HF Population Research Articles

IMPROVING THE KNOWLEDGE, RISK STRATIFICATION AND OUTCOMES IN ADVANCED HEART FAILURE. THE ISMETT HEART FAILURE REGISTRY

Abstract Background Advanced heart failure (AdHF) accounts for approximately 10% of patients in HF clinics worldwide. Clinical management of patients with AdHF remains challenging and most of the available studies focus on chronic but not advanced HF. Registry studies may provide important insights into this specific population. Methods All consecutive patients referred to our centre for AdHF therapies candidacy (left ventricular assist device (LVAD), heart transplant (HTx)) are prospectively studied and enrolled in the registry. On the same day, all patients undergo a comprehensive clinical and instrumental examination, including electrocardiogram, echocardiography, extended laboratory tests and right heart catheterisation. Most patients also undergo a cardiopulmonary exercise test and, in the case of a non–ischaemic aetiology, cardiac magnetic resonance imaging and genetic testing, if not already performed. Echocardiography is also performed to assess advanced echocardiographic measures (biventricular and atrial strain, myocardial work, 3–D chambers assessment). Results Forty–five patients were enrolled from March 1, 2023 to December 22, 2023 (enrolment rate 4.5 patients/month). Mean age was 54 years and 2/3 were male. Median disease duration was 69 (28–165) months. Non–ischemic HF was the most common aetiology with a NYHA IV prevalence of 4% (all others were in NYHA III). 31% of patients had chronic kidney disease and overall liver function was preserved. 67% of patients were treated with sacubitril/valsartan, > 90% were taking beta–blockers (median dose 4.8 mg bisoprolol–equivalent dose) and 84% SGLT2 inhibitors. Both standard and advanced echocardiography showed features of advanced disease. Over a median follow–up of 4 (2 – 6) months 2 (4%) patients died, 5 (11%) underwent urgent HTx and 8 (18%) underwent LVAD implantation. For most variables, there was a trend showing that patients with events were sicker but, currently, the sample size limited the statistical power. Conclusions A systematic comprehensive evaluation of patients with AdHF evaluated for advanced HF therapies could help to reduce the knowledge gap for this high–risk HF population.

Tetraploid wheat (Triticum turgidum) lines from the United States as a source of Hessian fly (Mayetiola destructor) resistance

AbstractDeploying resistant wheat cultivars is the most economical and environment‐friendly strategy to manage the devastating effects of the dipteran pest, Hessian fly (Hf; Mayetiola destructor). Currently, 37 Hf resistance genes have been identified to combat the 18 Hf genotypes documented so far. However, the Hf populations adapt rapidly to overcome the newly deployed resistance genes within a few years of release resulting in development of virulent Hf biotypes and breakdown of plant resistance. Identification of new and novel sources of resistance offers breeders additional resources that can be included in the breeding programmes to develop elite Hf‐resistant cultivars. In the current study, we screened 374 wheat (tetraploid and hexaploid) accessions originating from different regions of the United States and identified three tetraploid (Triticum turgidum) pasta wheat lines, one originating from North Dakota (PI 639869) and two from Minnesota (PI 352398 and CItr 15710) exhibiting ≥95% resistance to Hf biotype L at 20°C. Further, the wheat cultivar PI 352398 showed 100% resistance to six additional Hf genotypes including biotypes B, C, D, O, GP and vH13. The lines PI 639869 and CItr 15710 also showed >70% resistance with most biotypes, except against biotype GP with the former and biotype B with the latter. Interestingly, a few plants from these two cultivars exhibited putative tolerance to these biotypes where the plants showed normal growth but harboured white, live larvae and showed cell permeability that was intermediate in levels between Hf‐infested resistant and susceptible wheat. Additionally, since the increase in environmental temperatures to 25–30°C also negatively impacts Hf resistance, the three T. turgidum (PI 639869, PI 352398 and CItr 15710) cultivars were evaluated for Hf resistance at 30°C. None of the wheat cultivars were resistant to Hf biotype L at 30°C indicating a temperature‐dependent breakdown of resistance and are therefore not suitable for geographical regions with higher environmental temperatures. Taken together, these three wheat lines represent additional sources of Hf resistance that can be leveraged by breeders for developing durable elite lines.

Prevalence of polypharmacy in heart failure patients: A retrospective cross-sectional study in a tertiary hospital in Saudi Arabia

BackgroundCardiovascular disease is the leading cause of death and disability worldwide. It is a general term used to describe a group of disorders that affect the heart or blood vessels. This study aimed to evaluate the prevalence and predictors of polypharmacy in patients with heart failure. MethodsWe conducted a cross-sectional study in a tertiary hospital in Saudi Arabia. Data was extracted from an electronic database between January 2019, and December 2022. The study included all adult patients with heart failure who visited outpatient clinics; individuals with cancer were excluded. The outcome variable in our study was “polypharmacy” which was defined as the use of eight or more medications. Descriptive analysis was performed using frequencies and percentages for categorical variables. In addition, Multivariate logistic regression was used to assess the covariates associated with polypharmacy. ResultsA total of 331 patients with heart failure were included in this study. The prevalence of polypharmacy among our HF population was 39.88 %. Most participants were male (60.73 %), and 60 years or older (68 %). The most frequently used medications were beta-blockers (67.98 %) and diuretics (58.31 %), whereas the least frequently used medications were hydralazine and histamine H2 blockers (5.74, and 3.02 %, respectively). Polypharmacy was likely to be a non-significantly higher in individuals aged between 60 and 69 years (adjusted odds ratio (AOR) = 1.52; 95 % confidence interval (CI) 0.78–2.98) and suffering from hypertension (AOR = 1.48; 95 % CI 0.83–2.64). However, patients with heart failure and diabetes mellitus had a significant six-fold higher of polypharmacy than those without diabetes mellitus (AOR = 6.55; 95 % CI 3.71–11.56). ConclusionPatients with heart failure often use multiple medications. Patients with heart failure together with diabetes have a higher risk of polypharmacy. Therefore, healthcare professionals should manage polypharmacy to improve the outcomes in patients with heart failure.

A prospective, observational multicenter registry of heart failure patients in Germany: preliminary results of the ongoing H2-registry

Abstract Background Heart failure (HF) is a highly prevalent condition affecting 1-2% of the adult population in Europe. Despite pioneering improvements in HF treatment during the last two decades, hospitalization and mortality rates remain relatively high. Gathering real-world data on HF populations is crucial especially in the light of newly emerging therapeutic approaches. Purpose The H2-registry was set up in 2021 to provide up-to-date, real-world data on a contemporary cohort of hospitalized HF patients in Germany using a standardized set of outcome measures. Methods The ongoing H2-registry represents a prospective, investigator-initiated, multicenter observational registry. Inpatients ≥18 years of age with a present diagnosis of chronic or acute HF are recruited in secondary and tertiary hospitals throughout Germany. Patients are excluded if they present in any kind of shock during index hospitalization, or if they previously underwent heart transplantation or ventricular assist device therapy. Routine follow-up (FU) is conducted every 6 months. A standardized set of variables according to the International Consortium of Health Outcome Measurements (ICHOM) including a pre-defined selection of questionnaires to collect patient-reported outcome measures (PROMs) is used to objectively monitor the course of disease. Results Until the reference date 12/31/22, a total of 2,190 patients were included in ten active study centers. Mean age was 72 years, 36.8% were female, and mean left-ventricular ejection fraction (LVEF) was 43.4% (38.1% had an LVEF of ≤ 40%). In-hospital mortality at index case was 1.3%. Within the cohort with completed 6-month FU comprising of 976 patients, all-cause mortality was 11.3% (110). In addition, 24.2% (209) in the survival cohort had at least one HF-related re-hospitalization. Numbers for all-cause mortality and re-hospitalizations at 12-month FU were 21.3% (71) and 32.8% (86), respectively. Evaluations of Kansas City Cardiomyopathy Questionnaire (KCCQ-12) scores showed a significant improvement overall and in all sub-categories (p < 0.001) at 6- and 12-month FU. Conclusions The H2-registry currently represents the largest ongoing prospective registry of HF inpatients in Germany. Our preliminary data highlights the pronounced mortality risk and healthcare burden in this cohort. However, HF-related therapies initiated during the course of a hospitalization have the potential to significantly improve patients’ quality of life. In the near future, it its foreseeable that the actively recruiting H2-registry based on ICHOM-standards will markedly contribute to the collection of real-world data on HF patients.

Ten year evolution of clinical characteristics and short-term outcome of patients admitted with heart failure

Abstract Background/Introduction Heart failure (HF) continues to be a leading cause of morbidity, decreased quality of life (QoL) and mortality worldwide. Contributing to decreased QoL is the high rehospitalization rate, which is often related to non-cardiac causes, highlighting the important multimorbidity of the HF population. Detailed clinical and outcome data for HF admissions in Belgium over time are only scarcely available. Purpose We aimed to evaluate and compare two groups of patients admitted with HF ten years apart, regarding clinical characteristics, comorbidities, use of HF medication and devices, as well as rehospitalization rate and all-cause mortality three months post-discharge. Methods This is a monocentric retrospective observational cohort study conducted in Belgium. Two groups of patients admitted for acute decompensated HF who were discharged alive were included and compared: 340 patients during 2011-2012 and 319 patients during 2021-2022. Results The two cohorts did not differ significantly regarding age (77.3 vs. 78.4 years), gender (47.4 vs. 44.5% women), number of patients with HF with reduced ejection fraction (47.4 vs. 48.6%) and NT-proBNP on admission (8514 vs. 7398 pg/mL). Similarly, comorbidities including diabetes, chronic obstructive pulmonary disease, peripheral artery disease, stroke and renal failure were comparable in both groups. Concerning medical therapy at discharge, mineralocorticoid receptor antagonists (MRA) were used significantly more frequently in the latest cohort. However, there was no change in administration of beta-blockers or renin angiotensin aldosterone system antagonists. As part of the implementation of new therapies for heart failure with reduced ejection fraction, 29% of patients were prescribed sodium-glucose cotransporter-2 (SGLT-2) inhibitors, while sacubitril/valsartan was given in 13% of the cases. The use of internal defibrillators (ICD) and resynchronization devices (CRT) doubled from 2011-2012 to 2021-2022 (3.9 vs. 9.6%, p = 0.002). In-hospital length of stay decreased significantly over a ten-year period across all ejection fraction subgroups from 7 to 5 days (figure 1). The combined outcome of rehospitalization for HF and all-cause mortality three months post-discharge remained constant at approximately 20% (figure 2). Conclusion Clinical characteristics and comorbidities of patients admitted with acute decompensated HF did not change significantly between 2011 and 2022. Uptake of evidence-based medicine for HF increased, especially for MRA, SGLT-2 inhibitors and sacubitril/valsartan, as did the use of ICD and CRT, but still with considerable potential for improvement. Although in-hospital length of stay decreased significantly over time, rehospitalization rates for HF and all-cause mortality within 90 days post-discharge remained high and did not improve. These sobering results illustrate the need for continuing efforts to improve the care and outcome of HF patients.

Abstract 16269: Heart Failure With Preserved Ejection Fraction and Sudden Cardiac Death in the General Population

Background: Published data indicate that 50% of individuals with heart failure and reduced ejection fraction (HFrEF) suffer sudden cardiac death (SCD), however the burden of SCD in heart failure with preserved ejection fraction (HFpEF) remains inconclusive. Aim: Determine the prevalence of HFpEF in a community-based cohort of SCD. Methods: We prospectively identified cases with out-of-hospital SCD in a large metro area of the US Northwest (Pop. 1 million, 2002-2017) and determined HF status prior to SCD based on review of clinical records. Heart failure was subdivided into HFpEF (EF≥50%), HFmrEF (EF 40%-50%), and HFrEF (EF≤40%). In addition, since HFpEF is often underdiagnosed, we evaluated a modified H2FPEF algorithm for the identification of HFpEF among our SCD cohort with unknown HF subtypes. The score was comprised of clinical variables including age, BMI, atrial fibrillation, hypertension, and myocardial infarction. Score accuracy was assessed using receiver operating characteristic (ROC) analysis comparing known HFpEF from clinical records and echocardiography versus non-HF subjects. Next, the score was used to identify missing HFpEF cases within the HF and SCD population. Results: Among 4,683 total SCD cases, 1,013 (22%) had a clinical history of HF. Prevalence of HF sub-types was 42% for HFpEF, 19% for HFmEF and 39% for HFrEF cases. An algorithm score of 5 or greater differentiated HFpEF subjects from non-HF subjects with an AUC of 0.68 (p < 0.01). The algorithm was then deployed on cases with an unknown heart failure subtype and an additional 117 HFpEF subjects were identified. The adjusted total prevalence of HFpEF was 542 subjects (53%) in the SCD the cohort with HF. Conclusion: At least 40% of the SCD cases with HF carry a diagnosis of HFpEF, and our estimates suggest the prevalence may be as high as 53%. Ultimately, these findings highlight the need to develop effective options for primary prevention of SCD in HFpEF patients.

How to fill the gap in the symptomatic HF patient journey between optimal medical therapy and advanced heart failure treatment: two Italian surveys

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure (HF) is the pandemic of our century and an estimated 64.3 million people are living with HF worldwide. New therapies alongside the old ones have been recently introduced in clinical practice with good results but the prognosis for a high percentage of patients remains poor with a high mortality rate and markedly reduced functional status. Purpose This study aims to investigate through two surveys what physicians think are the current needs in HF management to gain insight into the epidemiology and characteristics of patients followed by Italian HF outpatient clinics. In particular, we evaluated the gap that Cardiac Contractility Modulation (CCM) could fill in HF management in a real-world scenario. Methods a 20-question survey on HF management in different scenarios addressed to all physicians operating in Italian centers involved in HF care was published on the website Cardioinfo. A second survey was sent to Italian high-volume referral outpatient HF clinics. The participating centers were asked to collect the number of patients admitted during 4 weeks and to fill out a 19 items survey regarding some characteristics of these patients. Results A total of 105 physicians (77% cardiologists) and 14 high-volume referral outpatient HF clinics took part in the surveys. Despite regular clinical follow-up at 3-6 months in 94% of cases, the currently available medical therapy is considered insufficient in stabilizing HF patients in 30% of cases. 23% of physicians perceive to have a lack of treatment options in symptomatic patients with reduced ejection fraction and this percentage rises to 66% in patients without reduced ejection fraction (Figure 1). Cardiac contractility modulation is considered a valid option by 15% of physicians. According to Food and Drug Administration criteria, in the cohort of patients referred to HF clinics around 3% of patients are suitable for CCM implantation (2 patients a month per heart failure outpatient clinic), but considering additional selection criteria the percentage of patients eligible may increase to 5-6%. Conclusions The surveys confirm the significant attention paid to HF in Italian hospitals, however the lack of therapeutic options for a non-negligible number of patients, who are clinically evaluated regularly, but without associated substantial changes in therapy, leads to frustration for the patient and the physician, and an increase in costs for the health care system. A relatively small percentage of the total HF population fulfills the indication for immediate CCM treatment. Nevertheless, considering the size of the HF population, CCM, reducing hospitalizations, improving functional capacity and QoL may be of key importance for many HF patients, especially the elderly.

C26 SIDE EFFECTS OF SGLT–2 INHIBITORS IN PATIENTS WITH HEART FAILURE: A META–ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract Background sodium–glucose cotransoporter–2 inhibitors (SGLT–2Is) improve prognosis in heart failure patients both with reduced (HFrEF) and preserved ejection fraction (HFpEF). However, these drugs can have some side effects. Purpose: estimate the relative risk of side effects in HF patients treated with SGLT–2Is irrespectively from left ventricular EF and setting (acute and chronic HF). Methods 4 randomized controlled trials (RCTs) enrolling patients with HFrEF 3 RCTs enrolling acute HF and 3 RCTs enrolling HFpEF were included. Among side effects, urinary infection, genital infection, acute kidney injury diabetic ketoacidosis, hypotension, hypoglycemia, hyperkalemia, hypokalemia, bone fractures and amputations were considered in the analysis. Results overall 22687 patients were included in the analysis: 8830 (39%) patients with HFrEF, 12563 (55%) with HFpEF and 1295 (6%) with acute HF. There weren’t differences between SGLT–2Is and placebo in the risk to develop diabetic ketoacidosis, hypoglycemia, hyperkalemia, hypokalemia, bone fractures and amputations. HFrEF patients treated with SGLT–2is had a significative reduction of acute kidney injury [RR 0.54; 95% CI 0.33–0.87) p= 0.011], whereas no differences have been reported in the HFpEF [RR 0.94 (95% CI 083–1.07) p=0.348] and acute setting [RR 0.97; 95% CI 0.58–1.64) p= 0.915] (Fig 1A). A higher risk to develop genital infection [overall 2.82; 95% CI 1.96–4.05) p <0.001] was found irrespectively from EF [HFrEF 2.38 (95%CI 1.34–4.24) p= 0.003; HFpEF RR 3.04 (95%CI 1.88–4.90) p <0.001] (Fig 1B). The risk to develop urinary infections and hypotension was increased in the overall HF population with a RR of 1.15 (95%CI 1.02–1.30) p= 0.028 and RR 1.15; 95%CI 1.02–1.29) p= 0.017, respectively (Fig 2 A–B). This risk was mainly driven by HFpEF patients [RR urinary infections 1.19 (95%CI 1.02–1.38) p= 0.029; RR hypotension 1.23 (95% CI 1.05–1.43) p= 0.011], whereas no differences have been reported in HFrEF [RR urinary infection 1.04 (95%CI 0.80–1.35) p= 0.774; RR hypotension 1.04 (95%CI 0.87–1.24) p= 0.687] and in the acute setting [RR urinary infections 1.19 (95%CI 0.81–1.74) p= 0.375; RR hypotension 1.23 (95%CI 0.78–1.96) p= 0.371]. Conclusions SGLT–2is increase the risk of genital infections in HF patients. In HFpEF patients SGLT–2Is increase the risk of urinary infections and hypotension compared to placebo, whereas reduce the risk of acute kidney disease in patients with HfrEF.

P80 EFFICACY OF DAPAGLIFLOZIN IN EARLY IMPROVEMENT OF QUALITY OF LIFE IN OUTPATIENT WITH CHRONIC HEART FAILURE

Abstract Sodium glucose cotransporter–2 inhibitors reduce mortality and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). As a consequence, they are recommended by the European guidelines as mandatory pillar for HFrEF treatment with a strong recommendation (IA). In order to confirm the quality of life improvement shown in prespecified analysis of randomised controlled trial, we administered the Kansas City Cardiomyopathy Questionnaire (KCCQ–12) to 21 patients treated with Dapagliflozin 10mg in an outpatient setting of four Heart Failure Unit of Val Padana Hospitals. Among 21 HFrEF patients included in the analysis 11 have had coronary artery disease, 12 had hypertensive or dilatative cardiomyopathy etiology. The average age of our population was 73 yrs (54–89), 67% were male and 33% female, every patient were in NYHA II class and average BNP was 315 pg/mL. All the patients received Dapagliflozin for the entire observation period without any discontinuation for adverse event or intolerance. Every patient received KCCQ–12 questionnaire twice: at Time 0 when the first dose of Dapagliflozin was administered and after 3 months (Time 1) to verify the variation of the score. During the follow–up different therapy or dose regimen change has not occurred, as baseline therapies were already optimized. Only one patient changed furosemide dosage, reduce it from 75 to 50 mg/die without significant changes in body weight. After 3 months from the first administration of Dapagliflozin the KCCQ–12 summary score has increased by 10,27 points (from baseline avg value to 57,89 – 22% increase (Figure 1). Each of the single components of the score (physical limitation, symptoms frequency, QOL single score, social limitation) had increase in a consistent way from baseline values (Figure 2) In conclusion our data from an outpatient setting of real–world chronic HF population confirm the results of secondary analysis of the Trials and show that adding Dapagliflozin to the standard of care therapy leads to an early improvement in quality of life and physical limitations as quantified by KCCQ–12 questionnaire results. Furthomore, the KCCQ–12 seems to be a reliable and a useful health status instrument to evaluate the performance of HF outpatients, especially to test the benefits of new therapies.

Analysis of morphological differences among different populations of golden pompano (Trachinotus ovatus)

To explore the external morphological differences of golden pompano in different geographical populations, eight quantitative traits of 210 samples from seven golden pompano populations were measured. Multivariate statistical methods, such as principal component analysis, discriminant analysis, cluster analysis, and One-way ANOVA, were used to compare morphological differences among the populations. Principal component analysis extracted the top five principal components with a cumulative contribution rate of 85.79%, of which the first three principal components could explain seven morphological features. The principal component scatter plot showed that the NH, CH, and LL populations had similar morphology. Using the stepwise discriminant method to establish the classification and discrimination functions of the seven populations, the discrimination accuracy of the DL population was 93.3% for P1 and 87.5% for P2, which was the highest, and the comprehensive discrimination rate was 71.4%. The clustering relationship diagram showed that the populations were divided into three branches, and the CH and NH populations were closest. In contrast, the DL and HF populations were farthest from the other populations. One-way ANOVA showed significant differences (P<0.05) among all traits of the populations, and the morphological differences between the HX and DL populations were the largest. The results of this study showed specific differences in the external morphology of golden pompano among different populations.

The GLVC scoring system: a single-center model for predicting survival and hospitalization in patients with heart failure

BackgroundHeart failure (HF) is the only cardiovascular disease with an ever-increasing incidence.AimsThe aim of this study was to assess the predictors of adverse clinical events (CE) and the creation and evaluation of the prognostic value of a novel personalized scoring system in patients with HF.MethodsThe study included 113 HF patients (median age 64 years (IQR 58–69); 57.52% male). The new novel prognostic score named GLVC (G, global longitudinal peak strain (GLPS); L, left ventricular diastolic diameter (LVDD); V, oxygen pulse (VO2/HR); and C, high sensitivity C-reactive protein (hs-CRP)) was created. The Kaplan–Meier method and log-rank test were used to compare the CE.ResultsResults from final analyses showed that low GLPS (< 13.9%, OR = 2.66, 95% CI = 1.01–4.30, p = 0.002), high LVDD (> 56 mm, OR = 2.37, 95% CI = 1.01–5.55, p = 0.045), low oxygen pulse (< 10, OR = 2.8, 95% CI = 1.17–6.70, p = 0.019), and high hs-CRP (> 2.38 µg/ml, OR = 2.93, 95% CI = 1.31–6.54, p = 0.007) were independent prognostic factors for adverse CE in HF population. All the patients were stratified into a low-risk or high-risk group according to a novel “GLVC” scoring system. The Kaplan–Meier analyses demonstrated that patients in the high-risk group were more predisposed to having higher adverse clinical events compared to patients in the low-risk group.ConclusionsA novel and comprehensive personalized “GLVC” scoring system is an easily available and effective tool for predicting the adverse outcomes in HF.Graphical abstract

Identification of new sources of Hessian fly resistance in tetraploid wheat

AbstractHessian fly (HF) (Mayetiola destructor Say) is an obligate destructive pest of wheat (Triticum aestivum L.) causing severe economic losses worldwide. Deployment of resistant wheat cultivars harboring HF resistance (H) genes is still the most effective and economical method to manage this insect pest. However, extensive use of H genes can impose selection pressure on HF populations, leading to the development of virulent biotypes that can breakdown plant resistance. Further, increase in environmental temperatures to 25–30°C during the wheat‐growing season can also negatively impact HF resistance, thereby necessitating the identification of new and novel sources of HF resistance and evaluate them for temperature sensitivity. In the current study, we evaluated the phenotypic response of 254 Triticum turgidum (L.) wheat accessions of African origin to Biotype L HF infestation. Of these, 10 accessions exhibited &gt;70% resistance to Biotype L HF infestation. These 10 resistant accessions also showed &gt;70% resistance when screened with vH13 HF biotype. Additionally, these HF resistant lines were evaluated for expression of resistance at a higher temperature of 30°C, and three tetraploid wheat accessions that maintained 100% resistance to Biotype L HF at the increased temperature were identified. These newly identified HF resistant lines offer valuable tools to breeders and farmers that can be used in breeding programs to develop cultivars for durable resistance to HF and efficient crop management.

Heart failure (MYHF) registry: shedding light on lipid profiles and in-hospital outcome of heart failure patients

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Novartis Corporation Sdn Bhd Background Heart failure is a debilitating disease associated with multiple comorbidities and poor prognosis. Dyslipidemia, is the top 5 most common comorbidities, including HF patients. Nonetheless, the lipid profiles in HF population is scarcely available and poorly understood. Purpose This report aimed to describe the lipid profiles and in-hospital outcome of hospitalized HF patients. Methods MYHF registry is a prospective, observational study of symptomatic HF patients (NYHA II-IV) hospitalized in 18 tertiary care centers in Malaysia over a period of 3 years starting in 2019. Lipid profiles will be described, and in-hospital outcome will be analyzed using univariate and multivariate models. Results In MYHF registry, 1 out of 2 hospitalized HF patients (55.7%) had ischemic heart disease, significantly higher in patients with HFrEF and HFmrEF, as compared to HFpEF (p&amp;lt;0.001). Similarly, 1 in 2 (46.6%) patients had dyslipidemia as comorbidity but was comparable across EF subgroups (p=0.365). Statin utilization at discharge increased by 20% from admission (from 62.2% to 74.6%), indicating that hospitalization provides good opportunity for statin initiation in indicated HF patients. At admission, the mean total cholesterol, LDL-C, HDL, and TG levels were 4.30 mmol/L (SD 1.66), 2.62 mmol/L (SD 1.34), 1.05 (SD 0.46), and 1.37 (SD 1.08), respectively. Of those with measured LDL-C level, only 31.4% achieved LDL-C goal of &amp;lt;1.8 mmol/L and 39.8% of patients had LDL-C ≥2.6 mmol/L. With univariate analysis, patients with LDL-C goal of ≥ 1.8 mmol/L had lesser risk of in-hospital mortality [OR 0.42 (0.21,0.86), p-value = 0.018], indicating LDL-C paradox. Further analysis with multivariate model revealed that patients with LDL-C goal of ≥ or &amp;lt; 1.8 mmol/L did not differ in in-hospital mortality outcome (p-value = NS). Conclusion Dyslipidemia is highly common in general population and in HF patients. With statin therapy, only 31.4% achieved LDL-C &amp;lt; 1.8 mmol/L at admission. The finding highlights the unmet need for combination lipid lowering therapies to get patient to LDL-C target goal. Hospitalization also provided good opportunity of statin therapy initiation. The knowledge gained will be crucial for guiding management of HF patients with common comorbidity like dyslipidemia.

Protocolized Diuretic Strategy as a Treatment Algorithm for Cardiorenal Syndrome

Background: A diuretic strategy is needed that is superior to current clinical care in the management of cardiorenal syndrome. Current HF guidelines do not provide any standard protocol for diuretic dosing. Aim: To determine if a protocolized diuretic treatment strategy (ProDiuS), compared to usual care (UC), results in improved decongestion, clinical outcomes, and health-related quality of life (HRQOL), while preserving renal function in hospitalized patients with cardiorenal syndrome. Materials and Methods: This trial was a prospective randomized single-blind trial of participants hospitalized for cardiorenal syndrome from November 1, 2013 to July 9, 2015. Participants were randomized to ProDiuS vs. UC and followed daily in hospital, and at 1-month and 3-month follow-up. ProDiuS was a stepped diuretic strategy targeting daily urine output of 3-5 L/day. UC was care at the discretion of treating providers. The primary outcome, change in body weight (kg) from randomization to 96 hours (day 4), was compared between the ProDiuS and UC groups using the t-test. Data analysis for secondary outcomes between the two groups were conducted using the t-test or Wilcoxon rank sum test depending on whether data was skewed for continuous variables, as well as linear regression modeling. For ordinal variables or proportions, data were analyzed using the exact chi-square test and logistic regression modeling. For mortality, time to death was analyzed as time-to-event data, with censoring at the time of death, date of last follow-up, or the end of the study (3 month follow-up), using Kaplan-Meier curves and log-rank tests, and Cox proportional hazards models to adjust for continuous and discrete covariates in the survival analysis. Results: The study did not enroll the prespecified number of subjects due to slow recruitment. Out of 786 prescreened patients, 19 participants were included in the trial. There were no significant differences in baseline characteristics. Mean age was 68.7±7.3 years and 72.2% were male. There was borderline higher change in body weight from baseline to day 4 or discharge in ProDiuS vs. UC (-6.12 vs. -2.07 kg; p=0.05). Net negative fluid balance, length of hospitalization, HF rehospitalizations, mortality, acute kidney injury, adverse outcomes, and HRQOL scores were similar between groups. Conclusion: Due to small sample size, firm conclusions cannot be drawn. However, these findings suggest that ProDiuS results in similar clinical and HRQOL outcomes as UC in HF patients treated at a large tertiary medical center in the short term. This trial was conducted in an advanced HF population on specialized HF services, which may have attenuated the efficacy of ProDiuS vs. UC. Further studies with larger sample size and more diverse HF populations are needed to determine the efficacy and safety of ProDiuS. Several lessons learned in attempting to design a trial of protocolized diuretic strategy in the cardiorenal population are discussed.

Pulsatile Pressure Delivery of Continuous-Flow Left Ventricular Assist Devices Is Markedly Reduced Relative to Heart Failure Patients.

Although continuous-flow left ventricular assist devices (CF-LVADs) provide an augmentation in systemic perfusion, there is a scarcity of in vivo data regarding systemic pulsatility on support. Patients supported on CF-LVAD therapy (n = 71) who underwent combined left/right catheterization ramp study were included. Aortic pulsatility was defined by the pulsatile power index (PPI), which was also calculated in a cohort of high-output heart failure (HOHF, n = 66) and standard HF cohort (n = 44). PPI was drastically lower in CF-LVAD-supported patients with median PPI of 0.006 (interquartile range [IQR], 0.002-0.012) compared with PPI in the HF population at 0.09 (IQR, 0.06-0.17) or HOHF population at 0.25 (IQR, 0.13-0.37; p < 0.0001 among groups). With speed augmentation during ramp, PPI values fell quickly in patients with higher PPI at baseline. PPI correlated poorly with left ventricular ejection fraction (LVEF) in all groups. In CF-LVAD patients, there was a stronger correlation with LV dP/dt (r = 0.41; p = 0.001) than LVEF (r = 0.21; p = 0.08; pint < 0.001). CF-LVAD support is associated with a dramatic reduction in arterial pulsatility as measured by PPI relative to HOHF and HF cohorts and decreases with speed. Further work is needed to determine the applicability to the next generation of device therapy.

Abstract 10590: Detection of Cardiac Attr Amyloidosis in a Real-World Hf Population by Natural Language Processing Guided Automated Data Extraction From Electronic Health Records

Background: As cardiac aTTR amyloidosis(aTTR-CM) is frequently underdiagnosed and missed, improved screening to enhance earlier diagnosis of the disease is essential. Recent observations have demonstrated that clinical clues related to the presence of aTTR-CM and additional predisposing or associated medical conditions derived from machine learning(ML) models may provide a systematic framework to increase the suspicion of aTTR-CM in heart failure(HF) pts. Objectives: The present study was set up to explore the use of a systematic framework to diagnose aTTR-CM in a real-world HF population. Methods: Between 2014 and 2018, 3035 HF pts (Age:74 ± 12 years; EF: 45 ± 19 %, male: 50 %) consecutively referred to a community HF clinic were assessed. Using targeted disease-specific electronic health record (EHR) models (Natural language processing/ LynxCare Inc., Leuven, Be) the prevalence and odds ratios for cardiac, non-cardiac, and combinations of both cardiac and non-cardiac phenotypes predictive for aTTR-CM were assessed. Results: 101 pts((Age: 78.57 ± 9.17 years; EF 46 ±15 %, male: 40% ) were diagnosed with aTTR-CM. Besides HF and cardiomyopathy-related phenotypes, atrial fibrillation was the strongest cardiac predictor for aTTR-CM(prevalence:76 %, OR 2.95, 95% CI= 2.10, 4.14) whereas the strongest non-cardiac predictor was carpal tunnel syndrome(prevalence :21 %, OR 6.55, 95% CI= 7.21, 5.90). The combination of heart block, joint disorders, and combined systolic and diastolic HF was the highest combined phenotype in aTTR-CM(prevalence:16 %, ORR 2.63, 95% CI = 0.96, 3.28). Conclusion: On top of well-known diagnoses and phenotypes unique combinations of cardiac and non-cardiac phenotypes predict aTTR-CM In a real-world HF population. Therefore, if successfully employed in the EHR this strategy may identify aTTR-CM pts and lead to earlier detection of it by raising the suspicion of the diagnosis in HF pts.

Abstract 12212: Heart Failure With Preserved Ejection Fraction: A Cardiologist Disorder or a Nephrologist Problem? Analysis From a Largely Hispanic Population

Introduction: Heart failure with preserved ejection fraction (HFpEF) has been recognized as a multisystem process and chronic kidney disease (CKD) plays a central role in this paradigm. However, racial/ethnic variability and prevalence of CKD are not well described. Hypothesis: We hypothesize that the South Texas Hispanic patient population has a different phenotypic expression of HFpEF compared to the largely White population in the EMPEROR-Preserved trial. Methods: Consecutive HFpEF patients (total n=204) were identified from a HF population screened for a clinical trial from 2019-2020 (n=188) and inpatients with HF exacerbation during 2021 (n=16) at University Hospital. HFpEF was defined as symptomatic HF with left ventricular ejection fraction (LVEF) &gt;40% on Echo. Clinical and lab variables were collected ±1 year from Echo date. Race/ethnicity was self-reported. CKD was identified from the problem list. Rates were compared with EMEPROR-Preserved trial’s HFpEF population which was largely White. Results: Of 204 HFpEF patients, 9 were Black, 14 were from other races, and due to small size were excluded from the analysis. Majority of the study population were Hispanics (130 of 181, 72%). LVEF was 40-50% in 31% of the study population. Table 1 demonstrates characteristics by EMPEROR population, and Hispanics and non-Hispanic Whites (NHW) in our analysis. Of significance, our population was younger, had DM2, CAD, CKD, and obesity at higher rates, and AFib and BNP at lower rates as compared to EMPEROR population. The differences in Hispanics and NHW were unremarkable except more HTN and lower eGFR in Hispanics. Conclusions: Hispanic patients with HFpEF have more frequent diabetes, CKD and CAD as compared to White population in EMPEROR-Preserved trial. In context of this observation and recent success of newer agents as empagliflozin, a multispecialty integrative approach is strongly warranted for management of HFpEF patient population.

Clinical outcomes in heart failure with reduced left ventricular ejection fraction and good functional capacity: The illusion of stability

BackgroundHeart failure (HF) remains a prevalent syndrome with significant morbidity and mortality. Optimal drug and device therapies are crucial to reduce the risk of death or HF admission. Yet, less symptomatic patients with good functional capacity are often perceived as having a low risk of adverse events and their attending physicians may suffer from prescription inertia or refrain from performing therapy optimization. Maximum or peak oxygen consumption (pVO2) assessed during cardiopulmonary exercise testing (CPET) is often used as a prognosis indicator and surrogate marker for functional capacity. Our goal was to assess clinical outcomes in a seemingly low risk HF population in Weber class A (pVO2>20 mL/kg/min) with reduced left ventricular ejection fraction (LVEF). MethodsSingle-center retrospective observational study enrolling consecutive HF patients with LVEF<40% (HFrEF) performing CPET between 2003 and 2018. Those with pVO2 >20 mL/kg/min were included. The primary endpoint was a composite of all-cause death or HF hospitalizations at two years after CPET. We also assessed the rates of N-terminal pro b-type natriuretic peptide (NT-proBNP) elevations at baseline. ResultsSeventy-two patients were included (mean age of 53±10 years; 86% male; 90% NYHA I-II; median LVEF 32%; median pVO2 24 mL/kg/min). At baseline, 93% had an NT-proBNP level >125 pg/mL (median NT-proBNP 388 [201–684] pg/mL). Overall, seven patients (10%) met the primary endpoint: three died (4%) and five (7%) had at least one HF admission. Among those who died, only one patient had an HF admission during follow up. ConclusionIn a clinically stable HFrEF population with good functional capacity, persistent neurohormonal activation was present in the majority, and one in ten patients died or had a HF admission at two years’ follow-up. These findings support the urgent need to motivate clinicians to pursue optimal drug uptitration even in less symptomatic patients.

Why does CRT work better in women?

Abstract Introduction It has been recently postulated that cardiac resynchronization therapy (CRT) might have a higher efficacy in women, with a greater reverse cardiac remodeling in this population. The reasons for these differences are not yet completely understood. We aimed to detect sex differences in the degree of ventricular asynchrony (VA) and mitral regurgitation (MR) in patients undergoing CRT implantation. Methods We analyzed baseline characteristics of a prospective international clinical trial that compared CRT response rate in a HF population with a comparable distribution of men and women (BIOWOMEN). A total of 408 patients were analyzed. The degree of mitral regurgitation and intra and inter-ventricular asynchrony was assessed by independent echocardiographers in a core lab. Inter-ventricular asynchrony was defined as an interventricular mechanical delay greater than 40ms and intra-ventricular asynchrony as differences greater than 50ms among regional pre-ejection periods. Multivariable logistic regression was performed using commercial data analysis software. Results As expected, ventricular asynchrony was dependent on QRS duration and the presence of LBBB (p&amp;lt;0.01). Baseline QRS duration was significantly shorter in women than men (155.85±19.0 in women vs 160.4±21.6, p=0.02). However, for a similar QRS duration, there were no differences in asynchrony parameters between the two groups (p=0.43; Figure 1). Female sex was associated with a significantly higher proportion of mitral regurgitation for a given QRS duration, which was independent of the etiology (p=0.05). Conclusions In our analysis, for a given QRS duration there was not a higher degree of asynchrony in women with HF. However, female sex was associated with a significantly higher proportion of mitral regurgitation for a given QRS duration irrespective of baseline HF etiology. Further investigations are needed to establish a possible link between these findings and better CRT outcomes in women. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): BIOTRONIK SE &amp; Co. KG

SGLT2 inhibitors in real-world patients with heart failure with preserved ejection fraction

Abstract Introduction The diagnosis and management of heart failure with preserved ejection fraction (HFpEF) is challenging since ejection fraction is normal, clinical signs are often lacking and there are few therapeutic options. Two randomized clinical trials have tested SGLT2i for the treatment of HFpEF: DELIVER (pending results) and EMPEROR-PRESERVED; the findings of the latter trial show that empagliflozin, a sodium-glucose cotransporter inhibitor (SGLT2i) reduces the risk of cardiovascular death or hospitalization for HF in patients with HFpEF regardless the presence of diabetes. The results of this clinical trial have allowed European Medicine Agency (EMA) to extend the indication also to the patients with HFpEF, however the characteristics of the trial population don't often correspond to real-word HF population. Aims This study aims to investigate the eligibility of the EMPEROR-PRESERVED and DELIVER trial to a real-world heart failure population comparing the baseline characteristics of our patients to the recruited patients of clinical trials. Material and methods In this retrospective, observational study, 206 HF outpatients were enrolled from September 2018 to September 2019. The percentages of eligible patients according to EMPEROR PRESERVED and DELIVER inclusion criteria were analyzed, then we analyzed the difference between the characteristics of our HFpEF population and trials population. Results 72 patients (35% of HF population) had heart failure with preserved ejection fraction. The EMPEROR-PRESERVED criteria and DELIVER trial were applied to these patients: 13 (18.1%) and 12 (16.7%) patients respectively fulfilled all enrolment criteria, whereas considering only EMA label criteria (EF &amp;gt;40% and eGFR &amp;gt;20 ml/min) 71 patients (98.6%) were eligible. The eligible patients according EMA criteria were significantly younger (67.3±14.3) than EMPEROR-PRESERVED population (72±9, p&amp;lt;0.001) and DELIVER population (72±10, p&amp;lt;0.001). The ejection fraction was significantly lower (50.2±5.8 vs 54±8.8; p&amp;lt;0.001) whereas eGFR was no significantly different (64.4±22.7 vs 60.6±19.8; p=0.17). Conclusion Only a small percentage of our heart failure with preserved ejection fraction population was eligible for SGLT2 inhibitors according trials criteria, whereas according to EMA label almost all patients are candidate to these drugs. Furthermore, these patients were younger than EMPEROR-PRESERVED and DELIVER population with lower EF. The difference of eligibility between trials and real population is related to inclusion criteria, in particular the trial patients had elevated NT-proBNP levels whereas in the real world this criterion isn't considered. There is a lack of data about real-world patients who are often different from trials population. National and international registries of HF population may resolve this issue. Funding Acknowledgement Type of funding sources: None.