Risk Of Acute Heart Failure Research Articles

One-year outcomes of patients with hypertrophic cardiomyopathy according to levels of inflammatory biomarkers

Abstract Background Hypertrophic cardiomyopathy (HCM) is a vastly heterogeneous sarcomere disorder unified by maximal left ventricular (LV) thickness increases. The lifetime relative risk of morbidity in HCM is four-fold higher than in the general population, primarily driven by arrhythmias and heart failure (HF). Numerous prognostic features have been identified, but our ability to identify high-risk patients of progression remains rudimentary. Small retrospective studies have shown that systemic inflammation is associated with adverse outcomes in patients with HF; others, small and single-center, have also shown associations between adverse outcomes and inflammation in HCM. Purpose We aimed to determine whether elevated levels of inflammatory biomarkers are associated with an increased risk of acute heart failure (AHF) and mortality at 1 year in a large cohort of patients with HCM across multiple centers in the United States (US). Methods In this retrospective study, using the US cohort of 60 healthcare organizations in the TriNetX database, we included more than 85,000 adult patients with HCM (ICD-10-CM codes I42.1 and I42.2) between 2004 and 2024. Patients were divided according to predetermined cut-offs of different inflammatory biomarkers (C-reactive protein [CRP], <2 mg/L vs. 2-100 mg/L; white blood cells [WBC], < vs. ≥ the median [8x10^3/µL]; neutrophils [Neu], < vs. ≥ the median [5x10^3/µL]). These cohorts were then 1:1 propensity score matched (PSM) for age, sex, and race. We used Kaplan-Meier survival curves to derive cumulative incidence curves (as 1 minus Kaplan-Meier survival estimates) for AHF (ICD-10-CM codes I50.21, I50.23, I50.31, I50.33, I50.41, I50.43) or death, and we compared them with the Log-rank (Mantel-Cox) test. We also derived Hazard Ratios (HR) with 95% Confidence Interval (CI) from Cox regression analysis to compare the outcomes within the groups at 1-year. Results After PSM, patients with HCM and CRP levels between 2-100 mg/L experienced higher rates of the composite outcome (19.6% vs. 12.2%, Log-rank p<0.001; HR 1.67, 95% CI [1.29-2.16]), as well as the separate outcomes of death (14.7% vs. 6.8%, Log-rank p<0.001; HR 2.23, 95% CI [1.68-2.98]) and AHF (10.9% vs. 7.5%, Log-rank p<0.001; HR 1.49, 95% CI [1.07-2.07]), compared to those with CRP <2 mg/L (Table 1)(Figure 1). Similarly, patients with Neu ≥5x10^3/µL reported higher incidences of the composite outcome (20.3% vs. 13.2%, Log-rank p<0.001; HR 1.62, 95% CI [1.55-1.68]) and the separates outcomes, compared to those with Neu <5x10^3/µL (Table 1) (Figure 1). Patients with WBC ≥8x10^3/µL also had increased rates of the composite outcome (19.4% vs. 14.1%, Log-rank p<0.001; HR 1.43, 95% CI [1.38-1.48]) and the separate outcomes, compared to those with WBC <8x10^3/µL (Table 1)(Figure 1). Conclusions In the first large 'real world' analysis of patients with HCM, elevated levels of inflammatory biomarkers were associated with worse outcomes of death and acute heart failure.

Catheter ablation vs antiarrhythmic therapy for atrial fibrillation in heart failure with preserved ejection fraction

BackgroundClinical outcomes of patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) treated with catheter ablation (CA) vs antiarrhythmic therapy (AAT) are not well known. ObjectiveThis study compared morbidity and mortality of patients with AF and HFpEF treated with CA vs AAT. MethodsAF and HFpEF patients from January 2017 to June 2023 were identified in TriNetX, a large global population-based database. Patients with prior diagnosis of heart failure with reduced ejection fraction (HFrEF) or crossover between AAT and CA were excluded. Baseline characteristics including age, sex, body mass index, type of AF, comorbidities, and cardiovascular medications were compared. The 2 groups were 1:1 propensity score matched for outcomes analysis. All-cause mortality, cerebrovascular accident/transient ischemic attack, and acute heart failure were compared with Kaplan-Meier curves. ResultsPatients treated with CA (n = 1959) and AAT (n = 7689) were 1:1 propensity score matched, yielding 3632 patients with no significant differences in baseline characteristics. Compared with AAT, CA was associated with decreased mortality (9.2% vs 20.5%; hazard ratio [HR], 0.431; 95% confidence interval [CI], 0.359–0.518; P < .001). In addition, CA was associated with reduced HFpEF (HR, 0.638; 95% CI, 0.550–0.741; P < .001) and acute HFrEF (HR, 0.645; 95% CI, 0.452–0.920; P = .015). There was no difference in composite of cerebrovascular accident/transient ischemic attack (HR, 0.935; 95% CI, 0.725–1.207; P = .607). ConclusionIn this retrospective study of patients with AF and HFpEF, CA was associated with lower mortality and risk of acute heart failure compared with AAT.

Moderate to severe anemia at admission increases the risk of complications in patients over 60 years with hip fracture

BackgroundAnemia frequently occurs in patients with hip fractures and represents a risk factor that can potentially be altered. To evaluate the association between admission anemia and complications in older hip fracture patients while exploring the potential impact of anemia on complications from the perspective of overall, operation and non-operation.MethodsThis retrospective study enrolled in-patients over 60 years old with hip fractures from January 2020 to November 2023. At admission, anemic patients were identified as having a hemoglobin level below 12 g/dL in females and 13 g/dL in males. Anemia was further classified as mild, moderate, or severe. Data encompassing demographics, comorbidities, medications, information on fracture and surgery, and complications were collected.ResultsA total of 462/679 patients had anemia, including 348, 105, and 9 with mild, moderate, and severe anemia, respectively. A total of 281 individuals experienced complications, including 212 and 69 with and without operation, respectively. Multivariate regression analysis identified anemia as a greater risk for acute heart failure (OR = 2.056, p = 0.037, 95% CI 1.043–4.052) than non-anemia. Moderate to severe anemia was a significant risk factor for any complication (OR = 1.584, p = 0.028, 95% CI 1.050–2.390), ≥ 2 (OR = 2.364, p = 0.001, 95% CI 1.443–3.872) or 3 (OR = 2.311, p = 0.022, 95% CI 1.131–4.720) complications, delirium (OR = 2.301, p = 0.018, 95% CI 1.156–4.579), venous thromboembolism (OR = 2.031, p = 0.042, 95% CI 1.025–4.025), and acute heart failure (OR = 2.095, p = 0.016, 95% CI 1.145–3.834), compared with mild to non-anemia. Similar results were observed in operated patients, while anemia and its severity were not associated with complications in non-operated patients.ConclusionModerate to severe anemia caused complications in elderly hip fracture patients, but it was not observed in non-operated individuals. These findings would support orthopedic physicians’ hierarchical management of anemic patients.

Incremental value of C-reactive protein to the MEESSI acute heart failure risk score.

We hypothesized that the current gold standard for risk stratification of patients with acute heart failure (AHF), the Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF (MEESSI-AHF) risk score, can be further improved by adding systemic inflammation as quantified by C-reactive protein (CRP). In a prospective multicentre diagnostic study (BASEL V), AHF was centrally adjudicated by two independent cardiologists. The MEESSI-AHF risk score was calculated using an established reduced and recalibrated model containing 12 independent risk factors. Model extension was performed by refitting and adding CRP in the logistic regression model with 30-day mortality as binary outcome. Discrimination, calibration and clinical usefulness were used to assess the performance of the extended Multiple Estimation of risk based on the Emergency department Spanish Score In patients (MEESSI) model. Validation was performed in an independent, retrospective and single-centre AHF cohort. Among 1208 AHF patients with complete data allowing calculation of the recalibrated MEESSI and the extended MEESSI models, the prognostic accuracy for 30-day mortality of the extended MEESSI model (c-statistic 0.83, 95% confidence interval [CI] 0.79-0.87) was significantly higher compared to the recalibrated model (c-statistic 0.79, 95% CI 0.75-0.83, p = 0.013). The extended model allowed to stratify a higher percentage of patients into the lowest risk group compared to the recalibrated model (33.1% vs. 20.3%). Demonstrating a calibration plot's slope of 1.00 (95% CI 0.81-1.19) and an intercept of 0.0 (95% CI -0.22 to 0.22), the extended MEESSI model achieved excellent and improved calibration. Results were confirmed in the independent validation cohort (n = 575). Quantifying inflammation using CRP concentration provided incremental value in AHF risk stratification using the established MEESSI model.

Patients with scheduled heart valve interventions are at very high risk for acute heart failure during prolonged waiting time

Abstract Funding Acknowledgements None. Background Postponement of non-emergency cardiac interventions is associated with increased rates of emergency hospitalizations. Affected patients show signs of acute heart failure during the waiting time. Since this worse outcome has been proven to persist even long post-procedure, patients at risk must be identified in advance. Purpose This study sought to identify predictors associated with acute heart failure during prolonged waiting time in cardiac patients scheduled for non-emergency interventions. Methods A retrospective, observational cohort study was conducted that included consecutive patients whose non-emergency cardiac intervention was postponed during the first Covid-19 related lockdown between March 19th and April 30th, 2020. The endpoint was heart failure at admission to the procedure performed, indicated by a NT-proBNP level &amp;gt; 900 pg/ml. Cox regression analysis was performed to identify characteristics of patients who met the endpoint. Results After postponing their non-emergency cardiac intervention for an average of 23 days, 89 of 178 postponed patients (59 %) at a mean age slightly above 70 years had a NT-proBNP level &amp;gt; 900 pg/ml. Cox regression analysis showed the criterion "planned heart valve procedure" to independently predict achievement of the endpoint (p &amp;lt; 0.001, OR 12.040, 95 % CI 3.423 – 42.353). Subgroup analysis (n = 49) showed that especially patients with atrioventricular valve regurgitation are at risk with an endpoint rate of 94.74 % compared to 69.00 % in patients undergoing aortic valve replacement (p = 0.008). Moreover, the intervention of the affected patients was performed more frequently as emergency hospitalization (p = 0.005) and lasted longer (p &amp;lt; 0.001). This was accompanied by worse cardiac status at the time of admission including worse NYHA class, higher biomarker levels and lower cardiac function (each p &amp;lt; 0.001). Additionally, worse outcome as demonstrated by higher rates of emergency hospitalization and death persisted even 12, 24 and 36 months after the procedure (each p &amp;lt; 0.001). Conclusion Patients scheduled for heart valve interventions and particularly due to atrioventricular valve regurgitation are at high risk of heart failure in case of prolonged waiting time. Therefore, this population does not appear to be suitable for postponement but, in contrast, seems to require acute cardiovascular care.

Clinical Implications of High-Sensitivity Troponin Elevation Levels in Non-ST-Segment Elevation Myocardial Infarction Patients: Beyond Diagnostics.

Standard troponin has long been pivotal in diagnosing coronary syndrome, especially Non-ST-Segment Elevation Myocardial Infarction (NSTEMI). The recent introduction of high-sensitivity troponin (hs-cTnI) has elevated it to the gold standard. Yet, its nuanced role in predicting angiographic lesions and clinical outcomes, notably in specific populations like obesity, remains underexplored. Aim: To evaluate the association between hs-cTnI magnitude in NSTEMI patients and angiographic findings, progression to acute heart failure, and its performance in obesity. Methods: Retrospective study of 208 NSTEMI patients at a large university center (2020-2023). Hs-cTnI values were assessed for angiographic severity, acute heart failure, and characteristics in the obese population. Data collected and diagnostic performance were evaluated using manufacturer-specified cutoffs. Results: 97.12% of patients had a single culprit vessel. Hs-cTnI elevation correlated with angiographic stenosis severity. Performance for detecting severe coronary disease was low, with no improvement using a higher cutoff. No association was found between hs-cTnI and the culprit vessel location. Hs-cTnI did not predict acute heart failure progression. In the obese population, hs-cTnI levels were higher, but acute heart failure occurred less frequently than in non-obese counterparts. Conclusions: In NSTEMI, hs-cTnI elevation is associated with significant stenosis, but not with location or acute heart failure. Obesity correlates with higher hs-cTnI levels but a reduced risk of acute heart failure during NSTEMI.

Prediction of in-hospital complications in takotsubo syndrome: prospective cohort study

BACKGROUND: Until recently, takotsubo syndrome (TS) was considered a fairly benign disease in both early and late periods. However, in recent years, in-hospital complications in the acute period of TS are common and can be life-threatening.&#x0D; AIM: Based on clinical and laboratory-instrumental data, this study aimed to build models for predicting the risk of developing in-hospital complications in patients with TS during the acute period.&#x0D; MATERIALS AND METHODS: This prospective cohort study included 60 patients with TS, with an average age of 65.5±13.4 years. In the acute period (7–14 days), standard clinical and laboratory examination, peripheral arterial tonometry using the «EndoPAT 2000» apparatus, and psychological testing using validated questionnaires (hospital anxiety and depression scale and Beck depression scale) were performed.&#x0D; RESULTS: The integrated model for predicting the risk of acute heart failure (AHF) development (pulmonary edema and cardiogenic shock) identified admission LVEF as the leading prognostic parameter. With LVEF ≤40.5%, the probability of AHF in patients with TS in the acute period was 62.5%, and in patients with TS and QTc interval 487 ms, the risk reached 100%. The sensitivity and specificity of the developed model were 72.7% and 97.4%, respectively. The integrated model for predicting the development of cardiovascular complications (CVCs) revealed that the number of leukocytes in the peripheral blood was the leading risk factor for adverse events in patients with TS in the acute period. With a leukocyte count 11.1×109/L, the risk of CVCs in patients with TS increased to 89.9%, and if the erythrocyte count was 4.69×1012/L or ≤4.29×1012/L, it could reach 100%. The sensitivity and specificity of the resulting model were 92.6 and 97.0%, respectively.&#x0D; CONCLUSION: The models proposed in this study for predicting the likelihood of developing severe AHF and the overall risk of CVCs in the acute period of TS are personalized and easy to use, allowing for the selection of optimized treatment techniques.

Construction and validation of nomogram prediction model for risk of acute heart failure in patients with acute exacerbation of chronic obstructive pulmonary disease.

To investigate the influencing factors of in-hospital acute heart failure (AHF) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to construct and validate a risk prediction nomogram model. Three Hundred Thirty patients with AECOPD admitted to our hospital from June 2020 to June 2023 were retrospectively analyzed as a training set for the construction of the model. Three Hundred Twenty-five AECOPD patients admitted to the Second People's Hospital of Hefei from 2006 to June 2023 were also collected as the validation set for the validation of the model. A nomogram model was constructed to predict the risk of nosocomial AHF in patients with AECOPD, and C-index and receiver operating characteristic curve were drawn to assess the predictive predictive efficacy of the model. Model fit was evaluated by Hosmer-Lemeshow test, calibration curve was drawn to evaluate the calibration of the model; decision curve was drawn to analyze the net benefit rate of this nomogram model. Multivariate logistic regression analysis indicated that body mass index, mmRC grade, neutrophils, lymphocytes, hemoglobin, creatinine, PO2, PCO2, and Homocysteine were independent risk factors for in-hospital AHF in patients with AECOPD. To construct a nomogram model for risk prediction of in-hospital AHF in patients with AECOPD. The C-index of the training set was 0.949 (95% CI: 0.91-0.961); the C-index of the validation set was 0.936 (95% CI: 0.911-0.961) suggesting good model discrimination. The receiver operating characteristic curve calculated area under curve for the training set was 0.949 (95% CI: 0.928-0.97); area under curve for the validation set was 0.936 (95% CI: 0.91-0.961) suggesting good model accuracy. The results of Hosmer-Lemeshoe goodness-of-fit test and calibration curve analysis showed that the calibration curve of this nomogram model was close to the ideal curve. The clinical decision curve also showed good clinical net benefit of the nomogram model. Body mass index, mmRC grade, neutrophils, lymphocytes, hemoglobin, creatinine, PO2, PCO2, and Homocysteine are risk factors for in-hospital AHF in AECOPD patients, and nomogram models constructed based on the above factors have some predictive value for in-hospital AHF in AECOPD patients. It is also vital for nursing staff to strengthen nursing care.

Comparing Racial Disparities of Cardiovascular Manifestations in Sickle Cell Trait

Introduction Sickle cell trait (SCT) is a genetic condition that affects millions of people globally, particularly those of African and Mediterranean descent. Various mechanisms have been suggested to contribute to cardiovascular pathology in SCT patients, including chronic anemia, arteriopathy, and cardiac remodeling. However, whether SCT carriers, particularly African Americans (AA), are at an increased risk for cardiovascular disease remains controversial. This study aimed to investigate potential differences in cardiovascular outcomes between AA and non-AA SCT carriers. Methods We screened the National Inpatient Sample (NIS) database 2016-2018 for cardiovascular outcomes during hospital admission in African American SCT carriers and compared them to SCT carriers of other races. The primary outcomes were major adverse cardiovascular events, including acute myocardial infarction, cardiac arrest, stroke, acute heart failure, and in-hospital mortality. Secondary outcomes included World Health Organization (WHO) group 5 pulmonary hypertension, acute pulmonary edema, valvular disease, pericarditis, tachyarrhythmia, conduction disorders, acute deep venous thrombosis and/or pulmonary embolism, avascular necrosis, and rhabdomyolysis. Univariate analysis was conducted, with a P value &amp;lt;0.05 considered statistically significant. Results A total of 29,060 SCT admissions were analyzed, with 24,659 attributed to African Americans and the remaining to other races. The study found that majority of the patients admitted were female (86% of African American patients and 84% of patients from other races). The average age of patients was 37 years for African Americans and 40 years for other races. African American patients had higher rates of comorbidities such as hypertension, diabetes, chronic kidney disease, and oral anticoagulant use compared to patients of other races. The study also found that African American SCT patients had a significantly higher risk of acute heart failure (5.7% vs. 3.5%, p&amp;lt;0.01), tachyarrhythmia (4.9% vs. 3.6%, p&amp;lt;0.01), and conduction disorders (1.6% vs. 1.1%, p=0.02) compared to patients of other races. Acute myocardial infarction (1.1% vs. 0.9%), valvular disease (2.7% vs. 2.3%), acute deep vein thrombosis/pulmonary embolism (2.2% vs. 2.0%), and rhabdomyolysis (0.6% vs. 0.5%) occurred at a higher rate in African American patients but did not reach statistical significance. Similarly, in-hospital mortality (0.7% vs 0.9%), cardiac arrest (0.4% vs 0.5%), and pericarditis (0.1% vs 0.2%), although occurring at lower rates in the AA population, did not reach statistical significance. Acute pulmonary edema (0.2% vs 0.2%), pulmonary hypertension (group 5) (0.1% vs 0.1%), stroke (1.1% vs 1.1%) and avascular necrosis (0.1% vs 0.1%) had similar rates in both AA and other races but did not reach statistical significance. Conclusion/Discussion African American patients with sickle cell trait compared to other races had higher rates of acute heart failure, tachyarrhythmias, and other conduction disorders. Aggressive screening for cardiac conditions and management of risk factors including smoking, obesity, high blood pressure, hyperlipidemia, etc., are warranted in this population to improve cardiovascular outcomes. Although the NIS database provides this study with large patient data, this study may be limited by difference in the number of patients in AA and other race cohorts at baseline, coding error, underreporting, misclassification, retrospective nature, and lack of matching. Further studies analyzing the cardiovascular morbidity and mortality in sickle cell trait carriers, including benefit of use of medications for primary/secondary prevention of cardiovascular conditions are warranted.

Simplified Rapid Hydration Prevents Contrast-Associated Acute Kidney Injury Among CKD Patients Undergoing Coronary Angiography

BackgroundPatients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) are at high risk of contrast-associated acute kidney injury (CA-AKI) and mortality. Therefore, there is a clinical need to explore safe, convenient, and effective strategies for preventing CA-AKI. ObjectivesThis study sought to assess whether simplified rapid hydration is noninferior to standard hydration for CA-AKI prevention in patients with CKD. MethodsThis multicenter, open-label, randomized controlled study was conducted across 21 teaching hospitals and included 1,002 patients with CKD. Patients were randomized to either simplified hydration (SH) (SH group, with normal saline from 1 hour before to 4 hours after CAG at a rate of 3 mL/kg/h) or standard hydration (control group, with normal saline 12 hours before and 12 hours after CAG at a rate of 1 mL/kg/h). The primary endpoint of CA-AKI was a ≥25% or 0.5-mg/dL rise in serum creatinine from baseline within 48 to 72 hours. ResultsCA-AKI occurred in 29 of 466 (6.2%) patients in the SH group and in 38 of 455 (8.4%) patients in the control group (relative risk: 0.8; 95% CI: 0.5-1.2; P = 0.216). In addition, the risk of acute heart failure and 1-year major adverse cardiovascular events did not differ significantly between the groups. However, the median hydration duration was significantly shorter in the SH group than in the control group (6 vs 25 hours; P < 0.001). ConclusionsIn CKD patients undergoing CAG, SH is noninferior to standard hydration in preventing CA-AKI with a shorter hydration duration.

CO184 US Population Burden of Acute Heart Failure Events and Hospitalization in Patients with Recent Worsening Heart Failure and Left Ventricular Ejection Fraction ≤30%

Increased risk of acute heart failure (HF) events has been reported for patients with HF with reduced ejection fraction (HFrEF) and worsening HF (WHF, ie, increasing signs and symptoms, including hospitalization/urgent treatment) or more severely reduced left ventricular ejection fraction (LVEF). We evaluated HF hospitalizations in patients with HFrEF, WHF, and LVEF ≤30% in real-world practice.

The effect of SGLT2i on in-hospital acute heart failure risk in acute myocardial infarction patients-a retrospective study.

The roles of sodium-glucose cotransporter 2 inhibitor (SGLT2i) in acute heart failure (AHF) risk after acute myocardial infarction (AMI) remain unclear. In this study, we explored the correlation between SGLT2i administration and short-term in-hospital AHF risk in AMI patients. This single-center, retrospective, and observational study included 990 AMI patients comprising 386 non-ST-segment elevation myocardial infarction (NSTEMI) and 604 segment elevation myocardial infarction (STEMI) patients enrolled from January 2019 to March 2022. Demographic information, clinical characteristics, medical treatment, and laboratory examination results during hospitalization were extracted from an electronic medical record system. The primary outcome was defined as all-cause AHF during hospitalization. In NSTEMI patients, a significantly lower proportion received SGLT2i treatment in the AHF group compared with the non-AHF group. During hospitalization, SGLT2i significantly reduced brain natriuretic peptide levels both in STEMI and NSTEMI patients. Multivariate logistic regression and stratification analyses suggested that SGLT2i is associated with reduced in-hospital AHF risk, and has a strong protective effect against AHF in NSTEMI patients with hypertension. Furthermore, SGLT2i significantly reduced the risk of in-hospital AHF for both patients with diabetes and non-diabetes. SGLT2i can reduce the risk of AHF in AMI patients during hospitalization.

Pregabalin Does Not Increase Risk of Heart Failure Exacerbation in Patients With Pre-existing Heart Failure.

Through actions of calcium channel trafficking inhibition and sodium/water retention, pregabalin may increase the risk of acute heart failure (AHF). The objective of this study was to determine the prevalence of heart failure (HF) acute exacerbations, measured by a composite of emergency department (ED) visits, per-patient per-year (PPPY) hospitalizations, time-to first ED admission, and time-to hospitalizations in pre-existing HF patients taking pregabalin compared with those who were pregabalin-naive. A retrospective cohort study of pregabalin users with HF were propensity score-matched to pregabalin-naïve patients with HF to evaluate the composite of ED admissions or PPPY hospitalizations, time-to first ED admission, and time-to hospitalizations during the 365 days post-index. Doubly robust generalized linear regression and Cox-proportional hazard regression modeling were undertaken for analysis of differences between groups. The matched cohort of 385 pregabalin users and 3460 pregabalin nonusers were principally middle-aged, equally gender distributed, and primary Caucasian. Most patients were on guideline-directed HF medical therapy. The estimated cumulative incidence of the primary outcome was a hazard ratio of 1.099 (95% CI: 0.789-1.530; P = 0.58). This large, single-center, cohort study shows pregabalin is not associated with an increased risk of AHF events in patients with pre-existing HF.

Nosocomial COVID-19: A Nationwide Spanish Study

Introduction: SARS-CoV-2 is a highly contagious virus, and despite professionals’ best efforts, nosocomial COVID-19 (NC) infections have been reported. This work aimed to describe differences in symptoms and outcomes between patients with NC and community-acquired COVID-19 (CAC) and to identify risk factors for severe outcomes among NC patients. Methods: This is a nationwide, retrospective, multicenter, observational study that analyzed patients hospitalized with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from March 1, 2020, to April 30, 2021. NC was defined as patients admitted for non-COVID-19 diseases with a positive SARS-CoV-2 test on the fifth day of hospitalization or later. The primary outcome was 30-day in-hospital mortality (IHM). The secondary outcome was other COVID-19-related complications. A multivariable logistic regression analysis was performed. Results: Of the 23,219 patients hospitalized with COVID-19, 1,104 (4.8%) were NC. Compared to CAC patients, NC patients were older (median 76 vs. 69 years; p < 0.001), had more comorbidities (median Charlson Comorbidity Index 5 vs. 3; p < 0.001), were less symptomatic (p < 0.001), and had normal chest X-rays more frequently (30.8% vs. 12.5%, p < 0.001). After adjusting for sex, age, dependence, COVID-19 wave, and comorbidities, NC was associated with lower risk of moderate/severe acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR]: 0.72; 95% confidence interval [CI]: 0.59–0.87; p < 0.001) and higher risk of acute heart failure (aOR: 1.40; 1.12–1.72; p = 0.003), sepsis (aOR: 1.73; 1.33–2.54; p < 0.001), and readmission (aOR: 1.35; 1.03–1.83; p = 0.028). NC was associated with a higher case fatality rate (39.1% vs. 19.2%) in all age groups. IHM was significantly higher among NC patients (aOR: 2.07; 1.81–2.68; p < 0.001). Risk factors for increased IHM in NC patients were age, moderate/severe dependence, malignancy, dyspnea, moderate/severe ARDS, multiple organ dysfunction syndrome, and shock; odynophagia was associated with lower IHM. Conclusions: NC is associated with greater mortality and complications compared to CAC. Hospital strategies to prevent NC must be strengthened.

1002 A HEART BEYOND A MIRROR: WHEN CCTGA ENCOUNTERS SITUS VISCERUM INVERSUS

Abstract Background Congenitally corrected transposition of great arteries (ccTGA) is an uncommon complex congenital heart disease with atrio-ventricular and ventriculo-arterial connections discondance. ccTGA may be associated with a situs solitus or situs inversus (34% of cases). Situs inversus is a mirror image of normal with the systemic ventricle situated on the right side. Instead, dextrocardia represents 20% of cases. Case clinic and discussion Came to our observation a 61 years old female, symptomatic for dyspnea on exertion (NYHA II). She had no past medical history of cardiovascular events. In anamnesis two full-term pregnancies without complications. Transthoracic echocardiogram found atrioventricular and ventriculo-arterial discordance in absence of significant valvulopathy. Cardiac computed tomography showed pulmonary veins linked to right atrium, superior and inferior cava veins connected to the left atrium; right atrium with tricuspid valve was connected to a morphologically left ventricle and left atrium with mitral valve was linked to morphologically right ventricle; pulmonary artery was connected to morphologically left ventricle instead aorta with aortic valve was linked to morphologically right ventricle. Cardiac MRI confirmed cctga in situs viscerum inversus, mild subpulmonary stenosis, moderate dilatation of arterial pulmonary trunk, and also intramyocardial late gadolinium enhancement due to fibrosis involving anterior and inferior interventricular junctions. Cardiac Holter monitoring showed sinus rhythm with some brief phases of low atrial rhythm, monomorphic isolated ventricular extrasystoles in absence of significant hyperkinetic or hypokinetic arrhythmias. CcTGA represents approximately 0.5% of all congenital heart disease. If undiagnosed in childhood, people usually become symptomatic during the first decades of life. Dyspnea, syncope and fatigue are the most frequent symptoms detected. Cardiac conduction disorders such as atrioventricular blocks are common due to the abnormal development of cardiac structures. Quality of life and its expectancy are related to the latency of the onset of heart failure symptoms. Only few patients remain asymptomatic beyond 50 years old. Symptoms and signs are frequently due to right sided (systemic) heart dysfunction and tricuspid valve insufficiency. A particular clinical situation worthy of attention is pregnancy because of the hemodynamic imbalance occurring. In fact, cardiac output increases of 40–50% above baseline determining an augmentation of stroke volume and heart rate. For these reasons, echo surveillance is needed every 4-8 weeks because of the increased risk of acute heart failure. An accurate assessment of heart rhythm has to be done due to the known predisposition to bradyarrhythmic and tachyarrhythmic events in ccTGA. Conclusions CcTGA patients require a strict cardiological follow up with echocardiographic assessment and periodic heart rhythm monitoring, in order to early detect worsening of cardiac function and significant abnormalities of the rhythm.

Abstract 11912: Pregabalin Use Increases the Risk of Acute Heart Failure in Patients With Heart Failure: A Population-Based Study

Introduction: Pregabalin, a structural analog to λ-aminobutyric acid, is prescribed for neurological disorders. Through actions to cause sodium/water retention, the agent may increase the risk of acute heart failure (AHF). Methods: We performed a retrospective cohort study using a repository of healthcare records obtained from a large U.S. academic healthcare system. HF patients were identified between 1/1/2016-12/31/2020. Patients who had initiated treatment with pregabalin were compared to patients with no post-HF pregabalin over a 365-day post-pregabalin period or post-HF period. Study outcomes were per-patient per-year (PPPY) emergency department (ED) admissions or PPPY hospitalizations, time-to first ED admission, and time-to hospitalizations. Outcomes encounters were adjudicated by a HF diagnosis (ICD-10, I50.x) at any position. We tested the association between the pregabalin exposure and outcomes using generalized linear regression and Cox-proportional hazard regression approach. Results: The study cohort included 483 pregabalin-HF patients and 21,150 pregabalin-naïve HF patients. The pregabalin-HF patients age was (mean±SEM: 62.2±0.7 vs. 66.2±0.1 years, p &lt;0.0001) and more females (54.9% vs, 44.4%, p &lt;0.0001) than pregabalin-naïve HF patients. Charleston comorbidity score was 3.66±0.14 vs. 3.23±0.02 ( p =0.007). Pregabalin use was associated with a 13% increase in PPPY AHF hospitalizations ( p &lt;0.036). A 15% increase in the PPPY ED pregabalin admissions was noted ( p =0.1142). Pregabalin ED admission or AHF hospitalization were 1.492 (95% CI: 1.204 ̶ 1.850 [ p =0.0003]) and 1.112 (95% CI: 0.922 ̶ 1.340 [ p =0.2663]). Conclusion: This retrospective cohort study shows pregabalin is associated with an increased risk of AHF in patients with existing HF. Pregabalin prescribing in HF should be considered with caution. Further signal evaluation to test the robust association between pregabalin and AHF is warranted.

Barriers and Opportunities Regarding Implementation of a Machine Learning-Based Acute Heart Failure Risk Stratification Tool in the Emergency Department.

Hospital admissions for patients with acute heart failure (AHF) remain high. There is an opportunity to improve alignment between patient risk and admission decision. We recently developed a machine learning (ML)-based model that stratifies emergency department (ED) patients with AHF based on predicted risk of a 30-day severe adverse event. Prior to deploying the algorithm and paired clinical decision support, we sought to understand barriers and opportunities regarding successful implementation. We conducted semi-structured interviews with eight front-line ED providers and surveyed 67 ED providers. Audio-recorded interviews were transcribed and analyzed using thematic analysis, and we had a 65% response rate to the survey. Providers wanted decision support to be streamlined into workflows with minimal disruptions. Most providers wanted assistance primarily with ED disposition decisions, and secondarily with medical management and post-discharge follow-up care. Receiving feedback on patient outcomes after risk tool use was seen as an opportunity to increase acceptance, and few providers (<10%) had significant hesitations with using an ML-based tool after education on its use. Engagement with key front-line users on optimal design of the algorithm and decision support may contribute to broader uptake, acceptance, and adoption of recommendations for clinical decisions.

314 Opportunities to Optimize Implementation of an Emergency Department Acute Heart Failure Risk Tool: A Mixed-Method Study of Physician Openness to Clinical Decision Support

Emergency department (ED) patients presenting with acute heart failure (AHF) are commonly admitted to the hospital, though a significant subset are at relatively low risk for adverse outcomes. We recently developed a novel machine learning (ML)-based AHF risk tool that predicts risk of 30-day serious adverse events. Successful implementation hinges upon physician acceptance of the tool and careful integration into existing workflows. Our objectives are to 1) understand ED physicians’ hesitations towards use of an AHF risk prediction tool; 2) identify opportunities to optimize implementation and integration into workflows; and 3) probe physicians on use of a ML-based model in clinical practice.

Prediction of the acute heart failure after cardiac valve surgery

Background. Postoperative acute heart failure is a frequent complication in cardiac surgery, prolonging the length of stay in the intensive care unit and the hospital length of stay.Aim. To develop prognostic risk model of the acute heart failure in the early postoperative period.Methods. This prospective cohort observation study included 121 adult patients who underwent cardiac valve surgery with cardiopulmonary bypass. The need for vasopressor and inotropic support on the first postoperative day was chosen as the primary endpoint. Univariable and multivariable analysis of logistic regression were used to evaluate the influence of preoperative and intraoperative risk factors.Results. Univariable analysis showed risk factors of using vasopressor and inotropic support on the first day after surgical intervention: duration of cardiopulmonary bypass (OR 1.02, 95% CI 1.005–1.030, p = 0.005), aortic cross-clamping time (OR 1.02, 95% CI 1.001–1.030, p = 0.006), Logistic EuroSCORE II (OR 1.16, 95% CI 0.90–1.49, p = 0.03) and tricuspid valve surgery (OR 2.59, 95% CI 1.09–6.10, p = 0.03). As a result of multivariable analysis, the final model included aortic cross-clamping time and Logistic EuroSCORE II.Use of vasopressors and inotropes on the first day after surgical intervention was associated with an increase of the following parameters: duration of mechanical ventilation (p = 0.013), length of stay in the intensive care unit (p = 0.001), hospital length of stay (p = 0.003), and total postoperative blood loss (p = 0.005).Conclusion. Aortic cross-clamping time and Logistic EuroSCORE II have an independent predictive value for determining the risk of acute heart failure after cardiac surgery. Received 7 February 2022. Revised 29 March 2022. Accepted 11 April 2022. Funding. The study had no sponsorship. Conflict of interest. Authors declare no conflict of interest. Ethics approval. The local ethics committee of Saint Petersburg State University approved the study (protocol No. 3/2019). Contribution of the authors. The authors contributed equally to this article.

Retrospective validation of acute heart failure risk stratification in the emergency department

BackgroundHeart Failure (HF) is a primary diagnosis for hospital admission from the Emergency Department (ED), although not all patients require hospitalization. The Emergency Heart Failure Mortality Risk Grade (EHMRG) estimates 7-day mortality in patients with acute HF in ED settings, but further validation is needed in the United States (US). ObjectivesTo validate EHMRG scores by risk-stratifying patients with acute HF in a large tertiary healthcare center in the US and analyze outcome measures to determine if EHMRG risk scores safely identify low-risk groups that may be discharged or managed in ED observation units (EDOUs). MethodsA retrospective cohort analysis of 304 patients with acute HF presenting to an ED at a large, tertiary healthcare center was completed. EHMRG scores were calculated to stratify patients according to published thresholds. Mortality and major adverse cardiac event (MACE) rates were analyzed. ResultsNo deaths occurred in very low and low-risk EHMRG groups at 7 days post discharge. 30-day mortality was significantly less in the lower risk groups (3.1%) when compared to all other patients (11.1%). MACE rates at 30 days in the very low risk group (15%) were significantly less when compared to all other patients (31.3%). Hospitalizations occurred in 23.4% of patients in lower risk groups. ConclusionsED risk stratification with EHMRG differentiates high-risk patients requiring hospitalization from lower risk patients who can be safely managed in alternative settings with good outcomes. Data supports improved pathways for patients with acute HF during a time of high hospital volumes.