History Of Chronic Heart Failure Research Articles

Long-term major events after hospital discharge for out-of-hospital cardiac arrest

BackgroundCardiac arrest remains a global health issue with limited data on long-term outcomes, particularly regarding recurrent cardiovascular events in patients surviving out-of-hospital cardiac arrest. (OHCA). We aimed to describe the long-term occurrence of major cardiac event defined by hospital admission for cardiovascular events or death in OHCA hospital survivors, whichever came first. Our secondary objective were to assess separately occurrence of hospital admission and death, and to identify the factors associated with major event occurrence. We hypothesized that patients surviving an OHCA has a protracted increased risk of cardiovascular events, due to both presence of the baseline conditions that lead to OHCA, and to the cardiovascular consequences of OHCA induced acute ischemia-reperfusion.MethodsConsecutive OHCA patients from three hospitals of Sudden Death Expertise Center (SDEC) Registry, discharged alive from 2011 to 2015 were included. Long-term follow-up data were obtained using national inter-regime health insurance information system (SNIIRAM) database and the national French death registry. The primary endpoint was occurrence of a major event defined by hospital admission for cardiovascular events and death, whichever came first during the follow-up. The starting point of the time-to-event analysis was the date of hospital discharge. The follow-up was censored on the date of the first event. For patients without event, follow-up was censored on the date of December, 29th, 2016.ResultsA total of 306 patients (mean age 57; 77% male) were analyzed and followed over a median follow-up of 3 years for hospital admission for cardiovascular event and 6 years for survival. During this period, 38% patients presented a major event. Hospital admission for cardiovascular events mostly occurred during the first year after the OHCA whereas death occurred more linearly during the all period. A previous history of chronic heart failure and coronary artery disease were independently associated with the occurrence of major event (HR 1.75, 95%CI[1.06-2.88] and HR 1.70, 95%CI[1.11-2.61], respectively), whereas post-resuscitation myocardial dysfunction, cardiogenic shock and cardiologic cause of cardiac arrest did not.ConclusionSurvivors from OHCA must to be considered at high risk of cardiovascular event occurrence whatever the etiology, mainly during the first year following the cardiac arrest and should require closed monitoring.

Development and validation of a prognostic scoring system for 1-year mortality in older patients with hip fractures.

Hip fractures in older people result in increased mortality. We developed and validated an accurate and simple prognostic scoring system for hip fractures that can be used preoperatively. Retrospective study. Multicenter. Patients aged ≥65years with hip fractures who underwent surgery between 2011 and 2021 were enrolled. The significant factors were determined with logistic regression analysis, and a scoring system was developed. The patients were classified into three groups, and a log-rank test was performed to evaluate 1-year survival rates. The model was internally and externally validated using the 5-fold cross-validation and data from another hospital, respectively. We included 1026 patients. The analysis revealed eight significant prognostic factors: sex, body mass index, history of chronic heart failure and malignancy, activities of daily living (ADLs) before injury, hemoglobin and the prognostic nutritional index (PNI) at injury, and the American Society of Anesthesiologists Physical Status. The area under the receiver operating characteristic curve (AUC) after internal validation was 0.853. The external validation data consisted of 110 patients. The AUC of the model for the validation data was 0.905, showing outstanding discrimination. Sensitivity and specificity were 88.7% vs. 100% and 93.3% vs. 95.2% for the development and validation data, respectively. We developed and validated an accurate and simple prognostic scoring system for hip fractures using only preoperative factors. Our findings highlight PNI as an important predictor of prognosis in hip fracture patients.

Clinical markers of cognitive impairment in patients with chronic heart failure of ischemic origin during out-patient regular follow-up: a cross-sectional study

Background: Cognitive impairment (CI) is present in 25–50% of chronic heart failure (CHF) patients. Doctors who monitor patients with cardiovascular disorders do not have clearly set criteria for their referral to a neurologist in case of suspected CI. Therefore, CHF patients do not receive treatment for CI on time.
 Aim: To identify significant clinical markers of CI in patients with CHF of ischemic origin.
 Materials and methods: This cross-sectional cohort study included 134 patients with CHF of ischemic origin (mean age 63.36 ± 10.63 years; men, 76.12%), who were regularly monitored in a municipal polyclinic. All patients were tested for CI with the Montreal Cognitive Assessment Scale (MoCA); basic hemodynamic parameters, lipid profile, brain natriuretic peptide (NT-proBNP) were assessed, and triglyceride-glucose index (TyG) and body mass index (BMI) were calculated. Cardio-ankle vascular index (CAVI) was measured, echocardiography and a 6-minute walk test (SMWТ) were performed and past history of CHF, arterial hypertension (AH) and diabetes mellitus (DM) was collected.
 Results: CI (MoCA score ≤ 25) was detected in 85 (63.43%) outpatients with CHF of ischemic origin; the group without CI (MoCA score 26) included 49 (36.67%) patients. There were significant correlations between MoCA and CAVI scores (partial correlation coefficient, r = -0.802, p 0.001; adjusted squared multiple correlation coefficient (adj. R2) = 0.881, p 0.001), MoCA and TyG (r = -0.357, p = 0.029; adj. R2 = 0.363, p 0.001), MoCA and SMWТ (r = -0.211, p = 0.037; adj. R2 = 0.696, p 0.001). The multivariate test for significance of planned comparisons between CAVI and MoCA scores (Wilks' lambda) was 0.005 (F = 4.74; p 0.001).
 Conclusion: CAVI, TyG and SMWТ values are the clinical markers of CI in patients with CHF of ischemic origin. There is a direct association between increased CAVI and the presence of CI, regardless of age, lipid metabolism parameters, structural and functional heart parameters, CHF duration, AH and DM. Identification of these markers could be an indication for an in-depth assessment of CHF patients by a neurologist.

Outcome and Risk of Poststroke Pneumonia in Patients with Acute Ischemic Stroke After Endovascular Thrombectomy: A Post Hoc Analysis of the DIRECT-MT Trial.

In this study, we aimed to investigate the risk factors and impact of poststroke pneumonia (PSP) on mortality and functional outcome in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT). This was a post hoc analysis of a prospective randomized trial (Direct intraarterial thrombectomy in order to revascularize AIS patients with large-vessel occlusion efficiently in Chinese tertiary hospitals: a multicenter randomized clinical trial). Patients with AIS who completed EVT were evaluated for the occurrence of PSP during the hospitalization period and their modified Rankin Scale (mRS) scores at 90days after AIS. Logistic regression analysis was conducted to investigate the independent predictors of PSP. Propensity score matching was conducted for the PSP and non-PSP groups by using the covariates resulting from the logistic regression analysis. The associations between PSP and outcomes were analyzed. The outcomes included 90-day poor functional outcome (mRS scores > 2), 90-day mortality, and early 2-week mortality. A total of 639 patients were enrolled, of whom 29.58% (189) developed PSP. Logistic regression analysis revealed that history of chronic heart failure (unadjusted odds ratio [OR] 2.011, 95% confidence interval [CI] 1.026-3.941; P = 0.042), prethrombectomy reperfusion on initial digital subtraction angiography (OR 0.394, 95% CI 0.161-0.964; P = 0.041), creatinine levels at admission (OR 1.008, 95% CI 1.000-1.016; P = 0.049), and National Institutes of Health Stroke Scale at 24h (OR 1.023, 95% CI 1.007-1.039; P = 0.004) were independent risk factors for PSP. With propensity scoring matching, poor functional outcome (mRS > 2) was more common in patients with PSP than in patients without PSP (81.03% vs. 71.83%, P = 0.043) at 90days after EVT. The early 2-week mortality of patients with PSP was lower (5.74% vs. 12.07%, P = 0.038). But there was no statistically significant difference in 90-day mortality between the PSP group and non-PSP group (22.41% vs. 14.94%, P = 0.074). The survivorship curve also shows no statistical significance (P = 0.088) between the two groups. Nearly one third of patients with AIS and EVT developed PSP. Heart failure, higher creatinine levels, prethrombectomy reperfusion, and National Institutes of Health Stroke Scale at 24h were associated with PSP in these patients. PSP was associated with poor 90-day functional outcomes in patients with AIS treated with EVT.

In-Hospital Onset of Transient Myoclonic State in Older Adults: A Case Report.

Transient myoclonic (TM) state in older adults is a neurological condition characterised by short-lived, repetitive myoclonus without consciousness disturbance. First reported in 1992, it predominantly affects older individuals with chronic diseases. Despite its clear symptomatology, TM often remains under-recognised, leading to potential misdiagnoses. We report a case of a 68-year-old woman with a history of chronic heart failure who developed TM during hospitalisation following medication adjustment for acute heart failure. The patient, who had no history of intracranial disease or epilepsy, experienced acute involuntary movements of the face and limbs three days after diuretic adjustment. She responded well to intravenous diazepam and oral clonazepam, with no recurrence of symptoms post-treatment. TM presents with bilateral, irregular, and repetitive myoclonus, mostly affecting the head, neck and upper extremities. Diagnosis is clinical, based on symptomatology and normal laboratory results. This case underscores the importance of recognising TM in differential diagnosis, especially in older patients in the acute or recovery phase of infection, or with medication changes. The potential role of fluid volume changes in TM pathophysiology in patients with underlying conditions such as hypertension or chronic heart failure is also highlighted. This case emphasises the need for heightened awareness and knowledge of TM among healthcare professionals. TM, though rare, requires awareness among clinicians for accurate diagnosis and management. It is crucial to avoid misdiagnosis and unnecessary interventions, and to provide appropriate information during care transitions, particularly in older adults with chronic conditions. Transient myoclonic (TM) state is a rare neurological condition in older adults, characterised by brief and repetitive myoclonus, primarily affecting the head, neck and upper extremities.The distinctive clinical diagnostic feature is myoclonus occurring without disturbances in consciousness, without amnesia or paralysis, while retaining the ability to perform directed movements. This condition can manifest at rest, may worsen with posture or movement, and tends to improve during sleep.Management strategies include ensuring smooth care transitions, avoiding misdiagnosis and educating patients and families about the risk of recurrence.

THE BENEFITS OF DUPLEX SCANNING OF EXTRACRANIAL CAROTID PATHOLOGIES FOR RISK STRATIFICATION OF ISCHEMIC STROKE

Abstract Introduction: Recent retrospective cohort study demonstrated the benefit of duplex scanning in the examination of the extracranial carotid artery pathologies for preventing cerebrovascular disorders. The aim of this study: was to evaluate the clinical and demographical characteristics and outcome in patients treated at National Scientific Center of Surgery, after detecting extracranial carotid artery stenosis ≥70%. Material and methods: A retrospective cohort study was conducted; 204 patients were included. Results: The most significant risk factors were: ischemic heart diseases – 95.6%, arterial hypertension – 80.1%, chronic heart failure – 83.8%, cholesterol level above the norm of 5.2 mmol/L-39.2%; 30.4% of patients had a history of postinfarction cardiosclerosis. There were a significant statistically difference between the prevalence of extracranial carotid artery stenosis depending on the risk factors (blood cholesterol levels, a clinical history of chronic heart failure, and acute cerebrovascular diseases p=0.048, p=0.003, p=0.048 respectively (p>0.05)). Conclusion: In summary, we conclude that surgery should be considered, and duplex ultrasound plays a crucial role in assessing the severity of carotid stenosis in atherothrombotic stroke patients with severe external carotid stenosis. These data indicate that physicians, should be aware of the usefulness of carotid duplex ultrasound scanning in stratifying the risk of cerebral and cardiovascular diseases based on various aspects.

T-wave alternans: an ominous pattern for malignant arrhythmias.

We report on a patient with a history of chronic heart failure caused by atrial fibrillation, who developed macrovolt T-wave alternans (TWA) and subsequent malignant arrhythmia after amiodarone treatment. The presence of TWA and QT alternans disappeared after discontinuation of amiodarone and appropriate magnesium replacement. Macroscopic T-wave alternans (TWA) is present when there is visible variation in the amplitude and/or polarity of T waves between beats in the absence of QRS alternans. TWA signifies significant vulnerability during repolarization and may be a harbinger of impending electrical instability. Although macroscopic TWA is not frequently encountered in routine clinical practice. Prompt identification is essential for proper management and prevention of malignant ventricular arrhythmias and sudden cardiac death.

Impact of pre-existing history of heart failure on patient profile, therapeutic management and prognosis in cardiogenic shock: Insights from the FRENSHOCK registry

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Emergency and Acute Cardiovascular Care Working Group from the French Society of Cardiology Aims There is a large heterogeneity in patients presenting with cardiogenic shock (CS). To better apprehend this heterogeneity is crucial to adapt treatment and improve prognosis in these severe patients. Of note the presence (or absence) of a pre-existing history of chronic heart failure (CHF) at time of CS onset may be entire part of this heterogeneity and data focusing on this aspect are lacking. Methods We aimed to compare CS patients with new-onset HF to those with worsening CHF in the multicenter FRENSHOCK registry. Altogether, 772 CS patients were prospectively included: 433 with a previous history of CHF and 339 without. Worsening CHF patients were older (68 +/- 13.4 vs. 62.7 +/- 16.2, p<0.001) and had a greater burden of extra-cardiac co-morbidities. At admission, acute myocardial infarction was predominantly observed in the new-onset HF group (49.9% vs. 25.6%, p<0.001). When focusing on hemodynamic parameters, worsening CHF patients showed more congestion and higher ventricular filling pressures. Worsening CHF patients experienced higher in-hospital all-cause mortality (31.3% vs. 24.2%, p=0.029). Conclusions Our results emphasize the great heterogeneity of the patients presenting with CS. Worsening CHF patients had higher risk profile and this translated in a 30% increase in in-hospital all-cause mortality. The heterogeneity of this population prompts us to better determine the phenotype of CS patients to adapt their management.

Impact of Chronic Heart Failure on Acute Pulmonary Embolism in-Hospital Outcomes (From a Contemporary Study)

There is a paucity of evidence on the impact of chronic heart failure (HF) on acute pulmonary embolism (PE) hospitalization outcomes. The aim of this study was to evaluate the in-hospital outcomes of patients with chronic HF and acute PE. A total of 1,391,145 hospitalizations with acute PE from the National Inpatient Sample Database from 2011 to 2019 were included. The database was queried for relevant International Classification of Diseases, Ninth and Tenth Revisions procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes for patients with acute PE were compared in patients with and without a history of chronic HF. Multivariate logistic regression analyses were performed, adjusting for age, race, gender, and statistically significant co-morbidities between cohorts. A pvalue <0.001 was considered significant. Overall, the mean age was 65.2±16years; 50.9% of patients were women, and 230,875 patients (16.6%) had chronic HF. The patients in the chronic HF cohort were predominantly older (mean age 69.0 vs 61.4years) and male (49.9% vs 48.3%). In the multivariate model, chronic HF was associated with increased all-cause mortality (odds ratio [OR] 1.6, 95% confidence interval [CI], 1.57 to 1.63, 10.4% vs 5.7%), acute respiratory distress (OR 1.7, 95% CI 1.70 to 1.74, 39.5% vs 22.1%), cardiac arrest (OR 1.4, 95% CI 1.40 to 1.49, 3.9% vs 2.2%), and cardiogenic shock (OR 3.0, 95% CI 2.85 to 3.06, 4.2% vs 1.2%). All pvalues were <0.001.In conclusion, patients with PE and chronicHF are associated with increased in-hospital complications compared with patients with PE and without chronic HF.Prospective studies are needed to evaluate optimal management strategies in this population at high risk.

Determinants of 1-Year Adverse Event Requiring Re-Hospitalization in COVID-19 Oldest Old Survivors.

The incidence of "Long COVID" syndrome appears to be increasing, particularly in the geriatric population. At present, there are few data regarding the relationship between long COVID and the risk of re-hospitalization in the oldest old survivors. Patients older than 80 years consecutively hospitalized for COVID-19 in our tertiary care hospital were enrolled and followed after discharge in a 12-month ambulatory program. A comprehensive geriatric assessment (CGA), including functional capabilities and physical and cognitive performances, was performed at 6-month follow-up. Frailty degree was assessed using a 30-item frailty index. The re-hospitalization rate was assessed at 12-month follow-up through a computerized archive and phone interviews. Out of 100 patients discharged after hospitalization for COVID-19 (mean [SD] age 85 [4.0] years), 24 reported serious adverse events requiring re-hospitalization within 12 months. The most frequent causes of re-hospitalization were acute heart failure (HF), pneumonia and bone fracture (15.3% each). By multivariate logistic analysis, after adjustment for potential confounders, history of chronic HF [aOR: 3.00 (CI 95%: 1.10-8.16), p = 0.031] or chronic renal failure [aOR: 3.83 (CI 95%: 1.09-13.43), p = 0.036], the burden of comorbidity [(CIRSc) aOR: 1.95 (CI 95%: 1.28-2.97), p = 0.002] and frailty [aOR: 7.77 (CI 95%: 2.13-28.27), p = 0.002] resulted as independent predictors of re-hospitalization. One-fourth of the oldest old patients previously hospitalized for COVID-19 suffered from adverse events requiring re-hospitalization, two-thirds of them within three months after discharge. Frailty, the burden of comorbidity, history of chronic HF or chronic renal failure, but not COVID-19 disease severity, independently predicted re-hospitalization.

New possibilities of electrocardiography: evaluation of the vectorcardiographic QRS loop planarity in patients with myocardial infarction

The aim of the work is to evaluate the planarity of the QRS loop and its relationship with systolic dysfunction of the left ventricle in patients in the subacute period of myocardial infarction (MI).Materials and methods. The ECG of 265 patients with a diagnosis of acute myocardial infarction were analyzed. The control group consisted of 55 healthy individuals. The planarity index was calculated as the ratio of the area of the QRS loop projection onto the plane (the polar vector of the QRS loop) and the true area of the QRS loop in space using a synthesized vectorcardiogram.Results. In patients with MI, the planarity index was significantly lower than in healthy individuals: 0,87 [0,71; 0,94] and 0,96 [0,93; 0,97], respectively, p &lt; 0,0001. Weak but significant correlations between the planarity index and the left ventricular ejection fraction (LVEF, r = 0,41, p &lt; 0,001) and with the number of affected segments of the left ventricle according to echocardiography (r = −0,43, p &lt; 0,001) were found. In patients with MI, the planarity index was lower in the presence of pulmonary edema in the acute period of MI (0,68 [0,54; 0,86]; without pulmonary edema 0,88 [0,76; 0,94], p &lt; 0,001), and in the presence of a history of chronic heart failure (0,79 [0,61; 0,88]; without chronic heart failure 0,88 [0,75; 0,94], p = 0,007). In patients with MI of both anterior and inferior localization, the planarity index was significantly lower with LV EF &lt; 50% compared with LV EF ≥ 50%. The planarity index was significantly lower in anterior MI than in inferior MI. Conclusion. In patients in the subacute period of MI, there is a decrease in the QRS loop planarity index, which correlates with the volume of myocardial damage, a decrease in LV EF, and the presence of acute and chronic heart failure. The QRS loop planarity index was significantly lower in anterior MI than in inferior MI.

Impact of heart failure on all-cause mortality in COVID-19: findings from the Eurasian International Registry.

To study all-cause mortality in patients hospitalized with COVID-19 with or without chronic heart failure (CHF) during hospitalization and at 3 and 6months of follow-up. The international registry Analysis of Comorbid Disease Dynamics in Patients with SARS-CoV-2 Infection (ACTIV) was conducted at 26 centres in seven countries: Armenia, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russian Federation, and Uzbekistan. The primary endpoints were in-hospital all-cause mortality and all-cause mortality at 3 and 6months of follow-up. Of the 5616 patients hospitalized with COVID-19, 917 (16.3%) had CHF. Total in-hospital mortality was 7.6%. In-hospital mortality was higher in patients with CHF than in patients without a history of CHF [17.7% vs. 4.0%, P<0.001; odds ratio (OR) 4.614, 95% confidence interval (CI) 3.633-5.859; P<0.001]. The risk of in-hospital all-cause mortality correlated significantly with the severity of CHF; specifically, the risk of in-hospital all-cause mortality was greater for patients in New York Heart Association functional classes III and IV (OR 6.124, 95% CI 4.538-8.266; P<0.001 vs. patients without CHF) than for patients in functional classes I and II (OR 2.446, 95% CI 1.831-3.267, P<0.001 vs. patients without CHF). The risk of mortality in patients with ischemic CHF was 58% higher than in patients with non-ischaemic CHF [OR 1.58 (95% CI 1.05-2.45), P=0.030]. In the first 3months of follow-up, the all-cause mortality rate in patients with CHF was 10.32%, compared with 1.83% in patients without CHF (P<0.001). At 6months of follow-up, NYHA classes II-IV was a strong risk factor for all-cause mortality [OR 5.343 (95% CI 2.717-10.508); P<0.001]. Hospitalized COVID-19 patients with CHF have an increased risk of in-hospital all-cause mortality, which remains high 6months after discharge.

Impact of Pre-Existing History of Heart Failure on Patient Profile, Therapeutic Management, and Prognosis in Cardiogenic Shock: Insights from the FRENSHOCK Registry.

There is a large heterogeneity among patients presenting with cardiogenic shock (CS). It is crucial to better apprehend this heterogeneity in order to adapt treatments and improve prognoses in these severe patients. Notably, the presence (or absence) of a pre-existing history of chronic heart failure (CHF) at time of CS onset may be a significant part of this heterogeneity, and data focusing on this aspect are lacking. We aimed to compare CS patients with new-onset HF to those with worsening CHF in the multicenter FRENSHOCK registry. Altogether, 772 CS patients were prospectively included: 433 with a previous history of CHF and 339 without. Worsening CHF patients were older (68 +/- 13.4 vs. 62.7 +/- 16.2, p &lt; 0.001) and had a greater burden of extra-cardiac comorbidities. At admission, acute myocardial infarction was predominantly observed in the new-onset HF group (49.9% vs. 25.6%, p &lt; 0.001). When focusing on hemodynamic parameters, worsening CHF patients showed more congestion and higher ventricular filling pressures. Worsening CHF patients experienced higher in-hospital all-cause mortality (31.3% vs. 24.2%, p = 0.029). Our results emphasize the great heterogeneity of the patients presenting with CS. Worsening CHF patients had higher risk profiles, and this translated to a 30% increase in in-hospital all-cause mortality. The heterogeneity of this population prompts us to better determine the phenotype of CS patients to adapt their management.

Prediction of vascular events in individuals with atherosclerotic lesions of various vascular basins: results of a 3-year prospective follow-up

Introduction. Today, cardiovascular diseases occupy a leading position in the structure of mortality, both in Russia and throughout the world. Every year more than 17 million people die from cardiac pathology, according to the World Health Organization, an increase in morbidity and mortality is expected in the future, which is explained, first of all, by an increase in the number of patients with diabetes and obesity.Aim. Development of optimal approaches to predicting cardiovascular events and unfavorable outcomes in patients with peripheral atherosclerosis during a 3-year prospective follow-up.Materials and methods. The study included 519 patients with atherosclerotic lesions of various vascular regions, of which 360 (69.4%) were men, 159 (30.6%) were women. The average age of the examined patients was 60.0 ± 8.7 years.Results. In the course of the analysis, it was noted that a factor such as the percentage of table stenosis of the left coronary artery (p = 0.013) influenced the risk of developing non-fatal cases of heart failure in patients with peripheral atherosclerosis. With regard to the end point – fatal cases of heart failure, the following factors demonstrated their statistical significance: age of onset of arterial hypertension, years (p = 0.020); history of chronic heart failure (p = 0.020); left atrial size, mm (p = 0.025); degree of stenosis of the posterior lateral branch, % (p = 0.038); presence of atherosclerotic lesions in the region of the posterior interventricular branch (p = 0.002); number of affected vascular beds (p = 0.044).Conclusions. Using logistic regression equations, original mathematical tools have been developed to assess the risk of developing both fatal and non-fatal heart failure in patients with peripheral atherosclerosis.

Predictive model for severe COVID-19 using SARS-CoV-2 whole-genome sequencing and electronic health record data, March 2020-May 2021.

ObjectiveWe used SARS-CoV-2 whole-genome sequencing (WGS) and electronic health record (EHR) data to investigate the associations between viral genomes and clinical characteristics and severe outcomes among hospitalized COVID-19 patients.MethodsWe conducted a case-control study of severe COVID-19 infection among patients hospitalized at a large academic referral hospital between March 2020 and May 2021. SARS-CoV-2 WGS was performed, and demographic and clinical characteristics were obtained from the EHR. Severe COVID-19 (case patients) was defined as having one or more of the following: requirement for supplemental oxygen, mechanical ventilation, or death during hospital admission. Controls were hospitalized patients diagnosed with COVID-19 who did not meet the criteria for severe infection. We constructed predictive models incorporating clinical and demographic variables as well as WGS data including lineage, clade, and SARS-CoV-2 SNP/GWAS data for severe COVID-19 using multiple logistic regression.ResultsOf 1,802 hospitalized SARS-CoV-2-positive patients, we performed WGS on samples collected from 590 patients, of whom 396 were case patients and 194 were controls. Age (p = 0.001), BMI (p = 0.032), test positive time period (p = 0.001), Charlson comorbidity index (p = 0.001), history of chronic heart failure (p = 0.003), atrial fibrillation (p = 0.002), or diabetes (p = 0.007) were significantly associated with case-control status. SARS-CoV-2 WGS data did not appreciably change the results of the above risk factor analysis, though infection with clade 20A was associated with a higher risk of severe disease, after adjusting for confounder variables (p = 0.024, OR = 3.25; 95%CI: 1.31–8.06).ConclusionsAmong people hospitalized with COVID-19, older age, higher BMI, earlier test positive period, history of chronic heart failure, atrial fibrillation, or diabetes, and infection with clade 20A SARS-CoV-2 strains can predict severe COVID-19.

A linear variant: A case of falx cerebri interhemispheric subdural hematoma

An 80-year-old female with a past medical history of chronic heart failure with reduced ejection fraction, Aortic valve replacement, atrial fibrillation, and recurrent pulmonary embolism on Xarelto presented to the Emergency Room with complaints of cough, shortness of breath, and head trauma following a fall. HR 112 bpm, RR 18/min, SPO2 96% on 6L, BP 160/80 mmHg, Temp 37.2. She was fully oriented and had no focal neurologic deficit; however, she was in respiratory distress and had diffuse rhonchi and rales in both lungs.

Saccular Pulmonary Aneurysm that Mimicking a Pulmonary Mass : a Case Report

Introduction: Pulmonary artery aneurysm (PAA) is a rare disorder. The pathophysiology of PAA was varies. Radiological modalities was very important due to an atypical clinical manifestations. Diagnosis approach of PAA is very important to avoid miss diagnosis and miss treatment. Case: A 51-year-old female patient came with chief complaints of shortness of breath since 5 years ago that was worsen 2 days before being admitted to emergency room. The complaints was felt throughout the day, that usually only appears if she did heavy activity due to history of chronic heart failure (CHF). Patient had a history of uncontrolled hypertension for years that leads to renal failure and CHF. A post pleural effusion evacuation Chest X-Ray evaluation revealed a well-defined but partially lobulated consolidation that is suspected as a lung mass. A CT scan with contrast showed a pulmonary aneurysm. A Doppler ultrasound revealed a pulmonary artery aneurysm showed by the turbulence of vascular flow. The patient got conservative oral therapy and monitoring for signs of aneurysm complications while waiting for the patient's agreement to be referred to tertiary hospital for CTPA (Computed Tomography Pulmonary Angiography) which is the gold standard on diagnosed PAA. Conclusion: PAA is a rare cardiovascular disorder with atypical clinical manifestations. Radiological examinations such as Doppler ultrasound, Trans Thoracic Echocardiography and Computed Tomography could be done for diagnostic approach of PAA in the hospital with limitation of radiologic modality. Diagnosis of PAA should be considered in the differential diagnosis of a pulmonary nodule or mass.

PO-701-05 ASSOCIATION OF ILLICIT DRUG POISONING WITH DYSRHYTHMIA - A PROPENSITY WEIGHTED ANALYSIS OF THE NATIONAL INPATIENT SAMPLE

Substance abuse is a progressive global epidemic requiring a complex multisystem approach to improve patient outcomes. While many studies have sought to evaluate outcomes of chronic substance abuse, there remains a paucity of literature to characterize the cardiovascular outcome of acute poisoning. We sought to evaluate the correlation between illicit drug poisoning and dysrhythmia. Objective: A composite database of National Inpatient Sample (NIS) for 2016 and 2017 was queried using ICD-10 codes[RG1] to identify patients with poisoning from several commonly abused substances including: cannabis, cocaine, heroin, amphetamines, hallucinogens, and LSD. A propensity weighted logistic regression analysis was performed controlling for age, gender, and comorbidities. Propensity weighted cohorts were compared for correlation with dysrhythmias [atrial fibrillation/flutter (AF/AFL), sick sinus syndrome (SSS), bradyarrhythmia, AV block (AVB1, AVB2, CHB), supraventricular tachycardia (SVT), ventricular tachycardia (VT), and ventricular fibrillation (VF)]. [RG1]Were ICD-10 codes available in 2016, 2017? The study cohort of 22,485 patients with hospitalization forillicit drug poisoning was evaluated.Average age was 40+ 0.2 years, 32% of whom were female. A propensity weighted logistic regression model using each dysrhythmia category as a dependent variable was performed using Stata 17.0 controlling for age, gender, and comorbidity (presence of AICD, Pacemaker, history of chronic heart failure, diabetes, ischemic stroke, COPD, PVD, CKD, OSA, hypertension, CAD). Using a Bonferroni correction for 15 variables, a p value threshold of 0.003 was used. As covariates were chosen based on prior available evidence to suggest harm, negative Z statistics were assumed to be erroneous. [RG1] Cannabis poisoning was found to have a strong correlation to bradyarrhythmia, AVB1. Cocaine poisoning was found to be strongly associated with SSS, AF/AFL, bradyarrhythmia, AVB1, AVB2, CHB, SVT, VF, and VT (Table 1). [RG1]These should be under methods. Patients with cannabis and cocaine poisoning were found to be strongly correlated with concurrent dysrhythmia.

Comparison of frequency of silent cerebral infarction as assessed by serum neuron specific enolase in patients with non-valvular atrial fibrillation: Warfarin versus direct oral anticoagulant

Background Cerebral infarction in patients with atrial fibrillation (AF) may clinically vary from being silent to catastrophic. Silent cerebral infarction (SCI) is the neuronal injury in the absence of clinically appearent stroke or transient ischaemic attack. Serum neuron specific enolase (NSE) is suggested to be a valid surrogate biomarker that allows to detect recent neuronal injury. We aimed to evaluate the incidence of recent SCI by positive NSE levels in patients with non-valvular AF (NVAF) on oral anticoagulants. Methods Blood samples for NSE were collected from 197 consecutive NVAF patients. NSE levels of greater than 12 ng/ml was considered as positive and suggestive of SCI. Results Patients were mainly female with a mean age of 69 years. Ninety-eight of them (49.7%) were taking warfarin. Mean INR level was 2.3 ± 0.9. Mean CHA2DS2-VASc score of the study population was 3.5 ± 1.5. Seventy-two patients (36.5%) were found to have NSE elevation. They were more likely to have history of chronic heart failure and previous stroke/TIA. Increased left atrial diameter and higher CHA2DS2-VASc were other factors associated with SCI. Patients on DOACs and patients taking aspirin on top of oral anticoagulant treatment were less likely to have SCI. Multivariate analysis demonstrated that increased left atrial diameter (OR: 2.5; 95% CI: 1.52–4; p < 0.001) and use of warfarin (OR: 2.8; 95% CI: 1.37–5.61; p = 0.005) were detected as independent predictors of SCI. Conclusions Our study revealed that DOACs were associated with significantly reduced SCIs compared with warfarin, probably due to more effective and consistent therapeutic level of anticoagulation.

Creation Of An Electronic Health Record Screening Tool To Identify Hospitalized Patients With Heart Failure & Iron Deficiency

<h3>Introduction</h3> Iron deficiency (ID) is common in patients with heart failure and negatively impacts quality of life and outcomes. Data recently published from AFFIRM-AHF demonstrated reduction in hospitalization in patients recovered from ADHF who received first dose of iron repletion during inpatient stay. As part of continuous Hospital Readmissions Reduction Program (HRRP) performance improvement efforts, we developed an electronic health record (EHR) screening tool to identify hospitalized patients with heart failure and ID. <h3>Hypothesis</h3> Creation of a EHR tool will lead to identification of patients who may benefit from IV iron repletion therapy to reduce utilization <h3>Methods</h3> Using an existing inpatient EHR census comprised of adults with a history of chronic heart failure, we modeled criteria after AFFIRM-AHF which included EF ≤ 50%, hemoglobin ≤ 13 mg/dL, ferritin ≤ 300 mg/dL and TSAT ≤ 20%. The tool captured patients admitted for ADHF daily over a 2-week period in April 2021 at an urban academic medical center. <h3>Results</h3> During study period, 261 patients were admitted for ADHF and 30 screened positive for ID. Characteristics are described in Table 1. In the 12 months prior to admission, 16.7% of patients had 1 emergency department visit for worsening HF, 23.3% had 1 prior hospitalization for ADHF and 30.0% had 2 or more prior hospitalizations. <h3>Conclusion</h3> An EHR tool easily and accurately identified patients with comorbid ID and HF. Including iron repletion in future inpatient clinical pathways or HRRP efforts may decrease utilization in this subset of patients.