Rehospitalization For Heart Failure Research Articles

Real-World Experience in Tricuspid Transcatheter Edge-to-Edge Repair: Transcatheter Tricuspid Valve Repair in Spain Registry.

Significant tricuspid regurgitation (TR) is associated with increased morbidity and mortality. The development of transcatheter valve repair therapies has opened a wide range of opportunities for treatment of patients with high surgical risk. Real-world data might improve patient selection and outcome. The authors sought to investigate acute and short-term cardiovascular outcomes of tricuspid transcatheter edge-to-edge repair (T-TEER) with dedicated devices in a real-world setting. This is a retrospective, single-arm, multicenter registry conducted at 15 sites in Spain. The primary end point was a composite of all-cause death, rehospitalization for heart failure, and tricuspid valve re-intervention. Patients included (n=283) were older (76±9 years, 70% female), and showed significant comorbidities. Massive or torrential TR was present in 55% of subjects, with secondary cause being the main mechanism of regurgitation in ≈80% of individuals. Intraprocedural success was achieved in 79% of patients. At 1-year follow-up, significant improvements in TR grade (≥3+, 100% to 25%, P <0.001) and New York Heart Association functional class (I/II, 33%-86%, P <0.001) were observed. Lead-induced cause and single leaflet device attachment emerged as independent predictors of at least severe predischarge residual TR. In-hospital mortality occurred in 4 (1.4%) patients, whereas the Kaplan-Meier estimated 1-year primary end point occurrence rate was 21%. Intraprocedural success (hazard ratio, 0.353 [95% CI, 0.156-0.798]; P=0.012), was found to be an independent predictor of primary end point. In a real-world contemporary setting, tricuspid transcatheter edge-to-edge repair with dedicated devices emerged as effective therapeutic option for patients with severe TR.

Transcatheter edge to edge compared with surgery in older patients with degenerative mitral valve regurgitation

ObjectivesTranscatheter edge-to-edge repair (TEER) is an alternative for patients with severe degenerative mitral regurgitation (MR). The objective of this study was to compare the outcomes of surgery and TEER in older patients with degenerative MR patients using real life data.MethodsConsecutives older patients (≥ 65 years-old), with severe symptomatic, degenerative MR requiring surgery or TEER between 2013 and 2023 were included. Exclusion criteria were secondary MR, and active endocarditis. Primary outcome was a composite of all-cause death, hospitalization for heart failure or mitral valve intervention within one year.ResultsA total of 295 patients were included (203 underwent surgery and 92 underwent TEER). At 1 year, 26 (9%) patients had died, required reintervention or rehospitalization for heart failure: 8 patients in the surgery group (4%) and 18(20%) in the TEER group(p < 0.01). Factors independently associated with the combined outcome were residual MR > 2 (aHR 4.31 (95% CI: 1.51–12.25)), history of cardiac surgery (aHR 6.24 (95%CI: 2.16–18.05)), BMI (aHR 0.88 (95% CI: 0.77–0.98)), TR > 2 at baseline (aHR: 2.47 (95% CI: 1.03–5.91)). After adjustement on confounding factors, intervention type was not associated with the primary composite outcome (aHR: 3.41 (95% CI: 0.63–18.27)), p = 0.15).ConclusionPatients with severe primary MR treated with TEER experienced a higher rate of adverse events within one year compared to surgically managed patients. However, these differences were mainly associated to clinical characteristics and were no longer significant after adjustment on residual MR > 2.Graphical

Pulmonary Hemodynamic Correlates and Prognostic Value of the Cardiopulmonary Exercise Score in Patients With Left Heart Failure

Abstract Objective: Pulmonary hypertension secondary to left heart failure is associated with an abnormal response to exercise and poor prognosis. The objective of this study is to develop an algorithm by using data from cardiopulmonary exercise testing (CPET) to assess the severity of pulmonary hemodynamics and predict clinical worsening and mortality in patients with heart failure. Methods: From April 2017 to December 2018, a total of 102 patients with heart failure who underwent CPET and invasive right heart catheterization participated in this prospective study. All enrolled patients had their clinical characteristics, hemodynamic parameters, and CPET results. Based on the CPET data namely peak oxygen uptake, the minute ventilation/carbon dioxide production slope, resting end-tidal carbon dioxide, oxygen uptake/work rate flattening, exercise oscillatory ventilation, and oxygen uptake efficiency slope, a Heart Failure Cardiopulmonary Exercise (HFCE) score was developed. The total score was then calculated to categorize patients into 3 groups: low score (0–3) (n = 31), intermediate score (4–7) (n = 45), and high score (8–14) (n = 26). Clinical events were defined as all-cause death and rehospitalization for heart failure, which were recorded and tracked for at least 12 months. Pearson’s correlation coefficients were calculated to assess the relationship between the HFCE score and hemodynamic parameters, 6-minute walk distance, and N-terminal-pro hormone brain natriuretic peptide. Cox proportional hazards regression analysis was used to identify independent predictors of clinical events. Survival curves for clinical events were generated using the Kaplan-Meier method and compared among the 3 groups with different HFCE scores with a log-rank test. Results: The high HFCE score group had a higher prevalence of New York Heart Association class Ⅲ–Ⅳ (high score vs. intermediate score vs. low score: 85% (22/26) vs. 56% (25/45) vs. 45% (14/31), P = 0.008), higher N-terminal-pro hormone brain natriuretic peptide levels (high score vs. intermediate score vs. low score: (3,039 ± 2,171) ng/L vs. (2,039 ± 2,353) ng/L vs. (1,438 ± 947) ng/L, P = 0.035), lower 6-minute walk distance (high score vs. intermediate score vs. low score: (312 ± 79) m vs. (362 ± 84) m vs. (363 ± 76) m, P = 0.042) compared to intermediate score or low score. The high HFCE score correlated well with high levels of pulmonary vascular resistance (r = 0.539, P &lt; 0.01), pulmonary artery wedge pressure (r = 0.292, P &lt; 0.01), and mean pulmonary artery pressure (r = 0.474, P &lt; 0.01), as well as low levels of cardiac output (r = –0.357, P &lt; 0.01). Moreover, 46 patients developed composed clinical events at 12 months. In the multivariate model, the HFCE score was an independent predictor of composed clinical events (hazard ratio = 1.142, 95% confidence interval: 1.041–1.253, P = 0.005). Kaplan-Meier analysis showed a significantly higher probability of composed clinical events in patients with a higher HFCE score (P log-rank = 0.004). Conclusion: The HFCE score—obtained through CPET—provides valuable prognostic information by indicating the severity of hemodynamics in patients with pulmonary hypertension secondary to left heart failure. It can likely serve as a reliable predictor for clinical worsening and mortality.

Clinical Importance of Protein Intake in Hospitalized Elderly Patients With Heart Failure.

The relationship between protein intake and the long-term prognosis of elderly patients with heart failure remains poorly understood. We investigated the association between predischarge protein intake and long-term prognosis in hospitalized elderly patients with heart failure. A single-center, retrospective analysis of hospitalized patients aged ≥65 years with heart failure and reduced ejection fraction was conducted. Protein intake was evaluated by nutritionists based on visual measurements of the percentage of dietary intake obtained for 7 days before discharge by a nurse. A cutoff of 1.2 g/kg/day protein intake was used to compare the incidence of a composite endpoint, including all-cause mortality and heart failure rehospitalization within 1 year. Among the 100 patients (median age 79 years; 47% male), 56% had low protein intake (<1.2 g/kg/day). Patients with low protein intake had a significantly higher rate of composite endpoints than those with high protein intake (50% vs. 20%; log-rank test P=0.03). Multivariable Cox proportional hazards model revealed that low protein intake was independently associated with long-term prognosis with a hazard ratio of 2.73 and a 95% confidence interval of 1.10-6.80 (P=0.03). Low protein intake in the predischarge phase was associated with long-term prognosis in hospitalized elderly patients with heart failure and reduced ejection fraction.

Transcatheter versus Surgical Aortic Valve Replacement in Patients Younger than 65 Years in the US.

To characterize trends and outcomes of aortic valve replacement in patients <65 with aortic stenosis between 2013 and 2021. This retrospective analysis included 9,557 patients who underwent biological aortic valve replacement in California, New York, and New Jersey from 2013 through 2021. Patients were stratified by approach: transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR). Our primary outcomes were 30-day and 6-year mortality and morbidity (stroke, heart failure rehospitalization, reintervention, and new pacemaker implantation). After propensity score matching, Cox-proportional hazard and Fine-Gray models were used to compare outcomes following TAVR and SAVR. The proportion of patients <65 years with aortic stenosis undergoing TAVR versus SAVR increased from 7.1% in 2013 to 54.7% in 2021. After propensity score matching, 30-day mortality was similar between both groups (1.0% vs. 1.5%, p=0.33). TAVR had a higher 6-year mortality (23.3% vs. 10.5%, HR: 2.27; CI: 1.82-2.83; p<0.001). The 30-day rate of new pacemaker implantation was higher after TAVR (10.7 vs. 6.2%, p<0.001). There was no difference in the 6-year cumulative incidence of stroke, heart failure hospitalizations, or reoperations. Multiple sensitivity analyses confirmed these findings. Despite clinical guidelines, the utilization of TAVR has increased in patients <65. TAVR in this population is associated with a higher 6-year mortality and a higher rate of new permanent pacemaker implantation when compared to a matched cohort treated with biologic SAVR. These findings support the need for a randomized controlled trial comparing long-term outcomes of TAVR versus SAVR in patients <65.

Risk and Protective Factors of Poor Clinical Outcomes in Heart Failure with Improved Ejection Fraction Population: A Systematic Review and Meta-Analysis.

Heart failure with improved ejection fraction (HFimpEF) patients could still develop adverse outcomes despite EF improvement. This study evaluates the risk and protective factors of poor clinical outcomes in HFimpEF patients. Systematic searching was done to include studies that evaluate the risks of developing poor outcomes in HFimpEF patients. HFimpEF is defined as improvement of 5-10% EF within 6-12 months or normalization of EF > 40%. Poor clinical outcome is defined as a composite of all-cause mortality, cardiovascular events, HF rehospitalization, and requirement of LVAD/ transplant. Odds ratios of outcome are pooled with random effects model. A subgroup analysis of multivariate analysis-only studies was also conducted. 32 studies comprising 10,740 HFimpEF patients are included. Poor clinical outcomes followed up for approximately 3 years, are seen in 18.9% of HFimpEF patients. Twelve statistically significant factors that increase the risk of outcome are found. Among them, anemia (OR 7.69, CI 3.48-16.99, I2 0%) and baseline NT pro-BNP (OR 3.25) are the two most important predictors. Other significant risk factors are increasing age, ischemic heart disease, NYHA III/IV, diabetes mellitus, atrial fibrillation, dyslipidemia, cerebrovascular disease, hypertension, use of diuretics, and baseline LVEDD. Alternately, protective factors of poor clinical outcome are regression of left atrial diameter (LAD) (OR 0.33, CI: 0.18-0.61, p 0.0003, I2 0%), use beta-blockers, SGLT- 2 inhibitors, and baseline LVEF level (OR 0.60, 0.78, 0.90, respectively). HFimpEF patients are not fully recovered and patient stratification based on risk and protective factors is recommended.

Sex-Based Differences and Outcomes in Unselected Patients Undergoing Coronary Angiography.

Background: The study investigates sex-related differences and outcomes in unselected patients undergoing invasive coronary angiography (CA). Sex-based differences with regard to baseline characteristics and management of patients with cardiovascular disease have yet been demonstrated. However, their impact on long-term outcomes in unselected patients undergoing CA remains unknown. Methods: Consecutive patients undergoing invasive CA from 2016 to 2022 were included at one institution. Prognosis of male and female patients undergoing CA was investigated with regard to the primary endpoint of rehospitalization for heart failure (HF) at 36 months. Secondary endpoints comprised the risk of acute myocardial infarction (AMI) and coronary revascularization at 36 months, as well as in-hospital all-cause mortality. Statistical analyses included Kaplan-Meier analyses, as well as uni- and multivariable Cox proportional regression analyses. Results: From 2016 to 2022, 7691 patients undergoing CA were included (males: 65.1%; females: 34.9%). Males had a higher prevalence of coronary artery disease (CAD) (76.2% vs. 57.4%; p = 0.001), alongside a higher prevalence of 3-vessel CAD compared to females (33.9% vs. 20.3%; p = 0.001). The risk of rehospitalization for HF at 36 months was higher in males compared to females (22.4% vs. 20.3%; p = 0.036; HR = 1.127; 95% CI: 1.014-1.254; p = 0.027), which was no longer observed after multivariable adjustment. Male sex was associated with a higher risk of coronary revascularization (9.6% vs. 5.9%; p = 0.001; HR = 1.659; 95% CI: 1.379-1.997; p = 0.001), which was still evident after multivariable adjustment (HR = 1.650; 95% CI 1.341-2.029; p = 0.001). However, neither the risk of AMI at 36 months (8.1% vs. 6.9%; p = 0.077), nor the risk of in-hospital all-cause mortality (6.9% vs. 6.5%; p = 0.689) differed significantly between the two sexes. Conclusions: In consecutive patients undergoing coronary angiography, male sex was independently associated with an increased risk of coronary revascularization, but not HF-related rehospitalization.

Follow-up at one year in a monocentric cohort of hospitalized heart failure patients in Paris (Île-de-France). Factors associated with re-hospitalization for heart failure, insight from SNDS database

Follow-up at one year in a monocentric cohort of hospitalized heart failure patients in Paris (Île-de-France). Factors associated with re-hospitalization for heart failure, insight from SNDS database

A Tri-Component (Glomerular, Tubular, and Metabolic) Assessment of Renal Function in Acute Heart Failure.

Background: Despite the prevalence of impaired renal function in acute heart failure (AHF) patients, the intricate relationship between glomerular, tubular, and metabolic renal function remains unexplored. We aimed to investigate the co-occurrence of glomerular, tubular, and metabolic renal dysfunction in AHF and their impact on prognosis. Methods: eGFR, spot urine sodium, and HCO3- were measured in 243 patients hospitalized for AHF. The population was stratified by the 4-point renal dysfunction score and linked with outcomes. Results: Glomerular dysfunction exhibited an elevated risk of death (HR of 2.04; 95% CI [1.24-3.36]; p = 0.006), combined risk of death, and HF rehospitalization (HR of 2.03; 95% CI [1.34-3.05]; p = 0.005). Similarly, tubular dysfunction correlated with a higher death risk (HR of 1.72; 95% CI [1.04-2.82]; p = 0.03) and a higher combined risk (HR of 1.82; 95% CI [1.21-2.74]; p = 0.004). While renal metabolic dysfunction was linked to increased death risk (HR of 1.82; 95% CI [1.07-3.11]; p = 0.028), it was not associated with composite risk (HR of 1.37; 95% CI [0.88-2.15]; p = 0.174). Multivariate analysis revealed a direct association between the renal dysfunction score and death risk (HR of 1.92 per 1 point; 95% CI [1.47-2.52]; p < 0.0001) and the combined risk of death and HF rehospitalization (HR of 1.78 per 1 point; 95% CI [1.43-2.22]; p < 0.0001). Conclusions: Renal dysfunction is common, with varied overlaps. Glomerular, tubular, and metabolic dysfunctions predict adverse outcomes in AHF. The established renal score may aid patient stratification and prognosis.

Comparison of short- and long-term outcomes between isolated and concomitant tricuspid valve surgery

BackgroundAccurate reflections of long-term outcomes of isolated tricuspid valve surgery are underreported in the literature. Most published cohort studies consisted of patients receiving tricuspid valve surgery concomitant with left-sided procedures. Patients who undergo isolated tricuspid valve surgery usually present late for surgery, with deteriorating risk factors leading to increased surgical risk. Thus, this study aimed to compare the short- and long-term outcomes of isolated tricuspid valve surgery with those of tricuspid surgery concomitant with left-sided valve procedures. This retrospective cohort study included 617 patients who underwent isolated and left-sided concomitant tricuspid valve surgery from 2009 to 2020. We grouped the patients into isolated (n = 63) vs. concomitant tricuspid surgery (n = 554).ResultsIsolated tricuspid surgery was associated with significantly greater rates of operative mortality (19% vs. 5.2%, P < 0.001), renal failure requiring dialysis (12.7% vs. 2.71%, P < 0.001), and need for ventilation > 24 h (22.22% vs. 12.27%, P = 0.028). ICU (3 days vs. 2 days, P = 0.005) and hospital stays (13 days vs. 11 days, P = 0.042) were significantly longer in isolated tricuspid surgery patients. Isolated tricuspid surgery independently predicted hospital mortality (OR: 4.00 (95% CI: 1.59–10.05), P = 0.003). The risk of follow-up mortality was higher in patients with isolated surgery (HR: 1.95 (95% CI: 0.98–3.86); P = 0.055). However, isolated tricuspid surgery was not associated with heart failure rehospitalization (HR: 1.11 (95% CI: 0.51–2.41); P = 0.798) or increased tricuspid valve reinterventions (HR: 1.42 (95% CI: 0.51– 3.92); P = 0.499).ConclusionsIsolated tricuspid surgery independently predicted hospital mortality and was associated with nonsignificantly higher long-term mortality. This finding highlights the importance of timely referral and intervention for patients with isolated tricuspid valve disease to optimize short- and long-term outcomes.

Prognostic Impact of Hospital Discharge After Heart Failure Admission Without Structured Heart Failure Follow-Up.

(1) Objective. The aim was to evaluate the risk of new exacerbations of heart failure (HF) in patients discharged from hospital emergency departments (EDs) without a structured HF follow-up. (2) Methods. This prospective, single-center cohort study included patients discharged from the ED following hospital admission for acute HF. The study analyzed the profile of patients seen in the ED and assessed their risk of new ED visits or HF-related hospitalizations within 12 months of discharge. (3) Results. A total of 779 patients were included, with a mean age of 82 ± 8 years; 471 were women (60.4%), and 674 (86.7%) had a history of prior HF episodes. Of these, 591 patients (76.1%) were referred to an unstructured HF follow-up in primary care (PC). Patients who experienced HF exacerbations within 12 months of ED discharge had a higher incidence of chronic kidney disease, elevated natriuretic peptide levels, and a higher number of prior HF exacerbations and were more likely to receive unstructured HF follow-up in PC. The presence of the last two factors was associated with the highest risk of HF exacerbation within 12 months of discharge (HR: 2.83; 95% CI: 1.60-5.03; p < 0.001). (4) Conclusions. Patients discharged from the ED after an HF episode and referred to PC without a structured HF follow-up have a high risk of ED revisits or rehospitalization for HF.

Orthostatic Heart Rate Changes and Prognostic Outcomes in Patients With Heart Failure.

Heart rate typically increases during postural changes from a supine to a standing position due to autonomic and hemodynamic factors. Changes in heart rate during orthostasis may reflect the extent of autonomic dysfunction in patients with heart failure (HF). Thus, orthostatic heart rate changes may be useful for evaluating autonomic function and may predict prognosis. This study examined the association between orthostatic heart rate changes and prognosis in patients with HF. We included 320 patients with HF in sinus rhythm (median age 70 years, 70.9% men) who were admitted to Kitasato University Hospital for HF treatment and whose heart rate was evaluated in the supine and upright positions during the stable period before discharge. We calculated heart rate changes based on supine and upright heart rate. We examined the association of orthostatic heart rate changes with patient prognosis (i.e., a composite of all-cause mortality or rehospitalization for HF). During the follow-up period (median 3.8 years; interquartile range 0.8-7.0 years), 129 events occurred. Orthostatic heart rate changes were associated with low composite event rates (log-rank P=0.015). After adjusting for potential confounders, increasing orthostatic heart rate changes were associated with decreased composite event rates (adjusted hazard ratio 0.954; 95% confidence interval 0.925-0.985; P=0.004). In patients with HF, poor orthostatic heart rate changes were associated with a worse prognosis.

Analysis of Right Ventricular Strain in Heart Failure with Preserved Ejection Fraction

Introduction: The complexity of the geometry and the unique architecture of the right ventricular (RV) myocardial fibers make the study of its function a significant challenge. However, the advent of new imaging techniques, such as RV strain imaging, has improved our understanding of its function. The aim of our study is to specify the principles of studying right ventricular deformation and its impact on the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). Materials and Methods: This is a two-year prospective study comparing echocardiographic parameters of right ventricular function in 87 patients followed in our unit for HFpEF at the Cardiology Department of ERRAZI Hospital, CHU Mohammed VI, Marrakech. Results: Over the past two years, our unit has hosted 87 patients diagnosed with HFpEF. The average age was 68 years and 5 months, with a female predominance. The most common cardiovascular risk factors were hypertension and obesity (BMI &gt; 30). Symptomatic presentations were dominated by exertional dyspnea, observed in 84% of cases, with resting dyspnea and cough affecting about half of the patients. Signs of left heart failure, such as crackling rales, were present in 44% of patients, while signs of right heart failure, such as lower limb edema, were noted in 41%, with jugular distension and hepatojugular reflux in 19%. Echocardiography revealed left ventricular hypertrophy in 57% of patients and left atrial dilatation in 65%. Right ventricular function was markedly impaired, with significant abnormalities in TAPSE (Tricuspid Annular Plane Systolic Excursion), S' wave, and Tei index values, highlighting a marked correlation between the Tei index and the deformation of the right ventricular lateral wall. Rehospitalization for heart failure occurred in 40.2% of the cohort, emphasizing the severe clinical implications of right ventricular dysfunction in this patient population. Discussion and Conclusion: RV strain in HFpEF is an analysis that has not yet revealed all its intricacies. This study demonstrates that there is an alteration in RV strain in patients with HFpEF, which has a prognostic impact on mortality and rehospitalization for cardiac decompensation. This suggests that this parameter should be integrated into routine evaluations of RV systolic function.

Cost-Effectiveness of the Self-Care Management System for Heart Failure.

We recently reported that the self-care management system for heart failure (HF) decreased re-hospitalization for HF. In the present study we estimate the cost-effectiveness of this system. We retrospectively enrolled 569 consecutive patients who were admitted for HF treatment at Kitano Hospital. In the present analysis, we sought to compare cardiovascular healthcare costs and the incremental cost-effective ratio (ICER), expressed as the cost per quality-adjusted life-years (QALY) gained, between patients using the self-care management system (n=153) and those not using the system (n=153) after propensity-score matching. To calculate the QALY, we used the New York Heart Association class and the corresponding scores of quality of life in every 3 months. The healthcare costs of cardiovascular disease were ¥129,747,016 in the user group and ¥156,427,032 in the non-user group, where 24 and 43 patients were hospitalized, respectively. The cost of this new system was ¥50,000 in the user group. The total costs were ¥129,797,016 in the user group and ¥156,427,032 in the non-user group. By using the system, the QALY increased from 0.653 to 0.686. The ICER was below 0 and the system was interpreted as cost-effective. Use of the self-care management system is likely to be a cost-effective treatment for HF with the increase in QALY and the decrease in healthcare costs.

The Prognostic Role of RDW in Hospitalized Heart Failure Patients with and Without Chronic Kidney Disease.

Background: Chronic kidney disease (CKD) and heart failure (HF) are interrelated conditions that exacerbate each other through mechanisms like fluid retention, neurohormonal activation, and inflammation. Red blood cell distribution width (RDW), a measure of red blood cell size variability, has emerged as a potential prognostic marker in HF. This study aimed to assess the prognostic value of RDW in HF patients, both with and without CKD, focusing on all-cause mortality and HF rehospitalizations. Methods: This observational retrospective study included 171 patients hospitalized for acute decompensated HF in a tertiary university hospital in Greece. Patients were divided into two groups based on their estimated glomerular filtration rate (eGFR), as Group 1 (eGFR < 60 mL/min/1.73 m2) and Group 2 (eGFR ≥ 60 mL/min/1.73 m2). RDW was measured upon admission, and outcomes of interest were all-cause mortality and HF rehospitalizations over a median follow-up period of 6.1 months. Statistical analyses included Kaplan-Meier survival curves, whereas the discrimination traits of RDW were evaluated by constructing receiver operating characteristic (ROC) curves and by calculating the area under the ROC curve (AUC). A p-value <0.05 was indicative of a statistically important result. Results: Patients in Group 1 (eGFR < 60 mL/min/1.73 m2) were older (80 (73-86) vs. 75 (62-83)) and manifested higher median RDW values (16.6 (15.0-18.8) vs. 15.6 (14.1-17.8)) and received less frequent (57.9% vs. 75%) mineralocorticoid receptor antagonists (MRAs) as compared to those in Group 2 (eGFR ≥ 60 mL/min/1.73 m2). RDW demonstrated better prognostic value in predicting combined mortality and rehospitalization outcomes in Group 2 patients (area under the curve: 0.70; 95% CI (0.62-0.80)) compared to those in Group 1 (area under the curve: 0.53; 95% CI (0.35-0.72)). No statistically significant differences (p = 0.579) were observed in survival between patients with high (≥15%) and low (<15%) RDW values in the overall population, though trends favored worse outcomes with elevated RDW. Similarly, no significant differences (p = 0.374) were observed in survival between patients with high (Group 2) and low (Group 1) eGFR values. Conclusions: RDW appears to be a meaningful prognostic biomarker for HF patients, particularly in those without CKD. Further multicenter studies are needed to validate its clinical utility and potential for guiding treatment in this high-risk population.

Pulmonary hypertension as a prognostic marker in low-flow low-gradient aortic stenosis: Insights from invasive hemodynamics and post-TAVR outcomes.

Pulmonary hypertension (PH) is a common and significant comorbidity in patients with low-flow low-gradient (LF-LG) aortic stenosis, impacting prognosis after transcatheter aortic valve replacement (TAVR). Non-invasive tools often fail to capture PH's full clinical impact due to inherent limitations. This study evaluates the prognostic significance of PH measured invasively and explores its implications on post-TAVR outcomes. This retrospective study analyzed 90 patients with symptomatic LF-LG aortic stenosis who underwent TAVR. Pulmonary artery systolic pressure (PASP) was categorized as mild (<35mmHg), moderate (35-50mmHg), or severe (>50mmHg) using invasive right heart catheterization. Key endpoints included 12-month all-cause mortality and heart failure rehospitalization, assessed via Kaplan-Meier survival analysis and Cox proportional hazards modeling. PH was present in 50% of patients, with moderate-to-severe cases showing higher mortality (25% vs. 8%, p<0.001) and rehospitalization rates (20% vs. 6%, p=0.02). Baseline PASP emerged as an independent predictor of mortality (HR 1.07 per mmHg, p<0.001) and rehospitalization (HR 1.04 per mmHg, p=0.01). Subgroup analyses revealed that patients with concomitant COPD or advanced diastolic dysfunction exhibited worse outcomes, underscoring the role of systemic disease burden. Invasive hemodynamic assessment provides superior prognostic insight for PH in LF-LG aortic stenosis patients. The findings advocate for targeted PH management strategies to improve post-TAVR outcomes and challenge the sole reliance on non-invasive methods in high-risk cohorts.

Cumulative Incidence and Prognostic Value of Readmissions in Patients With Heart Failure: Data From a Large Cohort Study of Real Clinical Practice in St. Petersburg.

Aim To evaluate the cumulative incidence and prognostic value of rehospitalizations in patients with heart failure (HF) within one year after discharge.Material and methods The data of patients with HF hospitalized for the first time (code I50.x in the diagnosis) for the period from January 01, 2022 through February 13, 2024 were selected from the St. Petersburg Chronic Heart Failure Registry. Age and gender characteristics, comorbidities, risk of rehospitalization and death after discharge from the hospital depending on the number of rehospitalizations were analyzed. Descriptive statistics methods, Kaplan-Meier survival analysis, and the Fine and Gray competing risks model were used. P&lt;0.001 was considered significant.Results The study included 43,143 patients with HF who were hospitalized for the first time. During a median observation time of 242 days, 6,395 (14.8%) patients were readmitted, most often once (78.4%). A greater number of rehospitalizations was typical for men, patients with HF of ischemic genesis, atrial fibrillation, diabetes mellitus, obstructive pulmonary diseases, and a history of COVID-19. The cumulative incidence of rehospitalizations for HF during 1, 3, 6, and 12 months was 3.2%, 7.0%, 10.8%, and 17.2%, respectively, taking into account the competing risk of death. With an increasing number of hospitalizations, the median time to the next hospitalization decreased, and the risk of readmission increased (p&lt;0.001). The probability of death within a year of the index hospitalization was 14.9% (95% confidence interval [CI]: 14.5%-15.3%). The all-cause death rate was 30, 44, and 54 cases per 100 patient-years for patients with one, two, and at least three readmissions vs. 19 cases per 100 patient-years for those without readmissions. Readmitted patients were characterized by an increased risk of death: the adjusted hazard ratios of death in patients with one, two, and at least three readmissions were 1.47 (95% CI: 1.36-1.59), 1.97 (95% CI: 1.69-2.30), and 2.24 (95% CI: 1.81-2.78), respectively.Conclusion In patients hospitalized with HF for the first time, the cumulative one-year HF readmission rate adjusted for the competing risk of death was 17.2%. Increased readmission rates were independently associated with increased odds of readmission and death.

Incidence, progression, and outcomes of heart failure with improved ejection fraction: The added value of longitudinally assessed ejection fraction

BackgroundThe revised universal definition of heart failure (HF) established a standardized definition for HF with improved ejection fraction (HFimpEF) and emphasized the importance of longitudinally assessing left ventricular EF (LVEF). We aim to investigate the incidence, disease progression, and clinical outcomes of HFimpEF in a longitudinal cohort of hospitalized HF patients. MethodsWe retrospectively included HF patients with baseline LVEF ≤40 % and satisfactory echocardiographic follow-ups. HFimpEF was defined as a ≥ 10-point increase in LVEF to >40 %. Transient HFimpEF was defined as a recurrent LVEF ≤40 % after achieving HFimpEF. Clinical outcomes were all-cause death, cardiovascular death, and HF rehospitalization. ResultsDuring a median follow-up of 47.9 months, 517 of 923 patients met HFimpEF criteria; 65.0 % HFimpEF cases occurred within 12 months. HFimpEF patients had lower risks of all-cause death (hazard ratio [HR] = 0.16, P < 0.001), cardiovascular death (HR = 0.19, P < 0.001), and HF rehospitalization (HR = 0.39, P < 0.001). However, 160 HFimpEF patients experienced LVEF worsening during follow-up; their risks for adverse events were higher (HR = 1.89 for all-cause death, HR = 2.13 for cardiovascular death, HR = 2.13 for HF rehospitalization, P < 0.05 for all) compared to persistent HFimpEF patients, and their capability of LVEF re-improvement was diminished. An inverted U-shaped LVEF profile for HFimpEF—characterized by a slow, modest increase followed by a decline—portended a higher mortality risk. ConclusionsHFimpEF was observed in 56.0 % of HF patients. Longitudinally assessing LVEF helps identify HFimpEF patients and facilitates disease progression monitoring and risk stratification.

Contemporary Use of β‐Blockers in Heart Failure Patients With and Without Atrial Fibrillation: A Nationwide Database Analysis

Evidence of the effectiveness of β‐blockers in heart failure (HF) and atrial fibrillation (AF) in a contemporary cohort is controversial. This study investigated the association between the use of β‐blockers and prognosis in hospitalized HF patients with and without AF in Japan. Patients hospitalized with the first episode of acute HF were identified from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2021. Associations of β‐blocker use and prognosis were compared by propensity score matching among the AF or non‐AF group. A mixed‐effects survival model was used, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Among 428,650 patients discharged with HF in 4,433 hospitals, 175,174 (40.9%) were ≥ 85 years old, 151,873 (35.4%) had complicated AF, and 236,457 (55.2%) were β‐blocker users. In a matched AF group, β‐blocker use was associated with a lower composite outcome of all‐cause mortality or HF rehospitalization (HR [95% CI], 0.95 [0.93–0.97]). A similar result was obtained in a matched non‐AF group (0.95 [0.94–0.96]). In addition, the HRs in patients aged ≥ 85 years and female patients were 1.00 [0.98–1.02] and 1.01 [0.98–1.03] in the AF group and 1.03 [1.01–1.05] and 0.98 [0.97–1.00] in the non‐AF group, respectively. The favorable prognostic associations of β‐blocker use were observed regardless of AF in patients across a broad spectrum of HF in a superaged society.

Prognostic value of heart rate and oxygen pulse response in heart failure with left ventricular ejection fraction over 40.

Heart rate (HR) and stroke volume (SV)-the components of cardiac output-have a complementary relationship. Poor HR increase during exercise is associated with poor exercise tolerance in heart failure (HF) with preserved ejection fraction (HFpEF), but its prognostic impact remains unclear. Furthermore, whether the compensation for poor HR increase with SV during exercise is associated with prognosis remains unknown. We evaluated 129 consecutive hospitalized HF patients with sinus rhythm and left ventricular ejection fractions > 40% who underwent cardiopulmonary exercise testing before discharge from the index hospitalization. Patients (age: 66 [55-74] years; 73% male) were divided into four groups by median HR reserve (HRR; peak-rest HR: 34bpm) and O2 pulse, a surrogate for SV, reserve (peak-rest O2 pulse: 4.8mL/beat). During a mean follow-up of 562 [294-961] days, cardiovascular events (cardiovascular death and/or HF rehospitalizations) occurred in 24 patients. Kaplan-Meier analysis identified significant differences in outcomes among the four groups (χ2 = 27.3, p < 0.001). Using the preserved HRR/preserved O2 pulse reserve group (n = 33) as a reference, the impaired HRR/impaired O2 pulse reserve group (n = 37) was associated with poor outcomes (adjusted hazard ratio: 5.66, 95% CI 1.15-27.74, p = 0.033), whereas the impaired HRR/preserved O2 pulse reserve group (n = 31) was not (adjusted hazard ratio: 0.38, 95% CI 0.03 to 4.76, p = 0.455). The overlap of lower increases in HR and O2 pulse, a surrogate for SV, during exercise was associated with an extremely poor prognosis in HFpEF.