Rehospitalization For Heart Failure Research Articles

Prognostic impact of cardiovascular polypharmacy on octogenarians with heart failure with preserved ejection fraction

Abstract Backgrounds Drug treatments of heart failure with preserved ejection fraction (HFpEF) have a little clinical benefit, but cardiovascular polypharmacy (CP) trend is observed in elderly HFpEF. We investigated the impact of CP on octogenarian with HFpEF. Methods We examined 783 consecutive octogenarians (≥80 years) enrolled in the PURSUIT-HFpEF registry. We defined medications for hypertension, dyslipidemia, heart failure (HF), coronary artery disease, stroke, peripheral artery disease, and atrial fibrillation as cardiovascular medications (CM). In this study, we defined CP as ≥5 CM. We investigated whether CP was correlated with the composite end point (CE) of all-cause mortality and HF rehospitalization. Results The proportion with CP was 51.9% (n=406). Background characteristics correlated with CP were frailty, history of coronary artery disease, atrial fibrillation and left atrial dimension. Multivariable Cox proportional hazards analysis showed CP was significantly and independently correlated with CE (hazard ratio (HR): 1.31; 95% confidence Interval (CI): 1.01-1.70) in addition to age, clinical frailty scale, history of HF admission and N-terminal pro brain natriuretic peptide (Table). Kaplan-Meier curve analysis showed that, compared with the non-CP group, the CP group had significantly higher risk of CE and HF (HR: 1.27; 95%CI: 1.04-1.56; P=0.02 and HR: 1.46; 95%CI: 1.13-1.88; P<0.01, respectively), but not any-cause death (Figure). In addition, diuretics were correlated with CE (HR: 1.61; 95%CI: 1.17-2.22; P<0.01), but antithrombotic drugs and HFpEF medications were not. Conclusions CP at discharge is a prognostic factor driven by HF rehospitalization in octogenarians with HFpEF. In these patients, diuretics may be correlated with the prognosis.

Impact of anaemia and iron deficiency on long-term outcomes following transcatheter edge-to-edge repair in degenerative vs. secondary mitral regurgitation: results from a large single-center study

Abstract Background Transcatheter mitral valve edge-to-edge repair (TEER) is an established therapeutic option for significant mitral regurgitation (MR), as an alternative for patients at high risk for open heart surgery. While mitral valve reconstruction is the guideline-recommended treatment modality for degenerative mitral regurgitation (DMR), secondary mitral regurgitation (SMR) is more complex and requires a multifaceted approach. Anaemia and iron deficiency (ID) are both associated with unfavourable outcomes in patients with cardiovascular diseases, particularly in those with heart failure. In patients undergoing TEER, the prevalence of ID and anaemia is exceptionally high. However, data regarding the impact of anaemia and ID on outcomes are limited to short- and mid-term follow-up periods. Purpose This retrospective single center study, aimed to investigate effects of anaemia and ID on long-term outcomes following TEER for relevant MR, as well as to relate it to the underlying MR aetiology. Methods A total of 833 patients (mean age 76.1 ± 8.4 years, 40.7% female, 63.3% secondary MR) were treated by TEER between September 2008 and July 2019. Patients were stratified based on their anaemia status (anaemia was defined as hemoglobin <12 g/dL in females and <13 g/dL in males) or ID (defined according to current HF guidelines as a serum ferritin concentration of <100 ng/mL or 100–299 ng/mL and a transferrin saturation <20%). Clinical follow-up was conducted primarily through in-person visits or by structured telephone interviews at 6 and 12 months after intervention and annually thereafter. The median follow-up time was 5.5 years, with a maximum follow-up of 12.3 years. Results Anaemia and ID were prevalent among patients with 61.6% and 68.1%, respectively. Among all anaemic patients, 73.5% also had ID. Anaemic patients had a lower functional status at baseline and were less likely to show improvement after TEER. Additionally, anaemia was significantly associated with all-cause mortality (hazard ratio [HR]=1.68, 95%-confidence interval [CI]: 1.36-2.07, p<0.001) and the composite endpoint of death or heart failure rehospitalization (HR=1.30, 95%-CI: 1.10-1.54, p=0.002). Moreover, anaemia was found to be an independent predictor for all-cause mortality in patients with secondary MR, with a 5-year mortality rate of 69.9% in anaemic patients compared to 47.8% in non-anaemic patients (p<0.001). However, ID was not associated with an increased risk of all-cause mortality or the composite endpoint of death or heart failure rehospitalization for either degenerative or secondary MR. Conclusion The high prevalence of anaemia and ID in patients undergoing TEER is noteworthy. Anaemia was associated with poorer functional baseline status and less post-interventional improvement. Furthermore, and in contrast to ID, anaemia was linked to higher mortality rates and more heart failure rehospitalizations, particularly in patients with secondary MR.Kaplan Meier survival analysisPredictors for all-cause mortality

Long-term prognostic significance modified body mass index in patients with decompensated acute heart failure: Insight from the OPAR study

Abstract Background/Introduction Malnutrition is a well-known poor prognostic factor in patients with acute decompensated heart failure (ADHF). Although conventional body mass index (cBMI) and serum albumin level are commonly used as indicators of malnutrition, these values are affected by fluid balance. The recently proposed modified BMI (mBMI, serum albumin [g/l] × cBMI [kg/m2] ) may be a better prognostic marker, but its usefulness in patients with ADHF remains unclear. Purpose This study aimed to investigate the prognostic significance of mBMI in patients hospitalized for ADHF. Methods The OPAR study is a single-center registry enrolling 605 consecutive patients who were admitted for ADHF with survival discharge between October 2011 and October 2017. The present study population was consisted of 573 patients admitted for ADHF who had a value of cBMI and serum albumin at discharge. The eligible patients divided into the following four groups according to the mBMI quartiles: lowest quartile (Q1, mBMI <600, n = 144), second quartile (Q2, 600≤ mBMI <715, n = 144), third quartile (Q3, 715≤ mBMI <842, n = 142), and highest quartile (Q4, mBMI ≥842, n = 143). The primary outcome measure was all-cause death, and the second outcome measures were cardiac death, non-cardiac death, and heart failure rehospitalizations. Cumulative incidences of death and heart failure rehospitalizations were estimated by the Kaplan-Meier and Gray’s method, respectively. Cox proportional hazards regression models were used to identify patients at risk of all-cause death to calculate the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The predictive power of mBMI for all-cause mortality was assessed using receiver operator characteristic curve analysis. Results During a median follow-up period of 4.68 years (interquartile range, 2.16–6.72 years), the cumulative 5-year incidences of all-cause death substantially increased in the lower mBMI quartiles (Q1: 60.7% [95% CI, 52.5%–68.9%], Q2: 53.9% [95% CI, 45.7%–62.5%], Q3: 38.8% [31.1%–47.7%], and Q4: 21.3%[15.3%–29.2%], log-rank P <0.001). After adjustment for the potential confounders, the excess risk of Q1 relative to Q4 for all-cause death tended to be higher (adjusted HR, 1.44 [95% CI, 0.94–2.20], P = 0.09). The predictive power of mBMI was modest with a C-statistic of 0.65 (95%CI, 0.61–0.70). The cumulative 5-year incidence of cardiac death and non-cardiac death also increased in the lower mBMI quartiles (Q1: 29.1% and 44.5%, Q2: 18.9% and 43.1%, Q3: 21.3% and 22.3%, and Q4: 7.2% and 15.2%, respectively, log-rank P <0.001 for both). The cumulative 5-year incidences of heart failure rehospitalizations did not significantly differ across the mBMI quartiles (P = 0.35). Conclusions The mBMI at discharge is a simple and potentially helpful marker for the prediction of long-term mortality in patients hospitalized for ADHF.Primary outcomeSecondary outcome

Incidence, predictors, and prognostic impact of rehospitalization after transcatheter aortic valve implantation.

Despite rehospitalization being common after transcatheter aortic valve implantation (TAVI), an in-depth analysis on this topic is missing. This study sought to report on the incidence, predictors, and prognostic impact of rehospitalization within 1 year following TAVI. All consecutive patients treated with TAVI between 2016 and 2020 in East Denmark were included. Medical records of all patients were reviewed to validate rehospitalizations up to 1 year after discharge from the index admission. The study population consisted of 1397 patients, of whom 615 (44%) had an unplanned rehospitalization within the first year post-TAVI. The rehospitalization incidence rate was three-fold higher in the early period (within 30 days) compared with the late period (30 days to 1 year; 2.5 vs. 0.8 per patient-year, respectively; P<0.001). Predictors of early unplanned rehospitalization were procedure-related complications and prior stroke, whereas late unplanned rehospitalization was associated with preexisting comorbidities. Predictors of heart failure (HF) rehospitalization included ischaemic heart disease, the extent of cardiac damage, atrial fibrillation, and New York Heart Association class at baseline. HF rehospitalization within 30 days and 1 year post-TAVI was associated with a markedly increased 1- and 5-year mortality risk [hazard ratio (HR) of 4.3 and 3.2 for 1-year mortality and HR of 3.2 and 2.9 for 5-year mortality, respectively; P<0.001]. Rehospitalization after TAVI is frequent in real-world practice. Early rehospitalization is mostly procedure related, whereas late rehospitalization is related to preexisting comorbidities. HF rehospitalization is associated with poor long-term survival and could be validated as a prognostically relevant endpoint for TAVI trials.

Urgent Transcatheter Edge-to-Edge Repair (TEER) of severe mitral regurgitation in patients with cardiogenic shock: A systematic review and meta-analysis of 5,428 patients

Abstract Background Patients presenting with severe mitral valve regurgitation (MR) and cardiogenic shock (CS) demonstrate a poor prognosis and high mortality rate. Transcatheter edge-to-edge repair (TEER) of the mitral valve regurgitation with MitraClip may alter patient management while alleviating hemodynamic instability. Aim To perform a systematic review of the published literature and meta-analysis on the use of MitraClip in patients with severe MR and CS. Methods We performed a systematic review and meta-analysis according to the PRISMA guidelines. We systematically explored published literature in MEDLINE (Pubmed) before January 8, 2023, for studies assessing urgent TEER with MitraClip in patients presenting with severe MR and CS. CS was defined as 1) CS according to ICD-10; 2) inotrope use; or 3) mechanical circulatory support before TEER. The primary outcome was device success and all-cause mortality rates while the secondary outcome was the incidence of myocardial infarction (MI), stroke, and hospitalization for heart failure (HF), during in-hospital/30-days and long-term periods. We calculated I² to test heterogeneity. We used random-effects modeling for the meta-analyses to assess the primary and secondary outcomes. Results In total 25 studies, including 5,428 patients met the predefined eligibility criteria and were included in this meta-analysis. During the in-hospital/30-day period, device success was achieved in 86% (95% CI: 80%-91%, I2 =49%) with MR ≤2+ to be described in 87% (95% CI: 79%-93%, I2 =75.8%) of the cases, while the overall all-cause mortality was 14% (95% CI: 10%-19%, I2 =84%). The incidence of MI and stroke hovered at 4% (95% CI: 1%-13%, I2 =92%) and 2% (95% CI: 1%-2%, I2 =0%), respectively. During a mean follow-up of 10.6 ± 6.4 months, the all-cause mortality was increased to 31% (95% CI: 24%-39%, I2 =92%), while hospitalization for HF is needed in 18% (95% CI: 9%-29%, I2 =80%) of the patients. In the subgroup analysis of patients in CS due to acute MI who underwent urgent TEER, 11 studies and 352 patients were included. Device success was achieved in 92% (95% CI: 75%-100%, I2 =77.8%) and the in-hospital/30-day mortality was 13% (95% CI: 5%-21%, I2 =60%). In a mean follow-up of 10.2 ± 8.3 months, long-term all-cause mortality fluctuated at the same rate of around 11% (95% CI: 2%-23%, I2 =70%). Conclusion The use of MitraClip in patients with MR and concurrent CS is associated with improved in-hospital/30-day and long-term survival. Our findings indicate that using MitraClip in the acute phase is a safe approach that can significantly reduce all-cause mortality, MI, stroke, and re-hospitalization for HF in this patient population.

Eight-year follow-up of cardiosphere-derived cell transplantation in patients with single ventricle congenital heart disease

Abstract Background Although transcoronary infusion of cardiosphere-derived cells (CDCs) in patients with single ventricles provides short-term improvement in cardiac function, the long-term efficacy is still unknown. Purpose: We tested the hypothesis that CDC infusion is associated with improved long-term clinical outcome in patients with single ventricles and heart failure. Methods: Patients were enrolled in the TICAP phase 1 (Transcoronary Infusion of Cardiac Progenitor Cells in Patients With Single Ventricle Physiology) and PERSEUS phase 2 (Cardiac Progenitor Cell Infusion to Treat Univentricular Heart Disease) trials between January 5, 2011, and January 30, 2015. The inclusion criteria were that patients were aged &amp;lt;6 years who were diagnosed with single ventricle lesions undergoing stage 2 (bidirectional Glenn: BDG) or stage 3 (total cavopulmonary connection: TCPC) palliation. Ventricular ejection fraction should be &amp;lt;60% during the initial screening through the final enrollment. Medical records of patients with single ventricles were obtained and analyzed as a control group who were eligible but were treated by staged palliation alone. We evaluated the effectiveness of CDCs using an integrated cohort study in 93 patients with single ventricles, including 41 patients who received CDC infusion and 52 controls. Results: At the time of this study, 36 patients with CDC infusion and 42 controls were alive without cardiac transplantation, with mean follow-up of 9.7±1.2 years. Survival rate did not differ between the 2 groups (log-rank P = 0.351), whereas overall patients treated by CDCs had lower incidents of late failure defined as late death, protein-losing enteropathy, plastic bronchitis, BDG or TCPC take down, disqualified TCPC candidate, Ross classification 3 or 4, or rehospitalization for heart failure (P = 0.048) compared with controls. Adverse events defined as unplanned cardiac operation, arrhythmia, thromboembolic events, cerebral hemorrhage, or tumor formation (P = 0.057) and unplanned catheter intervention (P = 0.094) did not differ between 2 groups. Conclusions: Intracoronary delivery of CDCs in patients with single ventricles did not improve all-cause mortality rate but significantly reduced the incidence of late failure at 8 years of follow-up.

Redox state of human serum albumin predicts 1-year prognosis in patients with heart failure: a single center prospective cohort study

Abstract Background As chronic inflammation would be a fundamental underlying mechanism in the pathogenesis in patients with heart failure (HF), oxidative stress has a possibility to closely associate with the prognosis. However, little is known about the association of oxidative stress with the prognosis in HF patients. Purpose In this study, we assessed the association of the fraction of human mercapto-albumin [f(HMA)], an index of the redox state of human serum albumin, with prognosis in patients hospitalized for HF with the aim to find the possible biomarker available on the prediction for adverse events in HF patients. Methods A single-center prospective cohort study was conducted. In the cohort, 290 ambulate patients admitted for acute HF or exacerbation of chronic HF were registered. Of these, 182 who were successfully followed-up patients were analyzed (median age: 79 years, men: 68.3%. median follow-up: 365 days). The primary outcome was a composite of HF rehospitalization and all-cause mortality. The high-performance liquid chromatography postcolumn bromocresol green method was used to part human serum albumin into human nonmercaptalbumin (oxidized form) and human mercaptalbumin (HMA, reduced form). We divided patients into two groups by median f(HMA) level. Kaplan-Meier Curve and the Cox proportional hazards model was used to examine the significance of f(HMA) as a prognostic indicator of HF patients, adjusting for potential confounding factors. Results Median level of f(HMA) was 57.2%. During 50,965 person-days of follow-up, 52 patients (28.6%) were re-hospitalized due to HF exacerbation, and 25 patients (13.7%) died due to cardiac or noncardiac reasons. Log-rank analysis showed that a high f(HMA) group reduced adverse events (Fig. 1). In the Cox proportional hazards model, a high level of f(HMA) was associated with a reduced risk of composite outcomes (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.39-1.07). In the subgroup analysis, high f(HMA) showed an event-reducing effect in HF rehospitalizations (HR 0.53; 95% CI 0.30-0.94), but not in all-cause mortality (HR 0.61; 95%CI 0.27-1.38). Conclusion The findings of this study support that f(HMA) could be a novel prognostic biomarker for HF patients.Fig. 1

Prognostic impact of a novel risk score for transcatheter edge-to-edge repair in patients with heart failure: sub-analysis of FRAGILE-HF

Abstract Background MitraScore is a novel, simple, and manually calculatable risk score developed as a prognostic model for patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation. As its components are considered prognostic in heart failure (HF), we aimed to investigate the usefulness of the MitraScore in HF patients. Methods We calculated MitraScore for 1100 elderly patients (&amp;gt;65 years old) hospitalized for HF in the prospective multicenter FRAGILE-HF study and compared its prognostic ability with other simple risk scores. The primary endpoint was all-cause deaths, and the secondary endpoints were the composite of all-cause deaths and HF rehospitalization and cardiovascular deaths. Results During a follow-up of two years, 226 all-cause deaths, 478 composite endpoints, and 183 cardiovascular deaths were observed. MitraScore successfully stratified patients for all endpoints in Kaplan-Meier analysis (p&amp;lt;0.001 for all). In multivariate analyses, MitraScore was significantly associated with all endpoints after covariate adjustments (adjusted hazard ratio (HR) [95% confidence interval]: 1.22 [1.10-1.36], p&amp;lt;0.001 for all-cause deaths; adjusted HR 1.17 [1.09-1.26], p&amp;lt;0.001 for combined endpoints; and adjusted HR 1.24 [1.10-1.39], p&amp;lt;0.001 for cardiovascular deaths). Hosmer-Lemeshow plot showed good calibration for all endpoints (p = 0.86-0.99). MitraScore resulted in significant reclassification improvements in all-cause and cardiovascular deaths as compared with the GWTG-HF risk score, BIOSTAT compact model, AHEAD and AHEAD-U scores, and HANBAH score. Conclusion MitraScore developed for patients undergoing TEER also showed strong discriminative power in HF patients. These results might suggest that HF patients and those receiving TEER shared similar prognostic factors.Kaplan–Meier curves for all-cause deathComparison with other scores

Tricuspid regurgitation and heart failure: the faith of treated vs untreated cohort in the percutaneous era

Abstract Background/Introduction Tricuspid regurgitation (TR) is associated with heart failure and reduced survival.Within a short-time period, transcatheter tricuspid valve repair or replacement (TTVR)(TTVr) for TR has evolved from innovation to clinical reality. Still, most patients arrive in an advanced state of heart failure (HF), as well as most cohorts remained untreated for various reasons. The faith of these two therapeutic approaches gives differences in results among survival and clinical status at distance. Purpose The present study’s aim is to provide 1 year results between TR patients treated with TTVR and TTVr compared to untreated patients, in terms of cardiac survival, rehospitalization, right-side heart failure symptoms development, and NYHA improvement. The secondary endpoint is to analyze gender disparities as well as echocardiographic and medical therapy changes between groups. Methods 78 patients (pts) have been prospectively inserted into a dedicated database from January 2020 till January 2023. 26 pts (36%) have been treated with TTVR/r (Treated Group-TG) and 51 pts (65%) have been left untreated with medical therapy (MT) optimization (UN-Treated Group-UNTG). In TG, 9 (34%) underwent TEER (Transcatheter Edge-To-Edge Repair), 13 (50%) annuloplasty and 4(15%) TTVr. Tri-Score was used to define right-side pathology in both groups; the Tri-Score mean of 3.9 (8-1 +/- SD 1.68) was in TG, while 6,17 (10-2+/- SD 1.9) in UNTG. In UNTG 52% were female gender while 76%in TG. Most of the patients in UNTG were in TR stage 5 (47%) while in stage 4 in TG (42%). For 1 year follow-up (FUP), Kaplan-Meier weighted survival curves related to cardiac death and HF rehospitalization have been computed as well as Chi-squared test to evaluate right-side HF symptoms progression, echocardiographic changes in right ventricular function, NYHA progression and medical therapy changes, between the 2 groups. Results Analyzing the cardiac death between the 2 groups, there was a significant statistical difference since TG has a less incidence of exitus in the general population (p-value =0,05), Figure 1. Concerning gender, in female gender, the treated pts have lower cardiac death incidence (p-value =0,03).Concerning HF hospitalization, TG has a lower incidence with p-value =0,005, Figure 2. No difference according to gender. In TG there was a significant improvement in NYHA class at FUP (p-value =0,001) as well as an improvement of right-side HF symptoms (p-value =0,001). In UNTG there was a significant increase in the dosage of HF drugs compared to TG, (p-value =0,001) as well as an increase in right ventricular function and dimension at echocardiogram (p-value =0,001). Conclusion(s) this study shows that treatment in case of TR with right side HF has a positive impact upon cardiac death,HF hospitalisation at 1 year. As well as there is a significant improvement in clinical and ecocardiographic status at FUP in treated group.figure 1figure 2

Impact of gender-related differences in outcomes in acute myocardial infarction: non-obstructive coronary arteries versus obstructive coronary arteries

Abstract Background Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) represents 6-10% of acute myocardial infarction (AMI) and is more prevalent in females. The impact of gender on the outcomes of MINOCA patients has been poorly understood. Purpose To evaluate the impact of gender on the prognosis of MINOCA. Methods We enrolled 2455 patients with AMI undergoing coronary angiography from January 2016 to June 2021. Patients were divided according to type of AMI and gender: male (n=1593) and female (n=607) in AMI with obstructive coronary arteries (MIOCA); male (n=87) and female (n=168) in MINOCA. Each cohort was further stratified based on age (&amp;lt;=/&amp;gt; 70 years). The primary endpoint was a composite of all-cause death, recurrent AMI, and hospitalization for heart failure (MACE) at 5-year follow-up. Secondary outcomes included: all-cause and cardiovascular death, recurrent AMI, HF re-hospitalization and stroke. Results MINOCA patients were more likely to be females compared to MIOCA ones (p&amp;lt;0.001). The incidence of MACEs was significantly higher in females compared to males, both in MINOCA (p=0.018) and MIOCA cohorts (p=0.002). Age was an independent predictor of MACEs in both cohorts. No difference in outcomes was found comparing females to males &amp;gt;70 years, in both MINOCA and MIOCA. MINOCA females &amp;lt;70 years old had a higher incidence of MACEs (p=0.003), mainly driven by a higher prevalence of re-hospitalization for HF (p=0.045) and recurrence of AMI (p=0.006). Only in this sub-group of MINOCA patients, female gender was an independent predictor of MACEs (HR=3.09; 95%CI: 1.02-9.59; p=0.040). MINOCA females &amp;lt;70 years old had worse outcomes than MIOCA peers. Conclusion MINOCA females &amp;lt;70 years old had a significantly higher incidence of MACEs, compared to males and MIOCA peers, likely due to the different pathophysiology of the ischemic event.Survival curves in MINOCA and MIOCASurvival curves stratified for age

Self-monitoring using Mobile App to improve symptoms and Reduce rehospitalization and morTality in Heart Failure (SMART-HF trial)i

Abstract Background Considering the uncertainty of the benefits of mobile apps in patients with heart failure (HF), we developed a mobile health platform and aimed to evaluate this intervention in terms of improving symptoms and outcomes in HF. Methods Seven tertiary hospitals in South Korea participated in this prospective, randomized, open-label, nationwide, multicenter, pilot trial (SMART-HF trial). Patients aged ≥20 years hospitalized for acute heart failure who were able to use a smartphone were enrolled before discharge. Eligible participants were then randomized 1:1 to either the intervention group (AIDA/KT-app with devices) or the control group (AIDA/KT-app only). The mobile health platform consists of three parts: 1) smartphone app for patients (2) dashboard system for physicians (3) clinical decision support system. Only in the intervention group, the applications were automatically paired with a Bluetooth blood pressure monitor, weight scale and body water analyzer. The intervention group were able to enter their HF symptom scale into the app and receive feedback or alerts on their input. In the control group, patients could only enter their blood pressure, weight, and HF symptom into the app, and there are no connected devices and no feedback from the app. Results 84 patients were randomized to the intervention group (n=43) and control group (n=41). Overall, 62.8% of the patients were male, and the median age was 63.0 years. At 4 weeks, dyspnea score by questionnaire (range 0-10) was 1.5±2.3, and 2.0±2.4 in the intervention and control groups, respectively, and was not significantly different (P=0.415). The total HF symptom score (range 0-12) including dyspnea, fatigue, edema, and palpitation entered by the participants in the apps was not significantly different between two groups (2.0±2.1, and 1.6±2.1, P=0.454). In the intervention group, the level of body water composition showed trend toward decreasing during study period (initial level 7.46 -&amp;gt; final level 6.71, P=0.10). App adherence during the study period was higher in the intervention group compared with control group (70.6±32.5% vs. 47.8±32.0%, P=0.004). App satisfaction scores tended to be higher in the intervention group (7.1±2.6 vs. 6.2±2.9, P=0.147). Secondary composite endpoints including death, rehospitalization, and urgent HF visit were not significantly different between two groups (4/40 vs. 3/38, P=0.999). Conclusions Our mobile health platform showed feasibility and efficacy for HF patients although clinical outcomes were not significantly different, maybe due to small sample size. Considering that motivating patients to use the mHealth tool more frequently may lead to greater clinical benefit, further large research with a positive user experience is needed for HF patient care.

In-hospital and 1-year mortality associated with percutaneous coronary intervention use in patients with acute myocardial infarction older than 90 years

Abstract Background Patients older than 90 years are less likely to receive percutaneous coronary intervention (PCI) for treatment of acute myocardial infarction (AMI). This is due to the lack of evidence derived from randomized trials, multimorbidity, and possible futility. We investigated the prognostic impact of PCI in a large population of patients hospitalized with AMI in the period 2003-2018, by using the Lombardy Health Database (Italy). Methods We analyzed data of all patients &amp;gt;90 years hospitalized with AMI (both STEMI and NSTEMI) in Lombardy. Patients were grouped according to whether they were treated or not with PCI during index hospitalization. The primary outcome was in-hospital mortality. One-year mortality and 1-year re-hospitalization for acute heart failure (AHF) or AMI were considered as secondary endpoints. Results During the study period, 15,954 patients (median age 92 [91-94] years); 50% STEMI) were hospitalized with a primary diagnosis of AMI. Twelve percent of them (n=1,954) were treated with PCI. The in-hospital mortality rate in the entire cohort was 22% (29% in STEMI and 15% in NSTEMI). It was significantly lower in patients treated with PCI than in those not treated with PCI (15% vs. 23%; P&amp;lt;0.0001). In the overall population, 1-year mortality was 56% and 1-year re-hospitalization for AHF/AMI was 19%. Both these endpoints were less frequent in PCI-treated (37% vs. 58% and 16% vs. 21%, respectively; P&amp;lt;0.0001). The adjusted risk of the study endpoints was significantly lower in patients treated with PCI: OR 0.61 (95% CI 0.54-0.69) for in-hospital mortality; HR 0.53 (95% CI 0.49-0.57) for 1-year mortality; HR 0.68 (95% CI 0.66-0.70) for 1-year re-hospitalization for AHF/AMI. The figure shows the 1-year survival curves of AMI patients treated or not treated with PCI. Similar results were found in STEMI and NSTEMI patients considered separately. Conclusions Our real-world data showed that in patients with AMI older than 90 years of age, PCI use is associated with a significant in-hospital and 1-year clinical benefit.

Wearable cardioverter defibrillator after ICD-system explantation: data from a multicenter registry

Abstract Background Data on the use of wearable cardioverter defibrillator (WCD) among patients after cardiac implantable electronic device explantation of 1- to 3-chamber Implantable Cardioverter-defibrillator system (ICD) are sparse. Subsequently several guidelines give a different recommendation regarding WCD indication in this cohort. Objectives We aimed to study the baseline characteristics and outcome of patients treated with WCD after ICD explantation. The primary outcome is appropriate WCD shock. Methods 1104 patients were included in a multicenter registry from seven European centers. Among this cohort 109 patients received a WCD to bridge the time after ICD-system explantation until reimplantation due to a persistent ICD-indication. The mean follow-up time of the whole cohort was 824±773 days. Cardiovascular history and non-cardiovascular morbidities were evaluated. In addition, the presence of ventricular tachyarrhythmias and/or WCD shocks was evaluated in the explantation group. Furthermore, after ICD-reimplantation the rate of rehospitalization for ventricular tachyarrhythmias, atrial fibrillation, stroke and congestive heart failure was followed. Results In the explantation group patients were older (65±14 versus 59±15; p&amp;lt;0.001) and were hospitalized longer (21±15 days versus 14±12 days; p&amp;lt;0.001). The index LVEF differed significantly (35.7±14.1% versus 29.3±11.5%; p&amp;lt;0.001). The LVEF value did not differ significantly over short-term follow-up (35.7±14.2% versus 37.9±11.9%; p=0.204). Wear days among patients after ICD-system explantation were 61±46 days. An appropriate WCD shock was documented in 7.3% after ICD-system explantation during WCD use. Up to 80.6% of patients after ICD-system explantation received a reimplantation. The rate of rehospitalization due to ventricular tachyarrhythmias was 7.3%, due to heart failure 6.8% and due to atrial fibrillation 4.1%. After ICD-implantation the rate of appropriate shocks was 12/89 (13.4%). In the multivariable regression analysis myocarditis and ICD-system explantation were positive predictors for the risk of ventricular tachyarrhythmias, but nevertheless an improved left ventricular ejection fraction (LVEF) and use of aldosterone antagonists were negative predictors for the risk of ventricular tachyarrhythmias. Conclusions Cccurrence of malignant arrythmia after ICD-system explantation is high and the use of WCD among these patients could be beneficial in preventing sudden cardiac death.

Evidence-based heart failure therapies at discharge of patients with acute coronary syndromes and reduced ejection fraction: Data from the ACSIS survey

Abstract Background Guideline-directed medical therapies for heart failure (HF) may benefit patients with reduced left ventricular ejection fraction (LVEF) following acute coronary syndromes (ACS), even in the absence of overt HF. Few real-world data are available regarding early implementation of HF therapies in patients with ACS and reduced LVEF. Methods Data collected from the 2021 nationwide, prospective ACS Israeli Survey (ACSIS). Drug classes included: (a) angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) or angiotensin receptor-neprilysin inhibitor (ARNI); (b) beta-blockers; (c) mineralocorticoid receptor antagonist (MRA) and (d) sodium-glucose cotransporter-2 inhibitors (SGLT2I). Utilization of HF therapies at discharge or 90-days following ACS was analyzed in relation to LVEF [reduced ≤40% (n=406) or mildly-reduced 41-49% (n=255)] and short-term adverse outcomes. Results History of HF, anterior wall myocardial infarction and Killip class II-IV (32% vs. 14% p&amp;lt;0.001) were more prevalent in those with reduced compared to mildly-reduced LVEF. ACEI/ARB/ARNI and BBC were used by &amp;gt;85% of patients in both LVEF groups, though ARNI was prescribed to only 3.9% (LVEF≤40%). MRA was used by 42.9% and 12.2% of patients with LVEF ≤40% and 41-49%, respectively, and SGLT2I in a quarter of both LVEF groups. Overall, ≥3 HF drug classes were documented in 44% of the patients. A trend towards higher rates of 90-day HF rehospitalizations, recurrent ACS or all-cause death was noted in those with reduced (7.6%) vs. mildly-reduced (3.7%) LVEF, p=0.084. No association was observed between the number of HF drug classes, or the use of ARNI and/or SGLT2I with adverse clinical outcomes. Conclusions In current clinical practice, the majority of patients with reduced and mildly-reduced LVEF are treated by ACEI/ARB and beta-blockers early following ACS, whereas MRA is underutilized and the adoption of SGLT2I and ARNI is low. A greater number of therapeutic classes was not associated with reduced short-term rehospitalizations or mortality.Drug therapies for heart failure

Ten year evolution of clinical characteristics and short-term outcome of patients admitted with heart failure

Abstract Background/Introduction Heart failure (HF) continues to be a leading cause of morbidity, decreased quality of life (QoL) and mortality worldwide. Contributing to decreased QoL is the high rehospitalization rate, which is often related to non-cardiac causes, highlighting the important multimorbidity of the HF population. Detailed clinical and outcome data for HF admissions in Belgium over time are only scarcely available. Purpose We aimed to evaluate and compare two groups of patients admitted with HF ten years apart, regarding clinical characteristics, comorbidities, use of HF medication and devices, as well as rehospitalization rate and all-cause mortality three months post-discharge. Methods This is a monocentric retrospective observational cohort study conducted in Belgium. Two groups of patients admitted for acute decompensated HF who were discharged alive were included and compared: 340 patients during 2011-2012 and 319 patients during 2021-2022. Results The two cohorts did not differ significantly regarding age (77.3 vs. 78.4 years), gender (47.4 vs. 44.5% women), number of patients with HF with reduced ejection fraction (47.4 vs. 48.6%) and NT-proBNP on admission (8514 vs. 7398 pg/mL). Similarly, comorbidities including diabetes, chronic obstructive pulmonary disease, peripheral artery disease, stroke and renal failure were comparable in both groups. Concerning medical therapy at discharge, mineralocorticoid receptor antagonists (MRA) were used significantly more frequently in the latest cohort. However, there was no change in administration of beta-blockers or renin angiotensin aldosterone system antagonists. As part of the implementation of new therapies for heart failure with reduced ejection fraction, 29% of patients were prescribed sodium-glucose cotransporter-2 (SGLT-2) inhibitors, while sacubitril/valsartan was given in 13% of the cases. The use of internal defibrillators (ICD) and resynchronization devices (CRT) doubled from 2011-2012 to 2021-2022 (3.9 vs. 9.6%, p = 0.002). In-hospital length of stay decreased significantly over a ten-year period across all ejection fraction subgroups from 7 to 5 days (figure 1). The combined outcome of rehospitalization for HF and all-cause mortality three months post-discharge remained constant at approximately 20% (figure 2). Conclusion Clinical characteristics and comorbidities of patients admitted with acute decompensated HF did not change significantly between 2011 and 2022. Uptake of evidence-based medicine for HF increased, especially for MRA, SGLT-2 inhibitors and sacubitril/valsartan, as did the use of ICD and CRT, but still with considerable potential for improvement. Although in-hospital length of stay decreased significantly over time, rehospitalization rates for HF and all-cause mortality within 90 days post-discharge remained high and did not improve. These sobering results illustrate the need for continuing efforts to improve the care and outcome of HF patients.

Early deterioration of right ventricular strain in patients undergoing transcatheter tricuspid valve intervention

Abstract Background Severe tricuspid regurgitation (TR) leads to volume overload and increased wall stress causing detrimental right ventricular (RV) remodelling and dysfunction and is associated with excess mortality. Transcatheter tricuspid valve interventions (TTVI) emerged to treat patients with severe TR and high surgical risk, but predictors of outcome remain largely unknown. RV free wall longitudinal strain (RVFWLS) is a sensitive parameter for RV dysfunction and has shown prognostic value in patients with functional TR treated conservatively. Periinterventional changes in RVFWLS and right atrial (RA) strain have not been evaluated in patients undergoing TTVI. Purpose To analyse the effect of transcatheter tricuspid valve annuloplasty (TTVA) and transcatheter edge-to-edge repair (TEER) on RVFWLS and RA strain, assessed by speckle tracking echocardiography, and their association with outcome. Methods We retrospectively analysed consecutive patients with severe TR that underwent TTVI at our centre between 2020 and 2022. 126 patients were included (n=48 underwent TTVA with the Cardioband system, n=78 underwent TEER with the PASCAL system). Established parameters for RV function (TAPSE, FAC) as well as RVFWLS and RA reservoir strain (RASR) were analysed at baseline and one month after TTVI. Results All patients (median age 80 years, 69% female, 79% in NYHA III/IV functional class) were at prohibitive surgical risk. RV function at baseline was slightly reduced according to FAC (34% [29-39]) and preserved according to TAPSE (18mm [15-20]), whereas RVFWLS (-18.6±5.7%) and RASR (10.0% [7.0-14.0]) were severely reduced in markedly dilated right heart chambers (RV basal 45mm [41-49], RA area 34 cm2 [28-41]). TR reduction following TTVI to TR grade ≤ 2 was achieved in 77%. Right heart chamber size significantly decreased after one month (RV basal 41mm [38-45], RA area 29cm2 [25-38], P&amp;lt;0.001), with no improvement of FAC (37% [30-40], P=0.668) or RASR (10% [7-13], P=0.143) but deterioration of RV longitudinal function (TAPSE 17mm [13-20], P=0.002; RFWLS -16.1±5.7%, P=0.001) compared to baseline. RVFWLS reduction occurred irrespective of the procedure performed (TEER [-9.2±41.4] vs. TTVA [-7.0±31.3], P=0.783). RVFWLS deterioration occurred in 63%, whereas it improved in 37% of patients. Symptomatic and clinical outcome did not differ in patients with deteriorated vs. improved RVFWLS (improvement of at least one NYHA class 61.9% vs. 58.3%, P=0.569, one-year mortality 13.7% vs. 12.3%, P=0.940, one-year heart failure rehospitalization 10.8% vs. 17.1%, P=0.701). Conclusion Deterioration of RVFWLS after TTVI possibly reflects the decreased wall stress due to TR and consecutive preload reduction. However, symptomatic and clinical outcomes did not differ in patients with deteriorated RVFWLS vs. patients with improved RVFWLS. Reduction of RA size after TTVI did not translate into improvement of RASR, indicating an already advanced pre-existing RA dysfunction.

Predicting heart failure readmission and all-cause mortality in patients with acute heart failure: a simple predischarge risk score

Abstract Introduction Predischarge risk stratification of patients hospitalized for acute heart failure (AHF) could facilitate tailored treatment and follow-up, however, simple scores to predict short-term risk for HF readmission or death are lacking. Purpose We sought to develop a congestion-focused risk score to predict HF readmission and all-cause mortality after discharge in patients hospitalized for AHF. Methods We used data from a prospective, two-center observational study in adults hospitalized for AHF. Laboratory data were collected on admission. Patients underwent a physical examination, 4-zone, and in a subset 8-zone, lung ultrasound (LUS), and conventional echocardiography at baseline (within a median of 1 day after admission). A second LUS was performed before discharge in a subset of patients. The primary endpoint was the composite of HF rehospitalization or all-cause death. HF hospitalizations were adjudicated blinded to LUS findings. Results Among 297 patients with complete data (median age 74 years, 43% women, mean left ventricular ejection fraction 39%), 76 patients (26%) were hospitalized for HF or died within 90 days after discharge. A stepwise Cox regression model selected four significant independent predictors of the composite outcome and each was assigned points proportional to its regression coefficient: NT-proBNP ≥2000 pg/mL (admission) (3 points), systolic blood pressure &amp;lt;120 mmHg (baseline) (2 points), left atrial volume index ≥60 mL/m² (baseline) (1 point) and ≥9 B-lines on predischarge 4-zone LUS (3 points). The weighted risk score provided adequate risk discrimination for the composite outcome (HR 1.48 per 1 point increase, 95% confidence interval: 1.32-1.67, p&amp;lt;0.001, C-statistic: 0.70; Figure 1). In a subset of patients with 8-zone LUS data (n=176), results were similar (C-statistic: 0.72). Conclusion A four-variable, weighted risk score integrating clinical, laboratory and ultrasound imaging data provided adequate risk discrimination for 90-day adverse outcomes in patients hospitalized for AHF. If validated in a larger dataset, this score could be used to identify patients needing the closest monitoring, more intensive follow-up and early treatment adjustment.Figure 1.

Abstract 15247: Usefulness of Circulating Human Epididymis Protein 4 to Predict Outcomes After Transcatheter Aortic Valve Implantation

Introduction: Plasma level of Human Epididymis protein 4 (HE4) has been shown to be associated with an increased risk of cardiac events in dilated and ischemic cardiomyopathies. Hypothesis: was to examine the prognostic value of HE4 in patients undergoing transcatheter aortic valve implantation (TAVI). Methods: Three hundred sixty-two patients (mean age: 79.6 ± 8.2 years; 57.3% men) undergoing TAVI for severe aortic stenosis were prospectively enrolled in this study. The cohort was divided into two groups according to the median value of pre-intervention HE4 plasma levels (115 pmol/l). The primary endpoints were: 1) all-cause mortality and rehospitalization for heart failure (HF), and 2) composite endpoints of rehospitalization for HF and all-cause mortality. Results: Patients with higher HE4 plasma levels were older (81.2 ± 7.8 years vs 78 ± 8.3 years, p&lt;0.001) and presented with more global comorbidities (i.e.: diabetes mellitus, chronic heart failure, renal failure, Euroscore II, STS score and left ventricular ejection fraction; all p&lt;0.05). During a median follow-up of 2.5 (1.9-3.2) years, 34 (9.4%) patients were rehospitalized for HF, 98 (27.3%) patients died and composite endpoint 113 (31%). The 4-year survival rate was significantly lower in patients with higher HE4 plasma levels (44% vs. 71%; p&lt;0.001). In the multivariable Cox proportional hazard regression model adjusted for diabetes mellitus, chronic heart failure, coronary artery disease, chronic obstructive pulmonary disease, atrial fibrillation, Society of Thoracic Surgeons score, and left ventricular ejection fraction, patients with HE4 &gt;115 pmol/l was associated with a markedly higher risk of all-cause mortality (HR [95%CI]: 3.32 [1.96-5.60], p&lt;0.001). They also had higher 4-year rates of HF rehospitalization (13 vs 6%; log-rank p-value=0.015) and of the composite of HF rehospitalization and all-cause mortality (45 vs 18%; adjusted HR [95%CI]: 2.38 [1.50 - 3.78], p&lt;0.001). Conclusion: Elevated HE4 plasma levels are independently associated with a higher risk of all-cause mortality and HF rehospitalization following TAVI. This novel biomarker may be useful to enhance risk stratification and therapeutic decision-making.

Abstract 13587: Hemoglobin Levels Can Predict Early Rehospitalization in Advanced Heart Failure Patients Listed for Heart Transplantation Without Inotropes or Mechanical Circulatory Support

Background: Anemia is a common comorbidity which often coexists in patients with heart failure (HF), and is associated with poor clinical outcome. However, it is unclear whether hemoglobin value has clinical impact in advanced HF patients. Hypothesis: Hemoglobin value influence the clinical outcome of patients with advanced HF. Methods: We retrospectively reviewed clinical data of ambulatory advanced HF patients who were listed for heart transplantation at our institute without intravenous inotropes or mechanical circulatory support (MCS) between 2011 and 2022. We divided the patients with a hemoglobin of lower or higher than the median value, and compared a composite of all-cause death and rehospitalization for HF within 1 year. Results: We enrolled consecutive 38 HF patients (28 males, 49±11 years old). All patients had New York Heart Association III or IV symptoms. The median hemoglobin value at the time of listing for heart transplantation was 12.9 g/dL, 42% met the criteria of anemia, and 67% had iron deficiency. Patients in the lower hemoglobin group were characterized by lower body mass index (19.7±3.0 vs. 21.7±3.1 kg/m 2 , P=0.049), lower systolic blood pressure (84.0±7.6 vs. 88.9±6.2 mmHg, P=0.034) and lower albumin (4.0±0.4 vs. 4.3±0.3 g/dL, P=0.031) than those in the higher hemoglobin group. Age, prevalence of male, left ventricular ejection fraction and brain natriuretic peptide were comparable between the two groups. No patient died in either group at 1 year. The HF rehospitalization-free survival rate was significantly lower in the lower hemoglobin group (41% vs. 82% at 1 year, P=0.020). By multivariate Cox regression analyses, hemoglobin as a continuous variable was an independent predictor for early HF rehospitalization (odds ratio 0.70, 95% confidence interval 0.49-0.97, P=0.030). Conclusion: Lower hemoglobin was a predictor of early HF rehospitalization in ambulatory advanced HF patients listed for heart transplantation without inotropes or MCS.

Abstract 11995: Contemporary Guideline-Directed Medical Therapy (GDMT) for Heart Failure is Associated With A Reduced Incidence of New-Onset Atrial Fibrillation

Backgrounds: Heart Failure (HF) is a risk factor for new-onset atrial fibrillation (AF), and the new-onset AF is associated with a worse prognosis in HF patients. It has been reported that renin-angiotensin system inhibitor (RASi), β-blocker, mineral-corticoid receptor antagonist (MRA) and Sodium-glucose cotransporter 2 inhibitors (SGLT2i) prevent the new-onset AF in HF patients. However, significance of contemporary guideline-directed medical therapy (GDMT) for HF (RASi/ARNI + β-blocker + MRA + SGLT2i) on new-onset AF is unknown. We investigated the impact of GDMT for HF on new-onset AF. Methods and Results: We retrospectively studied the long-term (The mean follow-up was 603 ± 410 days) incidence of new-onset AF in HFrEF and HFmrEF patients without episode of AF (n=410) admitted to our hospital due to decompensated HF between 2015 and 2022. Patients were divided into 2 groups; patients treated with ≦2 HF drugs (n=192) and patients with ≧3 HF drugs (n=218) after discharge. The incidence of new-onset AF was significantly fewer in the ≧3 HF drugs group (HR 0.36, 95%CI 0.16-0.82). A multivariate analysis revealed that ≧3 HF drugs use was an independent negative predictor of new-onset AF (HR 0.38, 95%CI 0.15-0.98, P=0.04). Even after a propensity score matching of clinical variables, the incidence of new-onset AF was consistently fewer in the ≧3 HF drugs group (HR 0.39, 95%CI 0.15-1.00, P=0.04). Finally, comparing between patients with and without new-onset AF, new-onset AF was significantly associated with re-hospitalization for HF (HR 5.41, 95%CI 3.32-8.89, P&lt;0.001) and all-cause death (HR 2.36, 95%CI 0.98-5.68, P=0.047) in the studied population. Conclusion: The contemporary GDMT is associated with a reducing of new-onset AF in HF patients, which may be involved in the better outcomes with it.