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In-Hospital Mortality Rate and Predictors of 30-Day Readmission in Patients With Heart Failure Exacerbation and Atrial Fibrillation: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF HEART FAILURE 2022; 4:145-153. [PMID: 36262793 PMCID: PMC9383350 DOI: 10.36628/ijhf.2022.0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/22/2022] [Accepted: 07/08/2022] [Indexed: 01/05/2023]
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López-Vilella R, Marqués-Sulé E, Laymito Quispe RDP, Sánchez-Lázaro I, Donoso Trenado V, Martínez Dolz L, Almenar Bonet L. The Female Sex Confers Different Prognosis in Heart Failure: Same Mortality but More Readmissions. Front Cardiovasc Med 2021; 8:618398. [PMID: 33748194 PMCID: PMC7973030 DOI: 10.3389/fcvm.2021.618398] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/10/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: Heart failure (HF) is a major cause of morbimortality both in men and women. Differences between sex in etiopathogenesis, response to treatment, and quality of care have been found in patients with HF. Females are usually under-represented in clinical trials and there is no solid evidence demonstrating the influence of sex in the prognostic of chronic HF. The primary objective of this study was to analyse the differences in mortality and probability of hospital readmission between males and females with HF. The secondary objective was to compare mortality and probability of hospital readmission by ejection fraction (reduced vs. preserved). Methods: Patients with decompensated HF that were consecutively admitted to a Cardiology Service of a tertiary hospital for 4 years were recruited. De novo HF, death during hospitalization, programmed admissions and those patients with moderate left ventricular ejection fraction (LVEF) (40-50%) were discarded. Finally, 1,291 patients were included. Clinical profiles, clinical history, functional status, treatment at admission, first blood analysis performed, readmissions and mortality at follow-up were analyzed and compared. All patients underwent an echocardiographic study at admission. HF with reduced ejection fraction (HFrEF) was considered when left ventricular ejection fraction (LVEF) was <40%, whilst HF with preserved ejection fraction (HFpEF) was considered when LVEF was ≥50%. Results: 716 participants were male (55%). Basal characteristics showed differences in some outcomes. No differences were found in probability of survival among patients with decompensated HF by sex and ejection fraction (p = 0.25), whereas there was a clear tend to a major survival in females with HFrEF (p < 0.1). Females presented more readmissions when compared to males, independently from the LVEF (females = 33.5% vs. males = 26.8%; p = 0.009). Adjusted multivariate analysis showed no association between sex and mortality (HR = 0.97, IC 95% = 0.73-1.30, p = 0.86), although there was association between female sex and probability of readmission (OR = 1.37, IC 95% = 1.04-1.82, p = 0.02). Conclusions: Sex does not influence mid-term mortality in patients admitted for decompensated HF. Nevertheless, probability of readmission is higher in females independently from LVEF. Thus, it should be considered whether healthcare may be different depending on sex, and a more personalized and frequent care may be recommended in females.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Rocío Del Pilar Laymito Quispe
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Valencia, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Martínez Dolz
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Valencia, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
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Hoang-Kim A, Parpia C, Freitas C, Austin PC, Ross HJ, Wijeysundera HC, Tu K, Mak S, Farkouh ME, Sun LY, Schull MJ, Mason R, Lee DS, Rochon PA. Readmission rates following heart failure: a scoping review of sex and gender based considerations. BMC Cardiovasc Disord 2020; 20:223. [PMID: 32408892 PMCID: PMC7222562 DOI: 10.1186/s12872-020-01422-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/09/2020] [Indexed: 12/23/2022] Open
Abstract
Background Although hospital readmission for heart failure (HF) is an issue for both men and women, little is known about differences in readmission rates by sex. Consequently, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear. Our study aims were: (1) to identify studies examining readmission rates according to sex, and (2) to provide a qualitative overview of possible considerations for the impact of sex or gender. Methods We conducted a scoping review using the Arksey and O’Malley framework to include full text articles published between 2002 and 2017 drawn from multiple databases (MEDLINE, EMBASE), grey literature (i.e. National Technical information, Duck Duck Go), and expert consultation. Eligible articles included an index heart failure episode, readmission rates, and sex/gender-based analysis. Results The search generated 5887 articles, of which 746 underwent full abstract text consideration for eligibility. Of 164 eligible articles, 34 studies addressed the primary outcome, 103 studies considered sex differences as a secondary outcome and 25 studies stratified data for sex. Good inter-rater agreement was reached: 83% title/abstract; 88% full text; kappa: 0.69 (95%CI: 0.53–0.85). Twelve of 34 studies reported higher heart failure readmission rates for men and six studies reported higher heart failure readmission rates for women. Using non composite endpoints, five studies reported higher HF readmission rates for men compared to three studies reporting higher HF readmission rates for women. Overall, there was heterogeneity between studies when examined by sex, but one observation emerged that was related to the timing of readmissions. Readmission rates for men were higher when follow-up duration was longer than 1 year. Women were more likely to experience higher readmission rates than men when time to event was less than 1 year. Conclusions Future studies should consider different time horizons in their designs and avoid the use of composite measures, such as readmission rates combined with mortality, which are highly skewed by sex. Co-interventions and targeted post-discharge approaches with attention to sex would be of benefit to the HF patient population.
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Affiliation(s)
| | | | - Cassandra Freitas
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada
| | - Peter C Austin
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Heather J Ross
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Ted Rogers Centre for Heart Research, Toronto, Canada
| | - Harindra C Wijeysundera
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Karen Tu
- Faculty of Medicine, University of Toronto, Toronto, Canada.,North York General Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Susanna Mak
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Sinai Health System, Toronto, Canada
| | - Michael E Farkouh
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Louise Y Sun
- ICES, Toronto, Canada.,Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Michael J Schull
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Robin Mason
- Women's College Research Institute, Toronto, Canada
| | - Douglas S Lee
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada. .,ICES, Toronto, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Faculty of Medicine, University of Toronto, Toronto, Canada. .,Ted Rogers Centre for Heart Research, Toronto, Canada.
| | - Paula A Rochon
- Women's College Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
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Hollinger A, Gayat E, Féliot E, Paugam-Burtz C, Fournier MC, Duranteau J, Lefrant JY, Leone M, Jaber S, Mebazaa A, Arrigo M. Gender and survival of critically ill patients: results from the FROG-ICU study. Ann Intensive Care 2019; 9:43. [PMID: 30927096 PMCID: PMC6441070 DOI: 10.1186/s13613-019-0514-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/06/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose Few studies analyzed gender-related outcome differences of critically ill patients and found inconsistent results. This study aimed to test the independent association of gender and long-term survival of ICU patients.
Materials and methods FROG-ICU was a prospective, observational, multi-center cohort designed to investigate the long-term mortality of critically ill adult patients. The primary endpoint of this study was 1-year mortality after ICU admission of women compared to men. Results The study included 2087 patients, 726 women and 1361 men. Women and men had similar baseline characteristics, clinical presentation, and disease severity. No significant difference in 1-year mortality was found between women and men (34.9% vs. 37.9%, P = 0.18). After multivariable adjustment, no difference in the hazard of death was observed [HR 0.99 (95% CI 0.77–1.28)]. Similar 1-year survival between women and men was found in a propensity score-matched patient cohort of 506 patients [HR 0.79 (95% CI 0.54–1.14)].
Conclusion Women constituted one-third of the population of critically ill patients and were unexpectedly similar to men regarding demographic characteristics, clinical presentation, and disease severity and had similar risk of death at 1 year after ICU admission. Trial registration ClinicalTrials.gov NCT01367093; registered on June 6, 2011. Electronic supplementary material The online version of this article (10.1186/s13613-019-0514-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexa Hollinger
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France.,Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Etienne Gayat
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France
| | - Elodie Féliot
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France
| | - Catherine Paugam-Burtz
- Anesthesiology and Perioperative Care Medicine Department, APHP Hopital Beaujon and University, Paris 7, France
| | - Marie-Céline Fournier
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France
| | - Jacques Duranteau
- Département d'Anesthésie-Réanimation, UMR 942, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Jean-Yves Lefrant
- Service des Réanimations, CHU Nîmes, Place du Pr Robert Debré, 30029, Nîmes Cedex, France
| | - Marc Leone
- Department of Anaesthesiology and Critical Care Medicine, AP-HM, Hôpital Nord, Marseille, France
| | - Samir Jaber
- Department of Anesthesiology and Intensive Care (DAR B), Saint Eloi University Hospital, Montpellier, France.,PhyMedExp, INSERM U-1046, CNRS, Montpellier University, Montpellier, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France. .,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France. .,Department of Anesthesiology and Intensive Care, Saint Louis - Lariboisière University Hospitals, 2 rue Ambroise Paré, 75010, Paris, France.
| | - Mattia Arrigo
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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Pellman J, Sheikh F. Atrial fibrillation: mechanisms, therapeutics, and future directions. Compr Physiol 2016; 5:649-65. [PMID: 25880508 DOI: 10.1002/cphy.c140047] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, affecting 1% to 2% of the general population. It is characterized by rapid and disorganized atrial activation leading to impaired atrial function, which can be diagnosed on an EKG by lack of a P-wave and irregular QRS complexes. AF is associated with increased morbidity and mortality and is a risk factor for embolic stroke and worsening heart failure. Current research on AF support and explore the hypothesis that initiation and maintenance of AF require pathophysiological remodeling of the atria, either specifically as in lone AF or secondary to other heart disease as in heart failure-associated AF. Remodeling in AF can be grouped into three categories that include: (i) electrical remodeling, which includes modulation of L-type Ca(2+) current, various K(+) currents and gap junction function; (ii) structural remodeling, which includes changes in tissues properties, size, and ultrastructure; and (iii) autonomic remodeling, including altered sympathovagal activity and hyperinnervation. Electrical, structural, and autonomic remodeling all contribute to creating an AF-prone substrate which is able to produce AF-associated electrical phenomena including a rapidly firing focus, complex multiple reentrant circuit or rotors. Although various remodeling events occur in AF, current AF therapies focus on ventricular rate and rhythm control strategies using pharmacotherapy and surgical interventions. Recent progress in the field has started to focus on the underlying substrate that drives and maintains AF (termed upstream therapies); however, much work is needed in this area. Here, we review current knowledge of AF mechanisms, therapies, and new areas of investigation.
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Affiliation(s)
- Jason Pellman
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
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Vanhercke D, Pardaens S, Weytjens C, Vande Kerckhove B, De Laet N, Janssens E, Van Camp G, De Sutter J. Prevalence, Determinants, and Prognostic Significance of Pulmonary Hypertension in Elderly Patients Admitted with Acute Decompensated Heart Failure: A Report from the BIO-HF Registry. Echocardiography 2014; 32:1333-8. [DOI: 10.1111/echo.12857] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daniel Vanhercke
- Department of Internal Medicine; Ghent University; Ghent Belgium
| | - Sofie Pardaens
- Department of Internal Medicine; Ghent University; Ghent Belgium
| | - Caroline Weytjens
- Department of Cardiology; University Hospital Brussels; Brussels Belgium
| | | | - Nancy De Laet
- Department of Cardiology; University Hospital Brussels; Brussels Belgium
| | - Emilie Janssens
- Department of Internal Medicine; Ghent University; Ghent Belgium
| | - Guy Van Camp
- Department of Cardiology; University Hospital Brussels; Brussels Belgium
| | - Johan De Sutter
- Department of Internal Medicine; Ghent University; Ghent Belgium
- Department of Cardiology; AZ Maria Middelares; Ghent Belgium
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