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Wang X, Pu J, Wang G, Xu H, Liu L, Li Z, Qin R, Zhao X, Li M, Hao Z, Hu H. Efficacy and safety analysis of angiotensin receptor neprilysin inhibition(ARNI)in patients with heart failure: a real-world retrospective study. BMC Cardiovasc Disord 2023; 23:343. [PMID: 37430227 DOI: 10.1186/s12872-023-03374-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/29/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND In a large randomized controlled trial (PARADIGM-HF), ARNI has been shown to significantly reduce cardiovascular mortality and hospitalization for patients with reduced ejection fraction in heart failure. This study analyzed the efficacy and safety of ARNI on the basis of various types of heart failure patients in southwestern Sichuan Province. METHODS This study included patients with heart failure who were treated at the Affiliated Hospital of North Sichuan Medical College from July 2017 to June 2021. This study analyzed the efficacy and safety of ARNI in the treatment of heart failure, and analyzed the risk factors for readmission after ARNI treatment. RESULTS After propensity score matching, a total of 778 patients were included in the study. The readmission rate for heart failure in patients treated with ARNI (8.7%) was significantly lower than that in the standard treatment group (14.5%) (P = 0.023). Both the proportion of patients with increased LVEF and with decreased LVEF were higher in the ARNI treatment group than in the conventional therapy group. Compared with receiving standard medical treatment, combined ARNI treatment resulted in a greater reduction in SBP (-10.00, 95%CI: -24.00-1.50 vs. -7.00, 95%CI: -20.00-4.14; P = 0.016) in HF patients. Combination ARNI therapy did not increase the risk of adverse events. The study found that age (> 65 vs. ≤65 years) (OR = 4.038, 95%CI: 1.360-13.641, P = 0.013) and HFrEF (OR = 3.162, 95%CI: 1.028-9.724, P = 0.045) were independent predictors of readmission in HF patients treated with ARNI. CONCLUSION Patients with heart failure treated with ARNI can improve clinical symptoms and reduce the risk of readmitted hospital admission. Age > ~ 65 years and HFrEF were independent predictors of readmission in HF patients treated in ARNI group.
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Affiliation(s)
- Xiaobo Wang
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
- Research Center for High Altitude Medicine of Qinghai University, Xining, 810001, China
| | - Jun Pu
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Guixia Wang
- Infectious Department, The Third People's Hospital of Chengdu, Chengdu, 610031, China
| | - Hui Xu
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Liming Liu
- Department of Gerontology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhen Li
- Undergraduate in clinical medicine, North Sichuan Medical College, Nanchong, China
| | - Ruijie Qin
- Undergraduate in clinical medicine, North Sichuan Medical College, Nanchong, China
| | - Xuemei Zhao
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Ming Li
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Zedong Hao
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Houxiang Hu
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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Lu YZ, Huang CW, Koyama S, Taitano M, Lee EA, Shen E, Nguyen HQ. Dementia and readmission risk in patients with heart failure participating in a transitional care program. Arch Gerontol Geriatr 2023; 110:104973. [PMID: 36870185 DOI: 10.1016/j.archger.2023.104973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Cognitive impairment is prevalent in patients hospitalized for heart failure (HF). We aimed to generate further evidence on the value of dementia screening in hospitalized HF patients by examining whether and when dementia would be an independent risk factor for 30-day readmission while modeling permutations of known risk factors such as patient demographics, disease burden, prior utilization, and index hospitalization characteristics. METHODS AND RESULTS A retrospective cohort study was employed, consisting of 26,128 patients (2,075 or 7.9% with dementia) in a transitional care program post HF hospitalization. The overall 30-day all-cause readmission rate was 18.1%. Patients with dementia had higher unadjusted rates of readmission (22.0 vs 17.8%) and death (4.5 vs. 2.2%) within 30 days post hospitalization, compared to those without dementia. Hierarchical multivariable proportional hazards regression results showed that dementia independently predicted readmission when both patient demographics and disease burden variables were controlled for (HR=1.15, p=0.02). However, the association between dementia and readmission was attenuated in the full model when prior utilization and index hospitalization characteristics were added (HR=1.04, p=0.55). For dementia patients, Charlson comorbidity index, prior ED visits, and length of stay were significant risk factors of readmission. CONCLUSIONS The presence of dementia and the predictors of 30-day readmission in those with dementia may help identify this subset of high-risk HF patients for potential efforts to improve their prognosis.
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Affiliation(s)
- Yang Z Lu
- Department of Health Care Administration, California State University - Long Beach, United States
| | - Cheng-Wei Huang
- Los Angeles Medical Center, Kaiser Permanente Southern California, United States
| | - Sandra Koyama
- Baldwin Park Medical Center, Kaiser Permanente Southern California, United States
| | - Maria Taitano
- South Bay Medical Center, Kaiser Permanente Southern California, United States
| | - Eric A Lee
- West Los Angeles Medical Center, Kaiser Permanente Southern California, United States
| | - Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente Southern California, United States
| | - Huong Q Nguyen
- Department of Research and Evaluation, Kaiser Permanente Southern California, United States; Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, United States.
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Deguchi T, Sato M, Kohyama N, Fujita K, Nagumo S, Suzuki H, Ebato M, Kogo M. Development of a model predicting cardiac events in heart failure patients with decreased renal function: a retrospective study. Int J Clin Pharm 2023; 45:210-219. [PMID: 36414822 DOI: 10.1007/s11096-022-01502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inappropriate and multiple medications affect the prognosis of patients with acute decompensated heart failure (ADHF). However, in ADHF patients with decreased renal function, there have been no reports on prognostic factors, including medication data, or models for predicting cardiac events. AIM To develop a model including medication data to predict cardiac events in ADHF patients with decreased renal function. METHOD This retrospective cohort study included 443 first-time admitted ADHF patients with decreased renal function (estimated glomerular filtration rate < 60 mL/min/1.73 m2 at discharge) in the Showa University Fujigaoka Hospital. The primary outcome was cardiac events within one year after discharge, defined as the composite of HF readmission, HF mortality, and cardiovascular mortality. The model for predicting cardiac events was developed using predictive factors extracted by multivariable analysis. The cardiac events curves were visualized using the Kaplan-Meier method and estimated using a log-rank test. RESULTS The incidence of cardiac events within one year after discharge was 20.1%. By multivariable analysis, we observed that atrial fibrillation, weight loss < 5%, brain natriuretic peptide ≥ 200 pg/mL, polypharmacy, and beta-blockers use below target dosage were significantly associated with an increased risk of cardiac events. The developed model, the cardiac events rate in the high-risk group was significantly higher than in the low-risk group (41.0 vs. 9.2%, p < 0.001). CONCLUSION The developed model for predicting cardiac events will be useful in decision-making to support appropriate early management of ADHF patients with decreased renal function.
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Affiliation(s)
- Tomokazu Deguchi
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan. .,Department of Pharmacy, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Miki Sato
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Noriko Kohyama
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Kanako Fujita
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan.,Department of Pharmacy, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Mari Kogo
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
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Umehara T, Kaneguchi A, Katayama N, Kawakami W, Kuwahara D, Kito N, Kakehashi M. Frailty in elderly patients with acute heart failure increases readmission. Heart Lung 2023; 57:102-109. [PMID: 36126425 DOI: 10.1016/j.hrtlng.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The readmission rate of heart failure (HF) patients has not decreased during the past few years. OBJECTIVES The purpose of this study was to examine whether factors such as left ventricular ejection fraction (LVEF) and frailty are associated with readmission and number of readmissions in HF patients. METHODS First, a propensity score matching method was used to adjust for confounding factors for readmission. Cox regression analysis was conducted to determine the factors that influenced readmission. Finally, multiple regression analysis was conducted to determine the factors that influenced the number of readmissions. The independent variables were basic and medical information, physical structure, physical functions, and activity for both Cox regression analysis and multiple regression analysis. RESULTS After matching based on the propensity score, 18 out of 18 (100.0%) patients in the readmission group (age: 85.0 ± 6.9 years, female rate: 50.0%, body mass index: 21.7 ± 3.4 kg/m2) and 18 out of 51 (35.3%) patients in the nonreadmission group (age: 84.3 ± 8.6, female rate: 50.0%, body mass index: 21.8 ± 4.5 kg/m2) were eligible for analysis. Cox regression analysis (hazard ratios) showed that sex (0.16), geriatric nutritional risk index (1.02), and degree of frailty (11.44) were extracted as significant factors. Multiple regression analysis (standardized regression coefficients) showed that the estimated glomerular filtration rate (-0.40), LVEF (-0.32), and degree of frailty (0.29) were extracted as significant factors. CONCLUSION Our results suggest that frailty is important to reduce the readmission rate and number of readmissions of the acute HF patients.
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Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan.
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Nobuhisa Katayama
- Department of Rehabilitation, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Wataru Kawakami
- Department of Rehabilitation, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Daisuke Kuwahara
- Department of Rehabilitation, Saiseikai Kure Hospital, Sanjo 2-1-13, Kure, Hiroshima, Japan
| | - Nobuiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Masayuki Kakehashi
- Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Hiroshima Minami-ku, Hiroshima, Japan
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Takeda T, Tsubaki A, Ikeda Y, Kato R, Hotta K, Inoue T, Kojima S, Kanai R, Terazaki Y, Uchida R, Makita S. The impacts of preoperative frailty on readmission after cardiac implantable electrical device implantation. PLoS One 2022; 17:e0277115. [PMID: 36327285 PMCID: PMC9632810 DOI: 10.1371/journal.pone.0277115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Cardiac implantable electrical devices (CIED) such as pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapies are generally recommended for older patients and those with severe heart failure (HF). However, there is currently a lack of evidence on the relationship between frailty and readmission rates among patients with CIED. This study investigated whether preoperative frailty influenced readmission rates among patients with CIED over a one-year period following implantation. The study retrospectively analyzed 101 patients who underwent CIED implantations. To compare frailty-based differences in their characteristics and readmission rates, these participants were categorized into frailty and non-frailty groups via the modified frailty index (mFI). The frailty group had a significantly higher readmission rate than the non-frailty group (non-frailty group vs. frailty group = 1 vs. 8 patients: P < 0.05). Further, a multivariate analysis showed that frailty was a significant readmission factor. Based on individual analyses with/without histories of HF, the readmission rate also tended to be higher among individuals considered frail via the mFI (readmission rate in HF patients: non-frailty group vs. frailty group = 1 vs. 5 patients: P = 0.65; non-HF patients: non-frailty group vs. frailty group = 0 vs. 3 patients: P = 0.01). Participants with preoperative frailty showed higher readmission rates within a one-year period following implantation compared to those without preoperative frailty. This tendency was consistent regardless of HF history. The mFI may thus help predict readmission among patients with CIED.
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Affiliation(s)
- Tomonori Takeda
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
- Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan
- * E-mail: ,
| | - Atsuhiro Tsubaki
- Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazuki Hotta
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Tatsuro Inoue
- Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Sho Kojima
- Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan
- Department of Rehabilitation, Kisen Hospital, Katsushika, Tokyo, Japan
| | - Risa Kanai
- Department of Nursing, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yoshitaka Terazaki
- Department of Nursing, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Ryusei Uchida
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Cognitive Dysfunction in Heart Failure: Pathophysiology and Implications for Patient Management. Curr Heart Fail Rep 2022; 19:303-315. [PMID: 35962923 DOI: 10.1007/s11897-022-00564-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE OF REVIEW There is increasing recognition of the prevalence and impact of cognitive dysfunction (CD) in heart failure (HF) patients. This contemporary review appraises the evidence for epidemiological association, direct pathophysiological links and emerging pharmacological and non-pharmacological interventions. Furthermore, we present evidence for care models that aim to mitigate the morbidity and poor quality of life associated with these dual processes and propose future work to improve outcomes. RECENT FINDINGS CD disproportionately affects heart failure patients, even accounting for known comorbid risk factors, and this may extend to subclinical left ventricular dysfunction. Neuroimaging studies now provide evidence of anatomical and functional differences which support previously postulated mechanisms of reduced cerebral blood flow, micro-embolism and systemic inflammation. Interventions such as multidisciplinary ambulatory HF care, education and memory training improve HF outcomes perhaps to a greater degree in those with comorbid CD. Additionally, optimisation of standard heart failure care (cardiac rehabilitation, pharmacological and device therapy) may lead to additional cognitive benefits. Epidemiological, neuroimaging and intervention studies provide evidence for the causal association between HF and CD, although evidence for Alzheimer's dementia is less certain. Specific reporting of cognitive outcomes in HF trials and evaluation of targeted interventions is required to further guide care provision.
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Kawase Y, Yoshida K, Matsushita S, Tada T, Yamamoto H, Katoh H, Kadota K. Trends in prognosis after hospitalization for acute heart failure in Kurashiki Central hospital 2015-2018: single-center prospective study. Heart Vessels 2022; 37:2014-2028. [PMID: 35748908 DOI: 10.1007/s00380-022-02116-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
Abstract
Recently, we have been working on enhancing the effectiveness of treatment for acute heart failure (HF) through team-based care. This study was designed to assess the benefits of this initiative by quantifying the prognostic impact on HF patients receiving treatment at our hospital. We identified 1977 consecutive HF patients (mean age 78.3 ± 11.9 years) being discharged from our hospital between February 2015 and December 2018, divided them by admission year, and tracked changes over time, with 2015 as a reference. The postdischarge clinical outcome measures were defined as a composite of all-cause death or rehospitalization for HF, all-cause death, and rehospitalization for HF. The risk of a composite of all-cause death or rehospitalization for HF was lower in 2017 (adjusted hazard ratio, 0.72; 95% confidence interval: 0.57 to 0.91; p = 0.005) and 2018 (adjusted hazard ratio, 0.78; 95% confidence interval: 0.61 to 0.99; p = 0.045) than in 2015, and that of all-cause death was lower in 2017 (adjusted hazard ratio, 0.72; 95% confidence interval: 0.53 to 0.98; p = 0.04) and 2018 (adjusted hazard ratio, 0.60; 95% confidence interval: 0.43 to 0.85; p = 0.004) than in 2015, but that of rehospitalization for HF was not significantly different through the study period. The mortality rate decreased at the end of the study period, but the rate of rehospitalization for HF did not. The benefits of team-based care were difficult to evaluate by quantification.
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Affiliation(s)
- Yuichi Kawase
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan.
| | - Kenta Yoshida
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Shunsuke Matsushita
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Takeshi Tada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Hiromi Yamamoto
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Harumi Katoh
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
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Umehara T, Kaneguchi A, Kawakami W, Katayama N, Kito N. Association of muscle mass and quality with hand grip strength in elderly patients with heart failure. Heart Vessels 2022; 37:1380-1386. [PMID: 35233647 DOI: 10.1007/s00380-022-02046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/18/2022] [Indexed: 11/26/2022]
Abstract
In patients with heart failure, it is unknown whether the extracellular water (ECW)/intracellular water (ICW) ratio is associated with muscle strength, and thus, it is not well understood whether poor muscle quality contributes to muscular weakness. This study examined the relationship among hand grip strength, skeletal muscle mass index (SMI), and upper limb ECW/ICW ratio in patients with heart failure. This study followed a cross-sectional design. Demographic data, medical information, and hand grip strength were collected. The SMI and ECW/ICW ratio were measured using bio-impedance analysis (BIA). Hierarchical multiple regression analysis was conducted to identify factors associated with hand grip strength. 51 patients with heart failure were analyzed for this study (mean age 84.58 ± 7.18). Hierarchical multiple regression analysis identified SMI as well as upper limb ECW/ICW ratio as factors associated with hand grip strength, independent of age, sex, body mass index, and Life Space Assessment scores. Standardized partial regression coefficients representing the magnitude of involvement of each independent variable were 0.33 and - 0.16. The coefficient of determination adjusted for degrees of freedom (R2), representing the contribution rate of the regression equation, was 0.830. We revealed that loss of hand grip strength in patients with heart failure is associated with not only with a decrease in skeletal muscle mass, but also with a decline in muscle quality, characterized by an increased upper limb ECW/ICW ratio. BIA is a simple and useful method to measure the ECW/ICW ratio, and in turn, the muscle quality, in patients with heart failure.
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Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan.
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Wataru Kawakami
- Department of Rehabilitation, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Nobuhisa Katayama
- Department of Rehabilitation, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
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Clinical value of the HATCH score for predicting adverse outcomes in patients with heart failure. Heart Vessels 2022; 37:1363-1372. [DOI: 10.1007/s00380-022-02035-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/28/2022] [Indexed: 01/15/2023]
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10
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Long-Term Outpatient Care and Rehospitalizations in Patients after Cardiac Electrotherapy Device Implantation. Medicina (B Aires) 2022; 58:medicina58020151. [PMID: 35208475 PMCID: PMC8879931 DOI: 10.3390/medicina58020151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: Cardiovascular implantable electronic device (CIED) treatment is widely used in modern cardiology. Indications for this type of treatment are increasing. However, a significant proportion of CIED implantation patients require subsequent hospitalization for cardiovascular reasons. Older age and the associated complex clinical picture necessitate multidisciplinary outpatient specialist care for these patients. The aim of this study was to analyze the reasons for subsequent hospitalizations in the cardiology department and the impact of outpatient specialty care on these hospitalizations. To the best of our knowledge, there are no such studies in the available literature. Materials and Methods: This study was conducted on a population of patients treated with CIED. Reasons for subsequent hospitalizations were divided into clinically and statistically valid groups according to the main diagnosis. Using an electronic database, causes of hospitalization were determined based on this diagnosis. Using data on consultations at outpatient specialty clinics, a logistic regression model was created for the probability of subsequent hospitalization for cardiovascular causes according to the specialty of the clinic. Results: The 9-year follow-up included a population of 2071 patients treated with CIED. During the follow-up period, 508 patients (approximately 24.5%) required subsequent hospitalization for cardiovascular reasons. The most common leading causes were heart failure, atrial fibrillation, and coronary artery disease. The need for consultation at outpatient specialty clinics increased the likelihood of hospitalization. Moreover, the need to consult patients in nephrology outpatient, pulmonary disease outpatient, and orthopedic outpatient clinics was the most significant. Conclusions: The use of electronic implantable cardiovascular devices is a very important part of therapy in modern cardiology. The methods for their use are constantly being improved. However, they represent only one stage of cardiac treatment. After CIED procedures, patients require further care in both inpatient and outpatient specialty care settings. In this paper, we outline the reasons for subsequent hospitalizations and the importance of outpatient specialty care in this context. Effective organization of care after CIED procedures may be important in reducing the most expensive component of this care, that is, inpatient treatment.
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Kamiya K, Adachi T, Iwatsu K, Kamisaka K, Iida Y, Iritani N, Yamada S. Association between a pre-admission limitation in walking ability and post-discharge adverse outcomes among hospitalized patients with heart failure: Report from a multicenter prospective cohort study. Int J Cardiol 2021; 337:105-112. [PMID: 33991566 DOI: 10.1016/j.ijcard.2021.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/06/2021] [Accepted: 05/10/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although limited walking ability at discharge is a known risk factor for adverse outcomes in older patients with heart failure (HF), the association between pre-admission limitations and adverse outcomes is unknown. Therefore, we evaluated the prevalence of a pre-admission limitation in walking ability and its relationship with post-discharge outcomes among patients with HF with reduced, mid-range, and preserved left-ventricular ejection fraction (HFrEF, HFmrEF, and HFpEF). METHODS We followed 2042 patients aged ≥65 years (HFrEF, n = 668; HFmrEF, n = 360; HFpEF, n = 1014) from a multicenter cohort study in Japan. A limitation in walking ability was defined as the necessity of any assistance or a walking aid. Adverse outcomes were defined as the composite of HF rehospitalization and all-cause death within 2 years after discharge. RESULTS During 2978.0 person-years of follow-up, 563 patients were rehospitalized due to HF exacerbation and 103 patients died. In HFrEF, HFmrEF, and HFpEF groups, the prevalence of a pre-admission limitation in walking ability was 12.1%, 18.6%, and 21.1%, respectively, the crude hazard ratios [95% confidence interval] of a pre-admission limitation in walking ability were 2.46 [1.79-3.39], 1.34 [0.87-2.06], and 1.94 [1.53-2.47], and the adjusted hazard ratios were 2.21 [1.58-3.16], 1.19 [0.75-1.89], and 1.39 [1.06-1.82], respectively. CONCLUSIONS A pre-admission limitation in walking ability is a predictor of post-discharge HF rehospitalization or all-cause death among patients with HFrEF and HFpEF, but not among patients with HFmrEF. Shortly after admission, information regarding pre-admission functional limitations should be obtained to better understand the risk of post-discharge adverse outcomes.
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Affiliation(s)
- Kuniyasu Kamiya
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kosai Hospital, Hirakata, Japan
| | - Kenta Kamisaka
- Department of Rehabilitation, Kitano Hospital, Osaka, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, Toyohashi, Japan
| | - Naoki Iritani
- Department of Rehabilitation, Toyohashi Heart Center, Toyohashi, Japan
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Yoshie K, Yamasaki M, Yokoyama M, Ueki Y, Tachibana E, Yonemoto N, Nagao K. Prognostic benefits of prior amiodarone or β-blocker use before the onset of ventricular arrhythmia with hemodynamic collapse. Heart Vessels 2021; 36:1430-1437. [PMID: 33721036 DOI: 10.1007/s00380-021-01821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
Although antiarrhythmic drugs have long been used for the suppression of various types of arrhythmias, their prior use before the onset of ventricular arrhythmia with hemodynamic collapse and the effect on prognosis is not well known. Data from 1004 consecutive patients with cardiovascular shock in the Japanese Circulation Society's Shock Registry were analyzed. Eighty-four cases of ventricular arrhythmia-induced shock and ROSC (return of spontaneous circulation) were divided into the prior amiodarone or β-blockers use group (Aβ group, n = 27) and the non-amiodarone and non-β-blockers use group (non-Aβ group; n = 57) based on treatment before the onset of those arrhythmias. Clinical outcomes related to hemodynamic collapse such as OHCA (out-of-hospital cardiovascular arrest) was less in the Aβ group [Aβ group, 11/26 (42%) vs. non-Aβ group, 41/56 (73%); p = 0.007]. Similarly, syncope was less common in the Aβ group than in the non-Aβ group [Aβ group 4/27 (15%) vs. non-Aβ group 27/57 (47%); p = 0.004]. Furthermore, prior amiodarone or β-blockers use before the onset of ventricular arrhythmias was strongly associated with both survival at discharge (odds ratio 3.19; 95% confidence interval 1.06-9.67; p = 0.040) and neurological outcomes at discharge (odds ratio 3.96; 95% confidence interval 1.32-11.85; p = 0.014) based on multivariate logistic regression analysis. Prior amiodarone or β-blockers use before the onset of malignant ventricular arrhythmia and maintaining appropriate blood concentrations in advance is associated with a good survival rate and better neurological outcomes after recovery from ventricular arrhythmia with hemodynamic collapse.
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Affiliation(s)
- Koji Yoshie
- JCS Shock Registry Scientific Committee, Tokyo, Japan.
- Department of Emergency and Intensive Care Center, Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan.
| | | | | | - Yasushi Ueki
- JCS Shock Registry Scientific Committee, Tokyo, Japan
| | | | | | - Ken Nagao
- JCS Shock Registry Scientific Committee, Tokyo, Japan
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Sadanaga T, Hirota S, Mitamura H. Factors associated with heart failure hospitalization in patients with high sodium excretion: subanalysis of the ESPRIT, evaluation of sodium intake for the prediction of cardiovascular events in Japanese high-risk patients, cohort study. Heart Vessels 2020; 36:85-91. [PMID: 32720095 DOI: 10.1007/s00380-020-01673-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/17/2020] [Indexed: 11/28/2022]
Abstract
We have reported that high sodium excretion ≥ 4.0 g/day, assessed by repeated measurements of spot urine, is associated with composite cardiovascular (CV) events of heart failure (HF) hospitalization, acute coronary syndrome, cerebrovascular events, and documented CV deaths in Japanese high-risk patients with either stable and compensated congestive HF, high brain natriuretic peptide, coronary artery disease, cerebrovascular disease, chronic kidney disease, or atrial fibrillation. A total of 520 patients were enrolled. During the median follow-up period of 5.2 years, 105 (20%) experienced composite CV events, which were predominantly driven by 60 (12%) HF hospitalizations. The aim of the present study was to elucidate which subgroups of patients with high sodium excretion were associated with HF hospitalization. We divided the enrolled patients into three groups according to the amount of sodium excretion (< 3.0 g/day, 3.0-3.99 g/day (reference), and ≥ 4.0 g/day) based on a median of 14 measurements during follow-up. We assessed the hazard ratio for HF hospitalization according to age, bodyweight, and gender, using the Cox hazard model. In the total population, high sodium excretion ≥ 4.0 g/day was associated with HF hospitalization [hazard ratio (HR) 1.75, confidence interval (CI) 1.05-2.83] after adjustment for gender, age, and bodyweight, but was not associated with other CV events. In older patients (≥ 75 years old), high sodium excretion ≥ 4.0 g/day was associated with HF hospitalization after adjustment for gender and bodyweight (HR 3.25, CI 1.55-6.55), which was not observed in younger (< 75 years old) patients. In patients with lower bodyweight (< 60 kg), high sodium excretion ≥ 4.0 g/day was associated with HF hospitalization after adjustment for age and gender (HR 3.05, CI 1.34-6.61), which was not observed in heavier (≥ 60 kg) patients. High sodium excretion is associated with HF hospitalization in patients with older age and lower bodyweight in Japanese high-risk patients.
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