Heart Failure Admission Rates Research Articles

NT-pro-BNP pre TAVI and relationship with long-term outcomes

Abstract Background Blood levels of NT-proBNP correlates with aortic valve stenosis and has been suggested as a future target for intervention or selection of patients for aortic valve replacement. Purpose To examine how levels of NT-proBNP pre-TAVI relates to risk of one-year rates of heart failure admission and mortality in patients undergoing TAVI. Methods With Danish nationwide registries, we identified all patients undergoing TAVI from 2014–2021 who had available pre-TAVI NT-pro-BNP measured up to one year prior to TAVI. According to NT-proBNP blood samples, patients were classified according to quartiles of pre-TAVI NT-proBNP levels. The quartiles were then converted into two final groups: Q1-3 including patients with NT-proBNP< 420 pmol/L and Q4 including patients with a NT-proBNP ≥ 420 pmol/L. Groups were compared using cumulative incidence curves of post-TAVI heart failure admissions and Kaplan-Meier estimates to assess comparative all-cause mortality. Adjusted rates of outcomes were assessed, using multivariable Cox analysis, with patients with NT-proBNP< 420 pmol/L serving as reference. Results We identified 1,140 patients undergoing a first-time TAVI procedure (53.1% male, median age 81 year) with an availabel NT-pro-BNP (19.5% of the national chohort of TAVI patients). Of these, 846 (74.21%) patients had a NT-proBNP < 420 pmol/L (55.0% male, median age 81 year) and 294 (25.79%) patients with NT-proBNP ≥ 420 pmol/L (53.1% male, median age 82 year). The one-year cumulative incidence of heart failure was 9.1% and 23.1% for patients with a NT-proBNP <420 pmol/L and ≥ 420 pmol/L, respectively (p<0.001) (Figure 1). This corresponded to an adjusted hazard ratio of 1.91 (95% CI: 1.33–2.74). The one-year cumulative incidence of all-cause mortality was 6.0% and 14.6% for patients with a NT-proBNP <420 pmol/L and ≥ 420 pmol/L, respectively (p<0.001) (Figure 1). This corresponded to an adjusted hazard ratio of 1.85 (95% CI: 1.17-2.92). Conclusion In patients undergoing TAVI, a baseline NT-proBNP ≥ 420 pmol/L was associated with increased one-year rates of heart failure admissions and mortality post-TAVI. The results suggest that NT-proBNP is associated with adverse outcomes on the long-term and that this could be a target for intervention.Figure 1:HF admission and mortality

Mortality and heart failure in patients with a history of atrial fibrillation undergoing mitral valve surgery

Abstract Background A history of atrial fibrillation (AF) is frequently seen in patients with mitral regurgitation. However, the impact of AF on heart failure (HF) and mortality following mitral valve repair/replacement for mitral regurgitation remains unclear. Purpose To examine the long-term risk of HF admission and mortality in patients undergoing mitral valve repair/replacement with or without AF. Methods We included adult patients undergoing mitral valve repair/replace for mitral regurgitation in Denmark (2000-2018). Patients were categorized according to a history of AF. We examined the cumulative incidences of HF admission and all-cause mortality with a maximum of three years of follow-up. Here we used Kaplan-Meier and Cumulative Incidence Function curves accounting for competing risk of death. Likewise, groups were compared using Cox proportional hazards in adjusted analyses. Results We included 4480 patients where 1685 (37.6%) patients had a history of AF (median age: 70, 66.1% males) and 2795 (62.4%) patients had no history of AF (median age: 64, 67.6% males). Patients with a history of AF had a higher proportion of chronic HF (42.0% vs 23.5%), ischaemic heart disease (37.4% vs 29.4%), and stroke (7.7% vs. 4.3%) at baseline. Patients with a history of AF before surgery admission were less likely to undergo mitral valve repair (65% vs. 72%). The cumulative three-year incidence of HF-admission was 23.7% in patients with a history of AF and 14.6% in patients without a history of AF (Figure A). Adjusted analysis found a statistically significant increased rate of HF admissions (HR=1.19 [95% CI 1.02-1.39]). The cumulative three-year incidence of mortality was 13.8% in patients with a history of AF, and 8.2% in patients without a history AF (Figure B). Adjusted analysis yielded no statistically significant difference in the associated rate of mortality (HR=1.16 [95% CI 0.95-1.43]). Factors associated with both increased HF admission and mortality were among others age, myocardial infarction, and known chronic HF. Conclusion One in three patients had a history of atrial fibrillation, and these patients were associated with an increased rate of both heart failure admission and mortality, but following adjustments the association was only statistically significant for heart failure admission.Cumulative incidence of HF-admissionCumulative incidence of mortality

Impact of first-time detected atrial fibrillation after transcatheter aortic valve replacement: A nationwide study

BackgroundThe prognostic implications of new-onset atrial fibrillation (AF) in conjunction with transcatheter aortic valve replacement (TAVR) is sparsely examined. Therefore, we aimed to examine the impact of first-time detected AF after TAVR on all-cause mortality and heart failure (HF). MethodsWith Danish nationwide data from 2008 to 2021, we identified all patients who underwent TAVR and were alive 30 days after discharge (index date). Patients were categorized into i) no AF; ii) history of AF; and iii) first-time detected AF within 30 days after discharge. From the index date, two-year rates of all-cause mortality and HF admissions were compared using multivariable adjusted Cox analysis. ResultsWe identified 6,807 patients surviving 30 days beyond TAVR: 4,229 (62.1%) without AF (55% male, median age 81), 2,283 (33.6%) with history of AF (58% male, median age 82), and 291 (4.3%) with first-time detected AF (56% male, median age 81). Compared with patients without AF, adjusted analysis yielded increased associated hazard ratio (HR) of all-cause mortality in patients with history of AF (1.53 [95% confidence interval [CI], 1.32–1.77]) and in patients with first-time detected AF (2.06 (95%CI, 1.55–2.73]). Further, we observed increased associated HRs of HF admissions in patients with history of AF (1.70 [95%CI, 1.45–1.99]) and in patients with first-time detected AF (1.77 [95%CI, 1.25–2.50]). ConclusionIn TAVR patients surviving 30 days beyond discharge, first-time detected AF appeared to be at least as strongly associated with two-year rates of all-cause mortality and HF admissions, as compared with patients with history of AF.

The State of Heart Failure Care in Canada: Minimal Improvement in Readmissions Over Time Despite an Increased Number of Evidence-Based Therapies

BackgroundAn unanswered question is whether the combination of advances in medical and device therapy over the past decade has translated into improved outcomes for patients with heart failure (HF) in Canada. MethodsThe Canadian Institute for Health Information (CIHI) Hospital Morbidity Database was used to identify hospitalizations for HF among patients aged 18 years and older in Canadian hospitals during fiscal years 2009/2010 and 2018/2019. We assessed interprovincial differences in age, sex, length of stay (LOS), discharge disposition, type of admitting hospital, and most responsible service, for all HF admissions. National and provincial rates of HF admissions and all-cause 30-day readmissions were calculated. ResultsAfter adjusting for age, the rate of HF admissions in Canada was 216 per 100,000 population in 2009/2010 and 2018/2019. The majority of patients with HF were admitted to general internal medicine and community hospitals in both 2009/2010 and 2018/2019. The national, crude, all-cause 30-day readmission rate stayed constant at 20.6%, and the majority of patients were readmitted with the diagnosis of HF in both 2009/2010 (62.5%) and 2018/2019 (59.0%). Median and interquartile range of HF LOS also remained unchanged at 7 days (3-14). ConclusionsThe national rate of HF admissions, 30-day readmissions, and HF LOS have remained unchanged from 2009/2010 to 2018/2019, despite advances in medical and device therapy during this timeframe.

Outcomes Associated with Early Post-Heart Transplant Restrictive Hemodynamics

<h3>Purpose</h3> The implications of the development of restrictive hemodynamics (RH) in the absence of overt graft dysfunction post heart transplantation (OHT) are unclear. We sought to determine the incidence of patients with post-OHT RH profiles and the respective clinical outcomes associated with this pathophysiologic state. <h3>Methods</h3> We retrospectively analyzed 164 (2008-2020) patients who underwent OHT at our institution. Hemodynamics were obtained during scheduled endomyocardial biopsies. Right atrial pressure ≥ 12, pulmonary capillary wedge pressure > 15, and cardiac index > 2.2 L/min/m2 in the absence of graft dysfunction by echocardiography and without evidence of rejection met criteria for a RH profile. We sought to identify if RH profiles persisted at 12 months in addition to rate of heart failure admissions, change in renal function (glomerular filtration rate, GFR), and calcineurin inhibitor protocol deviation (decreases in dosing) compared to controls who did not have primary graft dysfunction or abnormal hemodynamics. <h3>Results</h3> Of 164 patients, 39 had RH profiles at week 4. There was an increased risk of heart failure admissions in those with RH profiles (incident rate ratio 1.81, 95% CI 1.78-1.85, P<0.001) (Panel A). The weekly diuretic dose at 9 months in the RH group was 308 mg/week compared to 127 mg/week in controls (P=0.005) (Panel B). Lower GFR was observed in those with RH at 4 weeks compared to controls, though no significant decline in GFR was observed longitudinally (Panel C). Calcineurin inhibitor protocol deviation occurred in 15 of 39 patients with RH and in 23 of 125 patients without RH (P=0.02). RH persisted at one year in 25.6% of patients (10/39). <h3>Conclusion</h3> Post-OHT patients who develop a RH profile are more likely to experience heart failure hospitalizations, decreases in calcineurin-inhibitor dosing, and have higher loop diuretic doses. The majority tend to normalize their hemodynamic profile at 1 year. Further studies are required to elucidate what factors contribute to the development of this phenotype.

Reducing Heart Failure Hospitalizations Through Enhancement Of Multidisciplinary Roles And Targeted Patient Oversight

Reducing Heart Failure Hospitalizations Through Enhancement Of Multidisciplinary Roles And Targeted Patient Oversight

Benefits of a comprehensive care model in patients with heart failure and preserved ejection fraction: The UMIPIC program

BackgroundPatients with heart failure (HF) and preserved ejection fraction (HFpEF), in contrast to those with reduced ejection fraction, are older, have more comorbidities, and are not candidates for effective therapeutic measures. Therefore, they are at high risk for hospital admission and mortality. This study evaluated the benefit of a comprehensive continuous care program (UMIPIC program) in patients with HFpEF. MethodsWe prospectively analyzed data on 2401 patients with HFpEF attended to in internal medicine departments who form part of the RICA registry. They were divided into 2 groups: one was followed-up on in the UMIPIC program (UMIPIC group, n: 1011) and another received conventional care (RICA group, n: 1390). A total of 753 patients in each group were selected by propensity score matching and admissions and mortality were assessed during 12 months of follow-up after an episode of hospitalization due to HF. ResultsCompared to the RICA group, the UMIPIC group had a lower rate of HF admissions (19.2% versus 36.5%, respectively; hazard ratio [HR] = 0.56; 95% confidence interval [CI]: 0.45–0.68; p < 0.001) and mortality (12.6% versus 28%, respectively; HR = 0.40; 95% CI: 0.31−0.51; p < 0.001). There were no differences in hospitalizations for non-HF causes. ConclusionsImplementation of the UMIPIC program, which is based on comprehensive continuous care, for patients with HFpEF and a high degree of comorbidity reduces both admissions and mortality in the first year of follow-up.

Beneficios de un modelo asistencial integral en pacientes con insuficiencia cardíaca y fracción de eyección preservada: Programa UMIPIC

BackgroundPatients with heart failure (HF) and preserved ejection fraction (HFpEF), in contrast to those with reduced ejection fraction, are older, have more comorbidities, and are not candidates for effective therapeutic measures. Therefore, they are at high risk for hospital admission and mortality. This study evaluated the benefit of a comprehensive continuous care program (UMIPIC program) in patients with HFpEF. MethodsWe prospectively analyzed data on 2,401 patients with HFpEF attended to in internal medicine departments who form part of the RICA registry. They were divided into 2 groups: one was followed-up on in the UMIPIC program (UMIPIC group, n: 1,011) and another received conventional care (RICA group, n: 1,390). A total of 753 patients in each group were selected by propensity score matching and admissions and mortality were assessed during 12 months of follow-up after an episode of hospitalization due to HF. ResultsCompared to the RICA group, the UMIPIC group had a lower rate of HF admissions (19.2% versus 36.5%, respectively; hazard ratio [HR]=0.56; 95% confidence interval [CI]: 0.45-0.68; p<.001) and mortality (12.6% versus 28%, respectively; HR=0.40; 95% CI: 0.31-0.51; p<.001). There were no differences in hospitalizations for non-HF causes. ConclusionsImplementation of the UMIPIC program, which is based on comprehensive continuous care, for patients with HFpEF and a high degree of comorbidity reduces both admissions and mortality in the first year of follow-up.

POS-282 ASSOCIATION BETWEEN PRIMARY CARE CODING OF CHRONIC KIDNEY DISEASE (CKD) AND SUBSEQUENT HOSPITALISATIONS AND DEATH: A COHORT ANALYSIS USING NATIONAL AUDIT DATA

In UK primary care, there are payment incentives to test for chronic kidney disease (CKD) and to add CKD-specific diagnosis codes to the electronic patient health record to establish a register of stage 3-5 CKD patients. The National Chronic Kidney Disease Audit (NCKDA) in England and Wales found that not all patients with biochemical evidence of CKD stages 3-5 were coded; those who were not coded had less cardiovascular preventative care than those who were coded. Practice-level coding is less likely to be influenced by individual patient characteristics and is therefore potentially less confounded than analyses using patient-specific coding decisions. We investigated the association between practice-level coding of CKD and individual adverse outcomes to quantify the effects of coding in patients with CKD. We conducted a retrospective cohort study linking NCKDA primary care records with Hospital Episode Statistics (HES) admissions and Office for National Statistics (ONS) mortality data in England. Patients with confirmed CKD (2 x estimated glomerular filtration rate < 60 ml/min/1.73m2, separated by ≥ 90 days, with the latest measure within 2 years prior to data extraction) were included, excluding those with coded initiation of renal replacement therapy. Cox proportional hazards regression models with splines, adjusted for practice characteristics, were used to investigate the association between practice percentage of confirmed CKD cases with a stage 3-5 CKD code and patient outcomes: hospitalisation for cardiovascular (CV) events, hospitalisation for heart failure (HF), hospitalisation with acute kidney injury (AKI) and all-cause mortality. 167,208 patients from 637 primary care practices in England were included in analysis, with a median follow up time of 3.8 years for hospitalisations and 4.3 years for deaths. Patient characteristics were well balanced in the two-thirds of most typically performing practices (55% to 88% coded CKD), but with slight differences at the extremes. Rates of CV and HF admissions were significantly reduced as practice CKD coding performance increased (Figure 1). In practices coding 60% of CKD cases, patients had a 4.8% (0.9%, 9.0%) higher hazard of CV hospitalisations and an 8.6% (1.5%, 16.1%) higher hazard of HF hospitalisations than the average practice (74% coded). Trends of a small reduction in AKI but no substantial change in risk of deaths were also observed as CKD coding increased. Figure 1. Percent difference in hazard rates of outcomes according to practice percent coded CKD, compared to median practice coding (74% coded) among patients with confirmed CKD in the two-thirds of most typically performing practices (55% to 88% coded). Adjusted for practice characteristics: mean age, percent male, median rank of index of multiple deprivation, diabetes prevalence, hypertension prevalence, CVD prevalence, percent of CKD cases at stages 3b-5, percent of CKD patients admitted for COPD in last 3 years, percent of CKD patients admitted for cancer in last 3 years, percent GFR test in last year in diabetes, percent GFR test in last year in CKD, percent of adult population with CKD Increased CKD coding in primary care and subsequent care efforts appear to play a role in improving patient outcomes, although residual confounding due to unobserved practice characteristics cannot be ruled out.

Abstract 11676: Do Heart Failure Admission Rates Change Around Holidays? The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Heart failure (HF) exacerbations are often precipitated by dietary noncompliance, which is common around holidays. We examined whether HF hospitalizations would increase after major national holidays. Methods: The ARIC Study performed surveillance of HF admissions among patients age ≥55 years in 4 US communities from 2005-2014. HF admissions were identified by ICD-9 codes and validated by physician review. For each holiday (H), 4 days before the holiday (H-4 to H-1), and 4 days after the holiday (H+1 to H+4), we compared average daily HF admission rates, hospital length of stay (LOS), 28-day mortality, and 1-year mortality to the remaining days in each holiday’s month using Poisson regression using a complex sampling design. Results: ARIC identified 92,354 HF admissions (weighted). Patients admitted in holiday months were 46% male and 71% white, with average age 75 years. Compared to the holiday months, patients admitted on H were older (78 years, p&lt;0.01). Race, community, and HF by ejection fraction were similar among time periods. Average daily admissions around each holiday are shown in Figure 1. For all holidays combined, average daily admissions compared to the remainder of the holiday months (25.1 per day) were less frequent on both H-1 (18.5, p=0.002) and H-1/H combined (19.5, p=0.005). Hospital LOS was shorter for patients admitted on H for Thanksgiving (5.3 v 6.9 days, p=0.02) and Christmas (4.8 v 7.5, p=0.01), on H-1 for Christmas (5.3 v 7.5, p=0.04) and during H-4 to H-2 for New Year’s Day (6.7 v 8.7, p=0.02). 28-day mortality was lower for patients admitted on H-1 (p&lt;0.001) for Christmas. 1-year mortality was similar for all holidays and time periods. Conclusions: HF admission rates, hospital LOS, and mortality were similar in the 4 days following a holiday compared to the remainder of each holiday’s month. However, the day before and/or day of a holiday were associated with lower HF admission rates, shorter hospital LOS, and lower 28-day mortality.

The effect of the COVID-19 pandemic on heart failure unplanned admission: a single center study

BackgroundAcute heart failure (AHF) is a leading cause of admissions among adults. The COVID-19 pandemic has placed a high burden on healthcare systems globally. Many countries announced lockdowns which restricted residents' movement. There is a reported reduction in AHF admissions during the pandemic in several countries, potentially leading to adverse outcomes such as increased morbidity and mortality. To date, little is known on whether similar trends are observed in Southeast Asian (SEA) countries.PurposeWe aim to evaluate whether AHF admissions have been affected by the pandemic and the lockdown restrictions in a multi-ethnic, urban SEA country. We hypothesized that the pandemic and lockdown restrictions (called a “circuit breaker (CB)”) will influence heart failure (HF) admission rates.MethodsWe conducted a retrospective analysis of patients who were admitted with a principal diagnosis of HF to a tertiary hospital in a SEA country. The study period was from the first confirmed case of COVID-19 (January 23, 2020) to July 31, 2020 (n=378). This was further divided into 3 sub-periods for inter-year and intra-year subgroup analysis. Pre-CB: January 23, 2020 to April 6, 2020, CB: April 7, 2020 to June 1, 2020, and Post-CB reopening (Phase 1 & 2): June 2, 2020 to July 31, 2020. The control period was the same timeframe in the preceding year (January 23, 2019 to July 31, 2019) (n=398) and was similarly divided into 3 subgroups. The primary outcome was the overall HF admission rate. Where appropriate, Poisson regression or Negative Binomial regression was utilised to compare the incidence rate ratios of the HF admissions between the periods. Mann-Whitney test or student's t-test was used to compare the length of stay (LOS) and Charlson Comorbidity Index (CCI) scores.ResultsDetails on the study cohort can be found in Table 1. The study period's overall mean admission rate was 2.08 per day, which was not significantly different from the control (2.00 per day). Subgroup analysis showed that the CB admission rates were significantly lower compared to (i) the control (1.39 per day vs. 2.02 per day) and (ii) pre-CB period in the same year (1.39 per day vs. 2.44 per day) (Fig. 1). Phase 1 & 2 admission rates were significantly higher compared to the control (2.28 per day vs. 1.68 per day), and CB admission rates (2.28 per day vs. 1.39 per day). There were no inter-year or intra-year differences for LOS. There was a significant inter-year difference in CCI scores during the CB period (CB: 2.88 vs. control: 1.97).ConclusionsOur study showed significant decreases in AHF admissions during the CB period, and a significant increase in AHF admissions from CB to Post-CB reopening. These suggest that the lockdown restrictions had an influence on patients' health seeking behaviour. We also recognise the need to raise public awareness to encourage HF patients to seek timely treatment, prevent complications and adverse events.Funding AcknowledgementType of funding sources: None. Table 1. Study cohorts demographicsFigure 1. Weekly HF admissions to hospital in 2020

Thirteen-year trends in hospitalization and outcomes of patients with heart failure in Spain.

Heart failure is one of the most pressing current public health concerns. However, in Spain there is a lack of population data. We aimed to examine thirteen-year nationwide trends in heart failure hospitalization, in-hospital mortality and 30-day readmission rates in Spain. We conducted a retrospective observational study of patients discharged with the principal diagnosis of heart failure from The National Health System' acute hospitals during 2003-2015. The source of the data was the Minimum Basic Data Set. Temporal trends were modelled using Poisson regression analysis. The risk-standardized in-hospital mortality ratio was calculated usinga multilevelrisk adjustmentlogistic regressionmodel. A total of 1254830 episodes of heart failure were selected. Throughout 2003-2015, the number of hospital discharges with principal diagnosis of heart failure increased by 61%. Discharge rates weighted by age and sex increased during the period [incidence rate ratio (IRR): 1.03; 95% confidence interval (95% CI): 1.03-1.03; P<.001)], although this increase was motivated by the increase in older age groups (≥75years old). The crude mortality rate diminished (IRR: 0.99; 95% CI: 0.98-1, P<.001), but 30-day readmission rate increased (IRR: 1.05; 95% CI: 1.04-1.06; P<.001). The risk-standardized in-hospital mortality ratio did not change throughout the study period (IRR: 0.997; 95% CI: 0.992-1; P=.32). From 2003 to 2015, heart failure admission rates increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population ≥75years. 30-day readmission rates increased, but the risk-standardized in-hospital mortality ratio did not significantly change for the same period.

Seasonal variation of decompensated heart failure admissions and mortality rates in sub-Saharan Africa, Cameroon

BackgroundEpidemiological data of heart failure (HF) decompensation from the northern hemisphere suggests higher rates during winter. ObjectivesWe aimed to explore the seasonal variation in decompensated HF admission and mortality rates in a country with equatorial climate. MethodsWe conducted a retrospective cross-sectional study by chart review of the admission, discharge registries and patient files from 2016 to 2018 in the cardiology unit of the Yaoundé Central Hospital, Cameroon. Data was collected on HF morbidity and mortality from the registers and patients’ files. Corresponding seasonal climatic data was obtained from the meteorology office of the Cameroonian ministry of transports. Analysis of variance and Chi-square test were respectively used to compare the continuous and categorical data between across seasons. Correlation between continuous data was assess with the Spearman correlation. ResultsDecompensated HF accounted for 636 (36.2%) out 1755 cardiology unit admission and an 18% lethality rate. Decompensated HF admission, mortality and lethality rates were respectively 38.2%, 6.7% and 17.9% higher during the long rainy season (all P values>0.05). We observed a borderline-to-significant inverse linear continuous correlation between monthly temperatures and admission rate (r=−0.301; P=0.070), lethality rate (r=−0.361; P=0.030) and mortality rate (r=−0.385; P=0.020). There was no significant difference of the distribution of precipitating factors between seasons. ConclusionAlthough statistically insignificant, decompensated HF admissions and mortality increase in rainy season where the temperature is lower in an equatorial climate.

Models for Heart Failure Admissions and Admission Rates, 2016 through 2018.

Background: Approximately 6.5 to 6.9 million individuals in the United States have heart failure, and the disease costs approximately $43.6 billion in 2020. This research provides geographical incidence and cost models of this disease in the U.S. and explanatory models to account for hospitals’ number of heart failure DRGs using technical, workload, financial, geographical, and time-related variables. Methods: The number of diagnoses is forecast using regression (constrained and unconstrained) and ensemble (random forests, extra trees regressor, gradient boosting, and bagging) techniques at the hospital unit of analysis. Descriptive maps of heart failure diagnostic-related groups (DRGs) depict areas of high incidence. State- and county-level spatial and non-spatial regression models of heart failure admission rates are performed. Expenditure forecasts are estimated. Results: The incidence of heart failure has increased over time with the highest intensities in the East and center of the country; however, several Northern states have seen large increases since 2016. The best predictive model for the number of diagnoses (hospital unit of analysis) was an extremely randomized tree ensemble (predictive R2 = 0.86). The important variables in this model included workload metrics and hospital type. State-level spatial lag models using first-order Queen criteria were best at estimating heart failure admission rates (R2 = 0.816). At the county level, OLS was preferred over any GIS model based on Moran’s I and resultant R2; however, none of the traditional models performed well (R2 = 0.169 for the OLS). Gradient-boosted tree models predicted 36% of the total sum of squares; the most important factors were facility workload, mean cash on hand of the hospitals in the county, and mean equity of those hospitals. Online interactive maps at the state and county levels are provided. Conclusions. Heart failure and associated expenditures are increasing. Costs of DRGs in the study increased $61 billion from 2016 through 2018. The increase in the more expensive DRG 291 outpaced others with an associated increase of $92 billion. With the increase in demand and steady-state supply of cardiologists, the costs are likely to balloon over the next decade. Models such as the ones presented here are needed to inform healthcare leaders.

Abstract 16279: Impact of Race and Socioeconomic Status on Rates of Congestive Heart Failure Admissions, Readmissions, and Length of Stay

Introduction: Health disparities due to race and socioeconomic status persist among congestive heart failure (CHF) patients. Our hospital in the Philadelphia area is uniquely situated to study disparities as it sits on the border of a diverse inner city and suburban population. The area west of our hospital is known to have a drastically higher median income than the area to the east. We aimed to evaluate differences in rates of CHF admissions, readmissions, and length of stay (LOS) for patients based on race and socioeconomic status. Methods: From 3/1/2018 to 3/31/2020, 6,785 total patients were admitted to our hospital due to acute decompensated CHF. To compare rates of admission, readmission and a LOS &gt; 5 days based on race and socioeconomic status, we used the SlicerDicer function of the EPIC electronic record platform. For race, we compared data for white and black patients. For socioeconomic status, we included a 10-mile radius around our hospital and used public records to collect median household income for 11 zip codes to the east and 11 to the west. The average yearly median household income for the east and west zip codes were USD $27,171 and $134,390, respectively. Outcomes are expressed as percentages and compared using a Chi-square test of independence and 95% confidence interval (CI) for differences. Significance was assessed at the 0.05 level. Results: Admission rates were significantly higher among Black patients at 67% compared to White patients at 58% (95% CI 7-11%, p&lt;0.05). There was no significant difference between rates of readmission (60% for Black vs. 58% for White patients, 95% CI 0-4%, p=0.11) or LOS &gt; 5 days (56% for Black vs. 55% for White patients, 95% CI 0-3%, p=0.42). Admission rates were significantly higher among patients from low income areas at 70% compared to high income areas at 56% (95% CI 11-17%, p&lt;0.05). Readmission rates were not significantly different, 57% for low income and 56% for high income areas (95% CI 0-4%, p=0.82). Patients from low income areas were significantly more likely to have a LOS &gt; 5 days at 57% compared to patients from high income areas at 53% (95% CI 0.8-8%, p&lt;0.05). Conclusions: Race and socioeconomic status continue to impact CHF patients’ health outcomes including rates of admissions, readmissions, and length of stay.

Clinical and echocardiographic outcomes of patients with moderate to severe aortic stenosis and preserved, mid-range and reduced ejection fraction

Abstract Background Left ventricular ejection fraction (EF) plays an important role in risk stratifying and guiding therapy for patients with aortic stenosis (AS). This study aims to describe the clinical and echocardiographic outcomes of AS patients with preserved (ASpEF), mid-range (ASmrEF) and reduced (ASrEF) EF. Methods 713 consecutive patients with index echocardiographic diagnosis of moderate-severe AS (aortic valve area &amp;lt;1.5cm2) were allocated according to the EF into three groups: ASrEF (EF&amp;lt;40%), ASmrEF (EF 40–50%), and ASpEF (EF&amp;gt;50%). The study outcomes were defined as 5-year all-cause mortality, heart failure admissions, and aortic valve replacement (AVR). Results In comparison to patients with ASpEF, those with ASrEF were more frequently male, and systolic blood pressure was significantly lower on enrolment (p&amp;lt;0.001). Diabetes, ischemic heart disease and atrial fibrillation were more commonly seen in the ASrEF and ASmrEF groups, compared to ASpEF group. All-cause mortality rates were 30.5% for ASpEF, 50.8% for ASmrEF, 55.0% for ASrEF groups (p&amp;lt;0.001). Increased rates of heart failure admissions were seen in the ASmrEF and ASrEF groups (30.5% and 33.9%, respectively, vs. 14.9% in ASpEF group). Patients with ASrEF had significantly higher rates of AVR as compared to those in the ASmrEF and ASpEF groups (p=0.032). Conclusion Echocardiographic and clinical outcomes of ASmrEF patients resembled those of ASrEF more closely than the ASpEF patients. Stratifying AS patients according to the different EF groups may improve risk assessment and treatment strategies. Figure 1 Funding Acknowledgement Type of funding source: None

Cause-specific mortality and heart failure readmissions according to the HFA-PEFF algorithm in patients hospitalised for heart failure with preserved ejection fraction

Abstract Background The HFA-PEFF algorithm has been recently developed and is recommended by the European Society of Cardiology to make a diagnosis of heart failure with preserved ejection fraction (HFpEF). Based on functional echocardiography criteria, morphological criteria, and natriuretic peptide levels, a score from 1 to 6 is obtained with higher scores indicating a higher probability of HFpEF. Purpose This study investigates the prognostic value of the HFA-PEFF score in HFpEF patients hospitalised for decompensation. Methods This retrospective cohort study includes consecutive patients with HFpEF, admitted to Mayo Clinic Rochester between 2010–2015 and requiring treatment with intravenous loop diuretics for congestion. The HFA-PEFF score was calculated for all patients with echocardiography data available within 1 year and natriuretic peptide levels obtained upon admission. The study population was subsequently stratified according to HFA-PEFF score ≤4 (n=79), =5 (n=93), or =6 (n=271). Incidence rates of recurrent heart failure admissions per 100 patient-years of follow-up, time to all-cause mortality, and mortality causes were compared among strata. Results In 443 patients with HFpEF (78±12 years; 60% women), higher HFA-PEFF score was associated with older age, female gender, higher systolic blood pressure, and worse renal function. Heart failure readmission rates were higher in patients with HFA-PEFF score =5 [46.0 (38.5–53.5)] or HFA-PEFF score =6 [45.0 (40.1–49.8)] versus HFA-PEFF score ≤4 [28.9 (22.7–35.0); P-value&amp;lt;0.001 for differences; see upper panel figure]. Increasing HFA-PEFF score was associated with a shorter median survival (P-value&amp;lt;0.001), which was 65 months (36–89 months) in HFA-PEFF score ≤4, 45 months (26–59 months) in HFA-PEFF score =5, and 28 months (22–42 months) in HFA-PEFF score =6 (see lower panel figure). The proportions of deaths directly related to heart failure were comparable among HFA-PEFF strata (49% versus 49% versus 52%, respectively; P-value=0.903), as was the contribution of cardiovascular death (60% versus 57% versus 63%, respectively; P-value=0.662). Overall, few differences in patterns of mortality causes were observed among strata. There was a lower contribution of primary respiratory disease (mainly chronic obstructive pulmonary disease) to mortality in patients with a higher HFA-PEFF score (26% versus 19% versus 6%, respectively; P-value&amp;lt;0.001). Conclusions Higher HFA-PEFF score in hospitalized patients with HFpEF is associated with increased risk of subsequent heart failure readmissions and all-cause mortality, which includes both heart failure specific and non-heart failure mortality. Heart failure readmissions &amp; mortality Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Belgian American Educational Foundation (B.A.E.F.); Special Research Fund (BOF) of Hasselt University (Hasselt, Belgium)

Heart failure hospitalizations in persons with and without diabetes in an Italian region: 2008-2018

Abstract Background Hospitalization rate for heart failure (HF) is considered a prevention quality indicator and it is used as a tool to evaluate health services quality. This study aims to assess time trends in HF hospitalizations in a region of Southern Italy, focusing on diabetes mellitus as comorbidity. Methods Data were collected from hospital discharge records. All patients aged 18 or over hospitalized for HF in Abruzzo between 2008 and 2018 were selected, either with or without a diagnostic code of diabetes. Admissions for cardiac procedures were excluded. For each year, gender- and age-adjusted standardized hospitalization rates were calculated. Predictors of HF admissions were estimated by a multivariable regression model. Results Over the study period, 60,737 HF admissions occurred, 34,518 of which among people aged more than 65 (56.8%). A total of 15,424 hospitalizations were performed among diabetic patients (25.4%). The overall age- and gender-adjusted HF hospitalization rate declined substantially from 2008 to 2018 (-12.1%). Diabetes (adjOR 2.48; 95%CI 2.41-2.55), myocardial infarction (adjOR 3.92; 95%CI 3.70-4.14), peripheral vascular disease (adjOR 2.30; 95%CI 2.16-2.44), chronic obstructive pulmonary disease (adjOR 3.97; 95%CI 3.86-4.09) and renal disease (adjOR 5.61; 95%CI 5.44-5.78) were factors associated to an increased risk of HF hospitalization. Although HF admission rates remained higher, a significant reduction was highlighted among diabetic patients (-34.7%). Instead, time trend was nearly stable among persons without diabetes (+2.7%). Conclusions This study has shown a decline in HF hospitalization rate over the period considered, particularly among diabetic patients. HF hospitalization may be potentially avoided with good outpatient care. As the causes for HF admissions may include poor quality of care or problems accessing care, it is worthwhile to identify the triggering factors and the potential targets for an early intervention. Key messages A reduction of HF admissions was observed only among diabetics and not among people without diabetes. As the HF hospitalizations are potentially preventable, the knowledge of the epidemiology is crucial for management of preventive health care.

The use of sodium-glucose co-transporter 2 inhibitors in the inpatient setting: Is the risk worth taking?

In the outpatient setting, sodium-glucose co-transporter 2 inhibitors (SGLT2i) are recognized as effective agents to optimize glycaemia and also developing robust evidence for cardiovascular (CV) and renal protection in people with type 2 diabetes, particularly those at higher risk. However, data on the safety and efficacy of these drugs in hospitalized patients remain limited. The purpose of this review is to discuss the balance between risks and benefits of SGLT2i use in the inpatient setting. PubMed, Embase and Google Scholar databases were searched to identify relevant published work. Available evidence on the mechanisms of action and the safety profile of SGLT2i in the context of their use in hospitalized individuals are summarized and discussed in this narrative review. The rationale behind the use of these agents in the inpatient setting is based on the low risk of hypoglycaemia, the practical dosing scheme and the potential to decrease subsequent heart failure admission rates. In addition, data from animal studies indicate the ability of SGLT2i to ameliorate oxidative stress, suppress sympathetic activity, enhance autophagy and promote cardiac remodelling, when administered in the acute phase of CV episodes. On the other hand, these drugs have been linked to specific adverse events related to their mechanism of action, including an increased risk of euglycaemic diabetic ketoacidosis and volume depletion, which raises concerns over their usefulness in inpatients, particularly individuals with multimorbidities. Potential benefits deriving from the use of SGLT2i in the inpatient setting cannot mitigate possible risks, at least until robust evidence on their efficacy in hospitalized individuals become available. The concept of administering these agents in the acute phase of CV episodes, in people with or without diabetes, requires further evaluation in appropriately designed clinical studies.

One-year all-cause mortality risk among atrial fibrillation patients in Middle East with and without diabetes: The Gulf SAFE registry

BackgroundAtrial fibrillation (AF) poses a great risk of mortality, especially when associated with diabetes mellitus (DM). ObjectivesWe aimed to investigate the rate and risk factors for mortality among AF patients with and without DM in the population from the Middle East where it has never been investigated before. MethodsWe analyzed the Gulf-SAFE registry, involving patients with nonvalvular AF from the Middle East, for one-year all-cause mortality. The predictive capability of the CHA2DS2-VASc score for death was also investigated. ResultsAmong a total of 2043 AF patients 606 had DM. Patients with DM were older and had significantly higher prevalence of multiple comorbidities (p < 0.05, respectively). Among patients with DM, age ≥ 75 (relative risk 2.34, 95% confidence interval 1.19–4.61), heart failure (HF) (RR 2.14, 95%CI 1.03–4.43), peripheral vascular disease (PVD) (RR 3.36, 95%CI 1.22–9.30) and chronic kidney disease (CKD) (RR 2.60, 95%CI 1.16–5.81) were independent risk factors for one year all-cause mortality. Patients with DM had significantly higher rates of heart failure and AF-related hospital admissions, all-cause mortality and composite outcome rates, in one year follow up. Among patients with DM, the CHA2DS2-VASc score was predictive of one-year all-cause mortality with c-index of 0.741 (95%CI 0.688–0.794). ConclusionsAF patients in Middle East with DM have a higher risk for all-cause mortality, HF and AF admission and composite outcome, compared to patients without DM. Multiple risk factors contribute to the higher mortality rate among patients with DM.