Hospitalized Heart Failure Patients Research Articles

Value of non-invasive remote monitoring in managing weight, symptoms, and reducing hospitalizations in heart failure patients : An analysis of a French cohort over one year

Value of non-invasive remote monitoring in managing weight, symptoms, and reducing hospitalizations in heart failure patients : An analysis of a French cohort over one year

Impact of protein-energy malnutrition on mortality, length of stay, and hospitalization costs in patients with heart failure and a history of cancer.

e13799 Background: Protein-energy malnutrition (PEM) is a common comorbidity in patients with a history of cancer and significantly worsens outcomes in those with heart failure (HF). This study evaluates the impact of PEM on hospital outcomes and examines sociodemographic and clinical disparities. Methods: This retrospective cross-sectional study analysed the 2021 National Inpatient Sample (NIS). Outcomes included in-hospital mortality, LOS, and TOTCHG. Logistic regression was used for mortality, and linear regression was applied for LOS and TOTCHG, adjusting for age, sex, race, income, Charlson Comorbidity Index (CCI), and hospital characteristics. Results: Of 82,420 hospitalised HF patients with a history of cancer, 2.22% had PEM. Overall mortality was 8.5%, significantly higher in PEM patients (19.95%) compared to non-PEM patients (8.24%; p < 0.001). Adjusted odds of mortality for PEM patients were 2.73 (95% CI: 2.09–3.56; p < 0.001). Among breast cancer patients, mortality was 21.51% in PEM patients versus 6.88% in non-PEM patients (adjusted OR: 3.70; p < 0.001). Mean LOS for all HF patients was 7.37 days, extended to 10.79 days for PEM patients (p < 0.001). TOTCHG averaged $100,012, but PEM patients incurred significantly higher charges ($153,544 vs. $98,803; p < 0.001). PEM was disproportionately observed among low-income, Black, and Hispanic patients, who also experienced worse outcomes. Approximately 29.7% of PEM patients were from the lowest income quartile, and Black and Hispanic patients had higher rates of PEM compared to their White counterparts. Most PEM cases were observed in urban teaching hospitals (79.2%). Conclusions: PEM substantially worsens outcomes in HF patients with a history of cancer, leading to higher mortality, longer hospital stays, and increased costs. Disproportionate impacts on low-income, Black, and Hispanic patients emphasize the urgent need for early nutritional screening and interventions to improve outcomes and reduce disparities. Total Population Breast Cancer Kaposi Sarcoma Mortality (PEM) 19.95% 21.51% 4.9% Mortality (Non-PEM) 8.24% 6.88% 1.9% Mean LOS (PEM) 10.79 days 11.88 days 9.1 days Mean LOS (Non-PEM) 7.29 days 6.63 days 5.7 days Mean TOTCHG (PEM) $ 1,53,544.00 $ 1,53,957.00 $ 1,53,957.00 Mean TOTCHG (Non-PEM) $ 98,803.00 $ 84,106.00 $ 84,106.00

Multimodal analysis of congestion and prognostic utility of the VExUS protocol in hospitalized heart failure patients at a tertiary care hospital.

Multimodal analysis of congestion and prognostic utility of the VExUS protocol in hospitalized heart failure patients at a tertiary care hospital.

MEDICAL TREATMENT IMPLEMENTATION IN AMBULATORY PATIENTS WITH HF: PRELIMINARY DATA FROM THE NATIONWIDE BRING–UP3 HF STUDY

MEDICAL TREATMENT IMPLEMENTATION IN AMBULATORY PATIENTS WITH HF: PRELIMINARY DATA FROM THE NATIONWIDE BRING–UP3 HF STUDY

DISCHARGE MEDICAL TREATMENT IMPLEMENTATION IN PATIENTS ADMITTED FOR AHF: PRELIMINARY DATA FROM THE BRING–UP3 HF STUDY

DISCHARGE MEDICAL TREATMENT IMPLEMENTATION IN PATIENTS ADMITTED FOR AHF: PRELIMINARY DATA FROM THE BRING–UP3 HF STUDY

Meta-analysis of the efficacy and safety of SGLT-2 inhibitors in patients with heart failure and type 2 diabetes mellitus.

To investigate the efficacy and safety of sodium-glucose cotransporter 2 (SGLT-2) inhibitors in patients with heart failure (HF) and type 2 diabetes mellitus (T2DM). A manual search was conducted in 3 prestigious English databases, Cochrane Library, PubMed, and Web of Science, for studies published within the last decade, from July 2014 to July 2024. The extracted literature was synthesized to analyze the efficacy outcomes, survival prognostic indicators, and safety profiles of SGLT-2 inhibitors in patients with HF and T2DM. The Cochrane bias risk assessment scale was used as a tool to evaluate the quality of the literature, and Review Manager 5.4 software was used to create the bias risk chart. Data analysis and merging were completed with the help of Review Manager 5.4 and Stata 15.0 statistical software. Twelve studies encompassing 9509 patients were included in the meta-analysis. The results revealed that compared to the control group, the SGLT-2 inhibitor-treated group demonstrated significantly greater reductions in left ventricular end-diastolic volume index [mean difference (MD) = -7.25, 95% confidence intervals [95% CI] (-9.83, -4.67)], brain natriuretic peptide levels [MD = -36.96, 95% CI (-63.51, -10.41)], and N-terminal pro-brain natriuretic peptide [MD = -519.27, 95% CI (-660.77, -377.78)]. Furthermore, the SGLT-2 inhibitor-treated group exhibited significantly higher increases in Kansas City Cardiomyopathy Questionnaire scores [MD = 3.32, 95% CI (3.30, 3.34)], indicating improved quality of life. Additionally, the incidence of adverse events was significantly lower in the SGLT-2 inhibitor-treated group compared to the control group [OR = 0.78, 95% CI (0.69, 0.88)]. The pooled results of the meta-analysis indicated that SGLT-2 inhibitor therapy reduced the risk of cardiovascular death or HF hospitalization by 23%, the risk of cardiovascular death by 19%, and the risk of all-cause mortality by 9%. SGLT-2 inhibitor therapy significantly reduced the risks of all-cause mortality, cardiovascular death, and hospitalization for HF in patients with HF and T2DM. Additionally, SGLT-2 inhibitors significantly improve cardiac function, decrease the incidence of adverse events, and enhance the quality of life in these patients.

Atrial Fibrillation Ablation in Heart Failure and Preserved Ejection Fraction: An Observational Study of Risk Factors for Heart Failure Hospitalization.

Long-term heart failure hospitalization (HFH) after radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients with heart failure and preserved ejection fraction (HFpEF) and its risk factors remain to be investigated. AF patients with HFpEF who underwent RFCA from January, 2014 to December, 2018 from three centers were retrospectively included. Patients were assigned to the training and testing cohorts, respectively. In the training cohort, logistic regression analyses were performed to discriminate those with and without HFH. A scoring system was developed accordingly and validated. A total of 417 AF patients with HFpEF receiving RFCA were enrolled. About 35 patients (8.4%) had HFH for 6 years. In the training cohort, the use of diuretics, atrial tachycardia (AT)/AF recurrence, prior HFH, and female sex were independent predictors of HFH in the multivariable analysis. A DAPF score (ranging from 0 to 9.0) was developed. The area under the receiver operating characteristic curve (AUC) of the DAPF score was 0.880 (95% CI, 0.830- 0.929). A DAPF score ≥3.5 could predict HFH with a sensitivity of 81.8% and a specificity of 74.6%. The performance in the testing cohort remained robust (AUC, 0.858; 95% CI, 0.749- 0.967). HFH in patients with AF and HFpEF after RFCA is not rare. The DAPF score could predict the risk of HFH in AF patients with HFpEF after RFCA and guide our treatment strategy.

Intravenous Iron Sucrose for Acute Decompensated Heart Failure Patients with Reduced Ejection Fraction and Iron Deficiency.

The concurrent presence of iron deficiency (ID) and heart failure (HF) can worsen prognosis and reduce the quality of life for affected individuals. This study aimed to explore the effects of incorporating iron sucrose into standard HF treatments for patients with acute decompensated HF and ID. We prospectively enrolled 65 hospitalized HF patients, all with a left ventricular ejection fraction of ≤40% and ID, defined as ferritin levels below 100 ng/mL or ferritin levels between 100 and 299 ng/mL with transferrin saturation below 20%. Patients were randomized into two groups: the iron sucrose group, who received intravenous iron sucrose in addition to the standard HF treatment; a control group who received standard HF treatment alone serum ferritin, iron, transferrin saturation, and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores were measured at baseline and a 4-week follow-up. Baseline characteristics, iron profiles, and KCCQ scores were comparable between the two groups. At 4 weeks, patients in the iron sucrose group possessed significantly higher serum ferritin levels than those in the control group (ferritin 485.3 ± 269.7 ng/mL vs. 225.5 ± 162.5 ng/mL, p < 0.001; Δferritin 382.2 ± 243.5 ng/mL vs. 97.4 ± 143.0 ng/mL, p < 0.001, respectively). Only 9.1% of patients in the iron sucrose group remained within the ID criteria, compared to 36.7% in the control group (p = 0.012). The ΔKCCQ score was 10.6 points higher (27.8 ± 19.5 vs. 17.1 ± 17.8 points, p = 0.031) in the iron sucrose group than in the control group. Post-discharge intravenous iron sucrose may improve iron levels and quality of life in HF patients with ID. NCT06703411, https://clinicaltrials.gov/expert-search?term=NCT06703411.

A multicentre registry of hospitalized patients with acute and chronic heart failure: Study design of the H2-registry.

Heart failure (HF) is a highly prevalent condition affecting 1-3% of the adult population in Europe. Despite landmark improvements in HF care over 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. The Helios Heart (H2)-registry was established 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 with a focus on patient-reported outcomes (PROs). This manuscript describes the registry's design and presents an interim analysis of baseline characteristics and 1-year outcomes. The H2-registry is a prospective, investigator-initiated, multicentre observational registry in Germany that started in 2021 and is actively enrolling patients. Inpatients ≥18years of age with a present diagnosis of chronic or acute HF are recruited in secondary and tertiary hospitals throughout Germany. Routine follow-up (FU) is conducted every 6months. Data collection is based on a set of variables following recommendations of the International Consortium of Health Outcome Measurements (ICHOM) covering data on demographics, medical history, HF characteristics, medication, procedures, and patients' perceived health status via the collection of standardized PROs. Until 31 December 2023, a total of 2361 patients were enrolled in 10 study centres. Mean age in this cohort is 72years, 36.9% are female, and median left ventricular ejection fraction is 45%. An analysis of 6-month and 12-month outcomes in a cohort of 1593 patients with complete FU data revealed all-cause mortality rates of 9.0% and 16.2% at 6 and 12months, while HF-related rehospitalizations occurred in 24.4% and 43.5% at 6 and 12months. The H2-registry is currently the largest ongoing prospective registry of HF patients in Germany. It is foreseeable that the H2-registry will significantly contribute to the collection of real-world data and provide a comprehensive and unique perspective on the current characteristics, treatment strategies, and resulting outcomes of HF patients in Germany. NCT04844944.

Prognostic Value of Plasma Big Endothelin-1 in Patients Hospitalized for Heart Failure.

Endothelin-1 (ET-1) is a potent vasoconstrictor and multifunctional neuroendocrine hormone that is closely associated with the pathophysiology of heart failure (HF). Currently, the evidence about the predictive value of big ET-1 in HF remains insufficient. This study aims to investigate the prognostic importance of big ET-1 in HF. We examined the incidence of cardiovascular death in a single-center retrospective cohort of HF (de novo, worsening, or chronic included). The 4,368 hospitalized HF patients were enrolled. During the median follow-up of 875 (365-1,400) days, 851 (19.5%) patients had primary outcome events. Big ET-1 was independently associated with cardiovascular death as a continuous variable (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.06-1.21; p<0.001) and by tertiles (HR, 1.35; 95% CI, 1.06-1.72; p=0.017 for tertile 2 and HR, 1.70; 95% CI, 1.32-2.19; p<0.001 for tertile 3). This pattern of risk was maintained after further adjustment for NT-proBNP (HR, 1.11; 95% CI, 1.03-1.19; p=0.006 for continuous variable, HR, 1.30; 95% CI, 1.02-1.67; p=0.035 for tertile 2, and HR, 1.69; 95% CI, 1.23-2.05; p=0.034 for tertile 3). Net reclassification index (NRI) and integrated discrimination improvement (IDI) analysis showed that big ET-1 provided additional predictive power in combination with NT-proBNP (NRI, 0.11; 95% CI, 0.04-0.17; p=0.012 and IDI, 0.012; 95% CI, 0.003-0.017; p<0.001). Elevated big ET-1 was independently associated with cardiovascular death in patients with HF. Big ET-1 may be a promising indicator of HF prognosis. In combination with NT-proBNP, big ET-1 may provide incremental predictive information.

Long-term outcomes of pace-and-ablate strategy in patients with atrial fibrillation.

The pace-and-ablate strategy is second -line therapy to obtain rate control in patients with persistent symptomatic atrial fibrillation (AF) when other treatment options fail. This study aims to evaluate long-term effects on clinical outcomes following pace-and-ablate strategy in AF patients. This retrospective study includes patients who underwent successful pacemaker implantation (right ventricular pacing (RVP) or cardiac re-synchronization therapy (CRT)) followed by atrioventricular node ablation (AVNA) between 2010 and 2020. Patients were treated according to the prevailing guidelines. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization (HFH). Secondary endpoints were individual outcomes of all-cause mortality, HFH, and left-ventricular ejection fraction (LVEF) change. Two hundred ninety-eight patients were included, 162 undergoing RVP, and 136 receiving CRT, with a median follow-up of 5.8 years [4.1-8.0]. The primary endpoint occured in 47% of the RVP group and 49% of the CRT group (p = 0.206). All-cause mortality occurred in 36% of the RVP group and in 45% of the CRT group (p = 0.005). HFH occurred in 22% of the RVP group and in 15% of the CRT group (p = 0.328), with 17(10%) upgrades to CRT in the RVP group. Median LVEF in the RVP group remained stable (56% [49-60] to 53% [43-57]; p = 0.081), while it improved in the CRT group (31% [22-38] to 43% [32-51]; p < 0.001). Mortality and HFH in patients with AF managed through a pace-and-ablate strategy are high. Reassuringly, LVEF deterioration requiring upgrade to CRT is uncommon in patients undergoing RVP with normal baseline LVEF before AVNA. CRT improves LVEF in patients with reduced LVEF before AVNA.

Non-Invasive Measurement of Hemodynamic Parameters via Whole-Body Impedance Cardiography Among Hospitalized Heart Failure Patients: An Effective Alternative to Invasive Right Heart Catheterization?

(1) Background: The measurement of hemodynamic parameters has proven to be crucial in the treatment of hospitalized heart failure patients, necessitating invasive measurement by right heart catheterization (RHC). The reliability of whole-body impedance cardiography (ICG) among this cohort has not been investigated to date; (2) Methods: The RHC and whole-body ICG examinations measured cardiac output (CO), the cardiac index (CI), total peripheral resistance (TPR), and pulmonary vascular resistance (PVR). To assess the accuracy of the whole-body ICG measurement, bias and precision were calculated as the mean difference and the twofold standard deviation between the average values of measurements; (3) Results: A total of 203 patients were analyzed. No significant bias was observed between the non-invasive CO and CI measurements when compared with the RHC measurements (-0.14 ± 2.56 L/min, p = 0.1; -0.09 ± 1.3 L/min/m2, p = 0.06), but a significant bias occurred in the measurement of non-invasive TPR and non-invasive PVR (-1243 ± 3510 dyn × s-1 × cm-5, p = 0.001; -121 ± 504 dyn × s-1 × cm-5, p < 0.001); (4) Conclusions: CO and CI can be measured with whole-body ICG among hospitalized CHF patients with acceptable accuracy. The reliability of measuring TPR and PVR should be further investigated.

Economic impact of sotagliflozin among patients with heart failure and type 2 diabetes: Budget impact analysis from the US payer perspective.

Heart failure (HF) is a leading cause of mortality in the United States, often complicated by comorbidities like diabetes mellitus. These patients face high hospitalization risks, impacting clinical outcomes and health care resources. The Effect of Sotagliflozin on Cardiovascular Events in Patients with Type 2 Diabetes Post Worsening Heart Failure (SOLOIST-WHF) trial showed that sotagliflozin, a sodium-glucose cotransporter inhibitor, reduced rehospitalizations in patients with HF and diabetes mellitus. Although clinically beneficial, the economic impact of sotagliflozin from a payer perspective remains unclear, warranting further pharmacoeconomic analysis to guide managed care decisions. To quantify the budget impact of sotagliflozin for US payers over a 5-year time horizon. A payer-perspective budget impact model was developed to assess the financial impact of incorporating sotagliflozin for the treatment of patients recently hospitalized for HF with comorbid type 2 diabetes (T2D) over 5years to US payer health plans. The study used a population reflecting the SOLOIST-WHF clinical trial, with economic parameters adjusted by payer mix (all payer, commercial, Medicare, and Medicaid). Health care resource utilization included hospitalization, emergency department (ED) visit, and adverse events' care. Economic outcomes examined the medical and pharmacy budget impact for payers at the per-user, per member per month (PMPM), and total plan costs levels. For a hypothetical 1-million-member all-payer plan, 1,516 patients hospitalized for HF with comorbid T2D would be eligible for sotagliflozin. For all-payer plans, annual per-user costs increased by $4,996 because of higher pharmacy costs ($8,260) but were partially offset by lower medical costs (-$2,608) because of reduced rehospitalization and ED visits from sotagliflozin. PMPM total budget impact of sotagliflozin would be $0.08 PMPM in year 1 and $0.38 in year 5, corresponding with total plan cost of $75,736 in year 1 and $378,681 by year 5. Commercial payer PMPM costs were lower ($0.02 in year 1; $0.11 in year 5), and higher for Medicare ($0.23 PMPM in year 1, increasing to 1.13 PMPM in year 5). Breakeven rebate rates ranged between 31.5% and 79.4%. Although sotagliflozin increases pharmacy costs for recently hospitalized HF patients with T2D, approximately 21%-68% of pharmacy costs were offset from reduced rehospitalization and ED visits.

Intravenous Ferric Carboxymaltose in Heart Failure With Iron Deficiency

Uncertainty remains about the efficacy of intravenous iron in patients with heart failure and iron deficiency. To assess the efficacy and safety of ferric carboxymaltose in patients with heart failure and iron deficiency. This multicenter, randomized clinical trial enrolled 1105 patients with heart failure (defined as having a left ventricular ejection fraction of ≤45%) and iron deficiency (serum ferritin level <100 ng/mL; or if transferrin saturation was <20%, a serum ferritin level between 100 ng/mL and 299 ng/mL) at 70 clinic sites in 6 European countries from March 2017 to November 2023. The median follow-up was 16.6 months (IQR, 7.9-29.9 months). Administration of ferric carboxymaltose (n = 558) initially given at an intravenous dose of up to 2000 mg that was followed by 500 mg every 4 months (unless stopping criteria were met) vs a saline placebo (n = 547). The primary end point events were (1) time to cardiovascular death or first heart failure hospitalization, (2) total heart failure hospitalizations, and (3) time to cardiovascular death or first heart failure hospitalization in patients with a transferrin saturation less than 20%. All end point events were measured through follow-up. The end points would be considered statistically significant if they fulfilled at least 1 of the following conditions: (1) P ≤ .05 for all 3 of the end point comparisons, (2) P ≤ .025 for 2 of the end point comparisons, or (3) P ≤ .0167 for any of the 3 end point comparisons (Hochberg procedure). Of the 1105 participants (mean age, 70 years [SD, 12 years]; 33% were women), cardiovascular death or first heart failure hospitalization (first primary outcome) occurred in 141 in the ferric carboxymaltose group vs 166 in the placebo group (hazard ratio, 0.79 [95% CI, 0.63-0.99]; P = .04). The second primary outcome (total heart failure hospitalizations) occurred 264 times in the ferric carboxymaltose group vs 320 times in the placebo group (rate ratio, 0.80 [95% CI, 0.60-1.06]; P = .12). The third primary outcome (cardiovascular death or first heart failure hospitalization in patients with a transferrin saturation <20%) occurred in 103 patients in the ferric carboxymaltose group vs 128 patients in the placebo group (hazard ratio, 0.79 [95% CI, 0.61-1.02], P = .07). A similar amount of patients had at least 1 serious adverse event in the ferric carboxymaltose group (269; 48.2%) vs in the placebo group (273; 49.9%) (P = .61). In patients with heart failure and iron deficiency, ferric carboxymaltose did not significantly reduce the time to first heart failure hospitalization or cardiovascular death in the overall cohort or in patients with a transferrin saturation less than 20%, or reduce the total number of heart failure hospitalizations vs placebo. ClinicalTrials.gov Identifier: NCT03036462.

In-Hospital Adverse Events in Heart Failure Patients: Incidence and Association with 90-Day Mortality.

In-Hospital Adverse Events in Heart Failure Patients: Incidence and Association with 90-Day Mortality.

Blood pressure variability associated with in-hospital and 30-day mortality in heart failure patients: a multicenter cohort study

To investigate the association between blood pressure variability (BPV) and mortality (in-hospital and 30-day) among heart failure (HF) patients, and to examine these associations across patient subgroups. This multicenter retrospective cohort study analyzed 25,591 heart failure patients from two intensive care databases (eICU Collaborative Research Database [eICU-CRD] and the Medical Information Mart for Intensive Care IV [MIMIC-IV]). BPV was assessed using coefficient of variation of systolic (SBPV), diastolic (DBPV), and mean (MBPV) blood pressure measurements. Multivariable logistic regression and Cox proportional hazards models evaluated mortality associations, adjusting for clinical parameters. The observed mortality rates were 14.7% (in-hospital) and 17.3% (30-day). Higher BPV demonstrated significant associations with increased mortality risk, with SBPV showing the strongest relationship. For in-hospital mortality, each standard deviation increase in SBPV, DBPV, and MBPV corresponded to adjusted odds ratios of 1.56 (95% CI 1.51–1.62), 1.21 (95% CI 1.16–1.25), and 1.42 (95% CI 1.37–1.48), respectively. For 30-day mortality, adjusted hazard ratios were 1.37 (95% CI 1.33–1.41) for SBPV, 1.15 (95% CI 1.12–1.19) for DBPV, and 1.30 (95% CI 1.27–1.34) for MBPV. These associations remained robust across all patient subgroups. Increased blood pressure variability during hospitalization independently predicts higher in-hospital (14.7%) and 30-day mortality (17.3%) in HF patients, with SBPV showing the strongest association (OR: 1.56, 95% CI 1.51–1.62). BPV may serve as a valuable prognostic marker for risk stratification in hospitalized heart failure patients.

Risk of Heart Failure in Patients With Immune-Mediated Inflammatory Diseases: A Population-Based Study.

To evaluate the risk of heart failure (HF) in patients with immune-mediated inflammatory diseases (IMIDs) compared to the general population with and without diabetes mellitus (DM). A population-based cohort study was conducted in patients with rheumatoid arthritis (RA), radiographic axial spondyloarthritis (r-axSpA), psoriatic arthritis, and psoriasis (PsO) in Ontario from 2011 until 2019. The study outcome was first hospitalization for HF. Incidence rates of HF were calculated for each cohort. Hazard ratios (HRs) for HF were calculated using Cox proportional hazard models. The etiology of HF was descriptively classified into mutually exclusive groups based on comorbidities during HF hospitalization. A total of 243,061 patients with IMID, 748,517 with DM, and 8,278,934 non-IMID, non-DM controls were analyzed. The crude incidence rate for HF in IMID was 2.70 per 1000 person-years, with the highest rate in RA and lowest in r-axSpA. The risk of being hospitalized for HF was higher in IMID compared with non-IMID comparators (HR 1.34, 95% CI 1.30-1.38). This risk was highest among patients with RA (HR 1.61, 95% CI 1.54-1.68) and lowest in PsO (HR 1.09, 95% CI 1.03-1.15). In comparison, the risk of HF hospitalization in patients with DM was higher (HR 2.19, 95% CI 2.16-2.21). The most common antecedent comorbidity associated with HF in all patients with IMID was ischemic heart disease. In patients with IMID without DM, atrial fibrillation had a similar effect as ischemic heart disease. The risk of HF hospitalization is increased in patients with IMID compared to the general population.

Findings Across the Ejection Fraction Subgroups in Hospitalised Heart Failure Patients: The First MY-HF Registry Study

Background: Three main phenotypes describe heart failure (HF) according to left ventricular ejection fraction (LVEF). This study aims to describe the characteristics, management and outcomes of hospitalised patients with HF categorised by LVEF. Methods: The Malaysian National Heart Failure (MY-HF) Registry is a 3-year prospective, observational study of patients admitted for acute HF. This analysis includes 2,651 patients categorised into: HF with reduced ejection fraction (HFrEF; LVEF ≤40%), HF with mildly reduced ejection fraction (HFmrEF; LVEF 41−49%) and HF with preserved ejection fraction (HFpEF; LVEF ≥50%). Hospital readmission and mortality outcomes at 30 days and 1 year were examined. Results: The HFrEF subgroup represented the largest proportion of patients (66.2%), followed by HFpEF (22.1%) and HFmrEF (11.7%). The HFpEF subgroup was older (mean age 65.3 ± 13.3 years), had the highest proportion of females (53.5%) and had more patients with de novo HF at admission than the HFrEF subgroup (41.9% versus 31.4%). Comorbidities, such as hypertension, AF and chronic kidney disease, were more prevalent in the HFpEF than HFrEF subgroup. Conversely, more HFrEF patients had ischaemic heart disease and elevated N-terminal pro B-type natriuretic peptide levels (≥1,000 pg/ml). Similar 30-day and 1-year outcome rates were observed across the subgroups except for lower 30-day hospital readmission (p=0.024) and 1-year mortality (p=0.005) in the HFpEF subgroup. Older age (&gt;60 years) and New York Heart Association class III–IV increased 1-year readmission risk. Conclusion: The MY-HF Registry highlighted high 1-year mortality in patients with HF, especially those with advanced NYHA class or chronic kidney disease. This suggests potential areas for improvement in HF management, including medication regimens, adherence and comorbidity management. Future research exploring these factors could significantly impact clinical practice and patient outcomes.

Impact of Pharmacotherapy Optimization on Health-related Quality of Life in a Long-term Follow-up Program for Patients with Heart Failure

Background Heart failure (HF) is a complex clinical syndrome that impacts a patient's health and quality of life (QoL). Pharmacological management, especially therapy that adheres to established clinical guidelines on patients' health status and QoL, reduces mortality and hospitalization of HF patients and ejection fraction (HFrEF). Objective This study aimed to evaluate changing health-related quality of life (HRQoL) and medication prescription in patients with HF during a long-term monitoring program. Methods This observational analysis included 118 HF patients who were discharged from the Department of Cardiology after an episode of decompensated HF (ICD-10 code I50). HRQoL was observed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients were divided into two groups. Group I (N=71, 60.2%) had a decrease in MLHFQ scores of more than 10 points, and group II (N=47, 39.8%) had stable or less than 10-point increases in MLHFQ scores. Results In group I, there was a statistically significant decrease in the use of angiotensin-converting enzyme inhibitors (ACEI), an increase in the administration of angiotensin receptor-neprilysin inhibitors (ARNI), and the optimal use of renin-angiotensin-aldosterone system (RAAS) inhibitors. This group demonstrated substantial improvements in HRQoL across emotional, physical, and social domains. In contrast, group II exhibited suboptimal usage of RAAS inhibitors and modest improvements in HRQoL. Conclusion The optimization of medication therapy, including the transition to ARNIs and comprehensive RAAS inhibition, in group I (lower mean LVEF, higher proportion of NYHA class III-IV) contributed to substantial improvements in HRQOL. In contrast, the suboptimal usage of RAAS inhibitors in group II (higher mean LVEF, lower proportion of NYHA class III-IV) may have contributed to the modest HRQOL improvements observed in this group.

Echocardiographic index of left ventricular performance for prognostication in transthyretin cardiac amyloidosis: the central role of stroke volume index.

Cardiac amyloidosis typically causes restrictive cardiomyopathy, in which the impairment of diastolic function is dominant. Echocardiography provides prognostic information through some important parameters: left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, LVEF often remains preserved despite disease progression, and GLS is not routinely performed as it is limited by suboptimal image quality. The stroke volume index (SVi) has already been shown to correlate with mortality in heart failure patients; still, its prognostic role in transthyretin cardiac amyloidosis (TTR-CA) is poorly studied. This prospective study aimed to evaluate the role of SVi in predicting mortality and heart failure hospitalizations in patients with cardiac amyloidosis, comparing it to other parameters of left ventricular performance. Baseline clinical transthoracic echocardiogram and laboratory data were collected prospectively in 115 patients with diagnosed TTR-CA. The outcome was the occurrence of the composite of heart failure hospitalization and death and its association with SVi, LVEF, GLS and MCF was tested by Cox proportional hazard modelling. Over a mean follow-up of 16.1 months (interquartile range 7.4-24.9 months), 29 patients died, and 19 were hospitalized for heart failure. SVi was associated with the composite outcome of death and heart failure hospitalization [hazard ratio 0.96; 95% confidence interval (CI) 0.93-0.99] and remained an independent predictor of outcome after adjustment for NAC stage, mitral regurgitation degree, age and the use of disease-modifying treatment. The best cut-off of SVi to predict outcome was 35 ml/m2 (hazard ratio 2.30; 95% CI 1.03-5.17). SVi is superior to LVEF, MCF, and GLS for prognostication in patients with TTR amyloidosis.