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Miyazaki D, Tarasawa K, Fushimi K, Fujimori K. Risk Factors with 30-Day Readmission and the Impact of Length of Hospital Stay on It in Patients with Heart Failure: A Retrospective Observational Study Using a Japanese National Database. TOHOKU J EXP MED 2023; 259:151-162. [PMID: 36543246 DOI: 10.1620/tjem.2022.j114] [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: 12/24/2022]
Abstract
Heart failure is a major disease, and its 30-day readmission (readmission within 30-day after discharge) negatively impacts patients and society. Thus, we need to stratify the risk and prevent readmission. We aimed to investigate risk factors associated with 30-day readmission and examine the impact of length of hospital stay (LOS) on 30-day readmission. Using the Diagnosis-Procedure-Combination database from April 2018 to March 2021, we conducted multiple logistic regression to investigate risk factors with 30-day readmission. Also, we conducted subgroup analysis in the short LOS group. To examine the association between LOS and 30-day readmission, we performed propensity score matching between the short and middle LOS groups. As a result, we categorized 10,283 patients and 169,842 patients into the readmission group and the no-readmission group. We identified the following factors as the risk of readmission: short LOS, female, smoking, older age, lower body mass index, lower barthel index, artificial ventilator, beta-blockers, thiazides, tolvaptan, loop diuretics, carperitides, class Ⅲ antiarrhythmic agents, myocardial infarction, diabetes, renal disease, atrial fibrillation, dilated cardiomyopathy, and discharge to home. As a subgroup analysis in the short LOS group, we revealed that the short LOS group risk factors differed from overall. After propensity score matching in the short LOS group and middle LOS group, 37,199 pairs were matched, and we revealed that shorter LOS increases the risk of readmission. These results demonstrated that shortened LOS increases 30-day readmission, and risk factors are unique to each LOS. We suggest stratifying the readmission risk and being careful with early discharge.
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Affiliation(s)
- Daisuke Miyazaki
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
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Kiernan K, Dodge SE, Kwaku KF, Jackson LR, Zeitler EP. Racial and ethnic differences in implantable cardioverter-defibrillator patient selection, management, and outcomes. Heart Rhythm O2 2022; 3:807-816. [PMID: 36589011 PMCID: PMC9795300 DOI: 10.1016/j.hroo.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Racial and ethnic differences in treatment-cardiovascular and otherwise-have been documented in many aspects of the American health care system and can be seen in implantable cardioverter-defibrillator (ICD) patient selection, counseling, and management. ICDs have been demonstrated to be a powerful tool in the prevention of sudden cardiac death, yet uptake across all eligible patients has been modest. Although patients who do not identify as White are disproportionately eligible for ICDs in the United States, they are less likely to see specialists, be counseled on ICDs, and ultimately have an ICD implanted. This review explores racial and ethnic differences demonstrated in ICD patient selection, outcomes including shock effectiveness, and postimplantation monitoring for both primary and secondary prevention devices. It also highlights barriers for uptake at the health system, physician, and patient levels and suggests areas of further research needed to clarify the differences, illuminate the driving forces of these differences, and investigate strategies to address them.
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Affiliation(s)
- Katherine Kiernan
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Shayne E. Dodge
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kevin F. Kwaku
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Larry R. Jackson
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Emily P. Zeitler
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute, Lebanon, New Hampshire
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Rao VN, Mentz RJ, Coniglio AC, Kelsey MD, Fudim M, Fonarow GC, Matsouaka RA, DeVore AD, Caughey MC. Neighborhood Socioeconomic Disadvantage and Hospitalized Heart Failure Outcomes in the American Heart Association Get With The Guidelines-Heart Failure Registry. Circ Heart Fail 2022; 15:e009353. [PMID: 36378758 PMCID: PMC9673180 DOI: 10.1161/circheartfailure.121.009353] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/13/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neighborhood socioeconomic status (SES) is associated with worse health outcomes, yet its relationship with in-hospital heart failure (HF) outcomes and quality metrics are underexplored. We examined the association between socioeconomic neighborhood disadvantage and in-hospital HF outcomes for patients from diverse neighborhoods in the Get With The Guidelines-Heart Failure registry. METHODS SES-disadvantage scores were derived from geocoded US census data using a validated algorithm, which incorporated household income, home value, rent, education, and employment. We examined the association between SES-disadvantage quintiles with all-cause in-hospital mortality, adjusting for demographics and comorbidities. RESULTS Of 593 053 patients hospitalized for HF between 2017 and 2020, 321 314 (54%) had residential ZIP Codes recorded. Patients from the most compared with least disadvantaged neighborhoods were younger (mean age 67 versus 76 years), more often Black (42% versus 9%) or Hispanic (14% versus 5%), and had higher comorbidity burden. Demographic-adjusted length of stay increased by ≈1.5 hours with each increment in worsening SES-disadvantage quintiles. Adjusted-mortality odds ratios increased with worsening SES-disadvantage quintiles (Ptrend=0.003), and was 28% higher (adjusted OR=1.28 [1.12-1.48]) for the most compared with least disadvantaged neighborhood groups. CONCLUSIONS Patients hospitalized for HF from disadvantaged neighborhoods were younger and more often Black or Hispanic. SES disadvantage was independently associated with higher in-hospital mortality. Further research is needed to characterize care delivery patterns in disadvantaged neighborhoods and to address social determinants of health among patients hospitalized for HF. REGISTRATION: URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02693509.
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Affiliation(s)
- Vishal N. Rao
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Robert J. Mentz
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Amanda C. Coniglio
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Michelle D. Kelsey
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Gregg C. Fonarow
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Roland A. Matsouaka
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Adam D. DeVore
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Melissa C. Caughey
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina
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Myers VD, Gerhard GS, McNamara DM, Tomar D, Madesh M, Kaniper S, Ramsey FV, Fisher SG, Ingersoll RG, Kasch-Semenza L, Wang J, Hanley-Yanez K, Lemster B, Schwisow JA, Ambardekar AV, Degann SH, Bristow MR, Sheppard R, Alexis JD, Tilley DG, Kontos CD, McClung JM, Taylor AL, Yancy CW, Khalili K, Seidman JG, Seidman CE, McTiernan CF, Cheung JY, Feldman AM. Association of Variants in BAG3 With Cardiomyopathy Outcomes in African American Individuals. JAMA Cardiol 2019; 3:929-938. [PMID: 30140897 DOI: 10.1001/jamacardio.2018.2541] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance The prevalence of nonischemic dilated cardiomyopathy (DCM) is greater in individuals of African ancestry than in individuals of European ancestry. However, little is known about whether the difference in prevalence or outcomes is associated with functional genetic variants. Objective We hypothesized that Bcl2-associated anthanogene 3 (BAG3) genetic variants were associated with outcomes in individuals of African ancestry with DCM. Design This multicohort study of the BAG3 genotype in patients of African ancestry with dilated cardiomyopathy uses DNA obtained from African American individuals enrolled in 3 clinical studies: the Genetic Risk Assessment of African Americans With Heart Failure (GRAHF) study; the Intervention in Myocarditis and Acute Cardiomyopathy Trial-2 (IMAC-2) study; and the Genetic Risk Assessment of Cardiac Events (GRACE) study. Samples of DNA were also acquired from the left ventricular myocardium of patients of African ancestry who underwent heart transplant at the University of Colorado and University of Pittsburgh. Main Outcomes and Measures The primary end points were the prevalence of BAG3 mutations in African American individuals and event-free survival in participants harboring functional BAG3 mutations. Results Four BAG3 genetic variants were identified; these were expressed in 42 of 402 African American individuals (10.4%) with nonischemic heart failure and 9 of 107 African American individuals (8.4%) with ischemic heart failure but were not present in a reference population of European ancestry (P < .001). The variants included 2 nonsynonymous single-nucleotide variants; 1 three-nucleotide in-frame insertion; and 2 single-nucleotide variants that were linked in cis. The presence of BAG3 variants was associated with a nearly 2-fold (hazard ratio, 1.97 [95% CI, 1.19-3.24]; P = .01) increase in cardiac events in carriers compared with noncarriers. Transfection of transformed adult human ventricular myocytes with plasmids expressing the 4 variants demonstrated that each variant caused an increase in apoptosis and a decrease in autophagy when samples were subjected to the stress of hypoxia-reoxygenation. Conclusions and Relevance This study demonstrates that genetic variants in BAG3 found almost exclusively in individuals of African ancestry were not causative of disease but were associated with a negative outcome in patients with a dilated cardiomyopathy through modulation of the function of BAG3. The results emphasize the importance of biological differences in causing phenotypic variance across diverse patient populations, the need to include diverse populations in genetic cohorts, and the importance of determining the pathogenicity of genetic variants.
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Affiliation(s)
- Valerie D Myers
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Glenn S Gerhard
- Department of Human Genetics and Molecular Biochemistry, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Dennis M McNamara
- The Heart and Vascular Institute, the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dhanendra Tomar
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Muniswamy Madesh
- The Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Scott Kaniper
- Department of Human Genetics and Molecular Biochemistry, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Frederick V Ramsey
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Susan G Fisher
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Roxann G Ingersoll
- The McKusick-Nathans Institute for Genetic Medicine, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura Kasch-Semenza
- The McKusick-Nathans Institute for Genetic Medicine, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - JuFang Wang
- The Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Karen Hanley-Yanez
- The Heart and Vascular Institute, the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bonnie Lemster
- The Heart and Vascular Institute, the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jessica A Schwisow
- Department of Medicine, University of Colorado School of Medicine, Denver
| | - Amrut V Ambardekar
- Department of Medicine, University of Colorado School of Medicine, Denver
| | - Seta H Degann
- Department of Medicine, University of Colorado School of Medicine, Denver
| | - Michael R Bristow
- Department of Medicine, University of Colorado School of Medicine, Denver
| | - Richard Sheppard
- Department of Medicine, McGill University and the Jewish General Hospital, Montreal, Quebec, Canada
| | - Jeffrey D Alexis
- Department of Medicine, the University of Rochester, Rochester, New York
| | - Douglas G Tilley
- The Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Christopher D Kontos
- Division of Cardiology, Department of Medicine and the Department of Pharmacology and Cancer, Duke University School of Medicine, Durham, North Carolina
| | - Joseph M McClung
- Department of Physiology and Cardiovascular Sciences, East Carolina Diabetes and Obesity Institute, Brody School of Medicine, Greenville, North Carolina
| | - Anne L Taylor
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Clyde W Yancy
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Deputy Editor
| | - Kamel Khalili
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,The Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Charles F McTiernan
- The Heart and Vascular Institute, the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph Y Cheung
- The Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Arthur M Feldman
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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5
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Precision Medicine for Heart Failure: Back to the Future. J Am Coll Cardiol 2019; 73:1185-1188. [PMID: 30871702 DOI: 10.1016/j.jacc.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/16/2018] [Accepted: 01/01/2019] [Indexed: 11/21/2022]
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Olchanski N, Vest AR, Cohen JT, Neumann PJ, DeNofrio D. Cost comparison across heart failure patients with reduced and preserved ejection fractions: Analyses of inpatient decompensated heart failure admissions. Int J Cardiol 2018; 261:103-108. [PMID: 29657034 DOI: 10.1016/j.ijcard.2018.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/29/2018] [Accepted: 03/06/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Heart failure (HF) is the leading cause of inpatient admissions in the US for adults aged over 65 years and accounts for more than $17 billion in Medicare expenditures annually. There are limited published data on factors influencing expenditure and the relationship between cost and hospital length of stay. We sought to describe institutional costs of HF hospitalization, as well as demographic and clinical predictors of higher hospitalization costs in an academic hospital setting. METHODS AND RESULTS Demographic and clinical information was collected retrospectively for 564 unique consecutive patients with a decompensated HF admission during 2010-2013. Forty-six percent had a baseline LVEF >40%, categorized as HF with preserved ejection fraction (HFpEF). Forty-three percent were female and the mean age was 71 years. Patients with reduced ejection fraction (HFrEF) were predominantly male, younger and had a lower burden of baseline comorbidities than HFpEF patients. Length of stay was longer for HFrEF (median 4 days) than HFpEF (median 3 days, p = 0.01). Mean total hospitalization cost was $9521. Mean costs trended higher for HFrEF patients than for HFpEF patients ($10,286 versus $8858, p = 0.07). Room and board contributed more than half of all costs. CONCLUSIONS In this single-center study, we observed a trend towards higher HF hospitalization costs for patients with HFrEF, compared to HFpEF, even though patients with HFpEF are older and had more comorbid conditions. Costs were largely driven by length of stay, with higher heart rate at admission, lower systolic blood pressure, and higher creatinine associated with higher inpatient costs.
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Affiliation(s)
- Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA, United States.
| | - Amanda R Vest
- Division of Cardiology, Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA, United States
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA, United States
| | - David DeNofrio
- Division of Cardiology, Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
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7
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Pharmacological reasons that may explain why randomized clinical trials have failed in acute heart failure syndromes. Int J Cardiol 2016; 233:1-11. [PMID: 28161130 DOI: 10.1016/j.ijcard.2016.11.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/04/2016] [Accepted: 11/06/2016] [Indexed: 12/27/2022]
Abstract
Acute heart failure (AHF) represents a clinical challenge as it encloses a heterogeneous group of syndromes (AHFS) with different pathophysiology, clinical presentations, prognosis and response to therapy. In the last 25years multiple therapeutic targets have been identified and numerous new drugs were evaluated but, up to now, all failed to demonstrate a consistent benefit on clinical outcomes. Moreover, a repeated finding has been the poor correlation between the encouraging results of preclinical and early clinical trials and the lack of effect on outcomes observed in phase III trials. We review several possible pharmacological reasons that may explain the lack of success to develop new drugs and the pharmacological challenges to overcome in the future to develop new more effective and safer drugs for the treatment of AHFS.
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8
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Joynt KE, Peña JM. Explaining the Mortality-Readmissions Paradox for Racial and Ethnic Minorities. JACC. HEART FAILURE 2016; 4:894-896. [PMID: 27614944 DOI: 10.1016/j.jchf.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Karen E Joynt
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Jessica M Peña
- Departments of Medicine and Radiology, Weill Cornell Medical College, Dalio Institute of Cardiovascular Imaging at New York-Presbyterian Hospital, New York, New York
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Durstenfeld MS, Ogedegbe O, Katz SD, Park H, Blecker S. Racial and Ethnic Differences in Heart Failure Readmissions and Mortality in a Large Municipal Healthcare System. JACC. HEART FAILURE 2016; 4:885-893. [PMID: 27395346 PMCID: PMC5097004 DOI: 10.1016/j.jchf.2016.05.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/09/2016] [Accepted: 05/12/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study sought to determine whether racial and ethnic differences exist among patients with similar access to care. We examined outcomes after heart failure hospitalization within a large municipal health system. BACKGROUND Racial and ethnic disparities in heart failure outcomes are present in administrative data, and one explanation is differential access to care. METHODS We performed a retrospective cohort study of 8,532 hospitalizations of adults with heart failure at 11 hospitals in New York City from 2007 to 2010. Primary exposure was ethnicity and race, and outcomes were 30- and 90-day readmission and 30-day and 1-year mortality rates. Generalized estimating equations were used to test for associations between ethnicity and race and outcomes with covariate adjustment. RESULTS Of the number of hospitalizations included, 4,305 (51%) were for blacks, 2,449 (29%) were for Hispanics, 1,494 (18%) were for whites, and 284 (3%) were for Asians. Compared to whites, blacks and Asians had lower 1-year mortality, with adjusted odds ratios (aORs) of 0.75 (95% confidence interval [CI]: 0.59 to 0.94) and 0.57 (95% CI: 0.38 to 0.85), respectively, and rates for Hispanics were not significantly different (aOR: 0.81; 95% CI: 0.64 to 1.03). Hispanics had higher odds of readmission than whites (aOR: 1.27; 95% CI: 1.03 to 1.57) at 30 (aOR: 1.40; 95% CI: 1.15 to 1.70) and 90 days. Blacks had higher odds of readmission than whites at 90 days (aOR:1.21; 95% CI: 1.01 to 1.47). CONCLUSIONS Racial and ethnic differences in outcomes after heart failure hospitalization were present within a large municipal health system. Access to a municipal health system may not be sufficient to eliminate disparities in heart failure outcomes.
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Affiliation(s)
| | - Olugbenga Ogedegbe
- Department of Medicine, New York University School of Medicine, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York; Global Institute of Public Health, New York University, New York, New York
| | - Stuart D Katz
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Hannah Park
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Saul Blecker
- Department of Medicine, New York University School of Medicine, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York.
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10
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Ahmad T, Desai N, Wilson F, Schulte P, Dunning A, Jacoby D, Allen L, Fiuzat M, Rogers J, Felker GM, O’Connor C, Patel CB. Clinical Implications of Cluster Analysis-Based Classification of Acute Decompensated Heart Failure and Correlation with Bedside Hemodynamic Profiles. PLoS One 2016; 11:e0145881. [PMID: 26840410 PMCID: PMC4739604 DOI: 10.1371/journal.pone.0145881] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/09/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Classification of acute decompensated heart failure (ADHF) is based on subjective criteria that crudely capture disease heterogeneity. Improved phenotyping of the syndrome may help improve therapeutic strategies. OBJECTIVE To derive cluster analysis-based groupings for patients hospitalized with ADHF, and compare their prognostic performance to hemodynamic classifications derived at the bedside. METHODS We performed a cluster analysis on baseline clinical variables and PAC measurements of 172 ADHF patients from the ESCAPE trial. Employing regression techniques, we examined associations between clusters and clinically determined hemodynamic profiles (warm/cold/wet/dry). We assessed association with clinical outcomes using Cox proportional hazards models. Likelihood ratio tests were used to compare the prognostic value of cluster data to that of hemodynamic data. RESULTS We identified four advanced HF clusters: 1) male Caucasians with ischemic cardiomyopathy, multiple comorbidities, lowest B-type natriuretic peptide (BNP) levels; 2) females with non-ischemic cardiomyopathy, few comorbidities, most favorable hemodynamics; 3) young African American males with non-ischemic cardiomyopathy, most adverse hemodynamics, advanced disease; and 4) older Caucasians with ischemic cardiomyopathy, concomitant renal insufficiency, highest BNP levels. There was no association between clusters and bedside-derived hemodynamic profiles (p = 0.70). For all adverse clinical outcomes, Cluster 4 had the highest risk, and Cluster 2, the lowest. Compared to Cluster 4, Clusters 1-3 had 45-70% lower risk of all-cause mortality. Clusters were significantly associated with clinical outcomes, whereas hemodynamic profiles were not. CONCLUSIONS By clustering patients with similar objective variables, we identified four clinically relevant phenotypes of ADHF patients, with no discernable relationship to hemodynamic profiles, but distinct associations with adverse outcomes. Our analysis suggests that ADHF classification using simultaneous considerations of etiology, comorbid conditions, and biomarker levels, may be superior to bedside classifications.
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Affiliation(s)
- Tariq Ahmad
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Nihar Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Francis Wilson
- Program for Translational Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Phillip Schulte
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Allison Dunning
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Daniel Jacoby
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Larry Allen
- Division of Cardiology, Department of Medicine, University of Colorado, Denver, Colorado, United States of America
| | - Mona Fiuzat
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Joseph Rogers
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - G. Michael Felker
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Christopher O’Connor
- Inova Heart and Vascular Institute, Falls Church, Virginia, United States of America
| | - Chetan B. Patel
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, United States of America
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11
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Fontaine JM, Franklin SM, Gupta A, Kang CU. Mortality in African-Americans Following Cardiac Resynchronization Therapy: A Single Center Experience. J Natl Med Assoc 2016; 108:30-9. [DOI: 10.1016/j.jnma.2015.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Efird JT, Griffin WF, Sarpong DF, Davies SW, Vann I, Koutlas NT, Anderson EJ, Crane PB, Landrine H, Kindell L, Iqbal ZJ, Ferguson TB, Chitwood WR, Kypson AP. Increased Long-Term Mortality among Black CABG Patients Receiving Preoperative Inotropic Agents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:7478-90. [PMID: 26154656 PMCID: PMC4515669 DOI: 10.3390/ijerph120707478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 02/13/2015] [Accepted: 02/13/2015] [Indexed: 01/02/2023]
Abstract
The aim of this study was to examine racial differences in long-term mortality after coronary artery bypass grafting (CABG), stratified by preoperative use of inotropic agents. Black and white patients who required preoperative inotropic support prior to undergoing CABG procedures between 1992 and 2011 were compared. Mortality probabilities were computed using the Kaplan-Meier product-limit method. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. A total of 15,765 patients underwent CABG, of whom 211 received preoperative inotropic agents within 48 hours of surgery. Long-term mortality differed by race (black versus white) among preoperative inotropic category (inotropes: adjusted HR = 1.6, 95% CI = 1.009–2.4; no inotropes: adjusted HR = 1.15, 95% CI = 1.08–1.2; Pinteraction < 0.0001). Our study identified an independent preoperative risk-factor for long-term mortality among blacks receiving CABG. This outcome provides information that may be useful for surgeons, primary care providers, and their patients.
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Affiliation(s)
- Jimmy T Efird
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
- Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - William F Griffin
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - Daniel F Sarpong
- Center for Minority Health and Health Disparities Research and Education, Xavier University of Louisiana, New Orleans, LA 70125, USA.
| | - Stephen W Davies
- Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
| | - Iulia Vann
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Nathaniel T Koutlas
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - Ethan J Anderson
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Patricia B Crane
- The College of Nursing, East Carolina University, Greenville, NC 27834, USA.
| | - Hope Landrine
- Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Linda Kindell
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - Zahra J Iqbal
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - T Bruce Ferguson
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - W Randolph Chitwood
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - Alan P Kypson
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
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The complex relationship of race to outcomes in heart failure with preserved ejection fraction. Am J Med 2015; 128:591-600. [PMID: 25554372 PMCID: PMC4442751 DOI: 10.1016/j.amjmed.2014.11.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 11/22/2014] [Accepted: 11/24/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND An improved understanding of racial differences in the natural history, clinical characteristics, and outcomes of heart failure will have important clinical and public health implications. We assessed how clinical characteristics and outcomes vary across racial groups (whites, blacks, and Asians) in adults with heart failure with preserved ejection fraction. METHODS We identified all adults with heart failure with preserved ejection fraction between 2005 and 2008 from 4 health systems in the Cardiovascular Research Network using hospital principal discharge and ambulatory visit diagnoses. RESULTS Among 13,437 adults with confirmed heart failure with preserved ejection fraction, 85.9% were white, 7.6% were black, and 6.5% were Asian. After adjustment for potential confounders and use of cardiovascular therapies, compared with whites, blacks (adjusted hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.62-0.85) and Asians (HR, 0.75; 95% CI, 0.64-0.87) had a lower risk of death from any cause. Compared with whites, blacks had a higher risk of hospitalization for heart failure (HR, 1.48; 95% CI, 1.29-1.68); no difference was observed for Asians compared with whites (HR, 1.01; 95% CI, 0.86-1.18). Compared with whites, no significant differences were detected in risk of hospitalization for any cause for blacks (HR, 1.03; 95% CI, 0.95-1.12) and Asians (HR, 0.93; 95% CI, 0.85-1.02). CONCLUSIONS In a diverse population with heart failure with preserved ejection fraction, we observed complex relationships between race and important clinical outcomes. More detailed studies of large populations are needed to fully characterize the epidemiologic picture and to elucidate potential pathophysiologic and treatment-response differences that may relate to race.
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McNaughton CD, Cawthon C, Kripalani S, Liu D, Storrow AB, Roumie CL. Health literacy and mortality: a cohort study of patients hospitalized for acute heart failure. J Am Heart Assoc 2015; 4:jah3939. [PMID: 25926328 PMCID: PMC4599411 DOI: 10.1161/jaha.115.001799] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background More than 30% of patients hospitalized for heart failure are rehospitalized or die within 90 days of discharge. Lower health literacy is associated with mortality among outpatients with chronic heart failure; little is known about this relationship after hospitalization for acute heart failure. Methods and Results Patients hospitalized for acute heart failure and discharged home between November 2010 and June 2013 were followed through December 31, 2013. Nurses administered the Brief Health Literacy Screen at admission; low health literacy was defined as Brief Health Literacy Screen ≤9. The primary outcome was all-cause mortality. Secondary outcomes were time to first rehospitalization and, separately, time to first emergency department visit within 90 days of discharge. Cox proportional hazards models determined their relationships with health literacy, adjusting for age, gender, race, insurance, education, comorbidity, and hospital length of stay. For the 1379 patients, average age was 63.1 years, 566 (41.0%) were female, and 324 (23.5%) had low health literacy. Median follow-up was 20.7 months (interquartile range 12.8 to 29.6 months), and 403 (29.2%) patients died. Adjusted hazard ratio for death among patients with low health literacy was 1.34 (95% CI 1.04, 1.73, P=0.02) compared to Brief Health Literacy Screen >9. Within 90 days of discharge, there were 415 (30.1%) rehospitalizations and 201 (14.6%) emergency department visits, with no evident association with health literacy. Conclusions Lower health literacy was associated with increased risk of death after hospitalization for acute heart failure. There was no evident relationship between health literacy and 90-day rehospitalization or emergency department visits.
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Affiliation(s)
- Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN (C.D.M.N., A.B.S.)
| | - Courtney Cawthon
- Department of Medicine, Vanderbilt University, Nashville, TN (C.C., S.K., C.L.R.)
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University, Nashville, TN (C.C., S.K., C.L.R.)
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University, Nashville, TN (D.L.)
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN (C.D.M.N., A.B.S.)
| | - Christianne L Roumie
- Department of Medicine, Vanderbilt University, Nashville, TN (C.C., S.K., C.L.R.) Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville, TN (C.L.R.)
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Choi D, Nemi E, Fernando C, Gupta M, Moe GW. Differences in the Clinical Characteristics of Ethnic Minority Groups With Heart Failure Managed in Specialized Heart Failure Clinics. JACC-HEART FAILURE 2014; 2:392-9. [DOI: 10.1016/j.jchf.2014.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/04/2014] [Accepted: 02/08/2014] [Indexed: 11/25/2022]
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Piña IL, Ventura HO. Heart Failure in Ethnic Minorities. JACC-HEART FAILURE 2014; 2:400-2. [DOI: 10.1016/j.jchf.2014.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 03/28/2014] [Indexed: 11/15/2022]
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Cuyjet AB, Akinboboye O. Acute heart failure in the African American patient. J Card Fail 2014; 20:533-40. [PMID: 24814871 DOI: 10.1016/j.cardfail.2014.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/07/2014] [Accepted: 04/28/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND African Americans (AAs) are disproportionately affected by acute heart failure (AHF) compared with other racial/ethnic groups. Disparities in AHF risk factors among AAs are attributed to higher rates of hypertension and diabetes mellitus, lower socioeconomic status, higher dietary caloric and salt intake, and biologic/genetic differences. However, AAs are frequently underrepresented in AHF clinical trials, and race-related differences in risks and clinical outcomes are not well understood. OBJECTIVE The aim of this work was to review published data on AHF in the AA population, including management strategies that may differ based on race and common barriers to optimal care. METHODS Publications were identified in Pubmed (through June 10, 2013) with the use of the search strategy terms (acute heart failure) AND (black OR African American OR racial). RESULTS Racial disparities in the quality of AHF care are relatively uncommon; however, racial differences in pathophysiology have resulted in differing pharmacologic recommendations (eg, isosorbide dinitrate plus hydralazine is indicated only in AAs). Various socioeconomic factors influence disease progression, treatment compliance, and hospitalization/rehospitalization rates. CONCLUSIONS Further research would enhance understanding of pathophysiologic heart failure differences between racial groups. Programs are needed that incorporate known clinical and cultural differences to improve quality of care and reduce the disease burden of AHF for all patients.
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Affiliation(s)
| | - Ola Akinboboye
- Association of Black Cardiologists, Washington DC Heart House, Washington, DC; Weill Medical College of Cornell University, New York, New York; Laurelton Heart Specialists P.C., Rosedale, New York
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Heidenreich PA. Capsule commentary on Zhang et al., Race/ethnicity, disability, and medication adherence among medicare beneficiaries with heart failure. J Gen Intern Med 2014; 29:648. [PMID: 24481685 PMCID: PMC3965754 DOI: 10.1007/s11606-013-2736-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paul A Heidenreich
- Veterans Administration Palo Alto Healthcare System, 111C Cardiology, 3801 Miranda Avenue, Palo Alto, CA, 94306, USA,
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Lyons KJ, Ezekowitz JA, Liu W, McAlister FA, Kaul P. Mortality outcomes among status Aboriginals and whites with heart failure. Can J Cardiol 2014; 30:619-26. [PMID: 24882532 DOI: 10.1016/j.cjca.2014.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aboriginals have more cardiovascular risk factors than do non-Aboriginals that predispose them to the development of heart failure (HF). Whether long-term mortality outcomes and health care use differ between Aboriginals and whites with HF is unknown. METHODS The population consisted of all Albertans aged ≥ 20 years with an incident HF hospitalization between 2000 and 2008. Aboriginal status is recorded in the Alberta Health Care Insurance Registry and white ethnicity was determined using previously validated surname analysis algorithms. Cox and logistic regression was used to examine mortality outcomes after adjustment for key variables. RESULTS Compared with whites (n = 42,288), status aboriginal patients with HF (n = 1158) were significantly younger (mean age, 62.6 vs 75.4 years; P < 0.0001) and had higher rates of diabetes (45% vs 29%; P < 0.0001) and chronic obstructive pulmonary disease (40% vs 36%; P < 0.0001) but lower rates of most other comorbidities. Although crude mortality rates were lower in status Aboriginals than in whites at 1 year (22% vs 31%; P < 0.0001) and at 5 years (48% vs 59%; P < 0.0001), after adjustment, status Aboriginals exhibited increased mortality at 1 year (adjusted odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01-1.38) and 5 years (adjusted OR, 1.39; 95% CI, 1.16-1.67). Compared with whites, status Aboriginals used more health care resources in the years before and after an incident HF hospitalization but less specialist care. CONCLUSIONS Although status Aboriginals hospitalized for the first time with HF are > 10 years younger, they use more health care resources and have increased short- and long-term mortality compared with their white counterparts.
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Affiliation(s)
- Kristin J Lyons
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Justin A Ezekowitz
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada.
| | - Wei Liu
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Finlay A McAlister
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada; Division of General Internal Medicine and Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Padma Kaul
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
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Gonzalez-Zuelgaray J, Pellizon O, Muratore CA, Oropeza ES, Rabinovich R, Ramos JL, Tentori MC, Reyes N, Aguayo R, Marin J, Peterson BJ. Lack of current implantable cardioverter defibrillator guidelines application for primary prevention of sudden cardiac death in Latin American patients with heart failure: a cross-sectional study. Europace 2012; 15:236-42. [PMID: 22968848 DOI: 10.1093/europace/eus253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIMS This cross-sectional study evaluated the application of accepted international implantable cardioverter defibrillator (ICD) guidelines for primary prevention of sudden cardiac death in patients with heart failure. METHODS AND RESULTS The PLASMA (Probabilidad de Sufrir Muerte Arritmica) study was designed to characterize management of cardiac patients in Latin America. Twelve centres included 1958 consecutively admitted patients in cardiology units in 2008 and 2009. Discharged patients were evaluated for primary prevention, ICD indication and prescription by general cardiologists. Of 1711 discharged patients, 1525 (89%) had data available for evaluating indication status. Class I indications for ICD therapy were met for 153 (10%) patients based on collected data. Only 20 (13%, 95% confidence interval: 7.7-18.4%) patients with indication were prescribed an ICD. Patients prescribed an ICD were younger than patients who were not prescribed an ICD (62 vs. 68 years, P < 0.01). The reasons given by cardiologists for not prescribing an ICD for 133 patients with an indication were: indication criteria not met (75%), life expectancy <1 year (9.7%), rejection by the patient (5.2%), no medical coverage paying for the device (3.7%), psychiatric patient (2.2%), and other reasons (4.2%). CONCLUSIONS In Latin America, international guidelines for primary prevention ICD implantation are not well followed. The main reason is that cardiologists believe that patients do not meet indication criteria, even though study data confirm that criteria are met. This poses a significant challenge and underlines the importance of continuous and improved medical education.
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Choi DJ, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, Shin MS, Seong IW, Ahn Y, Kang SM, Kim YJ, Kim HS, Chae SC, Oh BH, Lee MM, Ryu KH. Characteristics, outcomes and predictors of long-term mortality for patients hospitalized for acute heart failure: a report from the korean heart failure registry. Korean Circ J 2011; 41:363-71. [PMID: 21860637 PMCID: PMC3152730 DOI: 10.4070/kcj.2011.41.7.363] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/14/2011] [Accepted: 02/03/2011] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives Acute heart failure (AHF) is associated with a poor prognosis and it requires repeated hospitalizations. However, there are few studies on the characteristics, treatment and prognostic factors of AHF. The aims of this study were to describe the clinical characteristics, management and outcomes of the patients hospitalized for AHF in Korea. Subjects and Methods We analyzed the clinical data of 3,200 hospitalization episodes that were recorded between June 2004 and April 2009 from the Korean Heart Failure (KorHF) Registry database. The mean age was 67.6±14.3 years and 50% of the patients were female. Results Twenty-nine point six percent (29.6%) of the patients had a history of previous HF and 52.3% of the patients had ischemic heart disease. Left ventricular ejection fraction (LVEF) was reported for 89% of the patients. The mean LVEF was 38.5±15.7% and 26.1% of the patients had preserved systolic function (LVEF ≥50%), which was more prevalent in the females (34.0% vs. 18.4%, respectively, p<0.001). At discharge, 58.6% of the patients received beta-blockers (BB), 53.7% received either angiotensin converting enzyme-inhibitors or angiotensin receptor blockers (ACEi/ARB), and 58.4% received both BB and ACEi/ARB. The 1-, 2-, 3- and 4-year mortality rates were 15%, 21%, 26% and 30%, respectively. Multivariate analysis revealed that advanced age {hazard ratio: 1.023 (95% confidence interval: 1.004-1.042); p=0.020}, a previous history of heart failure {1.735 (1.150-2.618); p=0.009}, anemia {1.973 (1.271-3.063); p=0.002}, hyponatremia {1.861 (1.184-2.926); p=0.007}, a high level of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) {3.152 (1.450-6.849); p=0.004} and the use of BB at discharge {0.599 (0.360-0.997); p=0.490} were significantly associated with total death. Conclusion We present here the characteristics and prognosis of an unselected population of AHF patients in Korea. The long-term mortality rate was comparable to that reported in other countries. The independent clinical risk factors included age, a previous history of heart failure, anemia, hyponatremia, a high NT-proBNP level and taking BB at discharge.
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Affiliation(s)
- Dong-Ju Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea
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Norgard NB, Prescott GM. Future of personalized pharmacotherapy in chronic heart failure patients. Future Cardiol 2011; 7:357-79. [DOI: 10.2217/fca.11.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
There is a significant amount of diversity among heart failure (HF) patients. Contemporary HF regimens often do not take into consideration many of the factors that might influence an individual’s response to treatment. Clinical recommendations based on trial data derived from mainly younger Caucasian male study populations have, in most cases, been applied equally to women and African–Americans. Subgroup analyses of randomized HF trials and results of retrospective cohort studies have been used for customizing HF regimens in women and African–Americans. Pharmacogenetics is an emerging strategy for personalizing HF therapy. Genetic biomarkers may play an important role in predicting a patient’s response to treatment and in predicting those at risk of toxicity. HF pharmacotherapy has improved over the last two decades; however, substantial work remains in order to personalize HF management and maximize the benefit of pharmacologic interventions, while limiting adverse events.
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Affiliation(s)
| | - Gina M Prescott
- University at Buffalo, School of Pharmacy & Pharmaceutical Sciences, New York State Center of Excellence in Bioinformatics & Life Sciences, B3–322, 701 Ellicott Street, Buffalo, NY 1420, USA
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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]
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Francis GS, Greenberg BH, Hsu DT, Jaski BE, Jessup M, LeWinter MM, Pagani FD, Piña IL, Semigran MJ, Walsh MN, Wiener DH, Yancy CW. ACCF/AHA/ACP/HFSA/ISHLT 2010 clinical competence statement on management of patients with advanced heart failure and cardiac transplant: a report of the ACCF/AHA/ACP Task Force on Clinical Competence and Training. Circulation 2010; 122:644-72. [PMID: 20644017 DOI: 10.1161/cir.0b013e3181ecbd97] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
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- American College of Cardiology Foundation, USA
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Francis GS, Greenberg BH, Hsu DT, Jaski BE, Jessup M, LeWinter MM, Pagani FD, Piña IL, Semigran MJ, Walsh MN, Wiener DH, Yancy CW. ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant. J Am Coll Cardiol 2010; 56:424-53. [DOI: 10.1016/j.jacc.2010.04.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Goda A, Lund LH, Mancini DM. Comparison across races of peak oxygen consumption and heart failure survival score for selection for cardiac transplantation. Am J Cardiol 2010; 105:1439-44. [PMID: 20451691 DOI: 10.1016/j.amjcard.2009.12.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 12/28/2009] [Accepted: 12/28/2009] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to determine whether peak oxygen consumption (VO(2)) and the Heart Failure Survival Score (HFSS) predict prognosis in European-American, African-American, and Hispanic-American patients with chronic heart failure referred for heart transplantation. The peak VO(2) and the HFSS have previously been shown to effectively risk stratify patients with chronic heart failure and are criteria for the listing for heart transplantation. However, the effect of race on the predictive value of these variables has not been studied. A total of 715 patients with congestive heart failure (433 European American, 126 African American, 123 Hispanic American, and 33 other), who had been referred for heart transplantation, underwent cardiopulmonary exercise testing with measurement of the peak VO(2) and calculation of the HFSS. A total of 354 patients had died or undergone urgent heart transplantation or implantation of a left ventricular assist device during the 962 +/- 912 days of follow-up. On univariate and multivariate Cox hazard analysis, both peak VO(2) and the HFSS were powerful prognostic markers in the overall cohort and in the separate races. In the receiver operating characteristic curve analysis, the areas under the curve at 1 and 2 years of follow-up were greater for the HFSS than for peak VO(2). In conclusion, HFSS and peak VO(2) can be used for transplant selection; however, in the era of modern therapy and across races and genders, the HFSS might perform better than the peak VO(2).
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Affiliation(s)
- Ayumi Goda
- Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Gordon HS, Nowlin PR, Maynard D, Berbaum ML, Deswal A. Mortality after hospitalization for heart failure in blacks compared to whites. Am J Cardiol 2010; 105:694-700. [PMID: 20185019 DOI: 10.1016/j.amjcard.2009.10.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 10/28/2009] [Accepted: 10/28/2009] [Indexed: 10/19/2022]
Abstract
Heart failure (HF) disproportionately affects black compared to white Americans, and overall mortality from HF is greater among blacks. Paradoxically, mortality rates after a hospitalization for HF are lower in black than in white patients. These racial differences might reflect hospital, physician, and patient factors and could have implications for comparative hospital profiles. We identified published studies reporting the posthospitalization mortality for black and white patients with a discharge diagnosis of HF and conducted random-effects meta-analyses with the outcome of all-cause mortality. We included 29 cohorts of hospitalized black and white patients with HF. The unadjusted mean mortality rate after HF hospitalization for black and white patients, respectively, was 6% and 9% for in-hospital, 6% and 10% for 30-day, 10% and 15% for 60- to 180-day, 28% and 34% for 1-year, and 41% and 47% for >1-year follow-up, respectively. The unadjusted combined odds ratios for mortality in black versus white patients ranged from 0.48 for in-hospital (95% confidence interval [CI] 0.45 to 0.51) to 0.77 after >1 year follow-up (95% CI 0.75 to 0.79). In meta-analyses using adjusted data, the combined odds ratio was 0.68 for short-term mortality (95% CI 0.63 to 0.74), and the combined hazard ratio was 0.84 for long-term mortality (95% CI 0.77 to 0.91). In conclusion, mortality after hospitalization for HF was 32% lower during short-term follow-up and 16% lower during long-term follow-up for black than for white patients. The mortality differences imply unmeasured differences by race in clinical severity of illness at hospital admission and might lead to biased hospital mortality profiles.
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Mansour IN, Napan S, Tarek Alahdab M, Stamos TD. Carbohydrate Antigen 125 Predicts Long-Term Mortality in African American Patients With Acute Decompensated Heart Failure. ACTA ACUST UNITED AC 2010; 16:15-20. [DOI: 10.1111/j.1751-7133.2009.00110.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arena R, Myers J, Abella J, Peberdy MA, Bensimhon D, Chase P, Guazzi M. Prognostic characteristics of cardiopulmonary exercise testing in caucasian and African American patients with heart failure. ACTA ACUST UNITED AC 2009; 14:310-5. [PMID: 19076854 DOI: 10.1111/j.1751-7133.2008.00024.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peak oxygen consumption (VO(2)) and ventilatory efficiency (minute ventilation/carbon dioxide output [VE/VCO(2)] slope) are prognostically important in heart failure (HF). The purpose of the present study was to compare the prognostic characteristics of these variables between Caucasian and African American patients. A total of 662 HF patients (455 Caucasian/207 African American) underwent cardiopulmonary exercise testing and were tracked for major cardiac events. The VE/VCO(2) slope was the strongest prognostic marker (chi-square >or=18.9, P<.001), irrespective of race. While peak VO(2) was a significant univariate predictor in both Caucasian (chi-square 42.0, P<.001) and African American (5.2, P=.02) subgroups, it was only retained in the Caucasian multivariate regression. The lack of predictive value of peak VO(2) in the African American subgroup was due to its lack of prognostic significance in female patients. While the VE/VCO(2) slope was the most robust prognostic marker in both Caucasian and African American patients, the predictive ability of peak VO(2) seems to be influenced by race and sex.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Health Sciences Campus, Richmond, VA 23298-0224, USA. raarena@.vcu.edu
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Abstract
PURPOSE OF REVIEW Hospitalization and mortality rates associated with heart failure are persistently high. This is due partly to aging of the population but mostly to delayed progress in the pharmacological treatment of decompensated heart failure. We will review the current recommendations and most recent advancement in the pharmacological treatment of acute decompensated heart failure while providing a systematic approach to the management of this prevalent condition. RECENT FINDINGS Loop diuretics, nitrates and inotropes such as dobutamine and milrinone are the current mainstay of acute heart failure management although their associated morbidity and possible mortality have raised serious concerns. Recent vasoactive agents such as Nesiritide, Tolvaptan and more recently the inotropic agent Levosimedan could offer improved hemodynamics and congestive relief to patients in acute pulmonary edema. SUMMARY Despite the promising results of these agents, further clinical trials are required prior to their international approval as first-line therapy. Although we can be optimistic that these vasoactive drugs might have favorable clinical outcomes and improve the intricate management of decompensated heart failure, their associated mortality benefit remains unclear and controversial.
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Horwich TB, Fonarow GC. Heart failure in African Americans: Earlier onset, different etiologies, and poorer prognosis. CURRENT CARDIOVASCULAR RISK REPORTS 2008. [DOI: 10.1007/s12170-008-0037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shroff GR, Taylor AL, Colvin-Adams M. Race-related differences in heart failure therapies: simply black and white or shades of grey? Curr Cardiol Rep 2007; 9:178-81. [PMID: 17470329 DOI: 10.1007/bf02938347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The magnitude of burden imposed by heart failure on society has necessitated the evolution of innovative strategies to identify specific avenues of treatment and the populations at highest risk. Multiple studies have demonstrated a higher burden of cardiovascular disease in black Americans. It has also been shown that the clinical characteristics of heart failure, therapeutic targets, and response to various treatment modalities, are different in blacks as compared with whites. This article explores the unique race-related differences in heart failure with particular emphasis on the currently recommended therapeutic agents in heart failure.
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Affiliation(s)
- Gautam R Shroff
- Cardiovascular Division, University of Minnesota, MMC 508, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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Ghali JK. Hydralazine and Nitrates: Beyond Race and Ethnicity. J Card Fail 2007; 13:238. [PMID: 17448423 DOI: 10.1016/j.cardfail.2007.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 02/19/2007] [Accepted: 02/21/2007] [Indexed: 11/29/2022]
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