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Wu L, Rodriguez M, Hachem KE, Tang WHW, Krittanawong C. Management of patients with heart failure and chronic kidney disease. Heart Fail Rev 2024; 29:989-1023. [PMID: 39073666 DOI: 10.1007/s10741-024-10415-9] [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] [Accepted: 07/01/2024] [Indexed: 07/30/2024]
Abstract
Chronic kidney disease (CKD) and heart failure are often co-existing conditions due to a shared pathophysiological process involving neurohormonal activation and hemodynamic maladaptation. A wide range of pharmaceutical and interventional tools are available to patients with CKD, consisting of traditional ones with decades of experience and newer emerging therapies that are rapidly reshaping the landscape of medical care for this population. Management of patients with heart failure and CKD requires a stepwise approach based on renal function and the clinical phenotype of heart failure. This is often challenging due to altered drug pharmacokinetics interactions with various degrees of kidney function and frequent adverse effects from the therapy that lead to poor patient tolerance. Despite a great body of clinical evidence and guidelines that have offered various treatment options for patients with heart failure and CKD, respectively, patients with CKD are still underrepresented in heart failure clinical trials, especially for those with advanced CKD and end-stage renal disease (ESRD). Future studies are needed to better understand the generalizability of these therapeutic options among heart failures with different stages of CKD.
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Affiliation(s)
- Lingling Wu
- Cardiovascular Division, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mario Rodriguez
- John T Milliken Department of Medicine, Division of Cardiovascular disease, Section of Advanced Heart Failure and Transplant, Barnes-Jewish Hospital, Washington University in St. Louis School of Medicine, St. Louis, USA
| | - Karim El Hachem
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland, Clinic, Cleveland, OH, USA
| | - Chayakrit Krittanawong
- Cardiology Division, Section of Cardiology, NYU Langone Health and NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
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Nishino M, Egami Y, Kawanami S, Abe M, Ohsuga M, Nohara H, Ukita K, Kawamura A, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M. Prognostic Comparison of Octogenarian vs. Non-Octogenarian With Acute Decompensated Heart Failure - AURORA Study. Circ J 2023; 88:103-109. [PMID: 37793831 DOI: 10.1253/circj.cj-23-0470] [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] [Indexed: 10/06/2023]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) is the main cause of hospitalization and death of octogenarians, but no data on the 1-year post-discharge mortality rate. We evaluated the clinical status and predictors of 1-year mortality in octogenarians with ADHF. METHODS AND RESULTS From the AURORA (Acute Heart Failure Registry in Osaka Rosai Hospital) study, we examined 1,246 hospitalized ADHF patients. We compared the in-hospital mortality rate and the proportion of heart failure (HF) with preserved ejection fraction (HFpEF) between octogenarians and non-octogenarians. After discharge we compared the 1-year mortality rate between these groups, and we also evaluated the predictors of death in both groups. The proportion of HFpEF among the in-hospital deaths of octogenarians was significantly higher than in non-octogenarians (46.2% vs. 15.0%, P=0.031). The 1-year mortality rate after discharge was significantly higher in the octogenarians than non-octogenarians (P=0.014). Multivariable Cox regression analysis revealed that albumin ≤3.0 g/dL and antiplatelet agents were useful predictors of 1-year death after discharge of octogenarians whereas chronic kidney disease was a predictor in the non-octogenarians. CONCLUSIONS The proportion of HFpEF among in-hospital deaths of octogenarians with ADHF was high as compared with non-octogenarians. When octogenarians with ADHF have severe hypoalbuminemia and antiplatelet agents, early nutritional and medical interventions after discharge may be important to improve the 1-year prognosis.
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Affiliation(s)
| | | | | | - Masaru Abe
- Division of Cardiology, Osaka Rosai Hospital
| | | | | | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital
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Georges G, Fudim M, Burkhoff D, Leon MB, Généreux P. Patient Selection and End Point Definitions for Decongestion Studies in Acute Decompensated Heart Failure: Part 1. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101060. [PMID: 39131061 PMCID: PMC11307876 DOI: 10.1016/j.jscai.2023.101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 08/13/2024]
Abstract
Despite recent advances in the treatment of patients with chronic heart failure, acute decompensated heart failure remains associated with significant mortality and morbidity because many novel therapies have failed to demonstrate meaningful benefit. Persistent congestion in the setting of escalating diuretic therapy has been repeatedly shown to be a marker of poor prognosis and is currently being targeted by various emerging device-based therapies. Because these therapies inherently carry procedural risk, patient selection is key in the future trial design. However, it remains unclear which patients are at a higher risk of residual congestion or adverse outcomes despite maximally tolerated decongestive therapy. In the first part of this 2-part review, we aimed to outline patient risk factors and summarize current evidence for early recognition of high-risk profile for residual congestion and adverse outcomes. These factors are classified as relating to the following: (1) previous clinical course, (2) severity of congestion, (3) diuretic response, and (4) degree of renal impairment. We also aimed to provide an overview of key inclusion criteria in recent acute decompensated heart failure trials and investigational device studies and propose potential criteria for selection of high-risk patients in future trials.
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Affiliation(s)
- Gabriel Georges
- Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Marat Fudim
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Martin B. Leon
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
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Omoomi S, Heidarpour M, Rabanipour N, Saadati M, Vakilbashi O, Shafie D. Prevalence of, association with, severity of, and prognostic role of serum hemoglobin level in acutely decompensated heart failure patients. BMC Cardiovasc Disord 2023; 23:491. [PMID: 37794317 PMCID: PMC10552373 DOI: 10.1186/s12872-023-03510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/13/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The role of hemoglobin (Hb) level in the short-term prognosis of patients with acute decompensated heart failure (ADHF) remains a matter of debate. We aimed to declare the prevalence of, association with, severity of, and prognostic role of SHL with ADHF. METHODS Using the data from the Persian Registry Of Cardiovascular Disease/ Heart Failure (PROVE-HF) study, we assessed the association between anemia and polycythemia (Hb < 13 g/dLit, > 16.5 g/dLit in males and < 12 g/dLit, and > 16 g/dLit in females, respectively) and short-term mortality using Cox proportional hazard modeling, with adjustment of clinically relevant variables. RESULTS Of 3652 ADHF patients, anemia was seen in 1673 patients (48.40%). The prevalence of mild, moderate, and severe anemia was 42.33% (n = 1546), 3.23% (n = 118), and 0.24% (n = 9), respectively. Also, 422 patients (11.55%) had polycythemia. Compared to non-anemic patients, anemic patients were mainly male, older, and were more likely to have diabetes mellitus (DM), renal dysfunction, hypertension (HTN), and thyroid disease. Significant predictors of short-term mortality were lower systolic and diastolic blood pressure, lower Hb level, and higher blood urea nitrogen (BUN). Anemic patients had higher all-cause mortality [adjusted hazard ratio (aHR) 1.213, 95% confidence interval [CI] 1.054-1.396]. Moderate anemia increased mortality by approximately 80% in males (aHR 1.793, 95% CI 1.308-2.458) and females (aHR 1.790, 95% CI 1.312-2.442), respectively. Polycythemia had no association with short-term mortality in both genders (P-value > 0.05). CONCLUSIONS This study revealed that anemia is an adverse prognostic factor for short-term mortality in ADHF patients, with higher mortality in moderately anemic patients.
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Affiliation(s)
- Sepehr Omoomi
- Cardiology/Heart Failure and Transplantation, Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Heidarpour
- Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Najmeh Rabanipour
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Science, Isfahan, Iran
| | - Mona Saadati
- Cardiology/Heart Failure and Transplantation, Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Vakilbashi
- Cardiology/Heart Failure and Transplantation, Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Cardiology/Heart Failure and Transplantation, Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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McCallum W, Sarnak MJ. Cardiorenal Syndrome in the Hospital. Clin J Am Soc Nephrol 2023; 18:933-945. [PMID: 36787124 PMCID: PMC10356127 DOI: 10.2215/cjn.0000000000000064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023]
Abstract
The cardiorenal syndrome refers to a group of complex, bidirectional pathophysiological pathways involving dysfunction in both the heart and kidney. Upward of 60% of patients admitted for acute decompensated heart failure have CKD, as defined by an eGFR of <60 ml/min per 1.73 m 2 . CKD, in turn, is one of the strongest risk factors for mortality and cardiovascular events in acute decompensated heart failure. Although not well understood, the mechanisms in the cardiorenal syndrome include venous congestion, arterial underfilling, neurohormonal activation, inflammation, and endothelial dysfunction. Arterial underfilling may lead to activation of the renin-angiotensin-aldosterone system and sympathetic nervous system, leading to sodium reabsorption and vasoconstriction. Venous congestion likely also mediates and perpetuates these maladaptive pathways. To rule out intrinsic kidney disease that is distinct from the cardiorenal syndrome, one should obtain a careful history, review longitudinal eGFR trends, assess albuminuria and proteinuria, and review the urine sediment and kidney imaging. The hallmark of the cardiorenal syndrome is intense sodium avidity and diuretic resistance, often requiring a combination of diuretics with varying pharmacological targets, and monitoring of urinary response to guide escalations in therapy. Invasive means of decongestion may be required including ultrafiltration or KRT such as peritoneal dialysis, which is often better tolerated from a hemodynamic perspective than intermittent hemodialysis. Strategies for increasing forward perfusion in states of low cardiac output and cardiogenic shock may include afterload reduction and inotropes and, in the most severe cases, mechanical circulatory support devices, many of which have kidney-specific considerations.
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Affiliation(s)
- Wendy McCallum
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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Association between the Length of Hospital Stay and 30-Day Outcomes in Patients Admitted with Acute Decompensated Heart Failure. Emerg Med Int 2023; 2023:6338597. [PMID: 36923467 PMCID: PMC10010878 DOI: 10.1155/2023/6338597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Method This study is performed in the context of the Persian Registry of Cardiovascular Disease/Heart Failure (PROVE/HF). We included all patients admitted with ADHF regardless of the etiology of heart failure (HF). LOS was classified in tertiles (<4 days, >4 and <6 days, and >6 days). Our outcomes were 30-day all-cause mortality and rehospitalization. Baseline characteristics and outcomes are reported according to the tertiles of LOS. A binary logistic regression and cox regression analysis were performed to evaluate the association between LOS and rehospitalization and death, respectively. Results Between April 2019 and March 2020, 385 patients with ADHF were registered in our study. The mean length of hospitalization was 6.35 ± 5.46 days, varying from a minimum of 0 days to a maximum of 47 days. One hundred patients had a hospital stay lower than 4 days; 151 individuals had an intermediate LOS (4-6 days); and 134 were hospitalized for more than 6 days. Our analysis indicated no association between LOS and 30-day rehospitalization and death in multivariable or univariable models. Conclusion This study found no association between LOS and rehospitalization or death in patients admitted with ADHF; however, further investigations are warranted.
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Li J, Jiang C, Lai Y, Li L, Zhao X, Wang X, Li L, Du X, Ma C, Dong J. Association of On-Admission Anemia With 1-Year Mortality in Patients Hospitalized With Acute Heart Failure: Results From the HERO Study. Front Cardiovasc Med 2022; 9:856246. [PMID: 35600475 PMCID: PMC9114434 DOI: 10.3389/fcvm.2022.856246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAnemia is common in patients with chronic heart failure (HF) and is associated with adverse outcomes. However, data regarding the prognostic value of on-admission anemia on mortality in patients hospitalized with acute HF were relatively limited and conflicting. This study aimed to investigate the association of on-admission anemia with 1-year mortality and evaluate whether anemia is an independent predictor of mortality in patients hospitalized with acute HF.MethodsThe present analysis included 4,244 patients hospitalized with acute HF from the HERO (Heart Failure Registry of Patient Outcomes) study. On-admission anemia was defined using the World Health Organization (WHO) criteria (hemoglobin <120 g/L in women and <130 g/L in men). Cox proportional hazards models were used to assess the association of anemia with 1-year all-cause and cardiovascular mortality.ResultsOf 4,244 patients, 2,206 (52.0%) patients had no anemia, 1,106 (26.1%) patients had mild anemia (men 110 ≤ hemoglobin < 130 g/L; women 110 ≤ hemoglobin < 120g/L), and 932 (22.0%) patients had moderate-to-severe anemia (hemoglobin < 110 g/L). After a median follow-up of 12.4 months (interquartile range: 11.9, 12.6), 867 (20.4%) patients died. Among the 742 (85.6%) deaths with confirmed causes, 664 (89.5%) were due to cardiovascular diseases. The mortality rates in patients with no anemia, mild anemia, and moderate-to-severe anemia were 16.6%, 20.4%, and 29.4%, respectively (p < 0.001). The association of anemia with increased all-cause mortality was significant in the unadjusted model (hazard ratio [HR]: 1.54, 95% confidential interval [CI]: 1.35–1.77, p < 0.001), and remained statistically significant after adjustment for most potential confounders (HR: 1.20, 95%CI: 1.03–1.40, p = 0.020), but no longer significant after additional adjustment for natriuretic peptides (HR: 1.02, 95%CI: 0.86–1.21, p = 0.843). When considering the degree of anemia, moderate-to-severe anemia was an independent predictor of all-cause mortality after full adjustment (HR:1.26, 95%CI: 1.03–1.54, p = 0.028), whereas mild anemia was not (HR: 0.84, 95%CI: 0.69–1.04, p = 0.104). A similar relationship was also found between anemia and cardiovascular mortality.ConclusionsOn-admission anemia, defined by the WHO criteria, is not an independent predictor of mortality in patients hospitalized with acute HF. Moderate-to-severe anemia in patients with acute HF is independently associated with increased mortality.
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Affiliation(s)
- Junlei Li
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Yiwei Lai
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Li Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyan Zhao
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaofang Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ling Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Du
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
- Heart Health Research Center (HHRC), Beijing, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- *Correspondence: Xin Du
| | - Changsheng Ma
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Jianzeng Dong
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Sklarz T, Italiano A, Menon N, Correia C, Sharma E, Wu S, Hunter K, Roy S. Impact of Correcting Nutritional Deficiency Anemias in the Elderly on Hospitalizations, Falls, and Mortalities. J Hematol 2022; 10:233-245. [PMID: 35059085 PMCID: PMC8734490 DOI: 10.14740/jh926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background The incidence and prevalence of anemia increase with age, particularly in adults older than 65 years, and it is associated with a number of adverse health outcomes (AHO), particularly hospitalizations, falls and mortalities. Given that approximately one-third of these anemias are due to reversible causes, we studied whether the treatment of nutritional deficiency anemia (NDA), namely iron deficiency anemia (IDA), cobalamin deficiency anemia (CDA), and folate deficiency anemia (FDA), improves AHO; and explored whether each NDA had different AHO. Methods We reviewed electronic medical records of our internal medicine office patients aged 65 years or older, who had a diagnosis of anemia in a non-acute setting. Results Total 600 patients were included. Mean age was 75.2 years. Thirty-one point three percent had NDA (CDA 15.3%, IDA 12.3%, FDA 3.7%); and 68.7% had other anemias whom we categorized as non-nutritional deficiency anemias (NNDA), which included anemia of chronic disease (11.2%), myelodysplastic syndrome (6.2%), renal insufficiency anemia (5.7%) and unexplained anemia (45.6%). Even after adequate treatment, IDA group had significantly more hospitalizations (median, 25th - 75th: 2 (0 - 4) vs. 0 (0 - 1), P < 0.001), falls (median, 25th - 75th: 1 (0 - 3) vs. 0 (0 - 1), P < 0.001) and mortalities (10.8% vs. 3.4%, P = 0.011); CDA group had significantly more hospitalizations (median, 25th - 75th: 1 (0 - 2) vs. 0 (0 - 1), P = 0.007), but no difference in falls (median, 25th - 75th: 0 (0 - 1) vs. 0 (0 - 1), P = 0.171) and mortalities (7.6% vs. 3.4%, P = 0.083); and FDA group had significantly more hospitalizations (median, 25th - 75th: 1 (0 - 2) vs. 0 (0 - 1), P = 0.001), but no difference in falls (median, 25th - 75th: 0 (0 - 1) vs. 0 (0 - 1), P = 0.615) and mortalities (4.5% vs. 3.4%, P = 0.550), compared to the NNDA group. Age, Black race, higher number of comorbidities, presence of malignancy and use of direct oral anticoagulants were associated with increased odds of AHO in patients with NDA. Conclusions Compared to the patients with NNDA, patients with IDA had more hospitalizations, falls and mortalities even after adequate treatment; while patients with CDA and FDA had only more hospitalizations. Adequate treatment mitigated falls and mortalities in elderly patients with CDA and FDA.
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Affiliation(s)
- Tammarah Sklarz
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Angelica Italiano
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Naveen Menon
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Caroline Correia
- Department of Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Elena Sharma
- Department of Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Samantha Wu
- Department of Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Satyajeet Roy
- Department of Medicine, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, USA.,Division of General Internal Medicine, Cooper University Health Care, Cherry Hill, NJ 08034, USA
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Rizzo C, Carbonara R, Ruggieri R, Passantino A, Scrutinio D. Iron Deficiency: A New Target for Patients With Heart Failure. Front Cardiovasc Med 2021; 8:709872. [PMID: 34447793 PMCID: PMC8383833 DOI: 10.3389/fcvm.2021.709872] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022] Open
Abstract
Iron deficiency (ID) is one of the most frequent comorbidities in patients with heart failure (HF). ID is estimated to be present in up to 50% of outpatients and is a strong independent predictor of HF outcomes. ID has been shown to reduce quality of life, exercise capacity and survival, in both the presence and absence of anemia. The most recent 2016 guidelines recommend starting replacement treatment at ferritin cutoff value <100 mcg/l or between 100 and 299 mcg/l when the transferrin saturation is <20%. Beyond its effect on hemoglobin, iron plays an important role in oxygen transport and in the metabolism of cardiac and skeletal muscles. Mitochondria are the most important sites of iron utilization and energy production. These factors clearly have roles in the diminished exercise capacity in HF. Oral iron administration is usually the first route used for iron repletion in patients. However, the data from the IRONOUT HF study do not support the use of oral iron supplementation in patients with HF and a reduced ejection fraction, because this treatment does not affect peak VO2 (the primary endpoint of the study) or increase serum ferritin levels. The FAIR-HF and CONFIRM-HF studies have shown improvements in symptoms, quality of life and functional capacity in patients with stable, symptomatic, iron-deficient HF after the administration of intravenous iron (i.e., FCM). Moreover, they have shown a decreased risk of first hospitalization for worsening of HF, as later confirmed in a subsequent meta-analysis. In addition, the EFFECT-HF study has shown an improvement in peak oxygen consumption at CPET (a parameter generally considered the gold standard of exercise capacity and a predictor of outcome in HF) in patients randomized to receive ferric carboxymaltose. Finally, the AFFIRM AHF trial evaluating the effects of FCM administration on the outcomes of patients hospitalized for acute HF has found significantly fewer hospital readmissions due to HF among patients treated with FCM rather than placebo.
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Affiliation(s)
- Caterina Rizzo
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Bari, Italy
| | - Rosa Carbonara
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Bari, Italy
| | - Roberta Ruggieri
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Bari, Italy
| | - Andrea Passantino
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Bari, Italy
| | - Domenico Scrutinio
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Bari, Italy
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Sadana D, Kummangal B, Moghekar A, Banerjee K, Kaur S, Balasubramanian S, Tolich D, Han X, Wang X, Hanane T, Mireles-Cabodevila E, Quraishy N, Duggal A, Krishnan S. Adherence to blood product transfusion guidelines-An observational study of the current transfusion practice in a medical intensive care unit. Transfus Med 2021; 31:227-235. [PMID: 33749043 DOI: 10.1111/tme.12771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/17/2021] [Accepted: 03/05/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Blood transfusions though life-saving are not entirely benign. They are the most overused procedure in the hospital and have been under scrutiny by the 'Choosing Wisely campaign'. The strict adoption of restrictive transfusion guidelines could improve patient outcomes while reducing cost. OBJECTIVES In this study, we evaluate adherence to restrictive transfusion guidelines, along with hospital mortality and length of stay (LOS) in transfusion events with a pre-transfusion haemoglobin (Hb) ≥7 g/dl. Additionally, we evaluated associated costs accrued due to unnecessary transfusions. METHODS We conducted a retrospective observational study in a 64-bed medical intensive care unit (MICU) of an academic medical centre involving all adult patients (N = 957) requiring packed red blood cell transfusion between January 2015 and December 2015. RESULTS In total, 3140 units were transfused with a mean pre-transfusion Hb of 6.75 ± 0.86 g/dl. Nine hundred forty-four (30%) transfusion events occurred with a pre-transfusion Hb ≥7 g/dl, and 385 (12.3%) of these occurred in patients without hypotension, tachycardia, use of vasopressors, or coronary artery disease. Forgoing them could have led to a savings of approximately 0.3 million dollars. Transfusion events with pre-transfusion Hb ≥7 g/dl were associated with an increased mortality in patients with acute blood loss (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.11-3.88; p = 0.02) and LOS in patients with chronic blood loss (β1 .8.26, 95% CI 4.09-12.43; p < 0.01). CONCLUSION A subset of anaemic patients in the MICU still receive red blood cell transfusions against restrictive guidelines offering hospitals the potential for effective intervention that has both economic and clinical implications.
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Affiliation(s)
- Divyajot Sadana
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Basheer Kummangal
- Department of Hospital Medicine, Detroit Receiving Hospital, Detroit, Michigan, USA
| | - Ajit Moghekar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kinjal Banerjee
- Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Simrat Kaur
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shailesh Balasubramanian
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deborah Tolich
- Department of Surgical Operations, Cleveland Clinic, Cleveland, Ohio, USA
| | - Xiaozhen Han
- Department of Quantitative Health Sciences, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tarik Hanane
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - NurJehan Quraishy
- Department of Clinical Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abhijit Duggal
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sudhir Krishnan
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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11
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Choi Y, Won KB, Kang HH, Change HJ. Association of serum hemoglobin level with the risk of carotid plaque beyond metabolic abnormalities among asymptomatic adults without major adverse clinical events: a cross-sectional cohort study. BMC Cardiovasc Disord 2021; 21:35. [PMID: 33648442 PMCID: PMC7923602 DOI: 10.1186/s12872-021-01852-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The serum hemoglobin (Hb) level is closely related to adverse clinical outcomes. However, data on the association of Hb levels with subclinical atherosclerosis beyond metabolic abnormalities are limited. METHODS This study evaluated the association among serum Hb level, metabolic syndrome (MetS), and the risk of carotid plaque formation in asymptomatic adults without a history of major adverse clinical events. RESULTS A total of 2560 participants (mean age: 60 ± 8 years, 32.9% men) were stratified into four groups based on Hb quartiles, as follows: ≤ 12.8 g/dL (group I), 12.9-13.6 g/dL (group II), 13.7-14.5 g/dL (group III), and ≥ 14.6 g/dL (group IV). The overall prevalence of MetS and carotid plaque was 37.2% and 33.4%, respectively. The prevalence of MetS increased with increasing Hb level (group I: 27.4% vs. group II: 35.9% vs. group III: 42.6% vs. group IV: 44.1%, p < 0.001). The prevalence of carotid plaque was 34.3%, 28.1%, 32.8%, and 39.5% in groups I, II, III, and IV, respectively. Univariate logistic regression analysis showed that MetS was associated with an increased risk of carotid plaque (odds ratio [OR] 1.568, 95% confidence interval [CI] 1.326-1.856, p < 0.001). Only group II showed a lower risk of carotid plaque than group I (OR 0.750, 95% CI 0.596-0.943, p = 0.014). Multiple logistic regression models showed consistent results after adjusting for clinical factors, including MetS and its individual components. CONCLUSION Serum Hb level is associated with the risk of carotid plaque beyond MetS and its components in a relatively healthy adult population.
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Affiliation(s)
- Yunsuk Choi
- Division of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Ki-Bum Won
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.,Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hyeon Hui Kang
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. .,Division of Pulmonary, Critical Care and Sleep Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
| | - Hyuk-Jae Change
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Abstract
Anemia is common in heart failure with preserved and reduced ejection fraction. It is independently associated with poor functional status, hospitalization, and reduced survival. Its etiology is complex and multifactorial. Hemodynamic and nonhemodynamic compensatory mechanisms have been discussed as a response to chronic anemia. Whether anemia is a risk marker of advanced disease or a risk factor for progressive heart failure is debated. Current guidelines recommend a diagnostic workup as a part of standard management. Studies investigating intravenous iron administration reported beneficial effects on clinical outcomes. This article reviews current information on anemia.
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Affiliation(s)
- Carmen C Beladan
- University of Medicine and Pharmacy "Carol Davila", Euroecolab; Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania.
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Ye SD, Wang SJ, Wang GG, Li L, Huang ZW, Qin J, Li CS, Yu XZ, Shen H, Yang LP, Fu Y, Zheng YA, Zhao B, Yu DM, Qin FJ, Zhou DG, Li Y, Liu FJ. Association between anemia and outcome in patients hospitalized for acute heart failure syndromes: findings from Beijing Acute Heart Failure Registry (Beijing AHF Registry). Intern Emerg Med 2021; 16:183-192. [PMID: 32356137 DOI: 10.1007/s11739-020-02343-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
Whether the anemia increases the risk of mortality in patients with acute heart failure (AHF) remains unclear. This study aims to explore the relationship between anemia and outcomes in patients with AHF including subgroup analysis. This study included 3279 patients with hemoglobin available from the Beijing Acute Heart Failure Registry (Beijing AHF Registry) study. The primary endpoint was all-cause mortality in 1 year, and the secondary endpoint was 1-year all-cause events including all-cause death and readmission. Logistic regression models were applied to describe related variables of anemia in patients with AHF. Multivariate Cox proportional hazards models described associations of anemia with clinical outcomes in the overall cohort and subgroups. 45.4% of the patients were found anemic. They were older and had more comorbidities than non-anemic patients. Variables including older age, female, chronic kidney dysfunction (CKD), lower hematocrit, lower albumin, with loop diuretics applied, without beta-blockers, angiotensin-converting enzyme inhibitors /angiotensin receptor blockers (ACEIs/ARBs) and spironolactone applied in the emergency department (ED) were associated with anemia in AHF patients. Anemic patients had higher 1-year mortality (38.4% vs. 27.2%, p < 0.0001) and 1-year events rates (63.2% vs. 56.7%, p < 0.0001). After adjusted for covariates, anemia was associated with the increase of 1-year mortality (hazard ratio [HR] 1.278; 95% confidence interval [CI] 1.114-1.465; p = 0.0005) and 1-year events (HR 1.136; 95% CI 1.025-1.259; p = 0.0154). The severer anemia patients had higher risks both of 1-year mortality and events. In the subgroup analysis, the independent associations of anemia with 1-year mortality were shown in the subgroups including age < 75 years, male, body mass index < 25 kg/m2 and BMI ≥ 25 kg/m2, New York Heart Association (NYHA) functional class I-II and NYHA functional class III-IV, with and without cardiovascular ischemia, heart rate (HR) < 100 bpm and HR ≥ 100 bpm, systolic blood pressure (SBP) < 120 mmHg and SBP ≥ 120 mmHg, left ventricular ejection fraction (LVEF) < 40% and LVEF ≥ 40%, serum creatinine (Scr) < 133 umol/l, and with diuretics use, with and without beta-blockers use, without ACEIs/ARBs use in the ED. Anemia is associated with older age, female, CKD, volume overload, malnutrition, with loop diuretics, without beta-blockers, ACEIs/ARBs and spironolactone administration, and higher mortality and readmission in AHF. The risk associations are particular significantly obvious in younger, male, overweight, preserved LVEF, lower Scr, with diuretics and beta-blockers, without ACEIs/ARBs administration subgroups.Clinical trial No. ChiCTR-RIC-17014222.
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Affiliation(s)
- Shao-Dong Ye
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Si-Jia Wang
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Guo-Gan Wang
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Lin Li
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Zhi-Wei Huang
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jian Qin
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Chun-Sheng Li
- Department of Emergency, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xue-Zhong Yu
- Department of Emergency, Peking Union Medical College Hospital, Beijing, 100032, China
| | - Hong Shen
- Department of Emergency, Chinese People's Liberation Army General Hospital, Medical School of Chinese People's Liberation Army, Beijing, 100853, China
| | - Li-Pei Yang
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Yan Fu
- Department of Emergency, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ya-An Zheng
- Department of Emergency, Peking University Third Hospital, Beijing, 100083, China
| | - Bin Zhao
- Department of Emergency, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Dong-Min Yu
- Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Fu-Jun Qin
- Department of Emergency, Liangxiang Hospital of Fangshan District, Beijing, 102400, China
| | - De-Gui Zhou
- Department of Emergency, Shunyi District Hospital, Beijing, 101300, China
| | - Ying Li
- Department of Emergency, People's Hospital of Beijing Daxing District, Beijing, 102600, China
| | - Fu-Jun Liu
- Department of Emergency, Beijing Luhe Hospital, Capital Medical University, Beijing, 101100, China
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Clinical Predictors Influencing the Length of Stay in Emergency Department Patients Presenting with Acute Heart Failure. ACTA ACUST UNITED AC 2020; 56:medicina56090434. [PMID: 32867269 PMCID: PMC7558979 DOI: 10.3390/medicina56090434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022]
Abstract
Background and objectives: Acute heart failure is a common problem encountered in the emergency department (ED). More than 80% of the patients with the condition subsequently require lengthy and repeated hospitalization. In a setting with limited in-patient capacity, the patient flow is often obstructed. Appropriate disposition decisions must be made by emergency physicians to deliver effective care and alleviate ED overcrowding. This study aimed to explore clinical predictors influencing the length of stay (LOS) in patients with acute heart failure who present to the ED. Materials and Methods: We conducted prognostic factor research with a retrospective cohort design. Medical records of patients with acute heart failure who presented to the ED of Ramathibodi Hospital from January to December 2015 were assessed for eligibility. Thirteen potential clinical predictors were selected as candidates for statistical modeling based on previous reports. Multivariable Poisson regression was used to estimate the difference in LOS between patients with and without potential predictors. Results: A total of 207 patients were included in the analysis. Most patients were male with a mean age of 74.2 ± 12.5 years. The median LOS was 54.6 h (Interquartile range 17.5, 149.3 h). From the multivariable analysis, four clinical characteristics were identified as independent predictors with an increase in LOS. These were patients with New York Heart Association (NYHA) functional class III/IV (+72.9 h, 95%Confidence interval (CI) 23.9, 121.8, p = 0.004), respiratory rate >24 per minute (+80.7 h, 95%CI 28.0, 133.3, p = 0.003), hemoglobin level <10 mg/dL (+60.4 h, 95%CI 8.6, 112.3, p = 0.022), and serum albumin <3.5 g/dL (+52.8 h, 95%CI 3.6, 102.0, p = 0.035). Conclusions: Poor NYHA functional class, tachypnea, anemia, and hypoalbuminemia are significant clinical predictors of patients with acute heart failure who required longer LOS.
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A Portable Smartphone-linked Device for Direct, Rapid and Chemical-Free Hemoglobin Assay. Sci Rep 2020; 10:8606. [PMID: 32451400 PMCID: PMC7248091 DOI: 10.1038/s41598-020-65607-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 05/06/2020] [Indexed: 12/13/2022] Open
Abstract
We describe the development and clinical evaluation of an automated smartphone-linked sensor capable of chemical-free, quantitative measurement of hemoglobin concentration ([Hb]) in whole blood samples. We have demonstrated that our sensor could analyze an unprocessed blood specimen with a mean processing time of <8 s and provided the [Hb] results with ~99% accuracy against a reference hematology analyzer with coefficient of variation (CV) of 1.21% measured at [Hb] = 11.2 g/dL. Its diagnostic capability for anemia was evaluated by measuring [Hb] of 142 clinical blood specimens and comparing the results with those from an automated hematology analyzer (ADVIA 2120i, Siemens AG, Germany) and a portable hemoglobinomteter (Hb201+, Hemocue, Sweden). The sensor yielded comparable sensitivities and specificities of 87.50% and 100.00% for males, and 94.44% and 100.00% for females, respectively, for anemic detection. The results suggested that our optical sensor based on the intrinsic photothermal response of Hb molecules and advances in consumer electronics, particularly smartphone capabilities, enables a direct, chemical-free [Hb] assay accessible to people in both developed and developing countries.
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Breen C, Maguire K, Bansal A, Russin S, West S, Dayal A, Berger A, Olson J, Hohmuth B. Reducing Phlebotomy Utilization With Education and Changes to Computerized Provider Order Entry. J Healthc Qual 2020; 41:154-159. [PMID: 31094948 DOI: 10.1097/jhq.0000000000000150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Daily phlebotomy is often a standard procedure in hospitalized patients. Recently, this practice has begun receiving attention as a potential target for efforts focused on eliminating overuse. Several organizations have published their efforts in this arena. Interventions have included education, feedback, and changes to computerized provider order entry (CPOE) but have yielded mixed results. METHODS A quality improvement initiative to reduce the utilization of daily phlebotomy was conducted at a 505-bed Academic Medical Center. This project involved a combination of educational interventions and changes to CPOE. The primary end point evaluated was the daily performance of complete blood counts (CBCs) and basic metabolic profiles (BMPs) on medical and surgery units relative to the corresponding hospital census. RESULTS Over the course of this project from August 1, 2013, to September 23, 2016, there was a 15.2% reduction in CBCs (p < .001 for linear trend) and 13.1% reduction in BMPs. DISCUSSION Our results suggest that layering multimodal interventions that involve both "hard-wired" changes to CPOE and education and performance feedback can result in decreased utilization of phlebotomy.
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17
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Llauger L, Jacob J, Herrero-Puente P, Aguirre A, Suñén-Cuquerella G, Corominas-Lasalle G, Llorens P, Martín-Sánchez FJ, Gil V, Roset A, Ruibal JC, Pérez-Durá MJ, Juan-Gómez MÁ, Garrido JM, Richard F, Lucas-Imbernon FJ, Alonso H, Tost J, Gil C, Miró Ò. The CRAS-EAHFE study: Characteristics and prognosis of acute heart failure episodes with cardiorenal-anaemia syndrome at the emergency department. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:406-418. [PMID: 32403935 DOI: 10.1177/2048872620921602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The coexistence of other comorbidities confers poor outcomes in patients with acute heart failure. Our aim was to determine the characteristics of patients with acute heart failure and cardiorenal anaemia syndrome and the relationship between renal dysfunction and anaemia, alone or combined as cardiorenal anaemia syndrome, on short-term outcomes. METHODS We analysed the Epidemiology of Acute Heart Failure in Emergency Departments registry (cohort of patients with acute heart failure in Spanish emergency departments). Renal dysfunction was defined by an estimated glomerular filtration rate <60 ml/min/m2, anaemia by haemoglobin values <12/<13 g/dl in women/men, and cardiorenal anaemia syndrome as the presence of both. Comparisons were made according to cardiorenal-anaemia syndrome positive (CRAS+) with respect to the rest of patients (CRAS-) and according the presence of renal dysfunction (RD+) and anaemia (A+), (alone, RD+/A-, RD-/A+) or in combination (RD+/A+; i.e. CRAS+) with respect to patients without renal dysfunction and anaemia (RD-/A-). The primary outcome was 30-day mortality, and the secondary outcomes were need for admission, prolonged hospitalisation (>10 days), in-hospital mortality during the index event, and reconsultation and the combination of 30-day post-discharge reconsultation/death. These short-term outcomes were compared and adjusted for differences among groups. RESULTS Of the 13,307 patients analysed, CRAS+ (36.4%) was associated with older age, multiple comorbidities, chronic use of loop diuretics, oedemas and hypotension. The 30-day mortality in CRAS+ was greater than in CRAS- (hazard ratio = 1.46, 95% confidence interval = 1.26-1.68) and RD-/A- (hazard ratio = 1.83, 95% confidence interval = 1.46-2.28) control groups. The mortality level was also higher in RD+/A- (hazard ratio = 1.40, 95% confidence interval = 1.10-1.78) and higher, but not statistically significant, in RD-/A+ (hazard ratio = 1.28, 95% confidence interval = 0.99-1.63) with respect to RD-/A-. All of the secondary outcomes, when related to CRAS- and RD-/A- control groups, were worse for CRAS+ and to a lesser extent, RD+/A-, being more rarely observed in RD-/A+. CONCLUSIONS Cardiorenal anaemia syndrome in acute heart failure is related to greater mortality and worse short-term outcomes, and the impact of renal dysfunction and anaemia seems to be additive.
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Affiliation(s)
- Lluis Llauger
- Emergency Department, Hospital Universitari de Vic, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Spain
| | | | | | | | | | - Pere Llorens
- Emergency Department, Hospital General de Alicante, Spain
| | - Francisco J Martín-Sánchez
- Emergency Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, University of Barcelona, Spain
| | - Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, Spain
| | - José C Ruibal
- Emergency Department, Hospital Universitari de Bellvitge, Spain
| | | | | | - José M Garrido
- Emergency Department, Hospital Virgen de la Macarena, Spain
| | | | | | - Héctor Alonso
- Emergency Department, Hospital Marqués de Valdecilla, Spain
| | - Josep Tost
- Emergency Department, Consorci Hospitalari de Terrassa, Spain
| | - Cristina Gil
- Emergency Department, Hospital Universitario de Salamanca, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona, Spain
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Sabah ZU, Aziz S, Wani JI, Masswary A, Wani SJ. The association of anemia as a risk of heart failure. J Family Med Prim Care 2020; 9:839-843. [PMID: 32318431 PMCID: PMC7114064 DOI: 10.4103/jfmpc.jfmpc_791_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 11/04/2022] Open
Abstract
AIM The present study was conducted to assess the presence of anemia in patients with advanced heart failure (HF) and compared the clinical characteristics of patients with anemia and without anemia. METHODOLOGY The present study was conducted on 102 patients (60 males, 42 females) with advanced HF admitted in hospital. In all, general physical and clinical examinations were performed. All were subjected to complete blood count (CBC), hematocrit, and assessment of urea, creatinine, sodium, potassium, and brain natriuretic peptide (BNP). The levels of serum iron, ferritin, iron saturation, and iron-binding capacity were also evaluated. The causes of HF were assessed. RESULTS Mean age was 48.2 ± 5.7 and 42.2 ± 6.2 years in males and females patients, respectively. Left ventricular ejection fraction (LVEF) was 0.26 ± 0.8 in males and 0.24 ± 0.5 in females. 71.5% males and 76.3% females were on inotropic support. The etiology of HF was ischemia in 29% males and 27% females, high blood pressure in 15% males and 12% females, obesity in 18% males and 19% females, valvular heart disease in 7% males and 5% females, diabetes in 11% males and 6% females, and idiopathy in 20% males and 31% females. There was a significant difference in mean age, initial HB, final HB, hypertension, creatinine, BNP, and initial hematocrit level in patients with anemia and without anemia (P < 0.05). Deaths in hospital were also significant (P < 0.05). CONCLUSION Anemia was seen in one-third of the patients with HF. Anemia was an independent marker with poor prognosis. Anemic patients were older than non-anemic patients.
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Affiliation(s)
- Zia Ul Sabah
- Department of Medicine, College of Medicine Abha, Kingdom of Saudi Arabia
| | - Shahid Aziz
- Department of Medicine, College of Medicine Abha, Kingdom of Saudi Arabia
| | - Javed Iqbal Wani
- Department of Medicine, College of Medicine Abha, Kingdom of Saudi Arabia
| | - Adel Masswary
- Consultant Interventional Cardiologist, Head of Department of Cardiology, Aseer Central Hospital Abha, Kingdom of Saudi Arabia
| | - Saleem Javaid Wani
- PG Student MD (Medicine), Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir
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Krittanawong C, Kumar A, Wang Z, Johnson KW, Rastogi U, Narasimhan B, Kaplin S, Virk HUH, Baber U, Tang W, Lansky AJ, Stone GW. Predictors of In-Hospital Mortality after Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:251-257. [PMID: 31759517 DOI: 10.1016/j.amjcard.2019.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
The development of aortic valve stenosis is strongly associated with older adults. Patients who undergo transcatheter aortic valve implantation (TAVI) for severe aortic stenosis frequently have heart failure (HF). We investigated the predictors of mortality after TAVI according to the presence of HF, and specifically HF with preserved ejection fraction (HFpEF) versus HF with reduced ejection fraction (HFrEF). Patients were identified from the Nationwide Inpatient Sample registry from January 2011 to September 2015 using the ICD-9 codes. Patients with HF who underwent TAVI were classified according to whether they were diagnosed with HFrEF or HFpEF. The principal outcome of interest was in-hospital mortality. Multivariable analysis was used to adjust for potential baseline confounders. Among 11,609 patients undergoing TAVI, 6,368 (54.9%) had baseline HF, including 4,290 (67.4%) with HFpEF and 2,078 (32.6%) with HFrEF. In TAVI patients with HF, in-hospital mortality was also not significantly different in those with HFrEF compared with HFpEF (3.66% vs 3.17%, respectively; adjusted odds ratio 1.14, 95% confidence interval 0.84 to 1.53; p = 0.38). Polyvalvular heart disease was an additional independent predictor of in-hospital mortality in HFrEF, whereas age, liver disease, and the absence of depression and anemia were additional independent predictors of mortality in HFpEF. In conclusion, baseline HF in patients undergoing TAVI is prevalent and is more commonly due to HFpEF than HFrEF. Mortality is similar in those with HFrEF and HFpEF. Knowledge of the specific predictors of mortality after TAVI in HF patients may be useful for patient selection and prognostic guidance.
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Michalak SS, Rupa-Matysek J, Hus I, Gil L. Unexplained anemia in the elderly - a real life analysis of 981 patients. Arch Med Sci 2020; 16:834-841. [PMID: 32542085 PMCID: PMC7286331 DOI: 10.5114/aoms.2019.82723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/06/2019] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION We aimed to analyze the prevalence of unexplained anemia (UA) and assess its characteristics, potential causes and impact on survival in an elderly population. MATERIAL AND METHODS Medical files of 981 patients aged ≥ 60 years consulted in one primary medical clinic in Poland in 2013-2014 were retrospectively analyzed. Anemia, defined according to WHO criteria, diagnosed during either hospitalization or outpatient treatment, from the age of 60, was included. Unexplained anemia was diagnosed if, based on available clinical data and laboratory tests and other assessments in medical records, none of the well-known types of anemia were identified. RESULTS Of 981 patients with anemia, UA was found in 48 (28.4%) patients (4.9% of those studied) and incidence increased with age (≥ 80 years, 12.3%). In 81.3% no full hematological diagnostics were performed. Patients with UA, as with those with defined anemia, when compared to the group without anemia were older, had more co-morbidities, were more frequently hospitalized, more frequently had dementia syndrome and obtained lower Barthel scores (p < 0.0001). In the groups of patients with UA and defined anemia, there were more deaths than in those without anemia (10% vs. 13% vs. 2%, p < 0.0001) with significant differences in survival rates observed during 3-year follow-up. CONCLUSIONS The increasing incidence with age of UA in the elderly population, insufficient diagnosis and the higher mortality of patients with UA in comparison to the group without anemia indicate the need to develop recommendations for its management by primary care physicians.
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Affiliation(s)
- Sylwia S. Michalak
- Department of Pharmacology and Toxicology, Faculty of Medicine and Health Science, University of Zielona Gora, Zielona Gora, Poland
- Corresponding author: Sylwia S. Michalak PhD, Department of Pharmacology and Toxicology, Faculty of Medicine and Health Science, University of Zielona Gora, 28 Zyty St, 65-046 Zielona Gora, Poland, Phone: +48 502 857 453, E-mail:
| | - Joanna Rupa-Matysek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Iwona Hus
- Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
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Prevalence of, associations with, and prognostic role of anemia in heart failure across the ejection fraction spectrum. Int J Cardiol 2020; 298:59-65. [DOI: 10.1016/j.ijcard.2019.08.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/11/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022]
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A Bayesian Study of the Dynamic Effect of Comorbidities on Hospital Outcomes of Care for Congestive Heart Failure Patients. TECHNOLOGIES 2019. [DOI: 10.3390/technologies7030066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Comorbidities can have a cumulative effect on hospital outcomes of care, such as the length of stay (LOS), and hospital mortality. This study examines patients hospitalized with congestive heart failure (CHF), a life-threatening condition, which, when it coexists with a burdened disease profile, the risk for negative hospital outcomes increases. Since coexisting conditions co-interact, with a variable effect on outcomes, clinicians should be able to recognize these joint effects. In order to study CHF comorbidities, we used medical claims data from the Centers for Medicare and Medicaid Services (CMS). After extracting the most frequent cluster of CHF comorbidities, we: (i) Calculated, step-by-step, the conditional probabilities for each disease combination inside this cluster; (ii) estimated the cumulative effect of each comorbidity combination on the LOS and hospital mortality; and (iii) constructed (a) Bayesian, scenario-based graphs, and (b) Bayes-networks to visualize results. Results show that, for CHF patients, different comorbidity constructs have a variable effect on the LOS and hospital mortality. Therefore, dynamic comorbidity risk assessment methods should be implemented for informed clinical decision making in an ongoing effort for quality of care improvements.
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Yogasundaram H, Chappell MC, Braam B, Oudit GY. Cardiorenal Syndrome and Heart Failure-Challenges and Opportunities. Can J Cardiol 2019; 35:1208-1219. [PMID: 31300181 PMCID: PMC9257995 DOI: 10.1016/j.cjca.2019.04.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/23/2019] [Accepted: 04/07/2019] [Indexed: 02/07/2023] Open
Abstract
Cardiorenal syndromes (CRS) describe concomitant bidirectional dysfunction of the heart and kidneys in which 1 organ initiates, perpetuates, and/or accelerates decline of the other. CRS are common in heart failure and universally portend worsened prognosis. Despite this heavy disease burden, the appropriate diagnosis and classification of CRS remains problematic. In addition to the hemodynamic drivers of decreased renal perfusion and increased renal vein pressure, induction of the renin-angiotensin-aldosterone system, stimulation of the sympathetic nervous system, disruption of balance between nitric oxide and reactive oxygen species, and inflammation are implicated in the pathogenesis of CRS. Medical therapy of heart failure including renin-angiotensin-aldosterone system inhibition and β-adrenergic blockade can blunt these deleterious processes. Renovascular disease can accelerate the progression of CRS. Volume overload and diuretic resistance are common and complicate the management of CRS. In heart failure and CRS being treated with diuretics, worsening creatinine is not associated with worsened outcome if clinical decongestion is achieved. Adjunctive therapy is often required in the management of volume overload in CRS, but evidence for these therapies is limited. Anemia and iron deficiency are importantly associated with CRS and might amplify decline of cardiac and renal function. End-stage cardiac and/or renal disease represents an especially poor prognosis with limited therapeutic options. Overall, worsening renal function is associated with significantly increased mortality. Despite progress in the area of CRS, there are still multiple pathophysiological and clinical aspects of CRS that need further research to eventually develop effective therapeutic options.
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Affiliation(s)
- Haran Yogasundaram
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Mark C Chappell
- Department of Surgery/Hypertension and Vascular Research, Cardiovascular Sciences Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Branko Braam
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
Cardiorenal syndrome commonly refers to the collective dysfunction of heart and kidney resulting in a cascade of feedback mechanism causing damage to both the organs and is associated with adverse clinical outcomes. The pathophysiology of cardiorenal syndrome is complex, multifactorial, and dynamic. Improving the understanding of disease mechanisms will aid in developing targeted pharmacologic and nonpharmacologic therapies for the management of this syndrome. This article discusses the various mechanisms involved in the pathophysiology of the cardiorenal syndrome.
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Affiliation(s)
- Ujjala Kumar
- Division of Nephrology-Hypertension, University of California San Diego, 9500 Gilman Drive# 9111H, La Jolla, CA 92093-9111, USA
| | - Nicholas Wettersten
- Division of Cardiology, University of California San Diego, 9434 Medical Center Drive, La Jolla, CA 92037, USA
| | - Pranav S Garimella
- Division of Nephrology-Hypertension, University of California San Diego, 9500 Gilman Drive# 9111H, La Jolla, CA 92093-9111, USA.
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The real-life data of hospitalized patients with heart failure: On behalf of the Journey HF-TR study investigators. Anatol J Cardiol 2019; 21:25-30. [PMID: 30587703 PMCID: PMC6382896 DOI: 10.14744/anatoljcardiol.2018.50880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Acute heart failure (AHF) is a life-threatening clinical syndrome characterized by rapid onset of heart failure (HF) symptoms and signs and requires urgent therapy. The aim of the present study was to evaluate the overall clinical characteristics, management, and in-hospital outcomes of hospitalized patients with AHF in a large sample of Turkish population. METHODS The Journey HF-TR study is a cross-sectional, multicenter, non-invasive and observational trial. Patients who were hospitalized with a diagnosis of AHF in the intensive care unit (ICU)/coronary care unit and cardiology wards between September 2015 and September 2016 were included in our study. RESULTS A total of 1606 (male: 57.2%, mean age: 67.8±13 years) patients who were diagnosed with AHF were enrolled in the study. Seventeen percent of the patients were admitted to the hospital with a diagnosis of new onset AHF. Hypertension (67%) and coronary artery disease (CAD) (59.6%) were the most frequent underlying diseases. Acute coronary syndrome accompanying HF (14.7%), infection (29.3%), arrhythmia (25.1%), renal dysfunction (23%), and non-compliance with medication (23.8%) were the precipitating factors. The median length of stay in the ICU was 3 days (interquartile range, IQR 1-72) and 7 days (IQR 1-72) for in-hospital journey. The guideline recommended medications were less likely used in our patient population (<73%) before admission and were similar to European and US registers at discharge. The in-hospital mortality rate was 7.6%. Hypertension and CAD were the most frequent underlying diseases in our population similar to other European surveys. Although our study population was younger than other registers, in-hospital mortality was high. CONCLUSION Analyses of such real-world data will help to prepare a national database and distinctive diagnosis and treatment algorithms and to provide observing compliance with the current European Society of Cardiology guidelines for more effective management of HF.
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Kim MC, Kim KH, Cho JY, Lee KH, Sim DS, Yoon HJ, Yoon NS, Hong YJ, Park HW, Kim JH, Ahn Y, Jeong MH, Cho JG, Park JC. Pre-discharge anemia as a predictor of adverse clinical outcomes in patients with acute decompensated heart failure. Korean J Intern Med 2019; 34:549-558. [PMID: 29562736 PMCID: PMC6506743 DOI: 10.3904/kjim.2017.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/30/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND/AIMS The impact of the timing of anemia during hospitalization on future clinical outcomes after surviving discharge from an index heart failure (HF) has been poorly studied in patients with acute decompensated heart failure (ADHF). METHODS A total of 384 surviving patients with acute ADHF were divided into two groups: an anemia group (n = 270, 199 anemia at admission and 71 pre-discharge anemia) and a no anemia group (n = 114). All-cause mortality and HF re-hospitalization were compared between groups. RESULTS During the follow-up period (median, 528 days), death occurred in 60 patients (15.6%) and HF re-hospitalization occurred in 131 patients (34.1%). Overall anemia was associated with increased mortality (hazard ratio [HR], 1.74; 95% confidence interval [CI], 1.03 to 3.01; p = 0.039), but not HF re-hospitalization (HR, 0.92; 95% CI, 0.59 to 1.42; p = 0.707). Pre-discharge anemia was significantly associated with increased mortality (HR, 1.68; 95% CI, 1.01 to 2.82; p = 0.048), but anemia at admission did not predict increased mortality or re-hospitalization. CONCLUSION Pre-discharge anemia, rather than anemia at admission, was identified as an independent predictor of mortality in patients with ADHF after surviving discharge. The results of the present study suggest that the identification and optimal management of anemia during hospitalization are important in patients with ADHF.
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Affiliation(s)
- Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Correspondence to Kye Hun Kim, M.D. Department of Cardiology, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6978 Fax: +82-62-223-3105 E-mail:
| | - Jae Yeong Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ki Hong Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Nam Sik Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
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Edmonston D, Morris JD, Middleton JP. Working Toward an Improved Understanding of Chronic Cardiorenal Syndrome Type 4. Adv Chronic Kidney Dis 2018; 25:454-467. [PMID: 30309463 DOI: 10.1053/j.ackd.2018.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 12/17/2022]
Abstract
Chronic diseases of the heart and of the kidneys commonly coexist in individuals. Certainly combined and persistent heart and kidney failure can arise from a common pathologic insult, for example, as a consequence of poorly controlled hypertension or of severe diffuse arterial disease. However, strong evidence is emerging to suggest that cross talk exists between the heart and the kidney. Independent processes are set in motion when kidney function is chronically diminished, and these processes can have distinct adverse effects on the heart. The complex chronic heart condition that results from chronic kidney disease (CKD) has been termed cardiorenal syndrome type 4. This review will include an updated description of the cardiac morphology in patients who have CKD, an overview of the most likely CKD-sourced culprits for these cardiac changes, and the potential therapeutic strategies to limit cardiac complications in patients who have CKD.
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van den Berge JC, Constantinescu AA, van Domburg RT, Brankovic M, Deckers JW, Akkerhuis KM. Renal function and anemia in relation to short- and long-term prognosis of patients with acute heart failure in the period 1985-2008: A clinical cohort study. PLoS One 2018; 13:e0201714. [PMID: 30086179 PMCID: PMC6080795 DOI: 10.1371/journal.pone.0201714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/21/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Renal dysfunction and anaemia are common in patients with acute heart failure (HF). It is not known whether their combined presence has additive prognostic value. We investigated their prognostic value separately and in combination, on prognosis in acute HF patients. Furthermore, we examined whether the improvement in prognosis was comparable between patients with and without renal dysfunction. METHODS AND RESULTS This prospective registry includes 1783 patients admitted to the (Intensive) Coronary Care Unit for acute HF in the period of 1985-2008. The outcome measure was the composite of all-cause mortality, heart transplantation and left ventricular assist device implantation. In patients without renal dysfunction, anemia was associated with worse 30-day outcome (HR 2.91; [95% CI 1.69-5.00]), but not with 10-year outcome (HR 1.13 [95% CI 0.93-1.37]). On the contrary, anemia was found to influence prognosis in patients with renal dysfunction, both at 30 days (HR 1.93 [95% CI 1.33-2.80]) and at 10 years (HR 1.27 [95% CI 1.10-1.47]). Over time, the 10-year survival rate improved in patients with preserved renal function (HR 0.73 [95% CI 0.55-0.97]), but not in patients with renal dysfunction. CONCLUSION The long-term prognosis of acute HF patients with a preserved renal function was found to have improved significantly. However, the prognosis of patients with renal dysfunction did not change. Anemia was a strong prognosticator for short-term outcome in all patients. In patients with renal dysfunction, anemia was also associated with impaired long-term prognosis.
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Affiliation(s)
- Jan C. van den Berge
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, the Netherlands
- * E-mail:
| | | | - Ron T. van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, the Netherlands
| | - Milos Brankovic
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, the Netherlands
| | - Jaap W. Deckers
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, the Netherlands
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Michalak SS, Rupa-Matysek J, Gil L. Comorbidities, repeated hospitalizations, and age ≥ 80 years as indicators of anemia development in the older population. Ann Hematol 2018; 97:1337-1347. [PMID: 29633008 PMCID: PMC6018572 DOI: 10.1007/s00277-018-3321-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/30/2018] [Indexed: 12/12/2022]
Abstract
Anemia represents a common condition among the elderly; however, its prevalence and causes are not well known. This retrospective analysis was performed on 981 patients aged ≥ 60 in Poland over 2013-2014. The prevalence of anemia was 17.2% and increased with age. The predominant causes of anemia were the following: anemia of chronic disease (33.1%), unexplained anemia (28.4%), deficiency anemia (22.5%, including iron deficiency 13%), and chemo-/radiotherapy-induced anemia (8.9%). In the multivariate logistic regression model, factors increasing the risk of anemia were the following: age ≥ 80 years (OR 2.29; 95%CI 1.19-4.42; P = 0.013), the number of comorbidities (two diseases OR 2.85; 95%CI 1.12-7.30; P = 0.029, three diseases OR 6.28; 95%CI 2.22-17.76; P = 0.001, four diseases OR 4.64; 95%CI 1.27-17.01; P = 0.021), and hospitalizations (OR 1.34; 95%CI 1.13-1.58; P = 0.001). After a 2-year follow-up, the cumulative survival among patients without anemia in relation to the group with anemia was 90.76 vs. 78.08% (P < 0.001). In the multivariate model, anemia (HR 3.33, 95%CI 1.43-7.74, P = 0.005), heart failure (HR 2.94, 95%CI 1.33-6.50, P = 0.008), and cancer (HR 3.31, 95%CI 1.47-7.49, P < 0.004) were all significantly correlated with mortality. In patients ≥ 60 years, the incidence of anemia increases with age, number of comorbidities, and frequency of hospitalizations and has an adverse impact on survival.
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Affiliation(s)
- Sylwia Sulimiera Michalak
- Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznań, Poland
| | - Joanna Rupa-Matysek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznań, Poland.
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznań, Poland
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Honda S, Nagai T, Nishimura K, Nakai M, Honda Y, Nakano H, Iwakami N, Sugano Y, Asaumi Y, Aiba T, Noguchi T, Kusano K, Yokoyama H, Ogawa H, Yasuda S, Anzai T. Long-term prognostic significance of urinary sodium concentration in patients with acute heart failure. Int J Cardiol 2018; 254:189-194. [DOI: 10.1016/j.ijcard.2017.08.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/12/2017] [Accepted: 08/21/2017] [Indexed: 01/31/2023]
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Donzé J, Labarère J, Méan M, Jiménez D, Aujesky D. Prognostic importance of anaemia in patients with acute pulmonary embolism. Thromb Haemost 2017; 106:289-95. [DOI: 10.1160/th11-04-0208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 05/12/2011] [Indexed: 11/05/2022]
Abstract
SummaryAlthough associated with adverse outcomes in other cardiopulmonary diseases, limited evidence exists on the prognostic value of anaemia in patients with acute pulmonary embolism (PE). We sought to examine the associations between anaemia and mortality and length of hospital stay in patients with PE. We evaluated 14,276 patients with a primary diagnosis of PE from 186 hospitals in Pennsylvania, USA. We used random-intercept logistic regression to assess the association between anaemia at the time of presentation and 30-day mortality and discretetime logistic hazard models to assess the association between anaemia and time to hospital discharge, adjusting for patient (age, gender, race, insurance type, clinical and laboratory variables) and hospital (region, size, teaching status) factors. Anaemia was present in 38.7% of patients at admission. Patients with anaemia had a higher 30-day mortality (13.7% vs. 6.3%; p <0.001) and a longer length of stay (geometric mean, 6.9 vs. 6.6 days; p <0.001) compared to patients without anaemia. In multivariable analyses, anaemia remained associated with an increased odds of death (OR 1.82, 95% CI: 1.60–2.06) and a decreased odds of discharge (OR 0.85, 95% CI: 0.82–0.89). Anaemia is very common in patients presenting with PE and is independently associated with an increased short-term mortality and length of stay.
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Mearin F, Lanas Á, Bujanda L, Canelles P, Cotter J, Hervás A, Martín de Argila C, Montoro M, Gisbert JP. Open questions and misconceptions in the diagnosis and management of anemia in patients with gastrointestinal bleeding. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 41:63-76. [PMID: 29107389 DOI: 10.1016/j.gastrohep.2017.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/17/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
Abstract
Despite high prevalence of iron deficiency anemia (IDA) in patients with acute or chronic gastrointestinal bleeding (GIB), IDA and iron deficiency (ID) are frequently untreated. Reasons may be misconceptions about the impact and diagnosis of IDA and the efficacy of new treatments. Addressing these misconceptions, this article summarizes current evidence for better understanding and management of GIB-associated IDA. Despite only few controlled studies evaluated the efficacy of iron treatment in patients with GIB, there is consistent evidence suggesting that: (a) IDA should be diligently investigated, (b) effective treatment of ID/IDA improves outcomes such as health-related quality of life and can avoid severe cardiovascular consequences, and (c) intravenous iron should be considered as well-tolerated treatment in this setting. Overall, the misconceptions and practices outlined in this article should be replaced with strategies that are more in line with current guidelines and best practice in GIB and other underlying conditions of ID/IDA.
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Affiliation(s)
- Fermín Mearin
- Servicio de Gastroenterología, Centro Médico Teknon, Barcelona, España
| | - Ángel Lanas
- Servicio de Enfermedades Digestivas, Hospital Universitario, Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínico Universitario, Zaragoza, España
| | - Luis Bujanda
- Departamento de Gastroenterología, Hospital Donostia/Instituto Biodonostia; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Universidad del País Vasco (UPV/EHU), San Sebastián, España
| | - Pilar Canelles
- Servicio de Patología Digestiva, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - José Cotter
- Departamento de Gastroenterología, Hospital da Senhora da Oliveira, Guimarães, Portugal; Instituto de Investigación en Ciencias de la Vida y la Salud (ICVS), Escuela de Ciencias de la Salud, Universidad de Minho, Portugal; ICVS/3B's, Laboratorio Asociado al Gobierno de Portugal, Braga/Guimarães, Portugal
| | - Antonio Hervás
- Servicio de Digestivo, Hospital Universitario Reina Sofía, Córdoba, España
| | - Carlos Martín de Argila
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - Miguel Montoro
- Departamento de Gastroenterología, Hospital General San Jorge, Huesca, España
| | - Javier P Gisbert
- Servicio de Aparato Digestivo, Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España.
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Abebe TB, Gebreyohannes EA, Bhagavathula AS, Tefera YG, Abegaz TM. Anemia in severe heart failure patients: does it predict prognosis? BMC Cardiovasc Disord 2017; 17:248. [PMID: 28915848 PMCID: PMC5603085 DOI: 10.1186/s12872-017-0680-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/08/2017] [Indexed: 01/04/2023] Open
Abstract
Background Anemia is highly prevalent in heart failure (HF) patients. However, the prevalence, clinical impact and prognostic factor of anemia in heart failure patients is widely varies. The aim of this study was to evaluate the prevalence of anemia in patients with HF, to compare baseline clinical characteristic and outcomes of severe HF patients with and without anemia admitted to Gondar University Referral Hospital (GURH), Gondar, Ethiopia. Method A retrospective cohort study was conducted and we assessed medical records of heart failure patients who were admitted Gondar University Referral Hospital in the period between December 02, 2010 and November 30, 2016. Kaplan Meier curve was used to analyze the survival status and log rank test was used to compare the curves. Multivariate Cox regression was used to analyze independent predictors of mortality in all HF patients. P value less than 0.05 was considered statistically significant. Result Three hundred and seventy patients participated in the study. The prevalence of anemia in the study cohorts was 41.90% and majority of the participants were females (64.59%). There was a significant difference in the level of hemoglobin, creatinine, and sodium among anemic and non-anemic patients. Anemic patients with HF tend to take angiotensin converting enzyme inhibitors (ACEI) less frequently. Kaplan Meier survival curves and Log rank test (P = 0.042) showed a significant difference in the prognosis of HF patients with anemia and non – anemic. More significant difference was observed (Log rank test, P = 0.001) in the study participants based on hemoglobin level. Furthermore, multivariate Cox regression showed: advanced age, levels of lower sodium and higher creatinine, and absences of medications like ACEI and Spironolactone independently predicted overall mortality. Conclusion HF patients with anemia tend to be older age, had lower hemoglobin and sodium level and higher creatinine value. Moreover, there was a significant difference in the prognosis between study cohorts, as anemic pateints tend to have a worse survival status . Even though, anemia is a significant risk marker, it is not an independent predictor of mortality in the current study.
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Affiliation(s)
- Tamrat Befekadu Abebe
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. .,Master's program in Health Economics, Policy and Management, Student, Department of Learning Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Sweden.
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Akshaya Srikanth Bhagavathula
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yonas Getaye Tefera
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Melaku Abegaz
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Migone de Amicis M, Chivite D, Corbella X, Cappellini MD, Formiga F. Anemia is a mortality prognostic factor in patients initially hospitalized for acute heart failure. Intern Emerg Med 2017; 12:749-756. [PMID: 28233161 DOI: 10.1007/s11739-017-1637-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/09/2017] [Indexed: 12/30/2022]
Abstract
Anemia is a risk factor related to morbidity and mortality in patients with chronic heart failure (HF). Less is known about its influence in patients in an early stage of HF. Our aim is to investigate the prognostic role of anemia in patients initially hospitalized for acute HF. We reviewed all consecutive patients admitted within a 18-month period with a main diagnosis of acute HF. We collected demographic, clinical and treatment data. Anemia is defined as Hemoglobin <12/13 g/dL upon admission in female/male patients, respectively. 719 patients were included (55.5% female), with a mean age of 78.7 ± 9 years. Anemia was present in 59.6% of patients upon admission, with a mean Hb of 10.4 ± 1.4 g/dL. Multivariate analysis confirms the relationship between the presence of anemia and older age, a previous diagnostic history of diabetes, and the presence of chronic kidney disease. In-hospital mortality is similar for anemic and non-anemic patients (6.8 vs 3.8%, p = n.s.) However, the difference is significant when one-year mortality is evaluated (31% in anemic patients vs 19% in non-anemic patients, p < 0.001). Cox regression analysis confirms the association between anemia and higher risk of one-year mortality, as well as with older age and a higher Charlson comorbidity index. Our study confirms that the presence of anemia is an independent factor for mid-term (1-year) mortality even in patients experiencing a first admission due to acute HF.
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Affiliation(s)
- Margherita Migone de Amicis
- Scuola di Specializzazione in Medicina Interna, Università degli Studi di Milano, Milan, Italy.
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy.
| | - David Chivite
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maria Domenica Cappellini
- Scuola di Specializzazione in Medicina Interna, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Kajimoto K, Minami Y, Sato N, Otsubo S, Kasanuki H. Gender Differences in Anemia and Survival in Patients Hospitalized for Acute Decompensated Heart Failure With Preserved or Reduced Ejection Fraction. Am J Cardiol 2017; 120:435-442. [PMID: 28583679 DOI: 10.1016/j.amjcard.2017.04.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/26/2017] [Accepted: 04/26/2017] [Indexed: 11/17/2022]
Abstract
In patients with acute decompensated heart failure (HF), the influence of gender on anemia, left ventricular ejection fraction (EF), and outcomes is unclear. We evaluated the association of anemia and left ventricular EF with survival in men or women hospitalized for acute decompensated HF. Of the 4,842 patients enrolled in the Acute Decompensated Heart Failure Syndromes registry, 4,215 patients (2,450 men and 1,765 women) discharged alive after hospitalization for acute decompensated HF were enrolled to evaluate the association of gender, anemia (hemoglobin <13.0 g/dl for men and <12.0 g/dl for women) at discharge, and a preserved or reduced EF with all-cause death or cardiac death after discharge. Men or women were divided into 4 groups based on left ventricular EF (preserved or reduced EF) and anemia status at discharge. The median follow-up period after discharge was 524 days (384 to 791). After adjustment for multiple co-morbidities, there was no adverse influence of anemia in men with a preserved EF, whereas anemia was an independent predictor of all-cause death in men with a reduced EF. Conversely, anemia was an independent predictor of all-cause death in women with a preserved EF but not in women with a reduced EF. With respect to cardiac death, multivariable analyses revealed highly similar trends as those for all-cause death in patients of both genders. In conclusion, in acute decompensated patients with HF with a preserved or reduced EF, there were marked differences between men and women with respect to the association of anemia and left ventricular EF with survival.
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Affiliation(s)
| | - Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoki Sato
- Department of Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | - Shigeru Otsubo
- Department of Blood Purification, Tohto Sangenjaya Clinic, Tokyo, Japan
| | - Hiroshi Kasanuki
- Department of Bioscience and Biotechnology, Faculty of Science and Engineering, Waseda University, Tokyo, Japan
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Lee WC, Fang HY, Chen HC, Chen CJ, Yang CH, Hang CL, Wu CJ, Fang CY. Anemia: A significant cardiovascular mortality risk after ST-segment elevation myocardial infarction complicated by the comorbidities of hypertension and kidney disease. PLoS One 2017; 12:e0180165. [PMID: 28749948 PMCID: PMC5531517 DOI: 10.1371/journal.pone.0180165] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/09/2017] [Indexed: 02/07/2023] Open
Abstract
Background The effect of anemia on patients with ST-segment elevation myocardial infarction (STEMI) remains a controversial issue. The aim of this study was to explore the effect of anemia on STEMI patients. Methods and results From January 2005 to December 2014, 1751 patients experienced STEMI checked serum hemoglobin initially before any administration of fluids or IV medications. 1751 patients then received primary percutaneous intervention immediately. A total of 1388 patients were enrolled in the non-anemia group because their serum hemoglobin level was more than 13 g/L in males, and 12 g/L in females. A total of 363 patients were enrolled in the anemia group because their serum hemoglobin level was less than 13 g/L in males, and 12 g/L in females. Higher incidences of major adverse cerebral cardiac events (22.9% vs. 33.8%; p<0.001) were also noted in the anemia group, and these were related to higher incidence of cardiovascular mortality (6.5% vs. 20.4%; p<0.001). A higher incidence of all-cause mortality (8.6% vs. 27.7%; p<0.001) was also noted in the anemia group. A Kaplan-Meier curve of one-year cardiovascular mortality showed significant differences between the non-anemia and anemia group in all patients (P<0.001), and the patients with hypertension (P<0.001), and chronic kidney disease (CKD) (P = 0.011). Conclusion Anemia is a marker of an increased risk in one-year cardiovascular mortality in patients with STEMI. If the patients have comorbidities such as hypertension, or CKD, the effect of anemia is very significant.
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Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
- * E-mail:
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
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Tymińska A, Kapłon-Cieślicka A, Ozierański K, Peller M, Balsam P, Marchel M, Crespo-Leiro MG, Maggioni AP, Jankowska EA, Drożdż J, Filipiak KJ, Opolski G. Anemia at Hospital Admission and Its Relation to Outcomes in Patients With Heart Failure (from the Polish Cohort of 2 European Society of Cardiology Heart Failure Registries). Am J Cardiol 2017; 119:2021-2029. [PMID: 28434647 DOI: 10.1016/j.amjcard.2017.03.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/30/2022]
Abstract
Anemia is a commonly observed co-morbidity in heart failure (HF). The aim of the study was to assess prevalence, risk factors for, and effect of anemia on short- and long-term outcomes in HF. The study included 1,394 Caucasian patients hospitalized for HF, with known hemoglobin concentration on hospital admission, participating in 2 HF registries of the European Society of Cardiology (Pilot and Long-Term). Anemia was defined as hemoglobin concentration of <13 g/dl for men and <12 g/dl for women. Primary end points were (1) all-cause death at 1 year and (2) a composite of all-cause death and rehospitalization for HF at 1 year. Secondary end points included inter alia death during index hospitalization. In addition, we investigated the effect of changes in hemoglobin concentration during hospitalization on prognosis. Anemia occurred in 33% of patients. Predictors of anemia included older age, diabetes, greater New York Heart Association class at hospital admission and kidney disease. During 1-year follow-up, 21% of anemic and 13% of nonanemic patients died (p <0.0001). Combined primary end point occurred in 45% of anemic and in 33% of nonanemic patients (p <0.0001). Anemia was strongly predictive of all the prespecified clinical end points in univariate analyses but not in multivariate analyses. Changes in hemoglobin concentration during hospitalization had no effect on 1-year outcomes. In conclusion, anemia was present in 1/3 of patients with HF. Mild-to-moderate anemia seems more a marker of older age, worse clinical condition, and a higher co-morbidity burden, rather than an independent risk factor in HF.
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Affiliation(s)
- Agata Tymińska
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Michał Peller
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Balsam
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Marchel
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Maria G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Universitario, A Coruña, La Coruña, Spain
| | - Aldo P Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | - Ewa A Jankowska
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wrocław, Poland
| | - Jarosław Drożdż
- Department of Cardiology, Medical University of Łódź, Łódź, Poland
| | | | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Son YJ, Kim BH. Prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure. Eur J Cardiovasc Nurs 2017; 16:687-695. [DOI: 10.1177/1474515117710154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Anemia is a frequent comorbidity in patients with heart failure. However, the incidence of anemia in patients with heart failure varies widely, and there is limited evidence on the association between anemia and rehospitalization and on the health consequences of anemia in patients with heart failure. Aims: We aimed to identify the prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure. Methods: This cross-sectional study included 284 patients with heart failure diagnosed at outpatient cardiology clinics at a tertiary care university hospital in Cheonan, South Korea. We obtained socio-demographic and clinical information, including frequency of readmissions and emergency department visits, using face-to-face interviews and medical record reviews. Results: The prevalence of anemia, defined based on World Health Organization guidelines, was 39.1% among patients with heart failure. Anemia was significantly more prevalent among patients with one or more re-admissions or emergency department visits compared with patients with no history of hospital re-admissions or emergency department visits (42.7% vs. 13.9% ( p = 0.001) and 55.1% vs. 34% ( p = 0.002) respectively). Anemia increased the risk of hospital readmission (odds ratio =8.04, 95% confidence interval, 2.19–29.54) and emergency department visit (odds ratio=2.37, 95% confidence interval, 1.22–4.60) in patients with heart failure. Conclusion: It is imperative that patients with heart failure presenting with anemia undergo appropriate nursing assessment and intervention. Future prospective studies targeting interventions to improve anemia are required to determine whether anemia influences readmission rates and emergency department visits.
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Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Bo Hwan Kim
- College of Nursing, Gachon University, Incheon, Korea
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Tim Goodnough L, Comin-Colet J, Leal-Noval S, Ozawa S, Takere J, Henry D, Javidroozi M, Hohmuth B, Bisbe E, Gross I, Shander A. Management of anemia in patients with congestive heart failure. Am J Hematol 2017; 92:88-93. [PMID: 27779769 DOI: 10.1002/ajh.24595] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/19/2016] [Accepted: 10/23/2016] [Indexed: 12/21/2022]
Abstract
Anemia is an independent risk factor for adverse patient outcomes. There are no guidelines for management of anemia in patients with congestive heart failure (CHF), despite its high incidence. Four objectives were defined by the International Anemia Management and Clinical Outcomes Expert Panel (AMCO), a multinational group of interdisciplinary experts identified by the Society for the Advancement of Blood Management (SABM) to: determine the prevalence of anemia in outpatients; to determine the prevalence of hospital-acquired anemia; to assess the impact of anemia management on clinical outcomes such as quality of life and functional status; and to provide recommendations for primary care physicians and specialists for the diagnosis, evaluation, and management of anemia in patients with CHF. Anemia and iron deficiency were confirmed to be highly prevalent in patients with CHF. Intravenous iron therapy improves anemia, cardiac function and exercise tolerance, leading to improvement in quality of life. Anemia management has been demonstrated to be cost-effective. Clinical care pathways to manage anemia in patients with CHF are recommended as best practices in order to improve patient outcomes. Am. J. Hematol. 92:88-93, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Josep Comin-Colet
- Department of Cardiology; Heart Failure Program, Bellvitge University Hospital and Biomedical Research Institute, Hospitalet de Liobregat; Barcelona Spain
| | - Santiago Leal-Noval
- Department of Critical Care, Critical Care Division; University Hospital “Virgen delRocío” Avda Manuel Siurot s/n; Seville Spain
| | - Sherri Ozawa
- Institute for Patient Blood Management and Bloodless Medicine and Surgery; Englewood Hospital and Medical Center; Englewood New Jersey
| | - Jacqueline Takere
- Department of Pharmacy, ASHP Pharmacy Residency Program, Investigation Drug Services; Clinical Coordinator for Pharmacy and Therapeutics/Oncology Services; Englewood New Jersey
| | - David Henry
- Department of Medicine; Penn Hematology/Oncology Abramson Cancer Center, Pennsylvania Hospital; Philadelphia Pennsylvania
| | - Mazyar Javidroozi
- Department of Anesthesiology; Englewood Hospital and Medical Center; Englewood New Jersey
| | - Benjamin Hohmuth
- Department of Hospital Medicine; Temple University School of Medicine, Representing Society of Hospital Medicine; Philadelphia Pennsylvania
| | - Elvira Bisbe
- Department of Anaesthesiology and Reanimation; Hospital Universitaridel Mar; Barcelona Spain
- Perioperative Medicine Research Group; Hospital del Mar Medical Research Institute. IMIM Coordination of Anemia Working Group España; Spain
| | - Irwin Gross
- Senior medical director; Accumen LLC; San Diego California
| | - Aryeh Shander
- Medicine and Surgery, Icahn School of Medicine; New York New York
- Department of Anesthesiology, Critical Care, Pain and Hyperbaric medicine, Englewood Hospital and Medical Center; TeamHealth Research Institute; Englewood New Jersey
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Cernea S. Heart Failure and Chronic Kidney Disease in Type 2 Diabetes. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Complex hemodynamic, neurohormonal and biochemical changes occur in heart failure and chronic kidney disease, and hyperglycemia/diabetes further accentuate the multifactorial pathogenetic mechanisms. The acknowledgement of concomitant heart and kidney dysfunction in patients with type 2 diabetes has major clinical implications with regards to prognosis, as they significantly increase the risk of mortality, and to therapeutical strategy of both conditions, as well as of hyperglycemia. A comprehensive interdisciplinary approach is needed in these cases in order to improve the outcomes.
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Affiliation(s)
- Simona Cernea
- Department M3/Internal Medicine IV, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
- Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
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The association between in-hospital hemoglobin changes, cardiovascular events, and mortality in acute decompensated heart failure: Results from the ESCAPE trial. Int J Cardiol 2016; 222:531-537. [DOI: 10.1016/j.ijcard.2016.07.264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/12/2016] [Accepted: 07/30/2016] [Indexed: 11/20/2022]
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Kajimoto K, Sato N, Takano T. Association of anemia and renal dysfunction with in-hospital mortality among patients hospitalized for acute heart failure syndromes with preserved or reduced ejection fraction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:89-99. [PMID: 26124457 DOI: 10.1177/2048872615593387] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the association of anemia and renal dysfunction with in-hospital outcomes in acute heart failure syndromes patients with preserved or reduced ejection fraction. METHODS AND RESULTS Of the 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 4693 patients were evaluated to investigate the association among anemia, renal dysfunction, a preserved or reduced ejection fraction and in-hospital mortality. They were divided into four groups based on hemoglobin and estimated glomerular filtration rate at admission. The in-hospital mortality rate was 5.9% and 6.9% of the preserved and reduced ejection fraction groups, respectively. After adjustment for multiple comorbidities, there was no association of either anemia or renal dysfunction alone with in-hospital mortality in preserved ejection fraction patients, but the combination of anemia and renal dysfunction was associated with a somewhat higher risk of in-hospital mortality than that without either condition (odds ratio (OR), 2.75; 95% confidence interval (CI), 0.72-10.41; p=0.137). In reduced ejection fraction patients, adjusted analysis showed that a significantly higher risk of in-hospital mortality was associated with anemia alone (OR, 2.56; 95% CI, 1.10 -5.94; p=0.029) and with anemia plus renal dysfunction (OR, 2.34; 95% CI, 1.09-5.03; p=0.029) relative to the risk without either condition. CONCLUSIONS Our findings demonstrate that anemia combined with renal dysfunction is not a risk factor for in-hospital mortality in patients with a preserved ejection fraction, whereas anemia is an independent predictor of in-hospital mortality risk in reduced ejection fraction patients regardless of renal dysfunction.
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Affiliation(s)
| | - Naoki Sato
- 2 Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | - Teruo Takano
- 3 Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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Baseline characteristics of patients with heart failure and preserved ejection fraction at admission with acute heart failure in Saudi Arabia. Egypt Heart J 2016; 69:21-28. [PMID: 29622951 PMCID: PMC5839361 DOI: 10.1016/j.ehj.2016.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/16/2016] [Accepted: 08/12/2016] [Indexed: 01/06/2023] Open
Abstract
Heart failure and preserved ejection fraction (HFpEF) is defined as heart failure symptoms and signs with a normal or near-normal ejection fraction (EF) with evidence of diastolic dysfunction. The few Middle Eastern studies that have been conducted were designed to compare patients with heart failure reduced ejection fraction (HFrEF) and HFpEF.The aim of this study was to study Saudi patients with HFpEF who presented with acute heart failure, and define their clinical characteristics and the signs and symptoms of heart failure, echocardiographic findings and medications at admission and at hospital discharge. Methods This is a prospective observational study in which patients were included following an acute heart failure presentation with N-terminal pro-BNP (NT-proBNP) > 300 ng/L and left ventricular ejection fraction (LVEF) > 50%. They were admitted to the coronary care unit of king Saud medical city from the period of March 2015 to September 2015. Results 114 patients were enrolled in the study and assessed at acute admission. Of these, 4% died on day one of admission.The mean ± SD age of 109 included patients was 59 ± 8 years and 55% were women. Hypertension (64%), dyslipidemia (76%), atrial tachyarrhythmia (38%), prior heart failure (33%) and anemia (35%), median NT-proBNP was 2490 ± 125 ng/l at admission. Mean (LVEF) was 61 ± 3, mean LV mass index was 118 ± 11, mean E/e' was 12.2 ± 2, and left atrial volume index was 47 ± 7 mL/m2. Mean global left ventricular strain was -13.5 ± 1.5. At discharge the majority of patients were still symptomatic with high NT-proBNP 542 ± 266. Conclusions Patients with HFpEF were old with slight female dominance, a high rate of hypertension, diabetes, dyslipidemia and much comorbidity. LVEF was preserved despite depressed left ventricular longitudinal and diastolic functions with high filling pressure. At discharge the patients were still symptomatic calling for further research to reach the best strategy for proper management.
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Wang CC, Chang HY, Yin WH, Wu YW, Chu PH, Wu CC, Hsu CH, Wen MS, Voon WC, Lin WS, Huang JL, Chen SM, Yang NI, Chang HC, Chang KC, Sung SH, Shyu KG, Lin JL, Mar GY, Chan KC, Kuo JY, Wang JH, Chen ZC, Tseng WK, Cherng WJ. TSOC-HFrEF Registry: A Registry of Hospitalized Patients with Decompensated Systolic Heart Failure: Description of Population and Management. ACTA CARDIOLOGICA SINICA 2016; 32:400-11. [PMID: 27471353 DOI: 10.6515/acs20160704a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Heart failure (HF) is a medical condition with a rapidly increasing incidence both in Taiwan and worldwide. The objective of the TSOC-HFrEF registry was to assess epidemiology, etiology, clinical management, and outcomes in a large sample of hospitalized patients presenting with acute decompensated systolic HF. METHODS The TSOC-HFrEF registry was a prospective, multicenter, observational survey of patients presenting to 21 medical centers or teaching hospitals in Taiwan. Hospitalized patients with either acute new-onset HF or acute decompensation of chronic HFrEF were enrolled. Data including demographic characteristics, medical history, primary etiology of HF, precipitating factors for HF hospitalization, presenting symptoms and signs, diagnostic and treatment procedures, in-hospital mortality, length of stay, and discharge medications, were collected and analyzed. RESULTS A total of 1509 patients were enrolled into the registry by the end of October 2014, with a mean age of 64 years (72% were male). Ischemic cardiomyopathy and dilated cardiomyopathy were diagnosed in 44% and 33% of patients, respectively. Coronary artery disease, hypertension, diabetes, and chronic renal insufficiency were the common comorbid conditions. Acute coronary syndrome, non-compliant to treatment, and concurrent infection were the major precipitating factors for acute decompensation. The median length of hospital stay was 8 days, and the in-hospital mortality rate was 2.4%. At discharge, 62% of patients were prescribed either angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers, 60% were prescribed beta-blockers, and 49% were prescribed mineralocorticoid receptor antagonists. CONCLUSIONS The TSOC-HFrEF registry provided important insights into the current clinical characteristics and management of hospitalized decompensated systolic HF patients in Taiwan. One important observation was that adherence to guideline-directed medical therapy was suboptimal.
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Affiliation(s)
- Chun-Chieh Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou
| | | | | | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern memorial Hospital, New Taipei City
| | - Pao-Hsien Chu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou
| | - Chih-Cheng Wu
- Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu
| | - Chih-Hsin Hsu
- Institute of Clinical Medicine, National Cheng Kung University, College of Medicine, and National Cheng Kung University Hospital, Tainan
| | - Ming-Shien Wen
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung
| | - Wei-Shiang Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | - Ning-I Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
| | - Heng-Chia Chang
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
| | - Kuan-Cheng Chang
- Division of Cardiovascular Medicine and Cardiovascular Research Laboratory, China Medical University Hospital, Taichung
| | | | - Kou-Gi Shyu
- Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Guang-Yuan Mar
- Division of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Kuei-Chuan Chan
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung
| | - Jen-Yuan Kuo
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
| | - Ji-Hung Wang
- Division of Cardiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien
| | - Zhih-Cherng Chen
- Division of Cardiovascular Medicine, Chimei Medical Center, Tainan
| | - Wei-Kung Tseng
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Wen-Jin Cherng
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
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Stienen S, Salah K, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Tijssen JP, Pinto YM, Kok WE. Targeting N-Terminal Pro-Brain Natriuretic Peptide in Older Versus Younger Acute Decompensated Heart Failure Patients. JACC-HEART FAILURE 2016; 4:736-45. [PMID: 27395353 DOI: 10.1016/j.jchf.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the prognostic value and attainability of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in young and elderly acute decompensated heart failure (ADHF) patients. BACKGROUND Less-effective NT-proBNP-guided therapy in chronic heart failure (HF) has been reported in elderly patients. Whether this can be attributed to differences in prognostic value of NT-proBNP or to differences in attaining a prognostic value is unclear. The authors studied this question in ADHF patients. METHODS Our study population comprised 7 ADHF cohorts. We defined absolute (<1,500 ng/l, <3,000 ng/l, <5,000 ng/l, and <15,000 ng/l) and relative NT-proBNP discharge cut-off levels (>30%, >50%, and >70%). Six-month all-cause mortality after discharge was studied for each level in Cox regression analyses, and compared between elderly (age >75 years) and young patients (age ≤75 years). Thereafter, we compared percentages of elderly and young patients attaining NT-proBNP levels (= attainability). RESULTS A total of 1,235 patients (59% male, 45% >75 years of age) was studied. Admission levels of NT-proBNP were significantly higher in elderly versus younger patients. The prognostic value of absolute and relative NT-proBNP levels was similar in elderly and young patients. Attainability was significantly lower in elderly patients for all absolute levels and a >50% relative reduction, but not for >30% and >70%. For absolute levels, attainability differences between age groups were decreased to a large extent after correction for admission NT-proBNP and anemia at discharge. For relative levels, attainability differences disappeared after correction for HF etiology and anemia at discharge. CONCLUSIONS In young and elderly ADHF patients, it is not the prognostic value of absolute and relative NT-proBNP levels that is different, but the attainability of these levels that is lower in the elderly. This can largely be attributed to factors other than age.
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Affiliation(s)
- Susan Stienen
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Khibar Salah
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Luc W Eurlings
- Department of Cardiology, VieCuri Medical Center, Venlo, the Netherlands
| | - Paulo Bettencourt
- Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
| | - Joana M Pimenta
- Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Valerio Verdiani
- Department of Internal Medicine and Emergency, Careggi University Hospital, Florence, Italy
| | - Luca Bettari
- Department of Cardiology, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Valentina Lazzarini
- Department of Cardiology, Ospedale San Pellegrino, Castiglione delle Stiviere, MN, Italy
| | - Jan P Tijssen
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Yigal M Pinto
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Wouter E Kok
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
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Kajimoto K, Sato N, Takano T. Relationship of renal insufficiency and clinical features or comorbidities with clinical outcome in patients hospitalised for acute heart failure syndromes. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:697-708. [DOI: 10.1177/2048872616658586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - Naoki Sato
- Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | - Teruo Takano
- Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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Wu JR, Moser DK, DeWalt DA, Rayens MK, Dracup K. Health Literacy Mediates the Relationship Between Age and Health Outcomes in Patients With Heart Failure. Circ Heart Fail 2016; 9:e002250. [PMID: 26721913 DOI: 10.1161/circheartfailure.115.002250] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have linked frequent rehospitalizations for heart failure (HF) and increased mortality with older age, higher severity of HF, lack of an evidence-based medication regimen, and inadequate health literacy. However, the pathway between age and health outcomes in patients with HF remains unknown. Therefore, the purpose of this study was to test whether the association between age and health outcomes can be explained by severity of HF, evidence-based medication use, and health literacy in patients with HF. METHODS AND RESULTS This was a longitudinal study of 575 rural patients with HF recruited from outpatient clinics and hospitals. Demographics, clinical data, and health literacy were collected at baseline. HF readmissions and cardiac mortality were followed for 2 years; 57% of patients were ≥ 65 years of age. Older patients with HF were more likely to have low health literacy and less likely to be prescribed angiotensin-converting enzyme inhibitors or β-blockers. Using Kaplan-Meier survival curves with log-rank tests, health outcomes were significantly worse in patients who were ≥ 65 years and in those with low health literacy. Separate Cox regressions revealed that age and health literacy predicted worse health outcomes (P = 0.006 and < 0.001, respectively). When health literacy was entered into the model, the hazard ratio for age changed from 1.49 to 1.29 (a 41% reduction); age was no longer a significant predictor of health outcomes, but health literacy remained significant (P < 0.001), demonstrating mediation. CONCLUSIONS Health literacy mediates the relationship between age and health outcomes in adults with HF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00415545.
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Affiliation(s)
- Jia-Rong Wu
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.).
| | - Debra K Moser
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Darren A DeWalt
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Mary Kay Rayens
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Kathleen Dracup
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
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49
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Goldberg JF, Shah MD, Kantor PF, Rossano JW, Shaddy RE, Chiou K, Hanna J, Hagan JL, Cabrera AG, Jeewa A, Price JF. Prevalence and Severity of Anemia in Children Hospitalized with Acute Heart Failure. CONGENIT HEART DIS 2016; 11:622-629. [PMID: 27060888 DOI: 10.1111/chd.12355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Anemia is common among adult heart failure patients and is associated with adverse outcomes, but data are lacking in children with heart failure. The purpose of this study was to determine the prevalence of anemia in children hospitalized with acute heart failure and to evaluate the association between anemia and adverse outcomes. DESIGN Review of the medical records of 172 hospitalizations for acute heart failure. SETTING Single, tertiary children's hospital. PATIENTS All acute heart failure admissions to our institution from 2007 to 2012. INTERVENTIONS None. OUTCOME MEASURES Composite endpoint of death, mechanical circulatory support deployment, or cardiac transplantation. RESULTS Patients ages ranged in age from 4 months to 23 years, with a median of 7.5 years, IQR 1.2, 15.9. Etiologies of heart failure included: dilated cardiomyopathy (n = 125), restrictive cardiomyopathy (n = 16), transplant coronary artery disease (n = 18), ischemic cardiomyopathy (n = 7), and heart failure after history of congenital heart disease (n = 6). Mean hemoglobin concentration at admission was 11.8 g/dL (±2.0 mg/dL). Mean lowest hemoglobin prior to outcome was 10.8 g/dL (±2.2 g/dL). Anemia (hemoglobin <10 g/dL) was present in 18% of hospitalizations at admission and in 38% before outcome. Anemia was associated with increased risk of death, transplant, or mechanical circulatory support deployment (adjusted odds ratio 1.79, 95% confidence interval = 1.12-2.88, P = .011). For every 1 g/dL increase in the patients' lowest hemoglobin during admission, the odds of death, transplant, or mechanical circulatory support deployment decreased by 18% (adjusted odds ratio = 0.82, 95% confidence interval = 0.74-0.93, P = 0.002). CONCLUSIONS Anemia occurs commonly in children hospitalized for acute heart failure and is associated with increased risk of transplant, mechanical circulatory support, and inhospital mortality.
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Affiliation(s)
| | - Mona D Shah
- Baylor College of Medicine, Houston, Tex, USA
| | | | - Joseph W Rossano
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Penn, USA
| | - Robert E Shaddy
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Penn, USA
| | - Kevin Chiou
- Baylor College of Medicine, Houston, Tex, USA
| | | | | | | | - Aamir Jeewa
- Baylor College of Medicine, Houston, Tex, USA
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50
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Kyriakou M, Kiff P. Prognosis of the comorbid heart failure and Anemia: A systematic review and meta-analysis. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ctrsc.2016.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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