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Li Q, Lin X, Bo X, Chen S, Zhao D, Liu J, Fan Q. Association of D-dimer to albumin ratio with adverse cardiovascular outcomes in ischaemic heart failure patients with diabetes mellitus: a retrospective cohort study. BMJ Open 2024; 14:e078013. [PMID: 38253454 PMCID: PMC10806579 DOI: 10.1136/bmjopen-2023-078013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To determine the association of D-dimer to albumin ratio (DAR) with major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in ischaemic heart failure patients with diabetes mellitus. DESIGN A retrospective observational cohort study. SETTING Single centre in Beijing, China, conducted at one of the largest cardiology centres in China. PARTICIPANTS From June 2017 to June 2019, 3707 patients with heart failure and concomitant multiple vessel disease undergoing elective PCI were screened. A total 1021 of patients were enrolled after exclusion and the follow-up period was up to 36 months. PRIMARY AND SECONDARY OUTCOME MEASURES The MACE was the primary measured outcome. The secondary outcomes were all-cause mortality, non-fatal myocardial infarction and any revascularisation. METHODS These participants were grouped according to DAR tertiles. The cumulative incidence functions, Cox regression, restricted cubic spline and receiver operating characteristic curves were used to determine the association between DAR and outcomes. The subgroup analysis was also performed. RESULTS After follow-up, MACE occurred in 404 (39.6%) participants. The cumulative hazards curve manifested significant differences in MACE, all-cause mortality and any revascularisation (log-rank test: all p<0.001). In adjusted models, DAR was an independent risk factor of MACE (tertile 2: HR 1.82, 95% CI 1.37 to 2.42; tertile 3: HR 1.74, 95% CI 1.28 to 2.36) and all-cause mortality (tertile 2: HR 2.04, 95% CI 1.35 to 3.11; tertile 3: HR 1.89, 95% CI 1.20 to 2.98). The optimal cut-off of DAR was 1.2. In the stratified analysis, sex, age, hypertension, hypercholesterolaemia, total revascularisation and any interfered vessel did not affect the independent predictive ability. CONCLUSION Higher DAR was independently associated with MACE and all-cause mortality after PCI in ischaemic heart failure patients with diabetes mellitus.
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Affiliation(s)
- Qiuyu Li
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiaolong Lin
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiaowen Bo
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Siyuan Chen
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Donghui Zhao
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Jinghua Liu
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Qian Fan
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
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Vinatzer H, Rzepka A, Hayn D, Ziegl A, Schreier G. Investigation of the time shift between wearable photoplethysmography sensors used for continuous heart rate monitoring. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4308-4311. [PMID: 36086137 DOI: 10.1109/embc48229.2022.9871629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this study, we investigated the effect of time shift in heartrate measurement by wearables, which might to be used in telehealth applications for patients suffering from heart failure. Six wearables commercially available on the market were tested in a 14-hour measurement. Each wearable was tested three times by five different test persons. A reference sensor was used to test the accuracy of the wearables. We found that different types of time shifts are common in the sensors we tested: time shifts of full days, time shifts of full hours (most probably due to incorrect or unspecified time zones) and time shifts in the range of seconds to minutes (most likely stemming from averaging, data transmission, etc.). We conclude that time shifts of all manufacturers need to be corrected prior comparison of a photoplethysmography signal with other signals. However, even after correction of the time shift, the reliability of the sensors seems to be too low for application in telehealth settings. Clinical relevance- This study shows that signals from state-of-the-art wearable photoplethysmography heart rate measurements show significant time shifts and marked differences even if time shifts were corrected. This limits their utility for clinical applications.
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Asai Y, Sato T, Kito D, Yamamoto T, Hioki I, Urata Y, Abe Y. Combination therapy of midodrine and droxidopa for refractory hypotension in heart failure with preserved ejection fraction per a pharmacist's proposal: a case report. J Pharm Health Care Sci 2021; 7:10. [PMID: 33653416 PMCID: PMC7927230 DOI: 10.1186/s40780-021-00193-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Patients with chronic heart failure (CHF) are often treated using many diuretics for symptom relief; however, diuretic use may have to continue despite hypotension development in these patients. Here, we present a case of heart failure with preserved ejection fraction (HFpEF), which is defined as ejection fraction ≥50% in CHF, and refractory hypotension, which was treated with midodrine and droxidopa to normalize blood pressure. Case presentation The patient was a 62-year-old man with a history of HFpEF due to mitral regurgitation and complaints of dyspnea on exertion. He had been prescribed multiple medications at an outpatient clinic for CHF management, including azosemide 60 mg/day, bisoprolol 2.5 mg/day, enalapril 2.5 mg/day, spironolactone 50 mg/day, and tolvaptan 15 mg/day. The systolic blood pressure (SBP) of the patient remained at 70–80 mmHg because the use of the diuretic could not be reduced or discontinued owing to edema and weight gain. He was hospitalized for the exacerbation of CHF. Although midodrine 8 mg/day was administered to improve hypotension, the SBP of the patient increased only up to 90 mmHg. On the 35th day after hospitalization, the urine volume decreased significantly (< 100 mL/day) due to hypotension. When droxidopa 200 mg/day replaced intravenous noradrenaline on the 47th day, the SBP remained at 100–120 mmHg and the urine volume increased. Conclusions Oral combination treatment with midodrine and droxidopa might contribute to the maintenance of blood pressure and diuretic activity in HFpEF patients with refractory hypotension. However, further long-term studies evaluating the safety and efficacy of this combination therapy for patients with HFpEF are needed.
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Affiliation(s)
- Yuki Asai
- Pharmacy, National Hospital Organization Mie Chuo Medical Center, 2158-5 Hisaimyojincho, Tsu, Mie, 514-1101, Japan.
| | - Tomoaki Sato
- Department of Cardiovascular Surgery, National Hospital Organization Mie Chuo Medical Center, 2158-5 Hisaimyojincho, Tsu, Mie, 514-1101, Japan
| | - Daisuke Kito
- Pharmacy, National Hospital Organization Mie Chuo Medical Center, 2158-5 Hisaimyojincho, Tsu, Mie, 514-1101, Japan
| | - Takanori Yamamoto
- Pharmacy, National Hospital Organization Mie Chuo Medical Center, 2158-5 Hisaimyojincho, Tsu, Mie, 514-1101, Japan
| | - Iwao Hioki
- Department of Cardiovascular Surgery, National Hospital Organization Mie Chuo Medical Center, 2158-5 Hisaimyojincho, Tsu, Mie, 514-1101, Japan
| | - Yasuhisa Urata
- Department of Cardiovascular Surgery, National Hospital Organization Mie Chuo Medical Center, 2158-5 Hisaimyojincho, Tsu, Mie, 514-1101, Japan
| | - Yasuharu Abe
- Pharmacy, National Hospital Organization Mie Chuo Medical Center, 2158-5 Hisaimyojincho, Tsu, Mie, 514-1101, Japan
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Arad M, Waldman M, Abraham NG, Hochhauser E. Therapeutic approaches to diabetic cardiomyopathy: Targeting the antioxidant pathway. Prostaglandins Other Lipid Mediat 2020; 150:106454. [PMID: 32413571 DOI: 10.1016/j.prostaglandins.2020.106454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/23/2020] [Accepted: 05/06/2020] [Indexed: 12/25/2022]
Abstract
The global epidemic of cardiovascular disease continues unabated and remains the leading cause of death both in the US and worldwide. We hereby summarize the available therapies for diabetes and cardiovascular disease in diabetics. Clearly, the current approaches to diabetic heart disease often target the manifestations and certain mediators but not the specific pathways leading to myocardial injury, remodeling and dysfunction. Better understanding of the molecular events determining the evolution of diabetic cardiomyopathy will provide insight into the development of specific and targeted therapies. Recent studies largely increased our understanding of the role of enhanced inflammatory response, ROS production, as well as the contribution of Cyp-P450-epoxygenase-derived epoxyeicosatrienoic acid (EET), Peroxisome Proliferator-Activated Receptor Gamma Coactivator-1α (PGC-1α), Heme Oxygenase (HO)-1 and 20-HETE in pathophysiology and therapy of cardiovascular disease. PGC-1α increases production of the HO-1 which has a major role in protecting the heart against oxidative stress, microcirculation and mitochondrial dysfunction. This review describes the potential drugs and their downstream targets, PGC-1α and HO-1, as major loci for developing therapeutic approaches beside diet and lifestyle modification for the treatment and prevention of heart disease associated with obesity and diabetes.
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Affiliation(s)
- Michael Arad
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Maayan Waldman
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Cardiac Research Laboratory, Felsenstein Medical Research Institute, Tel Aviv University, Tel Aviv, Israel
| | - Nader G Abraham
- Department of Pharmacology, New York Medical College, Valhalla, NY 10595, USA
| | - Edith Hochhauser
- Cardiac Research Laboratory, Felsenstein Medical Research Institute, Tel Aviv University, Tel Aviv, Israel.
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Shaaya G, Al-Khazaali A, Arora R. Heart Rate As a Biomarker in Heart Failure: Role of Heart Rate Lowering Agents. Am J Ther 2017; 24:e532-e539. [DOI: 10.1097/mjt.0000000000000336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ciarka A, Lund LH, Van Cleemput J, Voros G, Droogne W, Vanhaecke J. Effect of Heart Rate and Use of Beta Blockers on Mortality After Heart Transplantation. Am J Cardiol 2016; 118:1916-1921. [PMID: 27743576 DOI: 10.1016/j.amjcard.2016.08.084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
Heart transplantation (HT) recipients may have tachycardia secondary to cardiac denervation. As higher heart rate predicts worse outcomes in cardiovascular disease, we hypothesized that tachycardia and nonuse of β blockers are associated with increased mortality after HT. All patients who underwent HT at our institution from 1987 to 2010 were included. The association of heart rate 3 months after HT and β-blocker use during follow-up to mortality was assessed using Kaplan-Meier and multivariate Cox proportional hazards regression analyses adjusting for clinically relevant baseline variables. From 1987 to 2010, there were 493 HT. After excluding 29 who died within 3 months and 3 with follow-up <3 months, 461 HT recipients (50 ± 2 years; 20% women) were included. Over a follow-up of 12 ± 7 years, selected important univariate predictors of post-HT mortality were older age, male gender, higher body mass index, ischemic cardiomyopathy, longer post-HT intensive care unit stay, and hospitalization and at 3 months, increased mean pulmonary artery pressure, right atrial pressure and pulmonary capillary occlusion pressure, higher heart rate, and nonuse of β blockers during follow-up. In multivariate analysis, older ager, longer hospitalization, higher mean pulmonary artery pressure, higher heart rate at 3 months (hazard ratio 1.02 per beat, 95% confidence interval 1.008 to 1.035, p = 0.02) and nonuse of β blockers (hazard ratio 1.43, 95% confidence interval 1.002 to 2.031, p <0.05) were associated with mortality. In conclusion, in a large single-center cohort of HT recipients, higher heart rate and nonuse of β blockers were independently associated with higher mortality.
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Elder DH, Mohan M, Cochrane L, Charles H, Lang CC. Characterizing patients with chronic heart failure in community care after hospitalization: a potential role for ivabradine. Cardiovasc Ther 2016; 33:104-8. [PMID: 25809454 DOI: 10.1111/1755-5922.12117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS To identify the prevalence and characteristics of recently hospitalized chronic heart failure (CHF) patients in community care who meet the indication for ivabradine. METHODS A retrospective clinical audit of CHF patients recently hospitalized with acute decompensated heart failure (ADHF) and subsequently referred to the Tayside Heart Failure Nurse Liaison Service (THFNLS), a Scottish nurse-led community heart failure liaison service. Inclusion criteria were previous hospitalization with ADHF, subsequent referral to the THFNLS, data for ≥ 2 nurse visits, and a recorded pulse. The main outcome measure was the proportion of patients who meet the indicated criteria for ivabradine. RESULTS In the UK, ivabradine is indicated for CHF with systolic dysfunction in patients in sinus rhythm, with a heart rate ≥ 75 bpm, and NYHA class II-class IV. After up-titration of a beta-blocker, 19.0% of patients in the full dataset (158 of 830) met the indication for ivabradine at the last visit. Of these "ivabradine-suitable" patients, 101 of 158 (63.9%) received bisoprolol "at any time" during the study period; 20 of 158 (12.7%) achieved the target dose (10 mg daily); 52 of 158 (32.9%) received 5 mg or 7.5 mg daily; and 93 of 158 (58.9%) received <5 mg daily. CONCLUSIONS In this group of Scottish patients previously hospitalized with ADHF and under the care of a protocol-driven clinic, 19% met the indication for ivabradine and may benefit from the increased control of CHF that ivabradine can provide. Among these "ivabradine-suitable" patients, <15% achieved the target dose of beta-blockers, illustrating the substantial clinical need for a well-tolerated and effective therapy such as ivabradine.
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Affiliation(s)
- Douglas H Elder
- Division of Cardiovascular and Diabetes Medicine and Health Informatics Centre, University of Dundee, Dundee, UK
| | - Mohapradeep Mohan
- Division of Cardiovascular and Diabetes Medicine and Health Informatics Centre, University of Dundee, Dundee, UK
| | - Lynda Cochrane
- Division of Cardiovascular and Diabetes Medicine and Health Informatics Centre, University of Dundee, Dundee, UK
| | - Helena Charles
- Division of Cardiovascular and Diabetes Medicine and Health Informatics Centre, University of Dundee, Dundee, UK
| | - Chim C Lang
- Division of Cardiovascular and Diabetes Medicine and Health Informatics Centre, University of Dundee, Dundee, UK
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Lourenço P, Ribeiro A, Cunha FM, Pintalhão M, Marques P, Cunha F, Silva S, Bettencourt P. Is there a heart rate paradox in acute heart failure? Int J Cardiol 2015; 203:409-14. [PMID: 26544063 DOI: 10.1016/j.ijcard.2015.10.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 09/22/2015] [Accepted: 10/18/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Higher heart rate predicts higher mortality in chronic heart failure (HF). We studied the prognostic impact of admission heart rate in acute HF and analysed the importance of its change during hospitalization. METHODS Acute HF patients were studied. Endpoint was all-cause death. Patients were followed-up for 12 months from hospital admission. Cox-regression analysis was used to study the association of heart rate (both as a continuous and as a categorical variable) with mortality. Analysis was stratified according to admission rhythm and to systolic dysfunction. Multivariate models were built. Patients surviving hospitalization were additionally cross-classified attending to admission and discharge heart rates – cut-offs: 100 and 80 beats per minute (bpm), respectively. RESULTS We analysed 564 patients. Median age was 78 years and median admission heart rate 87 bpm. In a 12-month period 205 patients died, 23 in-hospital. Mortality increased steadily with heart rate decrease. Patients with heart rate ≥ 100 bpm had a multivariate-adjusted HR of 12-month death of 0.57 (95%CI: 0.39-0.81), and the HR was 0.92 (0.85-0.98) per 10 bpm increase in heart rate. Association of heart rate with mortality was stronger in patients in sinus rhythm (SR) and in those with systolic dysfunction. Eighty-seven patients had admission heart rate ≥ 100 and discharge heart rate < 80 bpm. In them, death rate was 14.9%; in the remaining patients it was 37.7%. CONCLUSIONS Higher admission heart rate predicted survival advantage in acute HF. Patients presenting with tachycardia and discharged with a controlled heart rate had better outcome than those admitted non-tachycardic or discharged with a non-controlled heart rate.
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Affiliation(s)
- Patrícia Lourenço
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal.
| | - Ana Ribeiro
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal
| | - Filipe M Cunha
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar São João, Porto, Portugal
| | - Mariana Pintalhão
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto; Unidade I&D Cardiovascular do Porto, Portugal
| | - Pedro Marques
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal
| | - Francisco Cunha
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal
| | - Sérgio Silva
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal
| | - Paulo Bettencourt
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto; Unidade I&D Cardiovascular do Porto, Portugal
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Wu WC, Jiang L, Friedmann PD, Trivedi A. Association between process quality measures for heart failure and mortality among US veterans. Am Heart J 2014; 168:713-20. [PMID: 25440800 DOI: 10.1016/j.ahj.2014.06.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 06/21/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The few available studies of the Centers for Medicare and Medicaid Services Hospital Inpatient Quality Reporting (IQR) care process indicators have not linked receipt of recommended care processes in heart failure (HF) with lower mortality. Because the Veterans Health Administration (VHA) also tracks hospital inpatient quality reporting indicators, in addition to VHA-specific inpatient (pneumococcal and influenza vaccination) and outpatient (angiotensin-converting enzyme inhibitor [ACEI] or angiotensin receptor blocker [ARB] use for left ventricular [LV] dysfunction and LV function documentation) care process indicators, we examined the association between receipt of these care processes and 30-day and 1-year mortality. METHODS Retrospective study of 107,045 patients with HF treated at 128 VHA hospitals between 2001 and 2007 and followed up through 2008. We assessed the relationship between receipt of each HF care process and death at 30 days (inpatients only) and 1 year (all patients), using generalized estimating equations to adjust for clinical characteristics and clustering within hospitals. RESULTS Overall, inpatient/outpatient use of ACEI/ARB and receipt of pneumococcal or influenza vaccinations were related to lower risks of 30-day and/or 1-year mortality (adjusted odds ratios 0.51-0.77 for vaccinations and 0.60-0.78 for ACEI/ARB use). Conversely, discharge instructions, inpatient/outpatient LV function assessment, or weight instructions before admission were either not related or related to a slightly increase in mortality. Stratified analyses by various mortality risk subgroups did not reveal discernable "dose-response" relationship between mortality risk stratification and the association of care process and mortality. CONCLUSIONS Receipt of care processes related to recommended medications and vaccinations were associated with lower 30-day and/or 1-year risk-adjusted mortality in patients with HF. Receipt of care processes that assess patient counseling or chart documentation was not related to lower mortality.
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Affiliation(s)
- Wen-Chih Wu
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI; Department of Medicine, Alpert Medical School of Brown University, Providence, RI; Medical Service, Providence Veterans Affairs, Providence, RI.
| | - Lan Jiang
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI
| | - Peter D Friedmann
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI; Department of Medicine, Alpert Medical School of Brown University, Providence, RI; Department of Community Health, Brown University, Providence, RI
| | - Amal Trivedi
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI; Department of Community Health, Brown University, Providence, RI; Medical Service, Providence Veterans Affairs, Providence, RI
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Habal MV, Liu PP, Austin PC, Ross HJ, Newton GE, Wang X, Tu JV, Lee DS. Association of heart rate at hospital discharge with mortality and hospitalizations in patients with heart failure. Circ Heart Fail 2013; 7:12-20. [PMID: 24297690 DOI: 10.1161/circheartfailure.113.000429] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) is associated with a high burden of morbidity and mortality. Hospital discharge is an opportunity for identification of modifiable prognostic factors in the transition to chronic HF. METHODS AND RESULTS We examined the association of discharge heart rate with 30-day and 1-year mortality and hospitalization outcomes in a cohort of 9097 patients with HF discharged from hospital. Discharge heart rate was categorized into predefined groups: 40 to 60 (n=1333), 61 to 70 (n=2170), 71 to 80 (n=2631), 81 to 90 (n=1700), and >90 bpm (n=1263). There was a significant increase in all-cause 30-day mortality with adjusted odds ratios of 1.59 (95% confidence interval [CI], 1.18-2.14; P=0.003) for discharge heart rates 81 to 90 bpm and 1.56 (95% CI, 1.13-2.16; P=0.007) for heart rates>90 bpm when compared with the reference group (heart rates, 61-70 bpm). Cardiovascular death risk at 30 days was also higher with adjusted odds ratio 1.59 (discharge heart rates, 81-90 bpm; 95% CI, 1.09-2.33; P=0.017) and 1.65 (discharge heart rates, >90 bpm; 95% CI, 1.09-2.48; P=0.017). One-year all-cause mortality (adjusted odds ratio, 1.41; 95% CI, 1.16-1.72; P<0.001) and cardiovascular death (adjusted odds ratio, 1.47; 95% CI, 1.12-1.92; P=0.005) were higher with discharge heart rates>90 bpm when compared with the reference group (heart rates, 40-60 bpm). Readmissions for HF (adjusted hazard ratio, 1.26; 95% CI, 1.04-1.54; P=0.021) and cardiovascular disease (adjusted hazard ratio, 1.29; 95% CI, 1.08-1.54; P=0.004) within 30 days were also higher with discharge heart rates>90 bpm. CONCLUSIONS Higher discharge heart rates were associated with greater risk of all-cause and cardiovascular mortality≤1-year follow-up and an elevated risk of 30-day readmission for HF and cardiovascular disease.
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Microvascular Effects of Heart Rate Control With Esmolol in Patients With Septic Shock. Crit Care Med 2013; 41:2162-8. [DOI: 10.1097/ccm.0b013e31828a678d] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lee CS, Lin TH, Hsu PC, Chu CY, Lee WH, Su HM, Voon WC, Lai WT, Sheu SH. Measuring left ventricular peak longitudinal systolic strain from a single beat in atrial fibrillation: validation of the index beat method. J Am Soc Echocardiogr 2012; 25:945-52. [PMID: 22763084 DOI: 10.1016/j.echo.2012.06.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is traditionally difficult to estimate left ventricular (LV) systolic function in atrial fibrillation (AF). The aim of this study was to validate the use of an index beat, the beat after the nearly equal preceding (RR1) and pre-preceding (RR2) intervals, for the measurement of LV peak longitudinal systolic strain (PLSS). The difference between RR1 and RR2 intervals of the index beat must be <60 msec. LV PLSS measured from the index beat (PLSSindex) was compared with LV PLSS measured from the conventional but time-consuming method of averaging multiple cardiac cycles (PLSSavg). METHODS Ninety-eight patients with persistent or permanent AF and resting ventricular rates ≤ 105 beats/min were prospectively included. LV PLSSindex and LV PLSSavg were obtained from two-dimensional speckle-tracking echocardiography. RESULTS LV PLSSindex had a highly significant correlation with LV PLSSavg (r = 0.970, P < .001). Bland-Altman analysis showed only small bias of 0.01%, and the 95% limits of agreement were +1.64% to -1.62%. Compared with those with lower risk scores of stroke indicated by CHADS(2) scores < 2 or CHA(2)DS(2)-VASc scores < 2, patients with higher risk scores of stroke indicated by CHADS(2) scores ≥ 2 or CHA(2)DS(2)-VASc scores ≥ 2 had lower PLSSavg and PLSSindex (P ≤ .012). CONCLUSIONS LV PLSSindex was a good alternative to LV PLSSavg in patients with AF. Use of the index beat to measure LV longitudinal systolic strain in patients with AF was as accurate as the time-consuming method of averaging multiple cardiac cycles.
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Affiliation(s)
- Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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