Previous History Of Heart Failure Research Articles

The effect of educational interventions by nurses through Orem's self-care theory on the ability of self-care in myocardial Infarction patients in public sector hospital: A quasi-experimental study.

To assess the impact of educational intervention by nurses guided by Orem's theory to reinforce the self-care abilities of patients experiencing myocardial infarction. The prospective, quasi-experimental case-control study was conducted from September 2020 to April 2021 at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, and comprised myocardial infarction and heart failure patients with comorbidities diabetes mellitus and hypertension. The patients were randomised into experiment group A and control group B. Group A received educational intervention one day before and one day after discharge in line with the American Heart Association guidelines. Two 30-45-minute sessions of seven modules were conducted. Group B received routine information from ward staff. Assessment was done at baseline and first month and second month post-intervention using the Heart Failure Self-Care Index version 6.2. Data was analysed using SPSS 21. Of the 80 patients, 40(50%) were in group A; 27(76.5%) males and 13(32.5%) females. The remaining 40(50%) patients were in group B; 20(50%) males and 20(50%) females. The overall age of the sample ranged 36-65 years and 48(60%) had a previous history of heart failure. The mean score of maintenance, management, confidence and overall self-care were significantly higher in group A compared to group B (p<0.05). Nursing self-care educational intervention based on Orem's theory was found to be highly effective among patients of myocardial infarction and heart failure with respect to their self-efficacy ability.

Does frailty have an influence on MINOCA?

Abstract Funding Acknowledgements None. Introduction Frailty is a condition that is associated with aging, the presence of comorbidities and disability. The occurrence of frailty may aggravate the course of illnesses, including myocardial infarction (MI), with significant higher rates of complications and mortality in frail patients. Purpose We aim to build and validate for our population a frailty índex (FI) using the information present in the National Registry of Acute Coronary Syndromes (ACS). This will later be used to characterize the sample and evaluate the impact of frailty in patients with acute myocardial infarction with non-obstructive coronary arteries (MINOCA), in terms of management, complications, in-hospital mortality and 1-year mortality in a real-world scenario. Methods Multicenter retrospective study, based on the National Registry of ACS, from 1/10/2010-24/10/2022. Only patients hospitalized with a diagnosis of MINOCA (coronary stenosis &amp;lt;50%) were included. FI was created including 22 variables identified from baseline characteristics (Table 1). The FI was calculated, ranging between 0-1. Patients were then divided into two groups: Group A - non-frail (FI ≤0.25) – and Group B – frail (FI&amp;gt;0.25). Kaplan-Meier test was performed to establish the survival rates, CV readmissions (R) and R for other causes, at one year. Results A total of 1358 patients were analyzed, 1195 in group A (88.0%) and 163 in group B (12.0%). Mean age was 63.9±13.9 years and 62.8% of the patients were male in group A, while in group B mean age was 68.0±10.8 and 72.4% were men. Group B had more cardiovascular risk factors, such as hypertension (94.5% vs 63.2% p&amp;lt;0.001), diabetes (55.2% vs 22.6% p&amp;lt;0.001), dyslipidemia (52.2% vs 89.0% p&amp;lt;0.001). Patients in group B also had more previous history of heart failure (27.6% vs 4.9% p&amp;lt;0.001), stroke (15.3% vs 3.9% p&amp;lt;0.001) and chronic kidney disease (17.8% vs 1.5% p&amp;lt;0.001). On admission, group B presented: higher heart rate (HR) (15.7% with HR ≥100bpm vs 9.0%; p=0.008), more atrial fibrillation (14.7% vs 6.7%, p&amp;lt;0.001); lower blood pressure (BP) (5.1% with BP &amp;lt;90mmHg vs 1.0%; p&amp;lt;0.001), and higher Killip-Kimball (KK) classification (24.1% in KK class &amp;gt;I vs 8.3%; p&amp;lt;0.001). During hospitalization, group B presented higher maximum creatinine values (2.0±2.2mg/dL vs 1.2±0.9 mg/2mg/dL, p&amp;lt;0.001) and lower hemoglobin values (11.9±2.2 vs 12.9±1.7g/dL, p&amp;lt;0.001). There were no differences between the two groups in terms of complications during hospitalization, intrahospital mortality or regarding lenght of hospital stay or mortality rates, R for CV causes and R for other causes at one-year follow-up, with a Kaplan-Meier test of p=0.186 (Figure 1A), p=0.789 (Figure 1B) and p=0.118 (Figure 1C), respectively. Conclusions As expected, frail patients have more comorbidities than non-frail patients. However, this does not translate into differences in terms of patients’ treatment, number of complications, intrahospital mortality, or 1-year follow up.Figures 1A, 1B and 1C

Relationship between high sensitivity troponin I and clinical outcomes in non–acute coronary syndrome (non-ACS) acute heart failure patients – a one-year follow-up study

ObjectiveThe primary objective of the study was to investigate the correlation between high-sensitivity troponin I (hsTropI) levels during hospitalization and the prognostic outcome in patients with non-acute coronary syndrome (non-ACS) acute heart failure, over a follow-up period of one year. The secondary objective was to assess and characterize acute heart failure during index hospitalization. MethodsHigh sensitivity troponin I value was noted both at the time of admission and discharge. The correlation of admission hsTropI along with other parameters and risk factors with in-hospital mortality was studied. Patients of index hospitalization after discharge were followed up for one year and the composite endpoint of cardiovascular death or re-hospitalization for heart failure was noted. The correlation between admission and discharge hsTropI values with the composite endpoint was then analyzed. ResultsOut of 350 patients, 38 (10.8 %) patients died during index hospitalization while 142 patients (46 %) developed composite outcomes during follow-up. Age, previous history of heart failure, atrial fibrillation, low left ventricular ejection fraction, systolic blood pressure, and high values of hsTropI above 99th percentiles were independent in-hospital mortality predictors. The value of hsTropI at the time of admission was not associated with poor composite outcome during follow-up. However, patients who showed an increasing trend of hsTropI value at the time of discharge were found to have a significant increase in the composite outcome. ConclusionHigh-sensitivity troponin I is a valuable biomarker that can predict in-hospital mortality and long-term follow-up outcomes in patients with acute heart failure. It plays a crucial role in developing improved strategies for heart failure surveillance and management in the community.

Cardiovascular Complications in Patients with Heart Failure and COVID-19: CARDIO COVID 19-20 Registry.

Since early 2020, different studies have shown an increased prevalence of COVID-19 and poorer prognosis in older adults with cardiovascular comorbidities. This study aimed to assess the impact of heart failure (HF) on cardiovascular complications, intensive care unit (ICU) admissions, and in-hospital mortality in patients hospitalized with COVID-19. The CARDIO COVID 19-20 registry includes 3260 hospitalized patients with a COVID-19 serological diagnosis between May 2020 and June 2021 from Latin American countries. A history of HF was identified in 182 patients (5.6%). In patients with and without previous HF, the incidence of supraventricular arrhythmia was 16.5% vs. 6.3%, respectively (p = 0.001), and that of acute coronary syndrome was 7.1% vs. 2.7%, respectively (p = 0.001). Patients with a history of HF had higher rates of ICU admission (61.5% vs. 53.1%, respectively; p = 0.031) and in-hospital mortality (41.8% vs. 24.5%, respectively; p = 0.001) than patients without HF. Cardiovascular mortality at discharge (42.1% vs. 18.5%, respectively; p < 0.001) and at 30 days post-discharge (66.7% vs. 18.0%, respectively) was higher for patients with a history of HF than for patients without HF. In patients hospitalized with COVID-19, previous history of HF was associated with a more severe cardiovascular profile, with increased risk of cardiovascular complications, and poor in-hospital and 30-day outcomes.

Mildly Reduced Renal Function Is Associated With Increased Heart Failure Admissions in Patients With Hypertrophic Cardiomyopathy.

The association between renal dysfunction and cardiovascular outcomes has yet to be determined in patients with hypertrophic cardiomyopathy (HCM). We aimed to investigate whether mildly reduced renal function is associated with the prognosis in patients with HCM. Patients with HCM were enrolled at two tertiary HCM centers. Patients who were on dialysis, or had a previous history of heart failure (HF) or stroke were excluded. Patients were categorized into 3 groups by estimated glomerular filtration rate (eGFR): stage I (eGFR ≥ 90 mL/min/1.73 m², n = 538), stage II (eGFR 60-89 mL/min/1.73 m², n = 953), and stage III-V (eGFR < 60 mL/min/1.73 m², n = 265). Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, hospitalization for HF (HHF), or stroke during median 4.0-year follow-up. Multivariable Cox regression model was used to adjust for covariates. Among 1,756 HCM patients (mean 61.0 ± 13.4 years; 68.1% men), patients with stage III-V renal function had a significantly higher risk of MACEs (adjusted hazard ratio [aHR], 2.71; 95% confidence interval [CI], 1.39-5.27; P = 0.003), which was largely driven by increased incidence of cardiovascular death and HHF compared to those with stage I renal function. Even in patients with stage II renal function, the risk of MACE (vs. stage I: aHR, 2.21' 95% CI, 1.23-3.96; P = 0.008) and HHF (vs. stage I: aHR, 2.62; 95% CI, 1.23-5.58; P = 0.012) was significantly increased. This real-world observation showed that even mildly reduced renal function (i.e., eGFR 60-89 mL/min/1.73 m²) in patients with HCM was associated with an increased risk of MACEs, especially for HHF.

Rationale and Design of Heart Failure Prevalence and Evolution of Heart Failure in Diabetes Mellitus Type II Patients at High Risk (HF-LanDMark Study).

(1) Background: Patients with diabetes mellitus (DM) are at increased risk for heart failure (HF). Accurate data regarding the prevalence of HF stages among diabetics in Greece are scarce. (2) Aim: The present study will examine the prevalence and evolution of HF stages among patients with type II DM (T2DM) diagnosed in the past 10 years, with no previous history of HF and at high CV risk, in Greece, as well as will explore the potential determinants of the development of symptomatic HF in these patients. (3) Methods: Through a non-interventional, epidemiological, single-country, multi-center, prospective cohort study design, a sample of 300 consecutive patients will be enrolled in 11 cardiology departments that are HF centers of excellence. Patients will be either self-referred or referred by primary or secondary care physicians and will be followed for up to 24 months. Demographic, clinical, echocardiography, electrocardiography, cardiac biomarkers (troponin, NT-proBNP) and health-related quality of life questionnaire data will be recorded as well as clinical events, including mortality, HF hospitalizations and HF-related healthcare resource utilization. The primary outcomes are the proportion of patients diagnosed with symptomatic HF (ACC/AHA Stage C) at enrolment in the overall study population and the proportions of patients with HF stages A, B and C, as well as by NYHA functional classification in the overall study population. (4) Conclusions: The HF-LanDMark study is the first epidemiological study that will assess the prevalence of HF among T2DM patients in Greece that could potentially enhance prompt therapeutic interventions shown to delay the development of HF in the T2DM patient population (HF-LanDMark, Clinical Trials.gov number, NCT04482283).

Left-bundle branch block, an alert for cardiac resynchronization therapy Characteristics of an unselected population with LBBB in Stockholm County.

The left bundle branch block (LBBB) might be the first finding of cardiovascular diseases but also the prerequisite for cardiac resynchronization therapy (CRT) in heart failure (HF) with reduced ejection fraction (HFrEF). The prognosis for patients with LBBB and the implications of CRT in an unselected real-world setting are of great interest. A central ECG database and national registers have been screened to identify patients with LBBB. Predictors of HF and use of CRT were identified with Cox models. The hazard ratios (HR) of death, cardiovascular death (CVD) and HF hospitalization (HFH) were estimated according to CRT use. Of 5,359 patients with LBBB and QRS>150ms, median age 76 years, 36% were female. At the time of index ECG, 41% had a previous history of HF and 27% developed HF. Among 1053 patients with a class I indication for CRT, only 60% received the CRT with a median delay of 137 days and it was associated with a lower risk of death (HR: 0.45 95% CI: 0.36-0.57), CVD (HR: 0.47 95% CI: 0.35-0.63) and HFH (HR: 0.56 CI: 0.48-0.66). The age over 75 years and the diagnosis of dementia and chronic obstructive pulmonary disease were predictors of CRT non-use while having a pacing/defibrillator device independently predicted CRT use. In an unselected LBBB population, CRT is underused but of great value for HF patients. Therefore, it is crucial to find ways of better implementing and understanding CRT utilization and characteristics that influence the management of our patients.

History of heart failure in patients with acute coronary syndrome: population characterization and impact on prognosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with Heart Failure (HF) usually have multiple co-morbidities, so their approach in the context of Acute Coronary Syndrome (ACS) could be an important challenge. Purpose To characterize patients with ACS and previous HF and evaluate its impact on the therapeutic approach, complications and in-hospital mortality. Methods We studied 745 patients admitted to a Cardiac Intensive Care Unit with a diagnosis of ACS. We considered 2 groups: patients with previous HF and patients without a previous history of HF. Age, gender, personal history, clinical and electrocardiographic presentation of the ACS, treatment at admission, left ventricular ejection fraction (EFj), coronary angiography and angioplasty were recorded. The following in-hospital complications were defined: heart failure, cardiogenic shock, need for invasive mechanical ventilation (IMV), re-infarction, mechanical complications, sudden aborted death, stroke and major hemorrhage. In-hospital mortality was compared between both groups. Results Patients with previous HF constituted 7.1% (53 patients) of the population studied. These were older (77.3 ± 8.9 vs 66.6 ± 13.6, p&amp;lt;0.001), a higher prevalence of arterial hypertension (88.7% vs 76.2%; p=0.03), of myocardial infarction (50.9% vs 24.3%, p&amp;lt;0.001), coronary artery bypass graft surgery (18.9% vs 5.2%, p&amp;lt;0.001), valvular disease 22.6% vs 1, 4%, p&amp;lt;0.001), peripheral arterial disease 22.6% vs 5.1%, p&amp;lt;0.001), chronic renal failure (41.5% vs 10.1%, p&amp;lt;0.001), chronic lung disease 22.6% vs 4.2%, p&amp;lt;0.001 and hemorrhage (9.6% vs 1.8%, p&amp;lt;0.001). Patients with HF presented more frequently with AMI without ST elevation (62.3% vs 45.7%; p&amp;lt;0.001) and infarction of undetermined location (26.4% vs 4.6%, p=0 .02) and Killip-Kimbal class ≥ 2 (64.2% vs 16.8%, p&amp;lt;0.001) and less with ST-elevation AMI (5.7% vs 42.5%, p&amp;lt;0.001) and pain (58.5% vs 87.7%, p&amp;lt;0.001). On admission, patients with previous HF underwent fewer coronary angiograms (56.6% vs 86.7%, p&amp;lt;0.001) and via the radial approach (53.6% vs 79.0%, p=0.001)5.7%, p&amp;lt;0.001), and less angioplasties (32.1% vs 68.7%, p&amp;lt;0.001). The presence of HF was associated with lower EFj (40.9 ± 10.4% vs 48.2 ± 9.9%, p=0.004), with greater development of HF during hospitalization (47.2% vs 12, 4%, p&amp;lt;0.001), greater need for non-invasive ventilation (17.0% vs 2.2%, p&amp;lt;0.001) and higher in-hospital mortality (13.7% vs 4.8%, p=0.008). Conclusion The previous presence of HF seems to condition the clinical and electrocardiographic presentation of the ACS and is associated with greater development of HF and in-hospital mortality.

Predictors of in-hospital mortality in infectious endocarditis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Infectious endocarditis has a high rate of in-hospital complications and mortality, ranging between 15 and 30%. Still, there is a paucity of studies on the assessment of short-term prognosis in these patients. Purpose To determine predictors of in-hospital mortality in patients with infective endocarditis. Methods This was a retrospective study that included all patients hospitalized in a single centre with the diagnosis of infective endocarditis, between 2000 and 2020. The relationship between clinical, laboratory and echocardiographic variables and in-hospital mortality was evaluated. Results A total of 161 patients were selected, 65.8% were males, with a mean age of 66.4±16.4 years. The in-hospital mortality rate was 16.8%, occurring on average after 35.0±17.5 days of hospitalization. The average length of stay was 44.5±22.8 days. Age &amp;gt;70 years was associated with higher mortality rate (p=0.021). There were no other significant differences between groups regarding clinical variables and comorbidities. Although not statistically significant, in-hospital mortality group had higher mean ejection fraction (57.2±2.7% vs. 54.6±12.9%). Laboratory parameters associated with mortality included isolation of Staphylococcus (p=0.019) or Enterococcus (p=0.045) in blood cultures. Though the classification of endocarditis (in native vs. prosthesis valve) did not differ between groups, the presence of perivalvular complications on echocardiography (p= 0.042) namely pseudoaneurysm (p=0.003), were more frequent in the group with higher mortality rate. There were 70 patients with indication for urgent surgery, namely for locally uncontrolled infection in 29.2%, heart failure (20.0%) and prevention of embolic events (18.1%). The existence of urgent surgical indication (p=0.009) was associated with higher mortality, and surgery during hospitalization was associated with lower mortality (p=0.011). In a multivariate regression analysis, after adjusting for all the possible confounders, the independent predictors of in-hospital mortality were the previous history of heart failure (HR = 3.29, 95%CI 1.41-7.66), chronic liver disease (HR = 4.33, 95%CI 1.23-15.30) and evolution with septic shock (HR = 6.87, 95%CI 2.89-16.39). Conclusions The present study confirms the high mortality rate of patients with infective endocarditis, highlighting the importance of patient baseline characteristics and comorbidities, as it identified as independent predictors of in-hospital mortality the previous history of heart failure, chronic liver disease and evolution with septic shock.

Surgery versus medical therapy in patients with infective endocarditis and surgical indication: a retrospective study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Infective endocarditis is a condition associated with poor outcomes. Even though we have guidelines that establish which patients could benefit from surgery, the decision to perform it is not straightforward and there are many factors to be considered before we decide surgical approach. Purpose To establish the impact of surgery versus medical treatment in patients with surgical indication according to the ESC guidelines, in our population. The primary outcome was a composite of death, embolic events, and recurrence of infective endocarditis. Methods We performed a retrospective study of the patients admitted to our center between 2000 and 2020, with the diagnosis of infective endocarditis. After selecting the patients with surgical indication, according to ESC guidelines, we divided them in two groups: group A (submitted to surgery) and group B (medical therapy only). Results A total of 70 patients (65.7% males, 34.3% females, mean age 68.5 ± 15.2) were included. Of these 51.4% were submitted to surgery and 48.6 % received only medical therapy. The group A patients were significantly younger (mean age 63.03 ± 16.03 versus 75.52 ± 10.40, p&amp;lt;0.001). There were no statistically significant differences in terms of previous history of heart failure (p=0.09), valvular heart disease (p=0.83), ischemic heart disease (p=0.47), diabetes (p=0.50), obesity (p=0.17), chronic kidney disease (p=0.68). In terms of local complications, group A had a higher prevalence of severe valvular regurgitation (72.2% vs 36.4%, p= 0.003), with no statistically significant differences in abscess, aneurysm, fistula. During a mean follow-up of 28.66 ± 39.07 months, 42 pts (60%) experienced the composite endpoint. Group A had significantly better outcomes compared to group B (47.2% versus 26.5%, p= 0.016). In a multivariate regression analysis, after adjusting for all the possible confounders, including age, not performing surgery was an independent predictor of the composite endpoint (HR 2.23 95% CI: 1.16-4.55, p=0.02). Conclusion In patients with surgical indication, surgery was associated with a significant improvement in prognosis. In our population, older patients were more likely to receive medical therapy. However, surgery was associated with better outcomes, independently of age, which suggests that this shouldn’t be the only factor that determines whether surgery is performed or not.

Effects of glucagon-like peptide-1 receptor agonists on patients with heart failure: a meta-analysis of randomized controlled trials.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce the risk of major adverse cardiovascular events (MACE) and heart failure in patients with type 2 diabetes mellitus (T2DM). However, these outcomes are not similarly demonstrated in those with prior heart failure in subgroup analyses of several randomized controlled trials (RCTs). We evaluated the effect of GLP-1RAs on MACE and heart failure admissions for T2DM patients with a previous history of heart failure. We searched PubMed and EMBASE through March 2022 to identify RCTs examining the effects of GLP-1RAs compared with placebo on MACE and heart failure admission in T2DM patients with a history of heart failure. MACE were mainly defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. We performed a meta-analysis with a random-effects model. Our analysis included subgroup analyses of 7 RCTs enrolling a total of 8,965 patients with T2DM and heart failure. Pooled analysis demonstrated a significantly decreased MACE (hazard ratio, 0.88; 95% confidence interval, 0.78-0.99; P = 0.039; I2 = 18.1%) in the GLP-1RAs group. In contrast, the rate of heart failure admission was not significantly different between the two groups (hazard ratio, 1.03; 95% confidence interval, 0.91-1.16; P = 0.67; I2 = 0.0%). GLP-1RAs significantly reduced MACE in T2DM patients with prior heart failure compared with the placebo group but did not affect the risk of heart failure admission.

Practical role of preoperative echocardiography in low-risk non-cardiac surgery.

Due to increased needs to reduce non-fatal as well as fatal cardiac events, preoperative echocardiography remains part of routine clinical practice in many hospitals. Data on the role of preoperative echocardiography in low-risk non-cardiac surgery (NCS) other than ambulatory surgeries do not exist. We aimed to investigate the role of preoperative echocardiography in predicting postoperative adverse cardiovascular events (CVEs) in asymptomatic patients undergoing low-risk NCS. The study population was derived from a retrospective cohort of 1,264 patients who underwent elective low-risk surgery at three tertiary hospitals from June 1, 2021, to June 30, 2021. Breast, distal bone, thyroid, and transurethral surgeries were included. Preoperative examination data including electrocardiography, chest radiography, and echocardiography were collected. The primary outcome was a composite of postoperative adverse CVEs including all-cause death, myocardial infarction, cerebrovascular events, newly diagnosed or acutely decompensated heart failure (HF), lethal arrhythmia such as sustained ventricular tachycardia/fibrillation, and new-onset atrial fibrillation within 30 days after the index surgery. Preoperative echocardiography was performed in 503 patients (39.8%), most frequently in patients with breast surgery (73.5%), followed by transurethral (37.7%), distal bone (21.6%), and thyroid surgeries (11.9%). Abnormal findings were observed in 5.0% of patients with preoperative echocardiography. Postoperative adverse CVEs occurred in 10 (0.79%) patients. Although a history of previous HF was an independent predictor of postoperative CVE occurrence (adjusted odds ratio, aOR: 17.98; 95% confidence interval, CI: 1.21-266.71, P = 0.036), preoperative echocardiography did not significantly predict CVE in multivariate analysis (P = 0.097). However, in patients who underwent preoperative echocardiography, the presence of abnormal echocardiographic findings was independently associated with development of CVE after NCS (aOR: 23.93; 95% CI: 1.2.28-250.76, P = 0.008). In particular, the presence of wall motion abnormality was a strong predictor of postoperative adverse CVE. In real-world clinical practice, preoperative echocardiography was performed in substantial number of patients with potential cardiac risk even in low-risk NCS, and abnormal findings were independently associated with postoperative CVE. Future studies should identify patients undergoing low-risk NCS for whom preoperative echocardiography would be helpful to predict adverse CVE.

Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions.

Left ventricular ejection fraction (EF) is an independent predictor of adverse outcomes after myocardial infarction (MI). However, current data on trajectories and determinants of EF are scarce. The present study aimed to describe the epidemiology of EF after MI. Data from a single-center prospectively-designed registry of consecutive patients hospitalized at a large tertiary cardiology center were utilized. Out of 1,593 patients in the registry, 1,065 were hospitalized for MI type I (65.4% STEMI) and had no previous history of heart failure or MI. At discharge, EF < 40% was present in 238 (22.3%), EF 40-50% in 326 (30.6%) and EF > 50% in 501 (47.0%). Patients with EF < 40% were often those who suffered subacute and anterior STEMI, had higher heart rate at admission and higher maximal troponin level, and had more often HF signs requiring intravenous diuretics. Among subjects with EF < 40%, the follow-up EF was available in 166 (80% of eligible). Systolic function recovered to EF > 50% in 39 (23.1%), slightly improved to EF 40-50% in 44 (26.0%) and remained below 40% in 86 (50.9%). Systolic function improvement to EF > 40% was predicted by lower severity of coronary atherosclerosis, lower leukocyte count, and the absence of atrial fibrillation. Despite recent improvements in in-hospital MI care, one in five patients has systolic dysfunction at hospital discharge. Out of these, EF improves in 51%, and full recovery is observed in 23%. The severity of coronary atherosclerosis, inflammatory response to MI, and atrial fibrillation may affect EF recovery.

Abstract 10770: Effects of Glucagon-Like Peptide-1 Receptor Agonists on Patients With or Without Heart Failure: A Meta-Analysis of Randomized Control Trials

Background: Glucagon-like peptide-1 receptor agonists (GLP -1RAs) reduce the risk of a major adverse cardiovascular event (MACE) and heart failure (HF) in patients with type 2 diabetes mellitus (T2DM). However, these outcomes are not similarly demonstrated in those with HF in subgroup analyses of several randomized controlled trials (RCTs). We evaluated the effect of GLP-1RAs on MACE and HF admissions for T2DM patients with the previous history of HF. Methods: We searched PubMed and EMBASE through March 2022 to identify RCTs examining the effects of GLP-1RAs compared to placebo on MACE and HF admission in T2DM patients with a history of HF. MACE was mainly defined as a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke. We performed a meta-analysis with random effects model. Results: Our analysis included subgroup analyses of 7 RCTs enrolling a total of 8,965 patients with T2DM and history of HF. Pooled analysis demonstrated a significant decreased MACE (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.78-0.99; P = 0.039; I2 = 18.1%) in the GLP-1RAs group (Figure 1A). In contrast, the rate of HF admission was not significantly different between the both groups (HR, 1.03; 95% CI, 0.91-1.16; P = 0.67; I2 = 0.0%) (Figure 1B). Conclusions: GLP-1RAs significantly reduced MACE in patients with HF and T2DM compared to the placebo group but did not affect the risk of HF admission in both groups.

Trajectories and determinants of left ventricular ejection fraction after first myocardial infarction in current era of primary coronary interventions

Abstract Background Left ventricular ejection fraction (EF) is an independent predictor of adverse outcomes after myocardial infarction (MI). However, contemporary data from the PCI era of MI therapy on trajectories and determinants of EF are scarce. Purpose The present study aimed to describe the epidemiology of systolic dysfunction and EF recovery among consecutive patients hospitalized for their first MI. Methods Data from a single-centre prospectively-designed AMBITION registry of consecutive patients hospitalized for MI between years 2017 and 2021 at a large tertiary cardiology centre were utilized. Results Out of 1593 patients in the registry, 1065 were hospitalized for MI type I and had no previous history of heart failure (HF) or coronary artery disease. Revascularisation was performed in 93.5% of patients: 901 (84.6%) underwent PCI, 89 (8.4%) CABG and 6 (0.6%) both. At discharge, EF&amp;lt;40% was present in 238 (22.3%), EF 40–50% in 326 (30.6%) and EF &amp;gt;50% in 501 (47.0%), respectively. Patients with EF&amp;lt;40% were more often those who suffered subacute and anterior STEMI, had higher heart rate at admission and higher maximal troponin level, and more often HF signs requiring intravenous diuretic therapy (Table 1). In the multivariate Cox analysis, EF&amp;lt;40%, together with age, glomerular filtration rate, glycemia level, clinical signs of HF, and atrial fibrillation were associated with increased mortality risk. Among subjects with EF&amp;lt;40%, the control follow-up EF determined on a median 153 days (IQR 101–407) after discharge was available in 166 patients. Among these, systolic function recovered to EF&amp;gt;50% in 38 (22.9%) and improved to EF 40–50% in 45 (27.1%). Improvement in systolic function to EF&amp;gt;40% was predicted by lower severity of coronary artery atherosclerosis (GENSINI score), by higher discharge EF, by the lower leukocyte count, the absence of atrial fibrillation during MI hospitalization and glycemia level (Table 2). Recovery of systolic function was associated with lower mortality risk (log-rank p=0.012). Conclusion In the current era of primary coronary intervention, only 22% of patients after the first MI have EF below 40%. Of them, EF improves in 50%, and full recovery is observed in 23% of patients. Severity or coronary atherosclerosis, inflammatory response to MI, atrial fibrillation and glucose metabolism may all affect EF recovery. These observations provide novel therapeutic targets for EF recovery. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health, Czech Republic

Utility of the Age Shock Index in 27312 patients with an acute coronary syndrome

Abstract Introduction The Shock Index (SI), defined as the ratio of heart rate (HR) to systolic blood pressure (SBP), represents a bedside reflection of the integrated response from the cardiovascular and autonomic systems and has been reported to predict adverse prognosis in patients with acute coronary syndromes (ACS). Age Shock Index (ASI), the product of SI multiplied with age, could also be useful in this setting, but its prognostic value is yet to be determined in ACS patients. Methods Acute myocardial infarction patients included in a national registry between October 2010 and January 2022. Optimal shock index cutoff was determined according to ROC curve analysis. Patients were categorized into two groups based on their initial ASI. Baseline characteristics, management and outcomes were compared between the two groups. The primary outcome was in-hospital cardiovascular death. Results A total of 27312 patients were included with a mean age of 66±13 years, 72.3% male, 47.5% with ST-elevation myocardial infarction. Based on ROC analysis, which showed AUC=0.80, the optimal ASI cutoff was 44 (with a sensitivity of 73% and a specificity of 74%); 19997 patients (73.2%) had an ASI &amp;lt;44 and 26.8% had an ASI ≥44. The former group was older (mean age of 75±10.0 vs 63±13.0 years, p&amp;lt;0.001), and had more comorbidities: arterial hypertension (77.3% vs 66.3%, p&amp;lt;0.001), diabetes mellitus (39.8% vs 28.1%, p&amp;lt;0.001), peripheral artery disease (7.1% vs 4.4%, p&amp;lt;0.001) and previous history of heart failure (11.0% vs 4.3%, p&amp;lt;0.001). Patients with ASI ≥44 had higher Killip class at admission and worse left ventricular ejection fraction on discharge (46.0±13.0 vs 53.0±11.0, p&amp;lt;0.001). In a multivariate regression analysis, after adjusting for possible confounders, ASI ≥44 was an independent predictor of cardiovascular death (HR 3.09, 95% CI: 2.56–3.71, p&amp;lt;0.001). ASI was a significantly better predictor of cardiovascular death than Shock Index (AUCASI = 0,80 vs AUCSI = 0.72, p&amp;lt;0,0001), but not in comparison to GRACE score (AUCASI=0.80 vs AUCGRACE=0.85, p&amp;lt;0.001) and TIMI (score AUCASI=0.80 vs AUCGRACE=0.84, p&amp;lt;0.001). At one year, using a Kaplan Meyer survival analysis, mortality was higher in patients with ASI ≥44 (log rank p&amp;lt;0.001) Conclusion ASI can identify almost immediately ACS patients at high risk of cardiovascular death, and combined with its simple use, makes it a practical tool for early risk stratification in these patients. Funding Acknowledgement Type of funding sources: None.

Post-COVID-19 cardiovascular complications and their association with clinical characteristics, symptoms and comorbidities – the LATE-COVID study

Abstract Background Among many complications of coronavirus disease 2019 (COVID-19) there is a wide range of cardiovascular (CV) problems ranging from mild to severe ones. Even asymptomatic patients and those with mild course of COVID-19 may develop severe CV complications. Factors leading to such state have not been extensively studied so far. Purpose We aimed to assess which factors were linked to the severe complications of COVID-19. Methods We included 200 consecutive patients admitted to the Department of Cardiology and Adult Congenital Heart Diseases of the Polish Mother's Memorial Research Institute (PMMHRI) due to post-Covid cardiovascular complications. SARS-CoV2 infection was confirmed with real-life PCR testing. Laboratory tests, 24-hour ECG monitoring and echocardiography were performed in all patients from the investigated group. For the purposes of our study severe complications were defined as: myocarditis, a decrease of ejection fraction &amp;gt;10% from the pre-disease value, thromboembolic complications, angina pectoris requiring myocardial revascularization and the new onset of atrial fibrillation of supraventricular tachycardia. Some patients presented more than one of the above. Statistical analysis was performed using the software Statistica v.13 (TIBCO Software Inc., Palo Alto, CA, USA). Data were presented as mean ±SD or median (25th-75th percentile) for continuous variables and as proportions for categorical variables. Comparisons between groups were performed using Student's t-test for independent variables and the Mann-Whitney U test or χ2 test with Yates's correction, as appropriate. For all calculations p-values &amp;lt;0.05 were considered statistically significant. Results Finally, we included 200 consecutive patients (aged 54±16 years, 76 males – 38%), hospitalized for COVID-19 complications after a median 3 (2–6) months following the acute phase of infection. On admission patients presented with dyspnea (23%), impairment of exercise tolerance (47%), chest pain (32%), increase in blood pressure (29%), palpitations (25%), weight loss (13%), brain fog (6%), general malaise (11%), headache (5%), limb pain (13%), swelling (14%). Severe complications of COVID-19 were diagnosed in 31 patients (16%).Taking into consideration symptoms, the presence of severe COVID-19 complications was significantly associated with dyspnoea and deterioration of exercise tolerance. In comparison to patients with mild complications, severe ones were linked to age (the older patients, the higher risk), previous history of heart failure and diabetes mellitus. We did not observe statistically significant differences in severity of complications depending on smoking status (Tables 1 and 2). Conclusions Previous history of heart failure and diabetes mellitus as well as symptoms (dyspnoea and deterioration of exercise tolerance) along with older age are related to more severe complications following COVID-19. Funding Acknowledgement Type of funding sources: None.

Survivors of Sudden Cardiac ArrestPresenting With Pulseless ElectricalActivity: Clinical Substrate, Triggers, Long-Term Prognosis.

The proportion of sudden cardiac arrest (SCA) presenting as pulseless electrical activity (PEA) is rising, and survival remains low. The pathophysiology of PEA-SCA is poorly understood, and current clinical practice lacks specific options for the management of survivors. In this study, the authors sought to investigate clinical profile, triggers, and long-term prognosis in survivors of SCA presenting with PEA. The community-based Oregon SUDS (Sudden Unexpected Death Study) (since 2002) and Ventura PRESTO (Prediction of Sudden Death in Multi-ethnic Communities) (since 2015) studies prospectively ascertain all out-of-hospital SCAs of likely cardiac etiology. Lifetime clinical history and detailed evaluation of SCA events is available. We evaluated all SCA survivors with PEA as the presenting rhythm. The study population included 201 PEA-SCA survivors. Of these, 97 could be contacted for access to their clinical records. Among the latter, the mean age was 67 ± 17 years and 58 (60%) were male. After in-hospital examinations, 29 events (30%) were associated with acute myocardial infarction, and 5 (5%) had bradyarrhythmias. Among the remaining 63 patients (65%), specific triggers remained undetermined, although 31 (49%) had a previous history of heart failure. Of the 201 overall survivors, 91 (45%) were deceased after a mean follow-up of 4.2 ± 4.0 years. Survivors under the age of 40 years had an excellent long-term prognosis. Survivors of PEA-SCA are a heterogeneous group with high prevalence of multiple comorbidities, especially heart failure. Surprisingly good long-term survival was observed in young individuals. Acute myocardial infarction as the precipitating event was common, but triggers remained undetermined in the majority. Provision of individualized care to PEA survivors requires a renewed investigative focus on PEA-SCA.

Predictors of Subsequent Heart Failure After Left Atrial Appendage Closure.

Left atrial appendage occlusion (LAAO) plays an important role in preventing stroke in patients with atrial fibrillation. However, LAAO may interact unfavorably with left atrial (LA) compliance and reservoir function and thus increase the risk of heart failure (HF). The purpose of this study was to identify predictors of subsequent HF after successful LAAO. A total of 98 patients (mean age 70±9 years, 68% male) who had undergone LAAO were included. The primary endpoint was unexpected HF admission after LAAO. During a mean period of 36±26 months, 16 of the 98 patients (16%) experienced hospital HF admission. In multivariate analysis, higher E/e' (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.02-1.20, P=0.014), higher left ventricular mass index (HR 1.02, 95% CI 1.00-1.03, P=0.023), history of HF (HR 4.78, 95% CI 1.55-14.7, P=0.006), and lower LA strain (HR 0.80, 95% CI 0.70-0.93, P=0.003) were independently associated with hospital HF admission. Patients with LAAO had a significantly higher incidence of subsequent HF than the control group after propensity score matching (P=0.046). LAAO increases the occurrence of HF, and it is not uncommon after successful LAAO. A previous history of HF, left ventricular mass index, E/e', and abnormal LA strain are independently associated with the development of HF. These parameters should be considered before attempting LAAO.

Inflammation in acute coronary syndrome: prognostic significance

Abstract Funding Acknowledgements Type of funding sources: None. Background In patients with acute coronary syndrome (ACS) the acute phase reactant, C-reactive protein (CRP), might be significantly elevated. Several reports suggest that CRP may play a direct pathophysiological role on the development and progression of atherosclerosis, and CRP values correlate with infarct size when measured by magnetic resonance imaging. Purpose The aim of the present study was to evaluate the prognostic value of CRP in patients presenting with an ACS. Methods Retrospective analysis of 635 consecutively admitted patients due to ACS in a single coronary intensive care unit. CRP levels were measured at admission. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether CRP was an independent predictor of outcome. Results In the studied sample, 75% were male. Median age was 69 [interquartile range (IQR) 57–78]. ST-elevation myocardial infarction (STEMI) occurred in 39.6%, non-ST segment elevation myocardial infarction in 44.9% and unstable angina in 15.5% of the patients. Median left ventricular ejection fraction (LVEF) was 48% (IQR 40–55%) and median CRP level at admission 0.7 mg/dL (IQR 0.5–1.9 mg/dL). Regarding important comorbidities and past medical history, 75.9% had hypertension (HTN), 34.0% diabetes, 20.3% chronic kidney disease (CKD), 68.6% dyslipidaemia and 17.3% heart failure (HF). The median follow-up was 34 months (IQR 22–72). In univariate analysis, CRP was significantly associated with all-cause mortality (HR 1.06 per 1 mg/dL increase, 95% CI 1.04–1.08, p&amp;lt;0.001), as was gender, age, LVEF, STEMI and previous history of diabetes, HTN, CKD or HF. In multivariate analysis, CRP remained significantly associated with the primary endpoint (HR 1.02, 95% CI 1.00–1.05, p=0.033), as did age, LVEF and previous history of HF. Conclusions In our study, CRP at admission was an independent risk factor for all-cause mortality following an ACS. This finding indicates that inflammation associated with the acute event has a significant impact in the long-term prognosis. More evidence is needed to determine if treating inflammation (and when, in the course of the disease) could result in better outcomes.