[Acute and chronic heart failure in light of the new ESC guidelines]

Exploring risk factors of short-term readmission in heart failure patients: A cohort study

BACKGROUND

The risk of all-cause mortality in patients with heart failure (HF) has been studied previously. Readmission risk of HF patients was rarely explored. Thus, we aimed to explore early warning factors that may influence short-term readmission of HF patients.

METHODS

The data of this study came from an HF database in China. It was a retrospective single-center observational study that collected characteristic data on Chinese HF patients by integrating electronic medical records and follow-up outcome data. Eventually, 1,727 patients with HF were finally included in our study.

RESULTS

In our study, the proportion of HF patients with New York Heart Association (NYHA) class II, III, and IV HF were 17.20%, 52.69%, and 30.11%, respectively. The proportion of patients with readmission within 6 months and readmission within 3 months was 38.33% and 24.20%, respectively. Multivariate logistic regression showed that NYHA class (p _III = 0.028, p _IV < 0.001), diabetes (p = 0.002), Cr (p = 0.003), and RDW-SD (p = 0.039) were risk factors for readmission within 6 months of HF patients. NYHA class (p _III = 0.038, p _IV < 0.001), CCI (p = 0.033), Cr (p = 0.012), UA (p = 0.042), and Na (p = 0.026) were risk factors for readmission within 3 months of HF patients.

CONCLUSIONS

Our study implied risk factors of short-term readmission risk in patients with HF, which may provide policy guidance for the prognosis of patients with HF.

Serum NT-proBNP and TUG1 as novel biomarkers for elderly hypertensive patients with heart failure with preserved ejection fraction

Patients with heart failure with preserved ejection fraction (HFPEF) account for ~50% of all cases of heart failure and their clinical prognosis is poor. The present study attempted to investigate the diagnostic value of circulating long non-coding RNA taurine upregulated gene 1 (TUG1) for HFPEF in subjects with hypertension. Between January 2017 and January 2019, 80 aged/elderly hypertensive patients with or without HFPEF were recruited for the present study. The concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the serum was measured using ELISA and TUG1 expression levels were determined using reverse transcription-quantitative PCR. Echocardiography was used for the determination of cardiac function. The results indicated that the levels of NT-proBNP and TUG1 were increased in the serum of hypertensive patients with HFPEF. Pearson analysis demonstrated that NT-proBNP and TUG1 were positively correlated with the left atrial diameter and negatively correlated with the ratio of the peak flow velocity in the early diastolic phase to the peak flow velocity in the late diastolic phase. In addition, a positive correlation was confirmed between TUG1 and NT-proBNP levels. Receiver operating characteristic curve analysis demonstrated that TUG1 and NT-proBNP were useful biomarkers for the diagnosis of HFPEF. In conclusion, it was observed that NT-proBNP and TUG1 were increased in the serum of hypertensive patients with HFPEF. Furthermore, TUG1 and NT-proBNP were indicated to be useful plasma biomarkers for the diagnosis of HFPEF.

[New pharmaceuticals in cardiology. Heart failure, anticoagulation, dyslipidemia]

Three innovative pharmaceuticals which might play an important role in the field of cardiology in the near future were recently tested in large clinical studies. Serelaxin, a vasoactive hormone peptide that is produced during pregnancy, reduces vessel resistance, increases cardiac output, and improves renal function. Lately, it was demonstrated that serelaxin significantly reduces congestion symptoms in patients with acute heart failure. As a secondary endpoint the mortality at day 180 was reduced. Therefore, serelaxin seems to be a promising new drug for the treatment of acute heart failure which might have a prognostic impact. Edoxaban is a selective factor Xa inhibitor, which inhibits thrombin production and thrombus formation. Two recently published studies reported that edoxaban is at least as effective as the vitamin K antagonist warfarin in prevention and treatment of venous thromboembolism and in the prevention of stroke and systemic embolism due to nonvalvular atrial fibrillation. Compared to warfarin, edoxaban significantly exhibited less frequent severe bleeding complications. Edoxaban will probably soon be the fourth new oral anticoagulant available for patients. The serine protease proprotein convertase subtilisin/kexin 9 (PCSK9) reduces the ability of the liver to bind low-density lipoprotein cholesterol (LDL-C) and to remove it from the circulation. Recently, a monoclonal antibody for PCSK9 was developed which induces a LDL-C plasma level reduction up to 73 % and also decreases lipoprotein(a) and apolipoprotein B. PCSK9 inhibition is a promising new mechanism for LDL-C reduction and the corresponding drug will be presumably approved soon by the regulatory authorities.