Heart Failure Score Research Articles

A Smartphone App to Improve Oral Anticoagulation Adherence in Patients With Atrial Fibrillation: Prospective Observational Study.

BackgroundPoor adherence to oral anticoagulation in elderly patients with atrial fibrillation (AF) has been shown to negatively impact health care costs, morbidity, and mortality. Although various methods such as automated reminders, counseling, telephone support, and patient education have been effective in improving medication adherence, the burden on health care providers has been considerable. Recently, an attempt has been made to improve medication adherence without burdening health care providers by using smartphone apps; however, the use of the app for elderly patients with AF is still limited.ObjectiveThe purpose of this study was to determine whether the newly developed smartphone app for patients with AF (the Smart AF), which integrates education, automatic reminder, and patient engagement strategies with a simple user interface, can improve medication adherence in elderly patients with AF.MethodsPatient enrollment was carried out by obtaining informed consent from patients with AF attending Kyoto Prefectural University of Medicine hospital between May 2019 and September 2020. Follow-up was planned at 1, 3, and 6 months after enrollment, and questionnaire reminders were automatically sent to patient apps at designated follow-up time points. A questionnaire-based survey of medication adherence was performed electronically using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) as the survey tool.ResultsA total of 136 patients with AF were enrolled in this study. During the follow-up period, 112 (82%) patients underwent follow-up at 1 month, 107 (79%) at 3 months, and 96 (71%) at 6 months. The mean age of the enrolled patients was 64.3 years (SD 9.6), and male participants accounted for 79.4% (108/136) of the study population. The mean CHADS2 (congestive heart failure, hypertension, age, diabetes, previous stroke, or transient ischemic attack) score was 1.2, with hypertension being the most common comorbidity. At the time of enrollment, 126 (93%) and 10 (7%) patients were taking direct oral anticoagulants and warfarin, respectively. For medication adherence as measured according to the MMAS-8, MMAS scores at 1 month, 3 months, and 6 months were significantly improved compared with baseline MMAS scores (all P values less than .01). The overall improvement in medication adherence achieved by the 6-month intervention was as follows: 77.8% (14/18) of the patients in the high adherence group (score=8) at baseline remained in the same state, 45.3% (24/53) of the patients in the medium adherence group (score=6 to <8) at baseline moved to the high adherence group, and 72% (18/25) of the patients in the low adherence group (score <6) moved to either the medium or high adherence group.ConclusionsThe Smart AF app improved medication adherence among elderly patients with AF. In the realm of medication management, an approach using a mobile health technology that emphasizes education, automatic reminder, and patient engagement may be helpful.

Liver Disease Among Mexican Americans Aged 67 Years and Older

Background:The Center for Disease Control and Prevention (CDC) reports that liver disease is a significant cause of morbidity and mortality in the US, afflicting 4.5 million people in 2018, or approximately 1.7% of the American adult population.Objective:To determine the prevalence and risk factors associated with liver disease among older Mexican Americans over 18 years of follow-up.Methods:Non-institutionalized Mexican Americans aged ≥67 years (N = 1938) from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1995/96-2012/13) were studied. Measures included socio-demographic variables, self-reported liver disease, language of interview, medical conditions, hand-grip strength, physical and cognitive function, depressive symptoms, and body mass index. Generalized estimating equation models were used to estimate the odds ratio and 95% confidence interval (CI) of liver disease over time.Results:The mean age at baseline was 74.9 ± 6.0 years and 58.4% were female. The prevalence of liver disease ranged from 2.4% to 8.4%. Over time, the odds ratio of reporting liver disease was 1.17 (CI = 1.12-1.22). Older age, Spanish interview, arthritis, diabetes, heart failure, cancer, and high scores on the Mini-Mental-State-Examination were factors associated with greater odds of reporting liver disease over time. Married participants reported lower odds of liver disease over time.Conclusions:The prevalence of liver disease in this population was high, ranging from 2.4% to 8.4%. Diabetes, heart failure, arthritis, and cancer were risk factors for liver disease. Screening for liver function among patients with these morbidities may help prevent liver disease in this population with high rates of diabetes and obesity.

Association of CHA2DS2-VASc score with successful recanalization in acute ischemic stroke patients undergoing endovascular thrombectomy.

The CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease and sex) score is a simple risk stratification algorithm to estimate stroke/thromboembolic risk in patients with non-valvular atrial fibrillation (AF). Higher pre-stroke CHA2DS2-VASc score is known to be associated with greater stroke severity and poorer outcomes. AF patients generally have higher CHA2DS2-VASc scores than non-AF patients. The Modified Thrombolysis in Cerebral Infarction (mTICI) score is the most widely used grading system to assess the result of recanalizing therapies in acute ischemic stroke (AIS). mTICI 2c and mTICI 3 are conventionally accepted as successful recanalization. We investigated whether pre-stroke CHA2DS2-VASc score is associated with mTICI recanalization score in AIS patients with and without AF undergoing percutaneous thrombectomy. One hundred fifty-nine patients with the diagnosis of AIS who were admitted within 6 h from symptom onset were included in the study (mean age: 65.7 ±12.9). All subjects underwent endovascular treatment. CHA2DS2-VASc scores of the participants were calculated. Subjects were grouped according to mTICI scores achieved after endovascular treatment. mTICI 2c and mTICI 3 were accepted as successful recanalization. Successful reperfusion was observed in 130 (81.8%) of all patients who underwent endovascular treatment (mTICI flow ≥ 2c) and first-pass reperfusion was observed in 107 (67.3%) patients. When the patients with successful (mTICI flow ≥ 2c) and unsuccessful (mTICI flow ≤ 2b) reperfusion were divided into groups, no significant difference was observed between the patients in terms of comorbidities such as AF, hypertension, hyperlipidemia, coronary artery disease and cerebrovascular accident history. Patients with unsuccessful reperfusion were older than patients with successful reperfusion (71.4 ±11.2 vs. 64.5 ±13.01, p = 0.006), with a higher CHA2DS2-VASc score (4.1 ±1.5 vs. 3.04 ±1.6, p = 0.002). In addition, the duration of the procedure was longer in the unsuccessful reperfusion group (92.4 ±27.2 min vs. 65.0 ±25.1 min, p < 0.001). CHA2DS2-VASc score significantly correlated with successful recanalization (correlation coefficient; 0.243, p = 0.002). Multivariate logistic regression analysis revealed that only CHA2DS2-VASc score (OR = 1.43, 95% CI: 1.09-1.87, p = 0.006) and procedure time (OR = 1.03, 95% CI: 1.01-1.05, p < 0.001) were independent predictors of successful reperfusion. The receiver-operating characteristic (ROC) curve was used to determine the cut-off value for the CHA2DS2-VASc score that best predicts successful reperfusion. The optimal threshold was 3.5, with a sensitivity of 58.6% and specificity of 59.2% (area under the curve (AUC): 0.669, p = 0.005). For the first time in the literature, we investigated and demonstrated that pre-stroke CHA2DS2-VASc score was associated with success of recanalization as assessed with mTICI 2c and mTICI 3 in a cohort of AIS patients regardless of AF presence who underwent endovascular treatment. Our findings deserve to be tested with large scale long term studies.

Evaluating the Clinical Utility of Polygenic Risk Score for Heart Failure

Evaluating the Clinical Utility of Polygenic Risk Score for Heart Failure

Effect of vitamin D on myocardial remodeling and inflammatory status in children with congenital heart disease.

Vitamin D insufficiency is a common public health problem that is often unrecognized in children with congenital heart disease, and is not generally evaluated at congenital heart disease (CHD) follow-up. Recent studies have suggested that inadequate vitamin D status may have an adverse effect on cardiovascular health. This study investigates the relationship between vitamin D levels and hemodynamic parameters in children with CHD. Included in the study 40 patients (25 females, 15 males) with CHD, who were evaluated for Ross heart failure score, vitamin D, parathyroid hormone (PTH), calcium, phosphorus, alkaline phosphatase (ALP), whole blood count (WBC) and echocardiographic measurements, and all measurements were repeated in the third month of the therapy. The mean vitamin D level was 16.4 ± 6.6 ug/L before and 27.5 ± 9.9 μg/L in the third month of therapy, while the mean PTH level was 53.3 ± 34.9 pg/mL before and 43.8 ± 21.4 pg/mL in the third month of therapy. The mean WBC was 8084 ± 2324/µL before and 7378±1893/µL in the third month of the therapy, and the mean platelet (PLT) count was 280,897 ± 80,119/µL before and 307,179 ± 60,202/µL in the third month of the therapy. The mean ejection fraction (EF) was 64% ± 7.2% before and 66.7% ± 6.2% in the third month of therapy, while the right ventricle (RV) myocardial performance index (MPI) was 32.1% ± 6.7% before and 28.9% ± 6.5% in the third month of the therapy. IL10 level was increased in four patients in the third month of therapy. A statistically significant decrease in PTH level and WBC, and an increase in PLT number and IL-10 level were detected by the therapy. Furthermore, echocardiographic findings revealed a statistically significant increase in EF and a decrease in RVMPI attributable to the therapy. The decreased levels of PTH, which is a proinflammatory marker, the increases in IL-10, which is an antiinflammatory cytokine, and the decreases in the number of WBC resulting from vitamin D treatment demonstrate the antiinflammatory effects of vitamin D. An improvement in EF means improvement in left ventricular contractility, while a decrease in RV MPI has been shown to improve the systolic and diastolic function of the right ventricle. These results suggest that vitamin D therapy has a positive effect on the heart, and so vitamin D levels should be evaluated during the routine follow-up of congenital heart disease.

Usefulness of the MAGGIC Score in Predicting the Competing Risk of Non-Sudden Death in Heart Failure Patients Receiving an Implantable Cardioverter-Defibrillator: A Sub-Analysis of the OBSERVO-ICD Registry.

The role of prognostic risk scores in predicting the competing risk of non-sudden death in heart failure patients with reduced ejection fraction (HFrEF) receiving an implantable cardioverter-defibrillator (ICD) is unclear. To this goal, we evaluated the accuracy and usefulness of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. The present analysis included 1089 HFrEF ICD recipients enrolled in the OBSERVO-ICD registry (NCT02735811). During a median follow-up of 36 months (1st–3rd IQR 25–48 months), 193 patients (17.7%) experienced at least one appropriate ICD therapy, and 133 patients died (12.2%) without experiencing any ICD therapy. The frequency of patients receiving ICD therapies was stable around 17–19% across increasing tertiles of 3-year MAGGIC probability of death, whereas non-sudden mortality increased (6.4% to 9.8% to 20.8%, p < 0.0001). Accuracy of MAGGIC score was 0.60 (95% CI, 0.56–0.64) for the overall outcome, 0.53 (95% CI, 0.49–0.57) for ICD therapies and 0.65 (95% CI, 0.60–0.70) for non-sudden death. In patients with higher 3-year MAGGIC probability of death, the increase in the competing risk of non-sudden death during follow-up was greater than that of receiving an appropriate ICD therapy. Results were unaffected when analysis was limited to ICD shocks only. The MAGGIC risk score proved accurate and useful in predicting the competing risk of non-sudden death in HFrEF ICD recipients. Estimation of mortality risk should be taken into greater consideration at the time of ICD implantation.

A Phenotyping of Diastolic Function by Machine Learning Improves Prediction of Clinical Outcomes in Heart Failure.

Background: Discriminating between different patterns of diastolic dysfunction in heart failure (HF) is still challenging. We tested the hypothesis that an unsupervised machine learning algorithm would detect heterogeneity in diastolic function and improve risk stratification compared with recommended consensus criteria.Methods: This study included 279 consecutive patients aged 24–97 years old with clinically stable HF referred for echocardiographic assessment, in whom diastolic variables were measured according to the current guidelines. Cluster analysis was undertaken to identify homogeneous groups of patients with similar profiles of the variables. Sequential Cox models were used to compare cluster-based classification with guidelines-based classification for predicting clinical outcomes. The primary endpoint was hospitalization for worsening HF.Results: The analysis identified three clusters with distinct properties of diastolic function that shared similarities with guidelines-based classification. The clusters were associated with brain natriuretic peptide level (p < 0.001), hemoglobin concentration (p = 0.017) and estimated glomerular filtration rate (p = 0.001). During a mean follow-up period of 2.6 ± 2.0 years, 62 patients (22%) experienced the primary endpoint. Cluster-based classification predicted events with a hazard ratio 1.68 (p = 0.019) that was independent from and incremental to the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) risk score for HF, and from left ventricular end-diastolic volume and global longitudinal strain, whereas guidelines-based classification did not retain its independent prognostic value (hazard ratio = 1.25, p = 0.202).Conclusion: Machine learning can identify patterns of diastolic function that better stratify the risk for decompensation than the current consensus recommendations in HF. Integrating this data-driven phenotyping may help in refining prognostication and optimizing treatment.

The use of N-terminal (1-76) pro-brain natriuretic peptide in the aetiology of severe respiratory distress in the paediatric emergency department.

Acute respiratory distress is one of the most common reasons for paediatric emergency visits. Paediatric patients require rapid diagnosis and treatment. Our aim in this study was to use N-terminal (1-76) pro-brain natriuretic peptide to differentiate respiratory distress of cardiac and pulmonary origin in children. Our aim was to investigate the role of N-terminal (1-76) pro-brain natriuretic peptide in the detection of patients with new-onset heart failure in the absence of an underlying congenital heart anomaly. All children aged 0-18 years who presented to the paediatric emergency department due to severe respiratory distress were included in the study prospectively. The patients' demographic characteristics, presenting complaints, clinical findings, and N-terminal (1-76) pro-brain natriuretic peptide concentrations, were investigated. In patients with severe Pediatric Respiratory Severity Score, congestive heart failure score was calculated using the modified Ross Score. This study included 47 children between the ages of 1 month and 14 years. The median N-terminal (1-76) pro-brain natriuretic peptide concentration was 5717 (IQR:16158) pg/mL in the 25 patients with severe respiratory distress due to heart failure and in the 22 patients with severe respiratory distress due to lung pathology was 437 (IQR:874) pg/mL (p < 0.001). In the 25 patients with severe respiratory distress due to heart failure, 8281 (IQR:8372) pg/mL in the 16 patients with underlying congenital heart anomalies, and 1983 (IQR:2150) pg/mL in the 9 patients without a congenital heart anomaly (p < 0.001). The 45 patients in the control group had a median N-terminal (1-76) pro-brain natriuretic peptide concentration of 47.2 (IQR:56.2) pg/mL. Using scoring systems in combination with N-terminal (1-76) pro-brain natriuretic peptide cut-off values can help direct and manage treatment.

Rearrest during hospitalisation in adult comatose out-of-hospital cardiac arrest patients: Risk factors and prognostic impact, and predictors of favourable long-term outcomes

BackgroundRearrest occurs commonly after initial resuscitation following out-of-hospital cardiac arrest (OHCA). We determined (1) the predictors of rearrest during hospitalisation that can be identified in the hours immediately after OHCA, (2) the association between rearrest and favourable long-term outcomes, and (3) the predictors of favourable long-term outcomes in rearrest patients. MethodsConditional multivariable logistic regression analyses were performed using the Korean Hypothermia Network prospective registry data, which included details of adult OHCA patients treated with targeted temperature management at 22 teaching hospitals in South Korea. ResultsAmong the 1,233 patients, 260 (21.1%) experienced rearrest. Of the 192 patients resuscitated from first rearrest, 33 (17.2%) achieved 6-month favourable outcomes. Arrhythmia, heart failure, ST-segment elevation, lower initial Glasgow coma scale (GCS) motor score, higher initial lactate level, and antiarrhythmic drug use within 1 h were independently associated with rearrest. Higher lactate level and antiarrhythmic drug use were associated with shockable first rearrest, while arrhythmia, heart failure, ST-segment elevation, and lower GCS motor score were associated with non-shockable first rearrest. Rearrest was independently associated with a lower likelihood of 6-month favourable outcomes (P = 0.003). Initial shockable rhythm after OHCA, absence of diabetes, shorter cumulative time to restoration of spontaneous circulation, coronary angiography, and hypophosphataemia within 7 d were independently associated with 6-month favourable outcomes in the patients resuscitated from first rearrest. ConclusionsRearrest during hospitalisation after OHCA was inversely associated with 6-month favourable outcomes. We identified several risk factors for rearrest and prognostic factors for patients resuscitated from first rearrest.

Incorporation of natriuretic peptides with clinical risk scores to predict heart failure among individuals with dysglycaemia.

To evaluate the performance of the WATCH-DM risk score, a clinical risk score for heart failure (HF), in patients with dysglycaemia and in combination with natriuretic peptides (NPs). Adults with diabetes/pre-diabetes free of HF at baseline from four cohort studies (ARIC, CHS, FHS, and MESA) were included. The machine learning- [WATCH-DM(ml)] and integer-based [WATCH-DM(i)] scores were used to estimate the 5-year risk of incident HF. Discrimination was assessed by Harrell's concordance index (C-index) and calibration by the Greenwood-Nam-D'Agostino (GND) statistic. Improvement in model performance with the addition of NP levels was assessed by C-index and continuous net reclassification improvement (NRI). Of the 8938 participants included, 3554 (39.8%) had diabetes and 432 (4.8%) developed HF within 5 years. The WATCH-DM(ml) and WATCH-DM(i) scores demonstrated high discrimination for predicting HF risk among individuals with dysglycaemia (C-indices=0.80 and 0.71, respectively), with no evidence of miscalibration (GND P ≥0.10). The C-index of elevated NP levels alone for predicting incident HF among individuals with dysglycaemia was significantly higher among participants with low/intermediate (<13) vs. high (≥13) WATCH-DM(i) scores [0.71 (95% confidence interval 0.68-0.74) vs. 0.64 (95% confidence interval 0.61-0.66)]. When NP levels were combined with the WATCH-DM(i) score, HF risk discrimination improvement and NRI varied across the spectrum of risk with greater improvement observed at low/intermediate risk [WATCH-DM(i) <13] vs. high risk [WATCH-DM(i) ≥13] (C-index=0.73 vs. 0.71; NRI=0.45 vs. 0.17). The WATCH-DM risk score can accurately predict incident HF risk in community-based individuals with dysglycaemia. The addition of NP levels is associated with greater improvement in the HF risk prediction performance among individuals with low/intermediate risk than those with high risk.

Abstract 10057: Subclinical Atrial Fibrillation is More Prevalent in Heart Failure with Preserved Ejection Fraction Compared to the General Population

Introduction: Atrial fibrillation (AF) is a common in patients with heart failure with preserved ejection fraction (HFpEF), and is associated with higher filling pressures, reduced exercise capacity, and reduced survival. The prevalence of subclinical AF in HFpEF remains unknown. Hypothesis: We hypothesized that subclinical AF was more prevalent in individuals with HFpEF when compared to individuals without clinical heart failure history. Methods: We evaluated subclinical AF in 101 HFpEF patients with no prior diagnosis of clinical AF using 14 day ambulatory ECG patch monitoring (Ziopatch XT, iRhythm Technologies). We compared the prevalence of subclinical AF in HFpEF with controls drawn from 3303 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) exam 6 follow-up, excluding those with known heart failure or high H2FpEF score who underwent the same ECG patch monitoring. Case-control comparisons of participants between the ages of 55 to 93 years were performed using multivariable logistic regression to adjust for demographic and clinical comorbidities, as well as patch monitoring duration. Results: 80 HFpEF patients and 1356 MESA participants were included. The HFpEF patients were younger (69 [63, 76] v. 72 [66, 80], p=0.02), more obese (BMI of 36 [30, 45] v. 27 [24, 30], p&lt;0.001) and more likely to have diabetes (34 v. 21%, p=0.01). There was a higher proportion of African Americans in the HFpEF group (57.5 v. 22.8%, p&lt;0.001). The prevalence of subclinical AF was 9.8% in HFpEF group and 6.2% in MESA participants. After multivariable adjustment for age, sex, race, body mass index, hypertension, diabetes, smoking pack-years and total analyzable time on ECG monitor there was a significantly higher odds of subclinical AF in HFpEF compared to MESA (OR 4.26 [1.2, 16.2], p=0.03). Conclusions: HFpEF patients have a higher prevalence of subclinical AF than the general population. Screening for atrial arrhythmias may be appropriate in HFpEF patients for timely initiation of thromboembolic prophylaxis, and may identify individuals at greater risk for clinical decompensation in light of the well documented risks associated with AF in HFpEF.

Abstract 13836: Unbiased Deep Learning Approach Utilizing Longitudinal Data in Assessing All-Cause Mortality in Patients With a De Novo or Worsened Heart Failure

Introduction: Heart failure (HF) is a heterogenous syndrome with complex pathophysiology. Biomarkers and clinical risk scores often fail to capture modifications in the treatment continuity and provide suboptimal patient-level precision in the prognostic stratification. Electronic patient records provide necessary granularity yielding opportunities to develop new artificial intelligence (AI) based strategies for comprehensive prognostic re-stratification. Hypothesis: We assessed the hypothesis that, utilizing longitudinal patient data in an AI approach, yields superior performance predicting all-cause mortality in a cohort of patients hospitalized with a de novo or worsened HF, compared to single observational time point predictions. Methods: In a cohort of 2449 HF patients hospitalized between 2011-2017, we utilized 151 451 patient exams from 422 parameters. Features included clinical phenotyping, medication, ECG, laboratory, echocardiography, catheterization data or percutaneous and surgical interventions gathered on a routine clinical basis reflecting standard of care as captured in individual electronic records. AI models were developed, and their performance on the validation set was compared to industry standard clinical scores. Results: AI models yielded performance ranging from 0.83 to 0.89 AUC on the outcome-balanced validation set in predicting all-cause mortality at 30-, 90-, 180-, 360- and 720-day time-limits. The primary endpoint, 1-year mortality prediction model, recorded 0.85 AUC on the validation set compared to 0.7 AUC (Seattle HF model) and 0.73 AUC (MAGGIC HF Score) respectively. Conclusions: Our findings present a novel, patient-level, AI-based risk prediction approach of all-cause mortality in heart failure utilizing all historical data available in electronic health records. This suggests the potential of AI based predictive models in a point-of-care approach to guide clinical risk stratification.

Pragmatic Weight Management Program for Patients With Obesity and Heart Failure With Preserved Ejection Fraction.

BackgroundObesity is associated with heart failure with preserved ejection fraction (HFpEF). Weight loss can improve exercise capacity in HFpEF. However, previously reported methods of weight loss are impractical for widespread clinical implementation. We tested the hypothesis that an intensive lifestyle modification program would lead to relevant weight loss and improvement in functional status in patients with HFpEF and obesity.Methods and ResultsPatients with ejection fraction >45%, at least 1 objective criteria for HFpEF, and body mass index ≥30 kg/m2 were offered enrollment in an established 15‐week weight management program that included weekly visits for counseling, weight checks, and provision of meal replacements. At baseline, 15 weeks, and 26 weeks, Minnesota Living With Heart Failure score, 6‐minute walk distance, echocardiography, and laboratory variables were assessed. A total of 41 patients completed the study (mean body mass index, 40.8 kg/m2), 74% of whom lost >5% of their baseline body weight following the 15‐week program. At 15 weeks, mean 6‐minute walk distance increased from 223 to 281 m (P=0.001) and then decreased to 267 m at 26 weeks. Minnesota Living With Heart Failure score improved from 59.9 to 37.3 at 15 weeks (P<0.001) and 37.06 at 26 weeks. Changes in weight correlated with change in Minnesota Living With Heart Failure score (r=0.452; P=0.000) and 6‐minute walk distance (r=−0.388; P<0.001).ConclusionsIn a diverse population of patients with obesity and HFpEF, clinically relevant weight loss can be achieved with a pragmatic 15‐week program. This is associated with significant improvements in quality of life and exercise capacity.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT02911337.

Derivation and Validation of Genome-Wide Polygenic Score for Ischemic Heart Failure.

BackgroundDespite advances in cardiovascular disease and risk factor management, mortality from ischemic heart failure (HF) in patients with coronary artery disease (CAD) remains high. Given the partial role of genetics in HF and lack of reliable risk stratification tools, we developed and validated a polygenic risk score for HF in patients with CAD, which we term HF‐PRS.Methods and ResultsUsing summary statistics from a recent genome‐wide association study for HF, we developed candidate PRSs in the Mount Sinai BioMe CAD patient cohort (N=6274) by using the pruning and thresholding method and LDPred. We validated the best score in the Penn Medicine BioBank (N=7250) and performed a subgroup analysis in a high‐risk cohort who had undergone coronary catheterization. We observed a significant association between HF‐PRS score and ischemic HF even after adjusting for evidence of obstructive CAD in patients of European ancestry in both BioMe (odds ratio [OR], 1.14 per SD; 95% CI, 1.05–1.24; P=0.003) and Penn Medicine BioBank (OR, 1.07 per SD; 95% CI, 1.01–1.13; P=0.016). In European patients with CAD in Penn Medicine BioBank who had undergone coronary catheterization, individuals in the top 10th percentile of PRS had a 2‐fold increased odds of ischemic HF (OR, 2.0; 95% CI, 1.1–3.7; P=0.02) compared with the bottom 10th percentile.ConclusionsA PRS for HF enables risk stratification in patients with CAD. Future prospective studies aimed at demonstrating clinical utility are warranted for adoption in the patient setting.

Risk Assessment Of Adverse Drug Reactions In Elderly Patients With Chronic Diseases

Introduction: The adverse drug reaction (ADR) is 4-7 times more common in elderly patients. That was also related to changes in pharmacokinetics and pharmacodynamics that triggered the emergence of Drug-Related Problems. Objective: The purpose of this study was to assess ADR in elderly patients with chronic diseases using the GerontoNET Score and the Screening Tool of Older People's Prescriptions (STOPP) criteria. Methods: The research design used a cross-sectional study which was analyzed descriptively. The sample consisted of 72 patients, aged more than 60 years, accompanied by chronic diseases, and hospitalized at Waluyo Jati Kraksaan Hospital. The exclusion criteria were patients referred to the Intensive Care Unit. Assessment to see the risk of ADR in elderly patients with chronic diseases using the GerontoNet Score while the wrong type of drug is given to elderly patients using the STOPP criteria. The variables contained in the GerontoNET Score are comorbid conditions ³4 (score= 1), heart failure (score= 1), liver disease (score = 1), the number of drugs such as: £5 (score= 0); 6-7 (score=1); ³8 (score=4), history of ADR (score=2), kidney failure (score=1). Results: The variable with the most ADR risk factors was the number of drugs ³8 drugs as many as 47 patients (65.3%) with GerontoNET score ³4 as much as 70.8%. The types of drugs included in the STOPP criteria are clopidogrel, Arixtra (fondaparinux), beta-blockers, NSAIDs, and furosemide. Conclusion: The risk factor for ADR was the number of drugs ³8 drugs.

A clinical score to predict mortality in patients after acute heart failure from Japanese registry.

AimsClinical scores that consider physical and social factors to predict long‐term observations in patients after acute heart failure are limited. This study aimed to develop and validate a prediction model for patients with acute heart failure at the time of discharge.Methods and resultsThis study was retrospective analysis of the Kitakawachi Clinical Background and Outcome of Heart Failure Registry database. The registry is a prospective, multicentre cohort of patients with acute heart failure between April 2015 and August 2017. The primary outcome to be predicted was the incidence of all‐cause mortality during the 3 years of follow‐up period. The development cohort derived from April 2015 to July 2016 was used to build the prediction model, and the test cohort from August 2016 to August 2017 was used to evaluate the prediction model. The following potential predictors were selected by the least absolute shrinkage and selection operator method: age, sex, body mass index, activities of daily living at discharge, social background, comorbidities, biomarkers, and echocardiographic findings; a risk scoring system was developed using a logistic model to predict the outcome using a simple integer based on each variable's β coefficient. Out of 1253 patients registered, 1117 were included in the analysis and divided into the development (n = 679) and test (n = 438) cohorts. The outcomes were 246 (36.2%) in the development cohort and 143 (32.6%) in the test cohort. Eleven variables including physical and social factors were set into the logistic regression model, and the risk scoring system was created. The patients were divided into three groups: low risk (score 0–5), moderate risk (score 6–11), and high risk (score ≥12). The observed and predicted mortality rates were described by the Kaplan–Meier curve divided by risk group and independently increased (P < 0.001). In the test cohort, the C statistic of the prediction model was 0.778 (95% confidence interval: 0.732–0.824), and the mean predicted probabilities in the groups were low, 6.9% (95% confidence interval: 3.8–10%); moderate, 30.1% (95% confidence interval: 25.4%–34.8%); and high, 79.2% (95% confidence interval: 72.6%–85.8%). The predicted probability was well calibrated to the observed outcomes in both cohorts.ConclusionsThe Kitakawachi Clinical Background and Outcome of Heart Failure score was helpful in predicting adverse events in patients with acute heart failure over a long‐term period. We should evaluate the physical and social functions of such patients before discharge to prevent adverse outcomes.

Global Longitudinal Strain and Global Circumferential Strain on Echo Heart Failure Score as 60-days Readmission Predictor in Congestive Heart Failure Patients with Left Ventricle Systolic Dysfunction in Makassar City

Introduction: The readmission rate due to heart failure increases every year in South Sulawesi. A Frequently used method for assessing readmission is an echocardiographic examination by measuring ejection fraction. However, recent studies show that the speckle tracking parameters are more sensitive to predict readmission of heart failure patients. In this study, we assess the role of Global Longitudinal Strain (GLS) and Global Circumferential Strain (GCS) parameters on the Echo Heart Failure Score (EHFS) as a 60-days readmission predictor in heart failure patients. Methods: We included 175 patients admitted through the inpatient installation of Integrated Heart Center Dr. Wahidin Sudirohusodo General Hospital. In addition, we reviewed up to 60 days after outpatient prospectively by collecting data through medical records. The correlation between echocardiographic parameters and readmissions was analyzed using the Spearman Rank Correlation. To determine each echocardiographic parameter's cut-off point, sensitivity, and specificity, we use Receiver Operating Characteristic (ROC) curve. Results:GLS and GCS are very sensitive and specific parameters in predicting 60-days readmission with an area under the curve (AUC) value &gt; 0.7. This study shows that adding GLS and GCS parameters to the EHFS increases the predicted value (AUC 0.850 vs. 0.820) and sensitivity to 79%. Conclusion: GLS and GCS parameters additional on EHFS can help predict 60-days readmission of heart failure patients with sensitivity and specificity of 79% and 83%, respectively. The present study shows that with higher GLS and GCS scores on the EHFS, the risk of readmission in heart failure patients will increase.

A Targeted Treatment Opportunity for HFpEF: Taking Advantage of Diastolic Tone.

A Targeted Treatment Opportunity for HFpEF: Taking Advantage of Diastolic Tone.

Oral anticoagulation therapy with rivaroxaban in elderly patients with atrial fibrillation. Results from EMIR study

Abstract Background Atrial fibrillation (AF) in elderly patients increases both bleeding and thromboembolic risks. Elderly patients benefit as much from anticoagulation therapy with positive net clinical benefit. However, there have been few studies that focused on the efficacy and safety of direct oral anticoagulants in elderly patients. The aim of this subanalysis from EMIR study was to assess the effectiveness of rivaroxaban in patients older than 75 years old. Methods EMIR Study (acronym from 'Estudio observacional para la identificaciόn de los factores de riesgo asociados a eventos cardiovasculares Mayores en pacientes con fIbrilaciόn auricular no valvular tratados con un anticoagulante oral directo (Rivaroxaban)') was an observational, multicenter, post-authorization and prospective study that involved AF patients under oral anticoagulation with rivaroxaban at least 6 months before enrolment. We analyzed baseline clinical characteristics and adverse events after 2.5 years of follow up. Results We analyzed 1,433 patients with median age of 74.7 (67.7–81.6). Of them 691 (48.2%) were ≥75 years. Elderly patients had higher prevalence of cardiovascular risk factors such previous stroke (16.8% vs 8.5%; p&amp;lt;0.001), heart failure (25.0% vs 20.6%; p&amp;lt;0.001), higher CHA2DS2-VASc (4.4±1.3 vs 2.7±1.2; p&amp;lt;0.001) and HAS-BLED (1.9±1.0 vs 1.2±1.0; p&amp;lt;0.001) scores. After 2.5 (2.2–2.6) years of follow-up, we observed low rate of adverse events in patients under rivaroxaban therapy. We observed higher rate of adverse events in elderly population for thromboembolic events (1.13%/year vs 0.36%/year; p=0.017) and major bleeding events (1.80%/year vs 0.36%/year; p&amp;lt;0.001) but those adverse rates were lower than expected according to previous studies (i.e. ROCKET-AF trial, rivaroxaban group had 4.86%/year of major bleeding or in XANTUS study was 3.2%/year of major bleeding in patients &amp;gt;75 years). We did not observe differences between groups from MACE (1.13%/year vs 1.01%/year; p=0.875) or cardiovascular death (0.86%/year vs 0.42%/year; p=0.170). Conclusion In real-world elderly population, rivaroxaban showed higher rates of thromboembolic and major bleeding events in elderly patients but with annual rates lower than expected according to previous studies like ROCKET-AF or XANTUS. Similar annual rates in elderly were observed for MACE and cardiovascular mortality than in younger patients, being rivaroxaban a good therapeutic alternative even for the elderly. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania S.L.

Impact of atrial tachycardia management on outcomes in adult patients with congenital heart disease

BackgroundAtrial arrhythmias are common complications in adults with congenital heart disease (ACHD) and are associated with high morbi-mortality. Atrial tachycardia (AT) including intra-atrial reentrant tachycardia and focal atrial tachycardia are the most prevalent arrhythmias in ACHD. We aimed to compare mid-term outcomes according to arrhythmia management. MethodsAll hospitalizations for AT in ACHD were retrospectively identified from medico-administrative database from September 2006 to September 2016 in two centers. Outcomes of patients with AT managed with direct-current cardioversion (DCCV) were compared with patients referred for catheter ablation (CA). Atrial arrhythmia recurrence, stroke, admission for heart failure and death were analyzed during follow-up. ResultsOne hundred and twenty-one ACHD with AT (median age 41 [IQR 32–52] years, male 62%, 41% moderate CHD and 38% complex CHD) were included. Median follow-up was 3.3 years [IQR 1.4–6.2]. Thirty-seven (30.5%) patients underwent DCCV and 84 (69.5%) CA. No significant difference in age, CHD complexity, history of atrial arrhythmia, heart failure, and CHA2DS2-VASC score were observe. Patients undergoing DCCV had higher NYHA class. Atrial arrhythmia recurrence was lower in CA group (Log-rank test, p ​= ​0.045). Most recurrences were AT, but atrial fibrillation was recorded in 35.1% after DCCV and 9.5% after CA (p ​= ​0.001). At the end of follow-up, patients who were initially treated by CA had a significantly lower incidence of severe cardiovascular events (48.6% in DCCV group vs. 16.7% in CA group, HR: 0.46, CI 95%: 0.22–0.93, p ​= ​0.031). ConclusionsA proactive management of AT by CA is associated with better long-term outcomes in ACHD.