1
|
Bozkurt B. Successful Decongestion as a Clinical Target, Performance Indicator, and as a Study Endpoint in Hospitalized Heart Failure Patients. JACC. HEART FAILURE 2023; 11:126-129. [PMID: 36599540 DOI: 10.1016/j.jchf.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
2
|
Nohria A, Drazner MH. Should weight loss be targeted during an acute heart failure admission? J Card Fail 2022; 28:1125-1127. [PMID: 35114385 DOI: 10.1016/j.cardfail.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Anju Nohria
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
| | - Mark H Drazner
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
3
|
Nanna MG, Sullivan AE, Bazylevska V, L Wong R, Murphy TE, Bellumkonda L, McNamara RL. Weight change in heart failure inpatients not associated with 30-day readmission. Future Cardiol 2020; 16:289-296. [PMID: 32286858 DOI: 10.2217/fca-2019-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The association of weight change and short-term readmission in patients hospitalized for heart failure (HF) has not been well studied. Methods: We collected clinical and weight data from patients admitted with decompensated HF to a single center (2012-2013). We performed logistic regression to determine the association between weight change and two outcomes: a total of 30-day HF-specific readmission and 30-day all-cause readmission. Results: Admission and discharge weights were documented in 479/658 patients (73%). Weight loss >2 kg was not associated with 30-day all-cause or HF-specific readmission when compared with more modest inpatient weight change (-2 kg to +2 kg; all-cause readmission odds ratio: 0.86; CI: 0.56-1.37; HF-specific readmission odds ratio: 1.15; CI: 0.61-2.16). Conclusion: Among HF inpatients, in-hospital weight loss was not associated with 30-day all-cause or HF-specific readmission.
Collapse
Affiliation(s)
- Michael G Nanna
- Duke Clinical Research Institute, Research Fellowship Training Program, Durham, North Carolina 27713, USA.,Duke University School of Medicine, Division of Cardiology, Durham, NC 27713, USA
| | - Alexander E Sullivan
- Duke University School of Medicine, Division of Cardiology, Durham, NC 27713, USA
| | - Vlada Bazylevska
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX 79430, USA
| | - Risa L Wong
- University of Washington & Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Terrence E Murphy
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Lavanya Bellumkonda
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| |
Collapse
|
4
|
Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J, Davis LL, Drazner MH, Kirkpatrick JN, Peterson PN, Reed BN, Roy CL, Storrow AB. 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2019; 74:1966-2011. [PMID: 31526538 DOI: 10.1016/j.jacc.2019.08.001] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
5
|
Prognostic Value of BNP Reduction During Hospitalization in Patients With Acute Heart Failure. J Card Fail 2019; 25:712-721. [DOI: 10.1016/j.cardfail.2019.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/23/2019] [Accepted: 04/04/2019] [Indexed: 01/04/2023]
|
6
|
Fudim M, Parikh KS, Dunning A, DeVore AD, Mentz RJ, Schulte PJ, Armstrong PW, Ezekowitz JA, Tang WHW, McMurray JJV, Voors AA, Drazner MH, O'Connor CM, Hernandez AF, Patel CB. Relation of Volume Overload to Clinical Outcomes in Acute Heart Failure (From ASCEND-HF). Am J Cardiol 2018; 122:1506-1512. [PMID: 30172362 DOI: 10.1016/j.amjcard.2018.07.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/15/2018] [Accepted: 07/18/2018] [Indexed: 01/01/2023]
Abstract
We aimed to study whether jugular venous distension (JVD) and peripheral edema were associated with worse outcomes in patients with acute heart failure in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure trial. Of 7,141 patients in Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure, 7,135 had complete data on baseline JVD and peripheral edema status. Patients were grouped according to baseline examination findings: (1) no JVD or peripheral edema; (2) JVD only; (3) peripheral edema only; (4) JVD and peripheral edema. We used unadjusted and adjusted logistic or Cox regression analyses to assess associations between groups and the outcomes of index length of stay (LOS), in-hospital mortality, 30- and 180-day all-cause mortality. Patients with peripheral edema (Groups 3 and 4) had higher body mass index, NT-proBNP and BNP values, and more co-morbid disease, and reduced left ventricular ejection fraction compared with patients in Groups 1-2. The median (25th-75th) LOS for Groups 1-4 was 6 (4-9), 5 (4-8), 7 (4-11), and 6 days (4-10), respectively. For the 30-day and 180-day outcomes, adjusted analyses found no significant difference in risk for patients presenting with JVD only or peripheral edema only as compared with patients without evidence of JVD or peripheral edema (p >0.05 for all). The presence of both JVD and peripheral edema was associated with an adjusted 24% increase in risk for all-cause mortality at 30 days, but no risk difference at 180 days. In conclusion, in patients with heart failure presenting to the hospital with dyspnea, the presence of peripheral edema is associated with a longer hospital LOS, but no difference in short- and long-term clinical outcomes when compared with patients wihout peripheral edema. The combination of peripheral edema and JVD identifies the highest risk cohort for poor clinical outcomes.
Collapse
Affiliation(s)
- Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina.
| | | | | | - Adam D DeVore
- Duke Clinical Research Institute, Durham, North Carolina
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta
| | | | | | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, the Netherlands
| | - Mark H Drazner
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Chetan B Patel
- Duke Clinical Research Institute, Durham, North Carolina
| |
Collapse
|
7
|
Clinical Significance of Early Fluid and Weight Change During Acute Heart Failure Hospitalization. J Card Fail 2018; 24:542-549. [DOI: 10.1016/j.cardfail.2017.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/24/2017] [Accepted: 12/21/2017] [Indexed: 01/11/2023]
|
8
|
Posada-Quintero HF, Reljin N, Eaton-Robb C, Noh Y, Riistama J, Chon KH. Analysis of Consistency of Transthoracic Bioimpedance Measurements Acquired with Dry Carbon Black PDMS Electrodes, Adhesive Electrodes, and Wet Textile Electrodes. SENSORS (BASEL, SWITZERLAND) 2018; 18:E1719. [PMID: 29861438 PMCID: PMC6022212 DOI: 10.3390/s18061719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/15/2018] [Accepted: 05/24/2018] [Indexed: 12/03/2022]
Abstract
The detection of intrathoracic volume retention could be crucial to the early detection of decompensated heart failure (HF). Transthoracic Bioimpedance (TBI) measurement is an indirect, promising approach to assessing intrathoracic fluid volume. Gel-based adhesive electrodes can produce skin irritation, as the patient needs to place them daily in the same spots. Textile electrodes can reduce skin irritation; however, they inconveniently require wetting before each use and provide poor adherence to the skin. Previously, we developed waterproof reusable dry carbon black polydimethylsiloxane (CB/PDMS) electrodes that exhibited a good response to motion artifacts. We examined whether these CB/PDMS electrodes were suitable sensing components to be embedded into a monitoring vest for measuring TBI and the electrocardiogram (ECG). We recruited N = 20 subjects to collect TBI and ECG data. The TBI parameters were different between the various types of electrodes. Inter-subject variability for copper-mesh CB/PDMS electrodes and Ag/AgCl electrodes was lower compared to textile electrodes, and the intra-subject variability was similar between the copper-mesh CB/PDMS and Ag/AgCl. We concluded that the copper mesh CB/PDMS (CM/CB/PDMS) electrodes are a suitable alternative for textile electrodes for TBI measurements, but with the benefit of better skin adherence and without the requirement of wetting the electrodes, which can often be forgotten by the stressed HF subjects.
Collapse
Affiliation(s)
| | - Natasa Reljin
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269 USA.
| | - Caitlin Eaton-Robb
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269 USA.
| | - Yeonsik Noh
- College of Nursing, University of Massachusetts Amherst, Amherst, MA 01003, USA.
- Department of Electrical and Computer Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA.
| | | | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269 USA.
| |
Collapse
|
9
|
Harjola VP, Mullens W, Banaszewski M, Bauersachs J, Brunner-La Rocca HP, Chioncel O, Collins SP, Doehner W, Filippatos GS, Flammer AJ, Fuhrmann V, Lainscak M, Lassus J, Legrand M, Masip J, Mueller C, Papp Z, Parissis J, Platz E, Rudiger A, Ruschitzka F, Schäfer A, Seferovic PM, Skouri H, Yilmaz MB, Mebazaa A. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 2017; 19:821-836. [PMID: 28560717 DOI: 10.1002/ejhf.872] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/20/2017] [Accepted: 04/04/2017] [Indexed: 12/18/2022] Open
Abstract
Organ injury and impairment are commonly observed in patients with acute heart failure (AHF), and congestion is an essential pathophysiological mechanism of impaired organ function. Congestion is the predominant clinical profile in most patients with AHF; a smaller proportion presents with peripheral hypoperfusion or cardiogenic shock. Hypoperfusion further deteriorates organ function. The injury and dysfunction of target organs (i.e. heart, lungs, kidneys, liver, intestine, brain) in the setting of AHF are associated with increased risk for mortality. Improvement in organ function after decongestive therapies has been associated with a lower risk for post-discharge mortality. Thus, the prevention and correction of organ dysfunction represent a therapeutic target of interest in AHF and should be evaluated in clinical trials. Treatment strategies that specifically prevent, reduce or reverse organ dysfunction remain to be identified and evaluated to determine if such interventions impact mortality, morbidity and patient-centred outcomes. This paper reflects current understanding among experts of the presentation and management of organ impairment in AHF and suggests priorities for future research to advance the field.
Collapse
Affiliation(s)
- Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Marek Banaszewski
- Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
| | | | - Ovidiu Chioncel
- Institute of Emergency in Cardiovascular Disease, University of Medicine Carol Davila, Bucharest, Romania
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Centre, Nashville, TN, USA
| | - Wolfram Doehner
- Centre for Stroke Research, Berlin, Germany.,Department of Cardiology, Charité Medical University, Berlin, Germany
| | - Gerasimos S Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Athens University Hospital Attikon, Athens, Greece
| | - Andreas J Flammer
- University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Valentin Fuhrmann
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Department of Research and Education, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Johan Lassus
- Cardiology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Matthieu Legrand
- U942 Inserm, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Investigation Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT), Nancy, France.,Department of Anaesthesiology, Critical Care and Burn Unit, St Louis Hospital, University Paris Denis Diderot, Paris, France
| | - Josep Masip
- Consorci Sanitari Integral (Public Health Consortium), University of Barcelona, Barcelona, Spain.,Department of Cardiology, Hospital Sanitas CIMA, Barcelona, Spain
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Research Centre for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - John Parissis
- National and Kapodistrian University of Athens, School of Medicine, Athens University Hospital Attikon, Athens, Greece
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alain Rudiger
- Cardio-Surgical Intensive Care Unit, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Schäfer
- Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
| | - Petar M Seferovic
- Department of Internal Medicine, Belgrade University School of Medicine, Belgrade, Serbia.,Heart Failure Centre, Belgrade University Medical Centre, Belgrade, Serbia
| | - Hadi Skouri
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Mehmet Birhan Yilmaz
- Department of Cardiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Alexandre Mebazaa
- U942 Inserm, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Investigation Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT), Nancy, France.,University Paris Diderot, Paris, France.,Department of Anaesthesia and Critical Care, University Hospitals Saint Louis-Lariboisière, Paris, France
| |
Collapse
|
10
|
Zile MR, Bennett TD, El Hajj S, Kueffer FJ, Baicu CF, Abraham WT, Bourge RC, Warner Stevenson L. Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor: Relationship to Mortality in Patients With Chronic Heart Failure. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003594. [PMID: 28062538 DOI: 10.1161/circheartfailure.116.003594] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this analysis was to examine whether implantable hemodynamic monitor-derived baseline estimated pulmonary artery diastolic pressure (ePAD) and change from baseline ePAD were independent predictors of all-cause mortality in patients with chronic heart failure. METHODS AND RESULTS Retrospective analysis used data from 3 studies (n=790 patients; 216 deaths). Baseline ePAD was related to mortality using a multivariable model including baseline and demographic data. Changes in ePAD defined as change from baseline to 6 months and from baseline to 14 days before death or exit from study were related to subsequent mortality, and analysis was adjusted for baseline ePAD. Area under the pressure versus time curve during 180 days before death or exit from study was related to mortality. Baseline ePAD, independent of other covariates, was a significant predictor of mortality (hazard ratio=1.07; 95% confidence interval=1.05-1.09; P<0.0001). Change in ePAD was an independent predictor of mortality (hazard ratio=1.07; 95% confidence interval=1.05-1.100; P=0.0008). Increased ePAD of 3, 4, or 5 mm Hg from baseline to 6 months was associated with increased mortality risk of 23.8%, 32.9%, or 42.8%. Change in ePAD from baseline to 14 days before death or exit from study was higher in patients who died (3.0±8 versus 1.7±10 mm Hg; P=0.003). Area under the pressure versus time curve in the final 180 days before death or exit from study was higher in patients who died versus those alive at end of study (185±668 versus 17±482 mm Hg.days; P=0.006). CONCLUSIONS Implantable hemodynamic monitor-derived baseline ePAD and change from baseline ePAD were independent predictors of mortality in chronic heart failure patients.
Collapse
Affiliation(s)
- Michael R Zile
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.).
| | - Tom D Bennett
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Stephanie El Hajj
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Fred J Kueffer
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Catalin F Baicu
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - William T Abraham
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Robert C Bourge
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Lynne Warner Stevenson
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| |
Collapse
|
11
|
Testani JM, Hanberg JS, Cheng S, Rao V, Onyebeke C, Laur O, Kula A, Chen M, Wilson FP, Darlington A, Bellumkonda L, Jacoby D, Tang WHW, Parikh CR. Rapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients With Heart Failure. Circ Heart Fail 2016; 9:e002370. [PMID: 26721915 DOI: 10.1161/circheartfailure.115.002370] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Removal of excess sodium and fluid is a primary therapeutic objective in acute decompensated heart failure and commonly monitored with fluid balance and weight loss. However, these parameters are frequently inaccurate or not collected and require a delay of several hours after diuretic administration before they are available. Accessible tools for rapid and accurate prediction of diuretic response are needed. METHODS AND RESULTS Based on well-established renal physiological principles, an equation was derived to predict net sodium output using a spot urine sample obtained 1 or 2 hours after loop diuretic administration. This equation was then prospectively validated in 50 acute decompensated heart failure patients using meticulously obtained timed 6-hour urine collections to quantify loop diuretic-induced cumulative sodium output. Poor natriuretic response was defined as a cumulative sodium output of <50 mmol, a threshold that would result in a positive sodium balance with twice-daily diuretic dosing. Following a median dose of 3 mg (2-4 mg) of intravenous bumetanide, 40% of the population had a poor natriuretic response. The correlation between measured and predicted sodium output was excellent (r=0.91; P<0.0001). Poor natriuretic response could be accurately predicted with the sodium prediction equation (area under the curve =0.95, 95% confidence interval 0.89-1.0; P<0.0001). Clinically recorded net fluid output had a weaker correlation (r=0.66; P<0.001) and lesser ability to predict poor natriuretic response (area under the curve =0.76, 95% confidence interval 0.63-0.89; P=0.002). CONCLUSIONS In patients being treated for acute decompensated heart failure, poor natriuretic response can be predicted soon after diuretic administration with excellent accuracy using a spot urine sample.
Collapse
Affiliation(s)
- Jeffrey M Testani
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.).
| | - Jennifer S Hanberg
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - Susan Cheng
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - Veena Rao
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - Chukwuma Onyebeke
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - Olga Laur
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - Alexander Kula
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - Michael Chen
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - F Perry Wilson
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - Andrew Darlington
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - Lavanya Bellumkonda
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - Daniel Jacoby
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - W H Wilson Tang
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - Chirag R Parikh
- From the Department of Internal Medicine (J.M.T., M.C., F.P.W., L.B., D.J., C.R.P.) and Program of Applied Translational Research (J.M.T., J.S., S.C., V.R., C.O., O.L., A.K., F.P.W., C.R.P.), Yale University School of Medicine, New Haven, CT; Piedmont Heart Institute, Fayetteville, GA (A.D.); and Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| |
Collapse
|
12
|
Sperry BW, Ruiz G, Najjar SS. Hospital readmission in heart failure, a novel analysis of a longstanding problem. Heart Fail Rev 2014; 20:251-8. [DOI: 10.1007/s10741-014-9459-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
13
|
Kociol RD, McNulty SE, Hernandez AF, Lee KL, Redfield MM, Tracy RP, Braunwald E, O'Connor CM, Felker GM. Markers of decongestion, dyspnea relief, and clinical outcomes among patients hospitalized with acute heart failure. Circ Heart Fail 2012; 6:240-5. [PMID: 23250981 DOI: 10.1161/circheartfailure.112.969246] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Congestion is a primary driver of symptoms in patients with acute heart failure, and relief of congestion is a critical goal of therapy. Monitoring of response to therapy through the assessment of daily weights and net fluid loss is the current standard of care, yet the relationship between commonly used markers of decongestion and both patient reported symptom relief and clinical outcomes are unknown. METHODS AND RESULTS We performed a retrospective analysis of the randomized clinical trial, diuretic optimization strategy evaluation in acute heart failure (DOSE-AHF), enrolling patients hospitalized with a diagnosis of acute decompensated heart failure. We assessed the relationship among 3 markers of decongestion at 72 hours-weight loss, net fluid loss, and percent reduction in serum N terminal B-type natriuretic peptide (NT-proBNP) level-and relief of symptoms as defined by the dyspnea visual analog scale area under the curve. We also determined the relationship between each marker of decongestion and 60-day clinical outcomes defined as time to death, first rehospitalization or emergency department visit. Mean age was 66 years, mean ejection fraction was 35%, and 27% had ejection fraction ≥50%. Of the 3 measures of decongestion assessed, only percent reduction in NT-proBNP was significantly associated with symptom relief (r=0.13; P=0.04). There was no correlation between either weight loss or net fluid loss and symptom relief, (r=0.04; P=0.54 and r=0.07; P=0.27, respectively). Favorable changes in each of the 3 markers of decongestion were associated with improvement in time to death, rehospitalization, or emergency department visit at 60 days (weight: hazard ratio, 0.91; 95% confidence interval, 0.85-0.97 per 4 lbs; weight lost; fluid hazard ratio, 0.94; 95% confidence interval, 0.90-0.99 per 1000 mL fluid loss; NT-proBNP hazard ratio, 0.95; 95% confidence interval, 0.91-0.99 per 10% reduction). These associations were unchanged after multivariable adjustment with the exception that percent reduction in NT-proBNP was no longer a significant predictor (hazard ratio, 0.97; 95% confidence interval, 0.93-1.02). The rates of death, HF hospitalization, or emergency department visit at 60 days for patients with 0, 1, 2, and 3 markers of decongestion (above the median) were 67%, 64%, 46%, and 38%, respectively (log rank P value=0.05). CONCLUSIONS Weight loss, fluid loss, and NT-proBNP reduction at 72 hours are poorly correlated with dyspnea relief. However, favorable improvements in each of the 3 markers were associated with improved clinical outcomes at 60 days. These data suggest the need for ongoing research to understand the relationships among symptom relief, congestion, and outcomes in patients with acute decompensated heart failure. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. UNIQUE IDENTIFIER: NCT00577135.
Collapse
|
14
|
Effect of admission oral diuretic dose on response to continuous versus bolus intravenous diuretics in acute heart failure: an analysis from diuretic optimization strategies in acute heart failure. Am Heart J 2012. [PMID: 23194486 DOI: 10.1016/j.ahj.2012.08.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Results from the DOSE-AHF study suggest that an initial continuous infusion of loop diuretics is not superior to bolus dosing with regard to clinical endpoints in acute heart failure. We hypothesized that outpatient furosemide dose was associated with congestion and poorer renal function and explored the hypothesis that a continuous infusion may be more effective in patients on higher outpatient diuretic doses. METHODS The DOSE-AHF study randomized 308 patients within 24 hours of admission to high versus low initial intravenous diuretic dose given as either a continuous infusion or bolus. We compared baseline characteristics and assessed associations between mode of administration (bolus vs continuous) and outcomes in patients receiving high-dose (≥120 mg furosemide equivalent, n = 177) versus low-dose (<120 mg furosemide equivalent, n = 131) outpatient diuretics. RESULTS Patients on higher doses of furosemide were less frequently on renin-angiotensin system inhibitors (P = .01) and had worse renal function and more advanced symptoms. There was a significant interaction between outpatient dose and mode of therapy (P = .01) with respect to net fluid loss at 72 hours after adjusting for creatinine and intensification strategy. Admission diuretic dose was associated with an increased risk of death or rehospitalization at 60 days (adjusted hazard ratio 1.08 per 20-mg increment in dose, 95% CI 1.01-1.16, P = .03). CONCLUSIONS In acute heart failure, patients on higher diuretic doses have greater disease severity and may benefit from an initial bolus strategy.
Collapse
|
15
|
Abstract
In patients with chronic heart failure, fluid retention (or hypervolemia) is often the stimulus for acute decompensated heart failure that requires hospitalization. The pathophysiology of fluid retention is complex and involves both hemodynamic and clinical congestion. Signs and symptoms of both hemodynamic and clinical congestion should be assessed serially during hospitalization. Core heart failure drug and cardiac device therapies should be provided, and ultrafiltration may be warranted. Critical care, intermediate care, and telemetry nurses have roles in both assessment and management of patients hospitalized with acute decompensated heart failure and fluid retention. Nurse administrators and managers have heightened their attention to fluid retention because the Medicare performance measure known as the risk-standardized 30-day all-cause readmission rate after heart failure hospitalization can be attenuated by fluid management strategies initiated by nurses during a patient's hospitalization.
Collapse
Affiliation(s)
- Nancy M Albert
- Nursing Research and Innovation, Nursing Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| |
Collapse
|
16
|
Veronesi G, Ferrario MM, Chambless LE. Comparing measurement error correction methods for rate-of-change exposure variables in survival analysis. Stat Methods Med Res 2011; 22:583-97. [PMID: 21300627 DOI: 10.1177/0962280210395742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this article we focus on comparing measurement error correction methods for rate-of-change exposure variables in survival analysis, when longitudinal data are observed prior to the follow-up time. Motivational examples include the analysis of the association between changes in cardiovascular risk factors and subsequent onset of coronary events. We derive a measurement error model for the rate of change, estimated through subject-specific linear regression, assuming an additive measurement error model for the time-specific measurements. The rate of change is then included as a time-invariant variable in a Cox proportional hazards model, adjusting for the first time-specific measurement (baseline) and an error-free covariate. In a simulation study, we compared bias, standard deviation and mean squared error (MSE) for the regression calibration (RC) and the simulation-extrapolation (SIMEX) estimators. Our findings indicate that when the amount of measurement error is substantial, RC should be the preferred method, since it has smaller MSE for estimating the coefficients of the rate of change and of the variable measured without error. However, when the amount of measurement error is small, the choice of the method should take into account the event rate in the population and the effect size to be estimated. An application to an observational study, as well as examples of published studies where our model could have been applied, are also provided.
Collapse
Affiliation(s)
- Giovanni Veronesi
- 1Dipartimento di Medicina Sperimentale,Università degli studi dell'Insubria,Via Rossi 9 - I-21100 Varese, Italy
| | | | | |
Collapse
|
17
|
Giamouzis G, Kalogeropoulos A, Georgiopoulou V, Laskar S, Smith AL, Dunbar S, Triposkiadis F, Butler J. Hospitalization Epidemic in Patients With Heart Failure: Risk Factors, Risk Prediction, Knowledge Gaps, and Future Directions. J Card Fail 2011; 17:54-75. [DOI: 10.1016/j.cardfail.2010.08.010] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 08/03/2010] [Accepted: 08/16/2010] [Indexed: 01/17/2023]
|
18
|
Jentzer JC, DeWald TA, Hernandez AF. Combination of Loop Diuretics With Thiazide-Type Diuretics in Heart Failure. J Am Coll Cardiol 2010; 56:1527-34. [DOI: 10.1016/j.jacc.2010.06.034] [Citation(s) in RCA: 265] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/30/2010] [Accepted: 06/01/2010] [Indexed: 01/29/2023]
|
19
|
|
20
|
Abstract
Chronic heart failure (CHF) remains the only cardiovascular disease with an increasing hospitalization burden and an ongoing drain on health care expenditures. The prevalence of CHF increases with advancing life span, with diastolic heart failure predominating in the elderly population. Primary prevention of coronary artery disease and risk factor management via aggressive blood pressure control are central in preventing new occurrences of left ventricular dysfunction. Optimal therapy for CHF involves identification and correction of potentially reversible precipitants, target-dose titration of medical therapy, and management of hospitalizations for decompensation. The etiological phenotype, absolute decrease in left ventricular ejection fraction and a widening of QRS duration on electrocardiography, is commonly used to identify patients at increased risk of progression of heart failure and sudden death who may benefit from prophylactic implantable cardioverter-defibrillator placement with or without cardiac resynchronization therapy. Patients who transition to advanced stages of disease despite optimal traditional medical and device therapy may be candidates for hemodynamically directed approaches such as a left ventricular assist device; in selected cases, listing for cardiac transplant may be warranted.
Collapse
Affiliation(s)
| | | | - Mandeep R. Mehra
- Address correspondence to Mandeep R. Mehra, MBBS, Division of Cardiology, University of Maryland School of Medicine, 22 S Greene St, Room S-3B06, Baltimore, MD 21201-1559 (). Individual reprints of this article and a bound reprint of the entire Symposium on Cardiovascular Diseases will be available for purchase from our Web site www.mayoclinicproceedings.com
| |
Collapse
|