Status Of Heart Failure Patients Research Articles

Accuracy and correlation of bed and standing scale weights in monitoring volume status in heart failure patients.

Introduction: Accurate volume status monitoring is crucial for effective diuretic therapy in patients with acute decompensated heart failure (ADHF). While guidelines recommend daily standing body weight measurement as an indicator of volume status, bed scales are commonly used in healthcare facilities. Methods: A method-comparison design was used to compare bed and standing scale weights among adults hospitalized with ADHF at Los Angeles County-University of Southern California Medical Center between March and April 2023. Results & Conclusion: Among 51weight pairs from 43 participants, a clinically significant mean difference of 1.42±1.18kg was observed, exceeding the recommended threshold. Inaccuracies, with 71% showing differences >0.6kg, highlight potential fluid management errors when relying on bed scales in ADHF hospitalizations.

Use of medical therapy and risk of clinical events according to frailty in heart failure patients-A real-life cohort study.

Although recent randomized clinical trials have demonstrated the advantages of heart failure (HF) therapy in both frail and not frail patients, there is insufficient information on the use of HF therapy based on frailty status in a real-world setting. The aim was to examine how frailty status in HF patients associates with use of HF therapy and with clinical outcomes. Patients with new-onset HF between 2014 and 2021 were identified using the nationwide Danish registers. Patients across the entire range of ejection fraction were included. The associations between frailty status (using the Hospital Frailty Risk Score) and use of HF therapy and clinical outcomes (all-cause mortality, HF hospitalization, and non-HF hospitalization) were evaluated using multivariable-adjusted Cox models adjusting for age, sex, diagnostic setting, calendar year, comorbidities, pharmacotherapy, and socioeconomic status. Of 35 999 participants (mean age 69.1 years), 68% were not frail, 26% were moderately frail, and 6% were severely frail. The use of HF therapy was significantly lower in frailer patients. The hazard ratio (HR) for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker initiation was 0.74 (95% confidence interval 0.70-0.77) and 0.48 (0.43-0.53) for moderate frailty and severe frailty, respectively. For beta-blockers, the corresponding HRs were 0.74 (0.71-0.78) and 0.51 (0.46-0.56), respectively, and for mineralocorticoid receptor antagonists, 0.83 (0.80-0.87) and 0.58 (0.53-0.64), respectively. The prevalence of death and non-HF hospitalization increased with frailty status. The HR for death was 1.55 (1.47-1.63) and 2.32 (2.16-2.49) for moderate and severe frailty, respectively, and the HR for non-HF hospitalization was 1.37 (1.32-1.41) and 1.82 (1.72-1.92), respectively. The association between frailty status and HF hospitalization was not significant (HR 1.08 [1.02-1.14] and 1.08 [0.97-1.20], respectively). In real-world HF patients, frailty was associated with lower HF therapy use and with a higher incidence of clinical outcomes including mortality and non-HF hospitalization.

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: <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:<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

Comparative study of the effects of left ventricular and biventricular pacing on indices of cardiac function and clinical status of heart failure patients: preliminary results of READAPT study

Abstract Nonresponse to cardiac resynchronization therapy (CRT) has been related with right ventricular dysfunction. Preferential left ventricular pacing (pLVP) can overcome iatrogenic right ventricular dysfunction by achieving left ventricle resynchronization and by allowing for intrinsic activation of the right side, with ramifications extending beyond cardiac output and atrial fibrillation occurrence. Moreover, the AdaptivCRT® algorithm also automatically adjusts interventricular (V-V) delay every minute, optimizing it by means of comparing relative activation delay between right and left ventricles (electrically – driven optimization). In the present study we evaluated the effects of a pLVP algorithm on 50 heart failure patients (all Caucasians, 49% male; 66 +/- 8 years old; 46% ischemic cardiomyopathy; 41% diabetics; NYHA II-III) following randomization to standard biventricular pacing and pLVP, on echocardiographic and cardiopulmonary exercise test indices of functional status, as well as a self-reported quality of life questionnaire. Device programming was based on echocardiography-evaluated maximization of stroke volume and subsequent interventricular and atrioventricular delay adjustments delegated to the device. The follow-up consisted of 6 and 12-months visits; after the 1rst month of optimizing maximum CRT response. Results Significant comparative effects of LVP over optimized CRT were noted regarding RV systolic velocity in TDI even from 6-months from baseline (6% increase, p=0.01); while end-systolic diameter of left ventricle was increased by 4% in 6-months in CRT group (p=0.01), while no significant difference was observed in LVP group. At 12 months endsystolic volume was significantly decreased (16%, p=0.01) and left ventricular systolic longitudinal strain was improved in 12 months in LVP group compared to CRT group (p- for interaction =0.001). Additionally, in cardiorespiratory exercise test LVP group showed improved inotropic reserve compared to CRT group according to maximum SBP achieved (20% increase, p<0.01 for interaction); while all other cardiorespiratory indices shoed borderline significant changes at 12 -months. Minnesota score was significantly reduced in LV-P group by 70% at 6-months; whereas no significant change was observed in CRT group (p for interaction <0.01). Conclusions In the preliminary findings of READAPT study, it seems that LV pacing optimized by a standardized echocardiographic protocol in patients with preserved AV conduction, LBBB, can achieve a higher percentage of synchronized LV pacing associated with improved patient quality of life; right ventricular function and endsystolic volume at 6 and 12-months of follow-up, over echo-optimized CRT pacing.

ESTIMATION OF PLASMA VOLUME IN PATIENTS PRESENTING WITH ACUTE DECOMPENSATED HEART FAILURE USING KAPLAN – HAKIM FORMULA AND CORRELATION OF PLASMA VOLUME SHIFT WITH OUTCOMES

Objective: Simple and non-invasive methods are required to estimate the plasma volume expansion to assess the congestion status in heart failure patients. To determine the effectiveness of Kaplan–Hakim formula in the quantification of the plasma volume expansion in acute decompensated heart failure (ADHF) and the correlation of the outcome factors with plasma volume shift (PVS). Methods: This prospective study included 384 participants diagnosed with ADHF. Newly diagnosed cases and patients receiving treatment for the past 6 months were included. Kaplan–Hakim formula was used to estimate the plasma volume. Duration of hospital stay, subsequent hospitalization for heart failure (HHF), cardiovascular disease mortality, and all-cause mortality rate at the end of follow-up time was also noted. Results: Among the study participants, 88 patients (22.92%) had PVS <5%, while the remaining 88.5% of the patients had PVS more than or equal to 5%. A strong association between guideline-recommended dose of ACEi/ARBs, beta-blockers, and normalcy of plasma volume status (p<0.001) was found. The mean duration of stay, number of repeated hospitalization, the incidence of worsening renal function, CV mortality rate, and all-cause mortality rate were significantly lower in participants with PVS ≥5% in comparison to those who had PVS < 5%. Kaplan–Hakim formula is a more practical and easy way to measure volume status in patients with ADHF. Conclusion: The use of RAAS antagonists and beta-blockers in their optimal dosage is associated with favorable plasma volume status in chronic HF patients.

THE EFFECT OF THE COMBINATION OF SEMI FOWLER POSITION AND RIGHT LATERAL ON HEMODYNAMIC CHANGES IN HEART FAILURE PATIENTS IN THE CVCU ROOM GRANDMED HOSPITAL LUBUK PAKAM

The results of a survey of the world community and in Indonesia, the most common disease and the most common cause of death is heart disease. Data from the World Health Organization (WHO) shows the prevalence that males experience more heart disease than females. Systemic and pulmonary disorders often occur because blood flow fails to enter the tissues due to failure of the heart pump, which affects the patient's hemodynamics. Changes in position have an impact on changes in central venous pressure values. The purpose of this study was to determine whether or not there was an effect of giving a combination of semi-Fowler's position with right lateral to changes in hemodynamic status of heart failure patients. Quasi experiment with one group pre test and post test method was used in this study. There were 10 respondents who were sampled using the quota sampling technique. This research was conducted at GrandMed Lubuk Pakam Hospital. The measuring instrument used in this study is an observation sheet. Data analysis was performed using paired simple T test. The results of this study obtained a p value = 0.001, this indicates that there is an effect of giving a combination of semi-Fowler's position with right lateral to changes in hemodynamic status in heart failure patients. Semi-Fowler's and lateral position actions help reduce oxygen consumption and increase maximum lung expansion and overcome damage to gas exchange so that it can reduce tightness and affect hemodynamic status. It is expected that nurses will provide education to patients so they want to change the semi-fowler's position with a right lateral combination in order to improve the patient's hemodynamic quality.
 

A novel echocardiographic index for prediction of malnutrition in acute heart failure

Introduction Malnutrition is common among heart failure (HF) patients. The prognostic nutritional index (PNI) and controlling nutritional status (CONUT) are widely used for evaluation of nutritional status in HF patients. Right ventricular dysfunction, functional tricuspid regurgitation, and elevated right atrial pressure might exacerbate malnutrition by promoting bowel congestion and malabsorption in HF patients. We aimed to investigate the relationship between echocardiographic measures of right heart function and nutritional status in patients hospitalised for acutely decompensated HF, and to define a simple nutritional heart failure index based on non-invasively measured right heart functions to predict nutritional status. Methods 133 consecutive patients who were admitted to inpatient cardiology clinics for acutely decompensated HF were included in the study. All patients underwent a comprehensive echocardiographic examination on admission day. PNI and CONUT scores were calculated in order to assess the nutritional status. Results We defined a novel nutritional heart failure index (HFI-N) based on the echocardiographic measurements of inferior vena cava diameter (IVC), IVC collapsibility and right atrial pressure to predict the nutritional status of the patients. The HFI-N index was a significant predictor for both PNI and CONUT scores. In addition, both PNI and CONUT scores were significantly correlated to length of hospital stay. Conclusion Malnutrition was associated with a prolonged hospital stay in HF patients. The newly defined HFI-N index is a good predictor of the nutritional status in patients with heart failure.

Coexistence of sarcopenia and osteoporosis in patients with heart failure: prevalence and association with functional status

Abstract Background Sarcopenia, the loss of muscle mass and function, and osteoporosis, a condition of low bone mass and micro-architectural deterioration of bone, frequently coexist and are associated with low functional status in heart failure (HF) patients. Aims We aimed to investigate the impact of coexistence of sarcopenia and osteoporosis on functional status in HF patients. Methods This cross-sectional study was conducted using data from patients who admitted to our institute for the diagnosis and management of HF from 1 November 2015 to 30 April 2021. All patients received the dual-energy X-ray absorptiometry (DEXA) method before discharge. The diagnosis of sarcopenia was made according to the criteria of Asia Working Group for Sarcopenia 2019 recommendation as follows: reduced skeletal muscle mass [appendicular skeletal muscle mass index (ASMI) by DEXA, <7.00 kg/m2 in males and <5.40 kg/m2 in females] plus lower muscle strength (handgrip strength, <28 kg in males and <18 kg in females) and/or poor physical performance (gait speed, <1.0 m/s; chair stand test time. ≥12 s; short physical performance battery ≤9 points). In addition, bone mineral densities (BMDs) at the lumbar spine, femoral neck, and total femur were measured by DEXA, and osteoporosis was diagnosed when BMDs at any of the three sites were less than 70% of Young Adult Mean (YAM). Functional status was assessed by the Barthel Index (BI) within three days before discharge, and patients with a BI score of <85 points was defined as having functional dependence (FD). The missing data were imputed using multiple imputation by chained -equations algorithm. Results Four hundred-thirty eight patients [median age of 74 years (interquartile range, 65–82 years), 37% females] were included in the analyses. Of these, percentage of HF patients with sarcopenia, osteoporosis, and sarcopenia and osteoporosis was 45%, 34%, and 20%, respectively (Figure 1A). The analysis of covariance showed a lower %YAM at any sites in patients with sarcopenia than those without sarcopenia (Figure 1B). When patients were divided into subgroups according to the presence or absence of sarcopenia and osteoporosis, the prevalence of FD was 32%, 34%, and 48% in patients with osteoporosis alone, sarcopenia alone, and sarcopenia and osteoporosis, respectively. Multivariate logistic regression analysis indicated that an increase in adjusted odds ratio (OR) for predicting FD was observed across subgroups in the following order: patients with osteoporosis alone [OR, 1.64; 95% confidence interval (CI), 0.63–4.24; p=0.31], those with sarcopenia alone (OR, 2.44; 95% CI, 1.13–5.25; p=0.02) and those with both conditions (OR, 3.34; 95% CI, 1.52–7.38; p<0.01) (Figure 2). Conclusion There was considerable overlap between sarcopenia and osteoporosis in HF patients, which appeared to be a risk factor for FD. Funding Acknowledgement Type of funding sources: None.

Time To Decongestion Following Heart Failure Hospitalization As Measured By Extracellular Fluid Nadir Using Bioimpedance Spectroscopy

<h3>Background</h3> : Evaluating volume status adequately remains a challenge to most practitioners. Following heart failure (HF) hospitalization, patients often are discharged on an increased diuretic regimen with uncertainty around how long it will take for a patient to reach true decongestion. Resolution of symptoms, weight monitoring, and peripheral edema are not always true indicators of a patient's current volume status. Bioimpedance Spectroscopy (BIS) has been shown to accurately measure extracellular fluid (ECF) and correlates well with bromide dilution (gold standard method). Reducing ECF is the main objective of diuretic therapy. <h3>Methods</h3> : Patients with NYHA Class II or III HF were enrolled in a multi-center observational study. Initial BIS measurement and body weight was obtained 48-72 hours following HF hospital discharge and measured daily thereafter. We report on 69 patients each of whom had between 30 and 90 days of monitoring post-discharge. Daily ECF and weight results were not made available to treating providers. <h3>Results</h3> : Time to ECF nadir was 16.9 ± 15.9 days (mean ± SD), range 0 to 62.9 days. ECF loss from initial measurement to nadir was 2.2 ± 1.9 liters, range 0 to 9.65 liters; ECF loss on a percentage basis was 10.3% ± 7.4%, range 0% to 32.6%. Time to weight nadir was 18.1 ± 15.5 days, range 0 to 49.9 days. Weight loss from initial measurement to nadir was 3.6 ± 3.9 kg, range 0 to 18.5 kg. Weight loss on a percentage basis was 4.5% ± 5.1%, range 0% to 28.7% and was significantly lower than the corresponding measure for ECF [median weight loss of 3.4% (95% CI: 2.1-4.2%) versus median ECF loss of 7.8% (95% CI: 6.7-10.4%), p<0.0001 by Wilcoxon test]. <h3>Conclusion</h3> : Daily noninvasive BIS measurements may assist in tracking fluid status in HF patients post-discharge from HF hospitalization. The more than two-fold ECF loss as compared to weight loss on a percentage basis (p<0.0001) demonstrates the sensitivity of BIS as diuretic decongestion reduces the ECF sub-compartment of overall body weight. Frequent monitoring of ECF may help guide diuretic therapy after HF hospitalization by focusing on the therapeutic target of interest. Time required to achieve clinical decongestion is highly variable and often takes longer than may be anticipated (average of 16.9 days).

Barthel Index score predicts mortality in elderly heart failure: a goal of comprehensive cardiac rehabilitation

Abstract Background Accurate prediction of mortality in heart failure (HF) patients is crucial for decision-making regarding HF therapies, but a strategy for the prediction of mortality in elderly HF patients has not been established. In addition, although favorable effects of comprehensive cardiac rehabilitation (CR) on clinical outcomes and functional status in HF patients have been demonstrated, a goal of comprehensive CR during hospitalization for reducing mortality remains unclear. Aims We examined whether assessment of basic activities of daily living (ADL) by the Barthel Index (BI), the most widely used tool for assessment of basic ADL, is useful for predicting all-cause mortality in elderly HF patients who received comprehensive CR. Methods This study was a single-center, retrospective and observational study. We retrospectively examined 413 HF patients aged ≥65 years (mean age, 78±7 years; 50% female) who were admitted to our institute for management of HF and received comprehensive CR during hospitalization. Functional status for performing basic ADL ability was assessed by the BI within 3 days before discharge. The clinical endpoint was all-cause death during the follow-up period. Results Of 413 HF patients, 116 patients (28%) died during a follow-up period of median 1.90-years (interquartile range, 1.20–3.23 years). Results of an adjusted dose-dependent association analysis showed that the hazard ratio (HR) of mortality increases in an almost linear fashion as the BI score decreases and that the BI score corresponding the hazard ratio of 1.0 is 85 (Figure A). To minimize the differences in potential confounding factors between patient with low BI (&amp;lt;85) and patients with high BI (≥85), inverse probability treatment weighting (IPTW) was calculated using propensity score. Kaplan-Meier survival curves, in which selection bias was minimized by use of IPTW for confounders, showed that patients with low BI (&amp;lt;85) had a higher mortality rate than did patients with high BI (≥85) (Figure B). In multivariate Cox regression analyses, low BI was independently associated with higher mortality after adjustment for predictors including brain natriuretic peptide and prior HF hospitalization (IPTW-adjusted HR, 1.75 [95% confidence interval, 1.03–2.98], p&amp;lt;0.001). Inclusion of the BI into the adjustment model improved the accuracy of prediction of mortality (continuous net reclassification improvement, 0.292, p=0.008; integrated discrimination improvement, 0.017, p=0.022). Conclusion A BI score of &amp;lt;85 at the time of discharge is associated with increased mortality independently of known prognostic markers, and achievement of functional status of a BI score ≥85 by comprehensive CR during hospitalization may contribute to a favorable outcome in elderly HF patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the Japan Society for the Promotion of Science

Effect of Dietary Education Program on Health Status of Heart Failure Patients.

The article’s abstract is not available.

A CNN-based novel solution for determining the survival status of heart failure patients with clinical record data: numeric to image

The aim of this study is to effectively evaluate numerical data, which are frequently encountered in the medical field, with popular deep learning-based Convolutional Neural Network (CNN) models. Heart failure is a common disease worldwide and it is very important to identify patients with a high survival rate and whose condition will deteriorate. A heart failure dataset consisting of numerical values only, needs to be converted into image data for analysis using the advantages of CNN. For this, first all raw data are normalized, then each normalized feature is placed in a region in the grid image. Thus, images with different brightness regions are obtained according to the numerical value of each feature. After the data augmentation step, these images are trained with five different CNN models (GoogleNet, MobileNet v2, ResNet18, ResNet50 and ResNet101) and classified. The highest accuracy of 95.13 % is obtained with the ResNet18 model and this accuracy is superior to studies using previous numerical raw data. The success proves the applicability of the proposed method and shows that numerical data in different fields can be easily classified with CNN models.

Prevalence and Determinant Factors of Coronary Heart Disease Status in Patients with Heart Failure

Abstract: As a cardiovascular disease, heart failure is one of prime mortality cause in the world. Coronary heart disease has a role in development of heart failure so that it becomes one of heart failure’s major clinical risk factor. This study aimed to calculate the prevalence of and identify the factors that influence coronary heart disease status of heart failure patients at Alamanda ward of RSUD Ulin Banjarmasin in 2016. Factors that were studied consisted of age, sex, family history of heart disease, smoking, diabetes mellitus, and hypertension. This study used analytical observation with cross-sectional approach on medical records that were obtained by purposive sampling method. The result showed 46.4% of 263 heart failure patients had coronary heart disease status. Multivariate analysis inferred hypertension as the factor that influences the coronary heart disease status of heart failure patients (OR = 1.98, 95% CI = 1.06 – 3.71, P = 0.033). Keywords: cardiovascular disease, heart failure, coronary heart disease, hypertension

High soluble transferrin receptor in patients with heart failure: a measure of iron deficiency and a strong predictor of mortality.

Iron deficiency (ID) is frequent in heart failure (HF), linked with exercise intolerance and poor prognosis. Intravenous iron repletion improves clinical status in HF patients with left ventricular ejection fraction (LVEF) ≤45%. However, uncertainty exists about the accuracy of serum biomarkers in diagnosing ID. The aims of this study were (i) to identify the iron biomarker with the greatest accuracy for the diagnosis of ID in bone marrow in patients with ischaemic HF, and (ii) to establish the prevalence of ID using this biomarker and its prognostic value in HF patients. Bone marrow was stained for iron in 30 patients with ischaemic HF with LVEF ≤45% and 10 healthy controls, and ID was diagnosed for 0-1 grades (Gale scale). A total of 791 patients with HF with LVEF ≤45% were prospectively followed up for 3 years. Serum ferritin, transferrin saturation, soluble transferrin receptor (sTfR) were assessed as iron biomarkers. Most patients with HF (n=25, 83%) had ID in bone marrow, but none of the controls (P < 0.001). Serum sTfR had the best accuracy in predicting ID in bone marrow (area under the curve 0.920, 95% confidence interval 0.761-0.987, for cut-off 1.25 mg/L sensitivity 84%, specificity 100%). Serum sTfR was ≥1.25 mg/L in 47% of HF patients, in 56% and 46% of anaemics and non-anaemics, respectively (P < 0.05). The reclassification methods revealed that serum sTfR significantly added the prognostic value to the baseline prognostic model, and to the greater extent than plasma N-terminal pro B-type natriuretic peptide. Based on internal derivation and validation procedures, serum sTfR ≥1.41 mg/L was the optimal threshold for predicting 3-year mortality, independent of other established variables. High serum sTfR accurately reflects depleted iron stores in bone marrow in patients with HF, and identifies those with a high 3-year mortality.

Abstract 17060: Machine Learning and Video Recognition for Automated Detection of Fluid Status in Heart Failure Patients

Introduction: There is a need for innovative solutions to better screen and diagnose the 7 million patients with chronic heart failure. A key component of assessing these patients is monitoring fluid status by evaluating for the presence and height of jugular venous distension (JVD). We hypothesize that video analysis of a patient’s neck using machine learning algorithms and image recognition can identify the amount of JVD. We propose the use of high fidelity video recordings taken using a mobile device camera to determine the presence or absence of JVD, which we will use to develop a point of care testing tool for early detection of acute exacerbation of heart failure. Methods: In this feasibility study, patients in the Duke cardiac catheterization lab undergoing right heart catheterization were enrolled. RGB and infrared videos were captured of the patient’s neck to detect JVD and correlated with right atrial pressure on the heart catheterization. We designed an adaptive filter based on biological priors that enhances spatially consistent frequency anomalies and detects jugular vein distention, with implementation done on Python. Results: We captured and analyzed footage for six patients using our model. Four of these six patients shared a similar strong signal outliner within the frequency band of 95bpm – 200bpm when using a conservative threshold, indicating the presence of JVD. We did not use statistical analysis given the small nature of our cohort, but in those we detected a positive JVD signal the RA mean was 20.25 mmHg and PCWP mean was 24.3 mmHg. Conclusions: We have demonstrated the ability to evaluate for JVD via infrared video and found a relationship with RHC values. Our project is innovative because it uses video recognition and allows for novel patient interactions using a non-invasive screening technique for heart failure. This tool can become a non-invasive standard to both screen for and help manage heart failure patients.

Elevated GDF-15 levels may indicate malnutrition in chronic compensated heart failure with or without diabetes mellitus

Abstract Background/Introduction Malnutrition is common in chronic heart failure (HF) and is associated with adverse outcomes. Elevated NT-proBNP may indicate increased cardiac stress, whereas growth differentiation factor 15 (GDF-15) is increased in response to tissue injury, inflammation and in diabetes mellitus (DM). GDF-15 also negatively regulates appetite, body weight and skeletal muscle homeostasis. Purpose We aim to assess the nutritional status of HF patients with or without DM, and determine if GDF-15 is associated with malnutrition. Methods We did a cross-sectional analysis on chronic HF patients in a prospective cohort study, forecAsting Heart Failure decompensation (AHF). Chronic compensated HF was defined as a state following hospital discharge for &amp;gt;30 days, or where there had not been hospitalisation for 30 days preceding phenotyping. Patients with a history of HF decompensation were included. Geriatric Nutritional Risk Index (GNRI), including body mass index (BMI) and serum albumin, was used to assess and categorise nutritional status. Patients were classified as being “malnourished” or “well-nourished” based on GNRI scores of &amp;lt;92 and ≥92, respectively. NT-proBNP and GDF-15 levels were measured and echocardiography was done. The study was approved by institutional review board and complied with Declaration of Helsinki. Results Among 73 patients (mean age 66 y, 58.9% male), 32.7% exhibited malnutrition as determined by GNRI. There was no difference in age, sex ratio and NYHA functional class between the malnourished and the well-nourished. BMI (22.1 vs 25.6, P&amp;lt;0.001) and levels of GDF-15 (7216.0 vs 2469.0, P&amp;lt;0.001) and NT-proBNP (7158.0 vs 1321.0, P=0.01) were different between the malnourished and well-nourished. Both GDF-15 and NT-proBNP were inversely correlated with GNRI (GDF-15, r=−0.39, P&amp;lt;0.001; NT-proBNP, r=−0.46, P&amp;lt;0.0001). As expected, DM HF patients had significantly higher levels of GDF-15 than non-DM HF patients. In subgroup analysis of DM HF patients, GDF-15 and NT-proBNP levels were higher in the malnourished than well-nourished (median log-[GDF-15], 9.15 vs 8.10, P&amp;lt;0.01; median log-[NT-proBNP], 9.44 vs 7.00, P&amp;lt;0.01). Whereas in non-DM HF, NT-proBNP levels were not different between the malnourished and well-nourished. Age- and sex-adjusted logistic regression model determined that per log increment in GDF-15 level there was a 5.8-fold increased risk of malnutrition (OR 5.81 [2.43–17.62], P&amp;lt;0.001), and for every log increment in NT-proBNP level there was a 1.8-fold increase in the risk of malnutrition (OR 1.82 [1.23–2.88], P&amp;lt;0.01). Conclusion(s) Malnutrition is common in chronic compensated HF patients with a history of hospitalisation, and is associated with elevated NT-proBNP and GDF-15 levels. Elevated GDF-15 levels independently predicted poor nutritional status, and with NT-proBNP may indicate a particularly high-risk HF subgroup Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): 1) Health and Medical Research Fund, Food and Health Bureau, 2) Direct Grant, Faculty of Medicine, CUHK

Effect of ferric-carboxy maltose on oxygen kinetics and functional status in heart failure patients with iron deficiency.

There is a very high prevalence of iron deficiency anemia in patients with systolic heart failure. The present study is a prospective, parallel, 1:1 randomized controlled trial of intravenous ferric-carboxy maltose compared with standard of care in patients with heart failure. A total of 70 patients who presented to us with symptomatic chronic heart failure were included and randomly assigned to either groups (35 per group). Post 12 weeks, there were improvements noticed in peak VO2, New York Heart Association functional classification, 6-min walk test distance covered and reduction in Minnesota Living with Heart Failure Questionnaire score in the ferric-carboxy maltose as compared with standard of care group. However, no improvement in ejection fraction was noticed.

Impact of Health Education Program on Health Status of Heart Failure Patients: A Quasi-Experimental Study

Heart failure, is a major cause of morbidity and mortality, especially in ageing people, it affects and kills a large number of people. Objective: The study aims to evaluate the effectiveness of an education program on the health status of patients suffering heart failure. The study design is quasi-experimental. The patients were allocated into either the experimental group ( taking the program, n = 200) or the control group (not taking the program, n= 200). The extent of samples knowledge about the disease was tested at both the pre and post education stages. A structured teaching program for imparting knowledge on various aspects of nutritional status was developed based on an extensive review of the literature and expert opinion. The results of the study were elicited based on two statistical approaches, first, descriptive statistics and the second is an inferential statistical analysis. The shows that health status sub main domains at pre-period in case and control groups was non significant, while the health status sub main domains at post period in both groups were high significant. Regarding the study global main domains in both groups along pre-post period were high significant.

Utilization of Ultrasound to Assess Volume Status in Heart Failure.

Heart failure (HF) represents a significant financial burden to the US health care system, affecting approximately 5.7 million Americans. By 2030, the prevalence of HF is expected to increase by 23%. Clinicians generally evaluate volume status in patients with HF by visualizing jugular venous distension to estimate right atrial pressure; a method with an estimated accuracy of only 50%. Currently, the only endorsed methods for acute HF diagnosis in the 2017 American College of Cardiology (ACC) guidelines are brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP), pre-discharge BNP or NT-proBNP, and myocardial fibrosis markers. However, serial testing of BNP to monitor therapy remains controversial. Moreover, an elevated BNP cannot be attributed solely to a cardiac cause. Given the limitations of the current methods, a robust tool is needed to reliably assess volume status in HF patients. It is now known that hemodynamic congestion from increases in intracardiac pressure occurs days to weeks prior to the onset of typical HF symptoms, such as weight gain and shortness of breath. It has been postulated that assessing the inferior vena cava (IVC) diameter with a portable ultrasound, may be the simple, reliable, and cost-effective method of evaluating right atrial pressure, and thus, the severity of HF. Given this exciting new tool in assessing volume status in patients with HF, we pose the question of whether this imaging modality can be used to risk-stratify patients and guide management. The aim of this paper is to highlight the many benefits of portable ultrasound in assessing volume status in this population, and to discuss whether this imaging modality can help guide physicians in the management of their HF patients.

Vitamin D Deficiency Predicts Poor Clinical Outcomes in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy.

Background and Aims Resynchronization therapy (CRT) improves mortality and induces reverse remodeling in heart failure (HF) patients with reduced ejection fraction and wide QRS. Nonetheless, some patients do not improve despite the optimal medical therapy and right indications for device implantation. Therefore, finding biomarkers suitable for identification of those patients is crucial. Vitamin D plays a classic hormonal role in the regulation of bone metabolism and also has physiological functions in wide range of nonskeletal tissues. Based on recent studies, low levels of vitamin D seem to directly contribute to pathogenesis and worsening of HF. We planned to assess the role of vitamin D levels on clinical outcomes of HF patients undergoing CRT. Methods and Results We enrolled 136 HF patients undergoing CRT. Total plasma vitamin D levels were measured at baseline and 6 months later. Primary endpoint was 5-year all-cause mortality; secondary endpoint was lack of good clinical response, defined as less than 15% increase of left ventricular ejection fraction after six months. During follow-up, 58 patients reached the primary, and 45 patients reached the secondary endpoint. Vitamin D levels less than 24.13 ng/mL predicted 5-year mortality (p = 0.045) and poor clinical response (p = 0.03) after adjusting to all significant baseline predictors. Conclusion Our study showed that vitamin D deficiency has a significant impact in heart failure patients; it is an independent predictor of lack of midterm clinical response and long-term mortality in patients undergoing CRT. Therefore, monitoring vitamin D status of heart failure patients could be of clinical significance.