Rehospitalization In Patients Research Articles

Association between triglyceride glucose-body mass index and long-term adverse outcomes of heart failure patients with coronary heart disease

BackgroundThe triglyceride glucose-body mass index (TyG-BMI) is recognized as a reliable surrogate for evaluating insulin resistance and an effective predictor of cardiovascular disease. However, the link between TyG-BMI index and adverse outcomes in heart failure (HF) patients remains unclear. This study examines the correlation of the TyG-BMI index with long-term adverse outcomes in HF patients with coronary heart disease (CHD).MethodsThis single-center, prospective cohort study included 823 HF patients with CHD. The TyG-BMI index was calculated as follows: ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2] × BMI. To explore the association between the TyG-BMI index and the occurrences of all-cause mortality and HF rehospitalization, we utilized multivariate Cox regression models and restricted cubic splines with threshold analysis.ResultsOver a follow-up period of 9.4 years, 425 patients died, and 484 were rehospitalized due to HF. Threshold analysis revealed a significant reverse “J”-shaped relationship between the TyG-BMI index and all-cause mortality, indicating a decreased risk of all-cause mortality with higher TyG-BMI index values below 240.0 (adjusted model: HR 0.90, 95% CI 0.86–0.93; Log-likelihood ratio p = 0.003). A distinct “U”-shaped nonlinear relationship was observed with HF rehospitalization, with the inflection point at 228.56 (adjusted model: below: HR 0.95, 95% CI 0.91–0.98; above: HR 1.08, 95% CI 1.03–1.13; Log-likelihood ratio p < 0.001).ConclusionsThis study reveals a nonlinear association between the TyG-BMI index and both all-cause mortality and HF rehospitalization in HF patients with CHD, positioning the TyG-BMI index as a significant prognostic marker in this population.

Beneficial Effects of Concomitant Long-Acting Injectable Antipsychotics on Time to Rehospitalization in Patients With Treatment-Resistant Schizophrenia Receiving Clozapine: A Retrospective Cohort Study.

Beneficial Effects of Concomitant Long-Acting Injectable Antipsychotics on Time to Rehospitalization in Patients With Treatment-Resistant Schizophrenia Receiving Clozapine: A Retrospective Cohort Study.

Glycated Hemoglobin Variability Is Associated With Adverse Outcomes in Patients With Heart Failure Irrespective of Diabetic Status.

The effect of glycated hemoglobin (HbA1c) variability on adverse outcomes in patients with heart failure (HF) is unclear. We aim to investigate the predictive value of HbA1c variability on the risks of all-cause death and HF rehospitalization in patients with HF irrespective of their diabetic status. Using a previously validated territory-wide clinical data registry, HbA1c variability was assessed by average successive variability (ASV) or SD of all HbA1c measurements after HF diagnosis. Multivariable Cox proportional hazards models were used to estimate the adjusted hazard ratio (HR) and its corresponding 95% CI. A total of 65 950 patients with HF were included in the study. Over a median follow-up of 6.7 (interquartile range, 4.0-10.6) years, 34 508 patients died and 52 446 required HF rehospitalization. Every unit increment of variability in HbA1c was significantly associated with higher HF rehospitalization (HR ASV, 1.20 [95% CI, 1.18-1.23]) and all-cause death (HR ASV, 1.50 [95% CI, 1.47-1.53]). Diabetes significantly modified the association between HbA1c variability and outcomes (Pinteraction<0.001). HbA1c variability in patients with HF without diabetes conferred a higher risk of rehospitalization (HR ASV, 1.92 [95% CI, 1.70-2.17] versus HR ASV, 1.19 [95% CI, 1.17-1.21]), and all-cause death (HR ASV, 3.90 [95% CI, 3.31-4.61] versus HR ASV, 1.47 [95% CI, 1.43-1.50] compared with patients with diabetes). HbA1c variability is significantly associated with greater risk of rehospitalization and all-cause death in patients with HF, irrespective of their diabetic status. These observations were more pronounced in patients with HF without diabetes.

Spironolactone for Preventing Contrast-Induced Nephropathy After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction and Chronic Kidney Disease.

Patients with acute myocardial infarction (AMI) and chronic kidney disease (CKD) are at high risk of contrast-induced nephropathy (CIN), which can subsequently worsen the overall prognosis. To evaluate the efficacy of spironolactone for CIN prevention, 410 patients with AMI and CKD receiving percutaneous coronary intervention (PCI) were retrospectively analyzed. Among them, 240 and 170 patients were enrolled in the standard treatment and spironolactone groups (spironolactone was administered 2 days before and 3 days after PCI), respectively. The primary endpoint of CIN was defined as a 0.5mg/dL or >25% increase from the baseline serum creatinine level within 48-72 h post-PCI. CIN incidence was significantly lower in the spironolactone group than in the standard treatment group (11.2 vs 26.7%, P < .001). Further, cardiac re-hospitalization (hazard ratio [HR]: 0.515; 95% CI: 0.382-0.694; P < .001) and cardiac death (HR: 0.612; 95% CI: 0.429-0.872; P = .007) risks were significantly lower in patients who received long-term spironolactone with a median treatment duration of 42 months after discharge. Spironolactone might lower the risk of CIN, and long-term use of spironolactone reduces the risk of cardiac re-hospitalization and cardiac death in patients with AMI and CKD undergoing PCI.

Chronic Effects of Adaptive Servo-Ventilation Therapy on Mortality and the Urgent Rehospitalization Rate in Patients Experiencing Recurrent Admissions for Heart Failure - A Multicenter Prospective Observational Study (SAVIOR-L).

This study investigated whether the chronic use of adaptive servo-ventilation (ASV) reduces all-cause mortality and the rate of urgent rehospitalization in patients with heart failure (HF).Methods and Results: This multicenter prospective observational study enrolled patients hospitalized for HF in Japan between 2019 and 2020 who were treated either with or without ASV therapy. Of 845 patients, 110 (13%) received chronic ASV at hospital discharge. The primary outcome was a composite of all-cause death and urgent rehospitalization for HF, and was observed in 272 patients over a 1-year follow-up. Following 1:3 sequential propensity score matching, 384 patients were included in the subsequent analysis. The median time to the primary outcome was significantly shorter in the ASV than in non-ASV group (19.7 vs. 34.4 weeks; P=0.013). In contrast, there was no significant difference in the all-cause mortality event-free rate between the 2 groups. Chronic use of ASV did not impact all-cause mortality in patients experiencing recurrent admissions for HF.

Mortality and rehospitalization in patients with pre-existing implantable pacemakers undergoing catheter ablation are related to increased comorbidity burden-data from the German Ablation Registry.

Catheter ablation of atrial fibrillation and atrial flutter is routinely performed in patients with implantable devices. The aim of the present study was to assess success rates and potential complications in a large registry cohort of patients with cardiac pacemakers. The German Ablation Registry is a nationwide, prospective registry with a 1-year follow-up investigating patients who underwent catheter ablation of supraventricular arrhythmias in 51 German centers. The present analysis focussed on the presence of cardiac pacemakers in 591 patients undergoing catheter ablation of atrial fibrillation or atrial flutter. These were compared to 7393 patients without a pacemaker. Patients with pacemakers were significantly older and presented more comorbidities like diabetes, renal failure, cardiovascular disease, or previous stroke. One-year mortality (2.4% vs. 1.3%, p = 0.022) and a combined endpoint of death, myocardial infarction, and stroke (3.6% vs. 2.1%, p = 0.014) were significantly elevated in patients with pacemakers. Re-hospitalization was also more common in patients with a pacemaker (53.3% vs. 45.0%, p < 0.01). After adjustment for important comorbidities, pre-existing pacemaker systems did not show any negative effect. Procedural success was reported in 98.8% vs. 98.4% (p = 0.93). Device-related complications were only observed in 0.4% of patients with pacemakers. Patients with pacemaker systems undergoing catheter ablation of atrial fibrillation or atrial flutter demonstrate an increased risk of death, cardiovascular events, and re-hospitalization. This observation can be largely attributed to an older patient population and an increased rate of comorbidities.

Prediction of risks and odds of rehospitalization of patients with eating disorders in anxiety-depressive disorders

The article represents the results of a study aimed on predicting the risks and odds of rehospitalization among patients with eating disorders in anxiety-depressive disorders. In total, 147 patients with anxiety and depressive disorders were examined. Patients were divided into a main group of 82 and a comparison group of 65 patients. The main group consisted of 21 (26%) men with a mean age of 38.33 (SD 11.53) and 61 (74%) women with a mean age of 43.15 (SD 11.44). The comparison group consisted of 19 (29%) men, mean age 37.53 (SD 9.75) and 46 (71%) women, mean age 45.22 (SD 12.17). At the time of the initial examination in the main group, 35 (43%) patients were hospitalized for the first time, 47 (57%) – rehospitalized; in the comparison group, 23 (35%) patients – for the first time hospitalized, and 42 (65%) – rehospitalized. It was found that 27 patients were rehospitalized within the next year after the intervention and treatment. Clinical-anamnestic, clinical-psychopathological and psychodiagnostic study supplemented by psychometric scales (PHQ-9 health questionnaire, Dutch Eating Behaviour Questionnaire (DEBQ), State-Trait Anxiety Inventory (STAI; C.D. Spielberger), Methodology for assessing the integrative Quality of Life Index (QLI; J.E. Mezzich)) was conducted. As a result of the study, it was found that patients in the main group had a 3.6 times lower risk of rehospitalization over the next year than patients in the comparison group. When constructing a unipolar regression model, the best predictive power and discriminative ability was demonstrated by the number of previous hospitalizations (p&lt;0.01, AUC 0.75 (0.67-0.82)) and the intervention in the main group, which reduced the odds of rehospitalization over the next year by 4.8 times. The highest discriminative ability was demonstrated by the multiple logistic regression model (AUC 0.83 (0.76-0.88)), according to which intervention in the main group reduced the odds of rehospitalization in the next year by 5.9 times. The results of the study became the basis for the development of differentiated treatment and correctional measures for eating disorders in patients with anxiety-depressive disorders to improve the quality of care, prevent psychosocial maladjustment and improve the quality of life of this population.

GDF-15: a novel biomarker of heart failure predicts short-term and long-term heart-failure rehospitalization and short-term mortality in patients with acute heart failure syndrome

BackgroundAcute heart failure (AHF) is a potentially life-threatening clinical syndrome, usually requiring hospital admission. Growth Differentiation Factor-15 (GDF-15) is a distant member of the transforming growth factor-β. The increased expression of GDF-15 has been observed during heart failure (HF) and is associated with worse outcomes. However, the relationship between GDF-15 and AHF is not well understood with limited evidence among Thai patients.PurposeInvestigate the correlation between biomarker levels (measured upon admission and discharge) and short- and long-term adverse outcomes, encompassing all-cause mortality and heart-failure (HF) rehospitalization (at 30, 90, and 180 days, as well as throughout the entire follow-up duration) in individuals experiencing acute HF.MethodsThis is a prospective single-center investigation involving patients admitted for AHF. Biomarkers, including GDF-15, high-sensitivity troponin T (hsTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP), were assessed upon admission and discharge. Outcomes, including all-cause mortality and HF rehospitalization, were examined. Logarithmic transformations were applied to the biomarker variables for subsequent analysis. Univariate and multivariate analyses of cause-specific hazards were conducted using the Cox proportional hazards regression model, while subdistribution hazards were assessed using the Fine-Gray regression model to evaluate outcomes.ResultsA total of 84 patients were enrolled (mean age of 69 years, 52% females). The GDF-15 level significantly decreased during admission (median at the time of admission 6,346 pg/mL, median at the time of discharge 5,711 pg/mL; p < 0.01). All-cause mortality at 30 days and 180 days were 6.0% and 16.7%, respectively. HF rehospitalization at 30 days and 180 days were 15.5% and 28.6%, respectively. Univariate analysis showed that total orthoedema congestion score (p = 0.02) and admission GDF-15 level (p = 0.01) were associated with 30-day all-cause mortality, whereas hsTnT or NT-proBNP levels did not show significant associations. However, higher levels of NT-proBNP upon admission were associated with all-cause mortality when considering the entire follow-up period (p < 0.01). Both univariate and multivariate analyses demonstrated that lower discharge GDF-15 levels and a greater reduction in GDF-15 levels from admission to discharge were associated with a lower risk of 30-day rehospitalization. Similarly, univariate analysis revealed that a greater reduction in NT-proBNP levels from admission to discharge was associated with lower 30-day rehospitalization rates. At 180 days, a greater reduction in GDF-15 levels remained associated with lower hazards and incidence of rehospitalization.ConclusionThe significant decrease in Growth Differentiation Factor-15 (GDF-15) levels during hospitalization suggests its potential as a dynamic marker reflecting the course of AHF. Importantly, higher GDF-15 levels at admission were associated with an increased risk of 30-day all-cause mortality, highlighting its prognostic value in this patient population. Moreover, lower discharge GDF-15 levels, reductions in GDF-15 from admission to discharge, and decreases in NT-proBNP from admission to discharge were associated with a reduced risk of 30-day rehospitalization.

A Study to Assess the Self-Efficacy, Health Related Quality of Life and Attitude towards Hospitalization among Re-Admitted Patients in Selected Hospitals, Vijayapur

We sought to examine the relationship between health-related quality of life (HRQL) and a first emergency rehospitalization and mortality in patients with heart failure (HF) having a wide variation in ventricular ejection fraction and functional status1 .  Aim The present study was aimed to evaluate the self- efficacy, health related quality of life and attitude towards hospitalization among re-admitted patients  Materials and Methods Hospital patients who have been readmitted are the study's source of data. A sample 142 obtained from hospitals for the correlation descriptive research design and quantitative methodology.  Results Out of 142patients majority 79(55.6%) had very high self efficacy, 58(40.8%) had high self efficacy and remaining 5(3.5%) patients had very low self efficacy out of 142 patients majority 121(85.2%) had good health related QOL, 19(13.4%) had moderate QOL and remaining 2(1.4%) patients had very good QOL out of 142 patients majority 79(55.6%) had positive attitude, 39(27.5%) had strongly positive attitude and remaining 24(16.9%) patients had fairly positive attitude.  Conclusion The aim of the study to assess quality of life among readmitted patients and some of the study subjects has the moderate quality of life and majority of the study subject is good quality of life and some of the participats fairly positive attitude towards the hospitalization and self efficacy.

Development of a self-care guideline to prevent rehospitalization in stroke patients: a modified Delphi study

Introduction: Since 2007, the number of stroke cases in Indonesia has continued to increase. Stroke patients who have passed the acute phase of stroke still have a risk of recurrent stroke and rehospitalization. This study aimed to develop self-care guidelines to prevent the rehospitalization of stroke patients. Methods: A three-round modified Delphi study was applied to a panel of 24 experts with different fields of expertise, consisting of doctors, nurses, families, and patients. In the first round, data were collected through a literature review and semi-structured interviews. In the second and third rounds, data were collected using a survey questionnaire on a 9-point Likert scale. Results: The first round produced seven themes around self-care activities, including drug therapy, physical exercise, diet and nutrition, stress management, self-motivation, functional status screening, and control for risk factors. In the second round, all types of self-care in the first round were agreed upon for content in preparing the guidebook. The third round resulted in agreement on the guidebook that had been designed, with scores of 8 and above by 100% of the expert panel. Conclusions: The development of a self-care guidebook to prevent rehospitalization of stroke patients through a three-round Delphi study has reached a consensus among the entire panel of experts. Further research by testing guidebooks in the healthcare system is needed to determine their effectiveness in preventing re-hospitalization in stroke patients.

Ventricular Tachycardia and Hospital Readmission in Patients Discharged From the Hospital After an Acute Myocardial Infarction

BackgroundAlthough ventricular tachycardia (VT) occurring during hospitalization for an acute myocardial infarction (AMI) increases mortality risk, its relationship with 30-day postdischarge rehospitalization has not been examined. MethodsUsing data from the Worcester Heart Attack Study, we examined the association between early (during the first 48 hours of admission) and late (after 48 hours from admission) VT with 30-day postdischarge all-cause and cardiovascular disease (CVD)-related rehospitalization while analytically controlling for several demographic and clinical factors. ResultsThe study population consisted of 3534 patients who were hospitalized with an AMI between 2005 and 2015 (average age, 67.2 years; 40.7% women); VT occurred in 452 patients (13.7%), with the majority of instances (81.2%) occurring within 48 hours of admission. The 30-day all-cause rehospitalization rate was 17.3%, with 70.9% of the hospitalizations related to CVD. The odds of rehospitalization were 1.63 times (95% confidence interval [CI] = 0.99-2.69) and 1.12 times (95% CI = 0.83-1.51) higher for patients with AMI who developed late VT and early VT, respectively, compared to patients who did not develop VT. The risk of rehospitalization among patients with late VT was higher (odds ratio = 2.22 (95% CI = 0.79-6.26) in those with ST-segment-elevation AMI, compared to those with non-ST-segment-elevation AMI (odds ratio = 1.45 (95% CI = 0.81-2.57); early VT was not associated with rehospitalization in patients with either AMI subtype. No significant association was present between the occurrence of VT and CVD-related rehospitalization. ConclusionsPatients who develop late VT may experience a higher risk of 30-day rehospitalization following hospital discharge for AMI, especially among those with ST-segment-elevation AMI. Larger studies are needed to confirm our findings.

Investigating Gait Speed as the Index of Exercise Tolerance in Heart Failure with Preserved Ejection Fraction

Introduction: As an essential factor affecting life prognosis and rehospitalization in patients with chronic heart failure, exercise tolerance is a significant outcome of cardiac rehabilitation. Heart failure with preserved ejection fraction (HFpEF) from reduced diastolic capacity has recently increased among patients with chronic heart failure. This study evaluates the factors indicating exercise tolerance in patients with HFpEF from various perspectives, including cardiac and skeletal muscle functions.&#x0D; Materials and Methods: The subjects were 31 patients with HFpEF who underwent cardiac rehabilitation. The exercise tolerance was assessed using a 6-min walking test. Physical function, physical activity, body composition test, baseline characteristics, blood data, and echocardiography results were extracted from medical records to identify the indicators of exercise tolerance&#x0D; Results: Gait speed significantly differed in exercise tolerance for HFpEF patients (β=0.75, P&lt;0.01). Unlike heart failure with reduced ejection fraction (HFrEF), HFpEF was not significantly different in brain natriuretic peptide levels and cardiac function.&#x0D; Conclusion: Gait speed indicates exercise tolerance in HFpEF patients; however, its pathological course differs from heart failure with reduced ejection fraction, suggesting that it is poorly related to brain natriuretic peptide, a biomarker for heart failure and cardiac function.

Analyzing Short and Medium-Term Morbidity and Mortality in Patients with Heart Failure and Borderline Ejection Fraction (EF: 40-49%).

Introduction: Heart failure with moderately impaired ejection fraction (HFmEF) has garnered increasing attention in recent years. However, understanding this new phenotype, particularly concerning morbidity and mortality, remains limited. Materials and Methods: A prospective, observational, and single-center study spanning 26 months was conducted on 204 patients with HFmEF selected from 447 patients with chronic heart failure (CHF) categorized based on their left ventricular ejection fraction (LVEF): HF with reduced ejection fraction (HFrEF) if LVEF ≤ 40% (n = 173) and HF with preserved ejection fraction (HFpEF) if LVEF ≥ 50% (n = 70). This study included a detailed evaluation of factors precipitating cardiovascular (CV) death and rehospitalizations in patients with HFmEF. Results: After a mean follow-up of 431 days in the HFmEF patient group, our results indicated that CV mortality at six months was 2.5%, and at one year, it was 5.9%. Prognostic factors for survival included chronic kidney disease, blood glucose level &gt; 1.4g/l, presence of moderate to severe secondary mitral insufficiency, sphericity index &lt; 1.7, elevated pulmonary vascular resistance, and resistance to diuretic treatment. HF rehospitalization rates at 6 and 12 months were 2.5% and 8.3%, respectively. Predictive factors for HF rehospitalizations included diabetes, hemoglobin level &lt; 13g/dl, left atrial volume &gt; 34 ml/m3-, mitral S-wave &lt; 0.05cm/s, non-improvement of global longitudinal strain, and resistance to diuretic treatment. Conclusion: This category of HF remains underrecognized and neglected by practitioners, and its prognosis is formidable, especially in the presence of adverse prognostic factors.

Early improvement of global longitudinal strain after iron deficiency correction in heart failure with reduced ejection fraction.

Iron deficiency correction with ferric carboxymaltose improves symptoms and reduces rehospitalization in patients with reduced left ventricular ejection fraction. The mechanisms underlying these improvements are poorly understood. This study aimed to determine changes in left ventricular contractility after iron treatment as reflected in global longitudinal strain. Prospective single-center study including 43 adults with reduced ejection fraction, non-anemic iron deficiency, and functional class II-III heart failure despite optimal medical treatment. Global longitudinal strain through speckle-tracking echocardiography was measured at baseline and 4weeks after ferric carboxymaltose. A significant improvement in global longitudinal strain was detected (from -12.3%±4.0% at baseline to -15.6%±4.1%, p<.001); ferritin and transferrin saturation index had increased, but ejection fraction presented no significant changes (baseline 35.7%±4.6%, follow-up 37.2%±6.6%, p=.073). In patients with heart failure and reduced ejection fraction, the correction of iron deficiency with ferric carboxymaltose is associated with an early improvement in global longitudinal strain, possibly suggesting a direct effect of iron correction on myocardial contractility.

Refining accuracy of RV–PA coupling in patients undergoing transcatheter tricuspid valve treatment

BackgroundAssessing right ventricular (RV) function is paramount for risk stratification, which remains challenging in patients with tricuspid regurgitation (TR). We assessed RV–pulmonary artery (PA) coupling and its predictability of outcomes after transcatheter tricuspid valve repair (TTVR).MethodsStudy participants comprised patients undergoing transcatheter tricuspid valve repair to treat symptomatic TR from June 2015 to July 2021. We calculated an RV–PA coupling ratio using a formula, which is dividing tricuspid annular plane systolic excursion (TAPSE) by echocardiographically estimated (ePASP) or invasively measured PASP (iPASP) at baseline. The primary outcome was all-cause mortality or heart failure rehospitalization within one year.ResultsThe study participants (n = 206) were at high surgical risk (EuroSCORE II: 7.4 ± 4.8%). The primary outcome occurred in 57 patients within one year. The c-statistics for the outcome were 0.565 (95% CI 0.488–0.643) for TAPSE/ePASP and 0.695 (95% CI 0.631–0.759) for TAPSE/iPASP. The correlation between the ePASP and iPASP was attenuated in patients with massive/torrential TR compared to those with severe TR (interaction p = 0.01). In the multivariable Cox proportional model, TAPSE/iPASP was inversely associated with the risk of the primary outcome (per 0.1-point increase: adjusted-HR 0.67, 95% CI 0.56–0.82, p < 0.001), independent of baseline demographics. According to the TAPSE/iPASP quartiles (i.e., ≤ 0.316; 0.317–0.407; 0.408–0.526; ≥ 0.527), the event-free survival was 43.4%, 48.3%, 77.9%, and 85.4% at one year after TTVR.ConclusionRV–PA coupling predicts one-year mortality and heart failure rehospitalization after TTVR in patients with TR. The predictability is improved if invasively-measured PA pressure is included.Graphical abstractAssessing right ventricular (RV) function is paramount for risk stratification. The present analysis confirms that RV–PA coupling, measured as TAPSE/PASP, predicts one-year mortality and heart failure rehospitalization in patients undergoing TTVR. There is a significant interaction between TR severity and the correlation of ePASP with iPASP, and therefore the correlation is attenuated in patients with massive to torrential TR. The predictability of RV–PA coupling is improved if PA pressure is measured invasively and included in the formula.

Evaluating dynamic and predictive discrimination for recurrent event models: use of a time-dependent C-index.

Interest in analyzing recurrent event data has increased over the past few decades. One essential aspect of a risk prediction model for recurrent event data is to accurately distinguish individuals with different risks of developing a recurrent event. Although the concordance index (C-index) effectively evaluates the overall discriminative ability of a regression model for recurrent event data, a local measure is also desirable to capture dynamic performance of the regression model over time. Therefore, in this study, we propose a time-dependent C-index measure for inferring the model's discriminative ability locally. We formulated the C-index as a function of time using a flexible parametric model and constructed a concordance-based likelihood for estimation and inference. We adapted a perturbation-resampling procedure for variance estimation. Extensive simulations were conducted to investigate the proposed time-dependent C-index's finite-sample performance and estimation procedure. We applied the time-dependent C-index to three regression models of a study of re-hospitalization in patients with colorectal cancer to evaluate the models' discriminative capability.

The clinical prognosis of elderly patients with decompensated congestive heart failure greatly improved for 7 years after introduction of our unique clinical pathway

Abstract Background In Japan, especially in rural areas where our facility is located, the number of elderly decompensated congestive heart failure(DCHF) cases is increasing remarkably. Their hospitalization period tends to prolonged due to various complications peculiar to the elderly, and after discharge, they often admit in a short period with DCHF. In August 2015, we introduced the clinical pathway (PATH), which stipulates the efficient medical care for DCHF and comprehensive patient education by multidisciplinary staff. We have previously reported its effect about wide shortening of mean hospitalization period and significant reduction of rehospitalization in CHF patients admitted to our hospital. Purpose In this study, we re-examined the short-term and long-term clinical effects of PATH in elderly DCHF patients for 7 years, and also considered the residual problems about them. Methods We enrolled 929 DCHF cases (1128 admissions) aged 75 years or older who ware admitted to our hospital from April 2014 to July 2022. We divided them into two groups: 152 cases(199 admissions) admitted before the introduction of PATH (N-group) and 667 cases(929 admissions) applied PATH (P-group). About two groups we compared the acute care situation for DCHF, mean hospitalization period(HP), and DCHF readmission rate within 1 year after discharge(RA). Results The mean age of the P-group was slightly older. There were no significant differences between the two groups in the living conditions before admission, the proportion of each underlying disease or clinical data at admission. The performance rate of each treatment procedure in the acute phase was lower, and these performance period ware all shorter in P-group. The introduction rate of cardiac rehabilitation was higher and start timing was earlier in P-group. (Figure1) As a result, HP was significantly shorter), and the RA rate was lower in P-group. However, even in P-group, the cases who could not be discharged from the hospital to home(OTHER-group) took more time to adjust for hospital transfer or nursing home admission, so their HP was longer than that of the cases who could be directly discharged to home(HOME-group). And the RA rate of cases with past history of hospitalization for DCHF(PH-group) was higher than that of cases without history(NPH- group). (Figure2) Conclusion In the 7 years after the introduction of unique clinical pathway for acute phase treatment of decompensated congestive heart failure, even in elderly patients, it confirmed that each acute phase treatment had become more efficient, and the mean hospitalization period had been widely shortened. In addition, comprehensive lifestyle guidance to prevent worsening of their condition has seemed to reduce the rehospitalization rate for heart failure after discharge. However, we also confirmed f a few residual problems to be solved about the cases who could not discharged at home for any reason or repeated re-admission for heart failure.Figure 2

The effect of sodium-glucose co-transporter-2 inhibitors following anterior ST-segment elevation myocardial infarction

Abstract Background Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been clearly demonstrated to be associated with lower rate of new-onset heart failure(HF) in patients under risk of HF. In addition, due to lower rehospitalisation and better functional status in HF patients, SGLT-2 inhibitors have became the cornerstone of treatment regardless of the diabetes status. New-onset HF is very common in survivors of anterior ST-segment elevation myocardial infarction(STEMI) and requires preventive strategies, however the role of SGLT-2 inhibition in this population is not well established yet. Purpose In this study, we aimed to demonstrate the role of the SGLT-2 inhibitors in patients with anterior STEMI. Methods We prospectively enrolled patients with diabetes mellitus who had anterior STEMI, which was managed with primary percutaneous coronary intervention. Patients with previous myocardial infarction, heart failure, under SGLT-2 inhibitor treatment and chronic kidney disease were excluded. Patients were divided into two groups according to SGLT-2 inhibitor treatment; group 1 patients treated with empaglifosine or dapaglifosine and group 2 received other classes of diabetes medicine. Comorbidities regarding smoking history (p: 0.871), hypertension (p: 0.064), previous cerebrovascular accident(p: 0,348) and coronary artery disease(p: 0.201) were comparable between groups. Presence of multivessel coronary artery disease (p: 0.259) and left main coronary artery involvement (p: 0.062) were also similar between groups. Glucose level on admission was similar (p: 0.782) between groups, however HBa1C level was significantly higher in group 1(p: &amp;lt;0.001). Left ventricular ejection fraction which was calculated prior to hospital discharge was also similar between groups(p: 0.297). Mean follow-up duration was 12 months and new-onset heart failure was significantly lower in group 1 patients(p:&amp;lt;0.001). In line with the rate of new onset-heart failure, pro-BNP levels at the 12th month visit were lower in group 1 patients (p: 0.042) which was similar during the STEMI hospitalization (p: 0.668). Multivariate analyses demonstrated that the use of SGLT-2 inhibitors independently associated with lower rate of new-onset HF. Conclusion Our results indicate that SGLT-2 inhibitors decrease the rate of new-onset heart failure during the follow-up in patients with previous myocardial infarction.Baseline characteristicsUnivariate and multivariate analysis

Transcatheter-edge-to-edge-repair of functional mitral regurgitation in advanced HFrEF: the impact of intrinsic left ventricular performance on the degree of MR reduction and clinical outcome

Abstract Background Transcatheter-edge-to-edge-repair (TEER) of functional mitral regurgitation (FMR) reduces rehospitalisation and all-cause mortality in patients with HFrEF/HFmrEF. Not conclusively clarified is the interaction of pre-interventional intrinsic left ventricular (LV) function with TEER success and clinical outcome. By using the gold standard of LV contractility analysis, the invasive pressure-volume loop technique, we examined the interaction of pre-and post-interventional intrinsic LV performance with the degree of MR reduction and all-cause mortality after TEER in patients with advanced HFrEF. Methods In a prospective study of 71 patients with advanced HFrEF (median EF 26%, 22-31%) and severe FMR, we quantified different intrinsic parameters of LV performance by PV-loop analysis (single beat analysis) pre-and post-interventionally. Results In 83% of the patients a MR reduction to grad &amp;lt; 2 could be achieved (hospital discharge). In the ROC analysis, the best cut-off to separate medium-term survival from all-cause mortality (median FU 2.9 years) was a post-interventional regurgitation fraction (RF) &amp;lt; 20% (AUC 0.72, p&amp;lt;0.001, sensitivity 83%, specificity 60%) and a R-volume (RV) &amp;lt; 18ml (AUC 0,7, p=0.002, sensitivity 67%, specificity 72%). The PV-loop-derived intrinsic LV contractility (LV-endsystolic elastance, Ees), LV afterload (arterial elastance, Ea), LV-Ao-coupling (Ees/Ea), LV-mechanical efficacy (ME), PV-loop area (PVA), stroke work, Tau; end-diastolic elastance (Eed), LVEF, LVEDV, and LVESV, pre- and post-TEER, were not predictive for the extent of MR reduction acutely, after 6 months FU, and for all-cause mortality. In multivariate cox-regression analysis, only a post-interventional RF&amp;lt;20% (HR 0.36, p=0.017) or RV&amp;lt;18ml (HR 0.32, p=0.005) and the pre-interventional LV-contractile reserve (LV-CR: post-extra-systolic augmentation of LV-Ees) remained independent predictors of all-cause mortality. In a second model, we included the degree of LV-remodeling (LV-R: LVESV reduction from hospital discharge to 6 months) in the model. In addition to pre-interventional LV-CR, and RF&amp;lt;20%, the LV-R remains independent predictive for all-cause mortality. Conclusion In our peri-mitral-TEER LV-PV-loop study, only the extent of MR reduction and the pre-interventional LV-CR, but not the intrinsic LV performance at rest, determine the medium-term survival of patients with advanced HFrEF and FMR. TEER-mediated MR reduction itself seems not be determined by the LV performance.

Abstract 17253: Concepts Associated With 30-day Rehospitalization From Unstructured Data Among Patients With Heart Failure

Introduction: Heart failure (HF) is a diagnosis for which the Centers for Medicare &amp; Medicaid Services mandated public reporting on 30-day risk-standardized rehospitalization rates. Examining risk factors predicting rehospitalization has been widely studied, and most of studies utilized structured data from electronic health records (EHRs) in HF. However, those studies did not use patient-level information that could be captured from unstructured data. Hypothesis: Unified Medical Language System (UMLS) concepts that may be used as factors that could be associated with the likelihood of 30-day rehospitalization among patients with HF by using natural language processing technique. Methods: We obtained notes from patients diagnosed with HF from EHRs from a tertiary hospital between June 1, 2015 and December 31, 2019. We analyzed 14 note types including physician notes, nursing notes and discharge summaries. We used the publicly available natural language processing software MetaMap to extract UMLS concepts that may be used as factors associated with the liekhood of 30-day rehospitalization and the Pandas package in Python for processing and analysis. Results: We identified 350,272 notes among 4,773 patients discharged with HF. The median age of the cohort was 76 years, 54.3% were male, and 89% white, and the 30 day-rehospitalization rate was 12.8%.. A total of 350,272 notes were for 4,164 patients who were not rehospitalized, and 57,212 notes for 609 patients who were rehospitalized. The UMLS concepts identified at a higher rate in notes of rehospitalized patients compared to non-rehospitalized patients included “personal appearance” (7.0% vs 5.5%), “power (psychology)” (3.5% vs 2.5%), and “intrinsic drive” (2.1% vs 1.1%). The UMLS Concepts that were mentioned less in rehospitalized patient notes include “family” (26.3% vs 30.8%), “home environment” (59.9% vs 64%), and “independence” (20.6% vs 24.6%). Conclusions: We identified six UMLS concepts associated with 30-day rehospitalization in patients with HF. Further study is warranted to determine whether incorporation of concepts from unstructured data could improve prediction of 30-day rehospitalization and provide opportunities for patient-level intervention.