 217-223 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar ].