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Naik MG, Budde K, Koehler K, Vettorazzi E, Pigorsch M, Arkossy O, Stuard S, Duettmann W, Koehler F, Winkler S. Remote Patient Management May Reduce All-Cause Mortality in Patients With Heart-Failure and Renal Impairment. Front Med (Lausanne) 2022; 9:917466. [PMID: 35899216 PMCID: PMC9309436 DOI: 10.3389/fmed.2022.917466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/14/2022] [Indexed: 01/17/2023] Open
Abstract
BackgroundRemote patient management (RPM) in heart failure (HF) patients has been investigated in several prospective randomized trials. The Telemedical Interventional Management in Heart Failure II (TIM-HF2)-trial showed reduced all-cause mortality and hospitalizations in heart failure (HF) patients using remote patient management (RPM) vs. usual care (UC). We report the trial's results for prespecified eGFR-subgroups.MethodsTIM-HF2 was a prospective, randomized, controlled, parallel-group, unmasked (with randomization concealment), multicenter trial. A total of 1,538 patients with stable HF were enrolled in Germany from 2013 to 2017 and randomized to RPM (+UC) or UC. Using CKD-EPI-formula at baseline, prespecified subgroups were defined. In RPM, patients transmitted their vital parameters daily. The telemedical center reviewed and co-operated with the patient's General Practitioner (GP) and cardiologist. In UC, patients were treated by their GPs or cardiologist applying the current guidelines for HF management and treatment. The primary endpoint was the percentage of days lost due to unplanned cardiovascular hospitalizations or death, secondary outcomes included hospitalizations, all-cause, and cardiovascular mortality.ResultsOur sub analysis showed no difference between RPM and UC in both eGFR-subgroups for the primary endpoint (<60 ml/min/1.73 m2: 40.9% vs. 43.6%, p = 0.1, ≥60 ml/min/1.73 m2 26.5 vs. 29.3%, p = 0.36). In patients with eGFR < 60 ml/min/1.73 m2, 1-year-survival was higher in RPM than UC (89.4 vs. 84.6%, p = 0.02) with an incident rate ratio (IRR) 0.67 (p = 0.03). In the recurrent event analysis, HF hospitalizations and all-cause death were lower in RPM than UC in both eGFR-subgroups (<60 ml/min/1.73 m2: IRR 0.70, p = 0.02; ≥60 ml/min/1.73 m2: IRR 0.64, p = 0.04). In a cox regression analysis, age, NT-pro BNP, eGFR, and BMI were associated with all-cause mortality.ConclusionRPM may reduce all-cause mortality and HF hospitalizations in patients with HF and eGFR < 60 ml/min/1.73 m2. HF hospitalizations and all-cause death were lower in RPM in both eGFR-subgroups in the recurrent event analysis. Further studies are needed to investigate and confirm this finding.
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Affiliation(s)
- Marcel G. Naik
- Charité—Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University of Berlin, Berlin, Germany
- *Correspondence: Marcel G. Naik
| | - Klemens Budde
- Charité—Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany
| | - Kerstin Koehler
- Charité—Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Eik Vettorazzi
- University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Hamburg, Germany
| | - Mareen Pigorsch
- Charité—Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Otto Arkossy
- Global Medical Office, Clinical and Therapeutical Governance Europe Middle East Asia, Fresenius Medical Care, Bad Homburg, Germany
| | - Stefano Stuard
- Global Medical Office, Clinical and Therapeutical Governance Europe Middle East Asia, Fresenius Medical Care, Bad Homburg, Germany
| | - Wiebke Duettmann
- Charité—Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University of Berlin, Berlin, Germany
| | - Friedrich Koehler
- Charité—Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Gottingen, Germany
| | - Sebastian Winkler
- Charité—Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Gottingen, Germany
- Unfallkrankenhaus Berlin, Department of Internal Medicine, Berlin, Germany
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Kobayashi M, Voors AA, Girerd N, Billotte M, Anker SD, Cleland JG, Lang CC, Ng LL, van Veldhuisen DJ, Dickstein K, Metra M, Duarte K, Rossignol P, Zannad F, Ferreira JP. Heart failure etiologies and clinical factors precipitating for worsening heart failure: Findings from BIOSTAT-CHF. Eur J Intern Med 2020; 71:62-69. [PMID: 31708361 DOI: 10.1016/j.ejim.2019.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/07/2019] [Accepted: 10/12/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Knowledge on the association between heart failure (HF) etiologies, precipitant causes and clinical outcomes may help in ascertaining patient's risk and in selecting tailored therapeutic strategies. METHODS The prognostic value of both HF etiologies and precipitants for worsening HF were analyzed using the index cohort of BIOSTAT-CHF. The studied HF etiologies were: a) ischemic HF; b) dilated cardiomyopathy; c) hypertensive HF; d) valvular HF; and e) other/unknown. The precipitating factors for worsening HF were: a) atrial fibrillation; b) non-adherence; c) renal failure; d) acute coronary syndrome; e) hypertension; and f) Infection. The primary outcome was the composite of all-cause death or HF hospitalization. RESULTS Among 2465 patients included in the study, 45% (N = =1102) had ischemic HF, 23% (N = =563) dilated cardiomyopathy, 15% (N = =379) other/unknown, 10% (N = =237) hypertensive and 7% (N = =184) valvular HF. Patients with ischemic HF had the worst prognosis, whereas patients with dilated cardiomyopathy had the best prognosis. From the precipitating factors for worsening HF, renal failure was the one independently associated with worse prognosis (adjusted HR (95%CI) = =1.48 (1.04-2.09), p < 0.001). We found no interaction between HF etiologies and precipitating factors for worsening HF with regard to the study outcomes (p interaction > 0.10 for all). Treatment up-titration benefited patients regardless of their underlying etiology or precipitating cause (p interaction > 0.10 for all). CONCLUSIONS In BIOSTAT-CHF, patients with HF of an ischemic etiology, and those with worsening HF precipitated by renal failure (irrespective of the underlying HF etiology), had the highest rates of death and HF hospitalization, but still benefited equally from treatment up-titration.
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Affiliation(s)
- Masatake Kobayashi
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, INSERM, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein, Groningen, the Netherlands
| | - Nicolas Girerd
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, INSERM, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Maxime Billotte
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, INSERM, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen (UMG), Göttingen, Germany
| | - John G Cleland
- National Heart & Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences, Glenfield Hospital, and NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein, Groningen, the Netherlands
| | - Kenneth Dickstein
- University of Bergen, Bergen, Norway; University of Stavanger, Stavanger, Norway
| | - Macro Metra
- Cardiology, University and Civil hospitals of Brescia. Italy
| | - Kevin Duarte
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, INSERM, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Patrick Rossignol
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, INSERM, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, INSERM, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - João Pedro Ferreira
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, INSERM, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.
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Jacob J, Llauger L, Herrero-Puente P, Martín-Sánchez FJ, Llorens P, Roset A, Gil V, Fuentes M, Lucas-Imbernón FJ, Miró Ò. Acute heart failure and adverse events associated with the presence of renal dysfunction and hyperkalaemia. EAHFE- renal dysfunction and hyperkalaemia. Eur J Intern Med 2019; 67:89-96. [PMID: 31331793 DOI: 10.1016/j.ejim.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To study the outcomes of patients with acute heart failure (AHF) presenting renal dysfunction (RD) or hyperkalaemia (Hk) alone or in combination. METHOD We analysed the data of the EAHFE registry, a multicentre, non interventionist cohort with prospective follow-up of patients with AHF. Four groups were defined based on the presence or not of RD or Hk alone or in combination. The primary endpoint was 30-day all-cause mortality. RESULTS A total of 11,935 of the 13,791 patients included in the EAHFE registry were analysed. Of these, 5088 (42.6%) did not have RD or Hk (NoRD-NoHk), 150 (1.3%) had no RD but had Hk (NoRD-Hk), 6012 (50.4%) had RD but not Hk (RD-NoHk) and 685 (5.7%) had both RD and Hk (RD-Hk). Thirty-day all-cause mortality was greatest in the RD-Hk group with an adjusted Hazard Ratio (HR) of 2.44 (confidence interval 95% [CI95%] 1.67-3.55; p < 0.001) and in the RD-NoHk group with an adjusted HR of 1.34 (CI95% 1.04-1.71; p = 0.022). There were no significant differences in in-hospital mortality and reconsultation at 30 days for HF. For the combined endpoint of 30-day all-cause mortality the adjusted HR was 1.33 (CI95% 1.04-1.70); (p = 0.021) for the RD-Hk group. CONCLUSIONS The association of 30-day all-cause mortality with the presence of RD and Hk in patients presenting AHF at admission is greater than in those without this combination.
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Affiliation(s)
- Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Lluis Llauger
- Emergency Department, Hospital Universitari de Vic, Barcelona, Spain.
| | | | - Francisco Javier Martín-Sánchez
- Emergency Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Facultad de Medicina, Universidad Complutense, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Spain
| | - Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Victor Gil
- Emergency Department, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Marta Fuentes
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
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Llauger L, Jacob J, Miró Ò. Renal function and acute heart failure outcome. Med Clin (Barc) 2018; 151:281-290. [PMID: 29884452 DOI: 10.1016/j.medcli.2018.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/28/2018] [Accepted: 05/01/2018] [Indexed: 12/18/2022]
Abstract
The interaction between acute heart failure (AHF) and renal dysfunction is complex. Several studies have evaluated the prognostic value of this syndrome. The aim of this systematic review, which includes non-selected samples, was to investigate the impact of different renal function variables on the AHF prognosis. The categories included in the studies reviewed included: creatinine, blood urea nitrogen (BUN), the BUN/creatinine quotient, chronic kidney disease, the formula to estimate the glomerular filtration rate, criteria of acute renal injury and new biomarkers of renal damage such as neutrophil gelatinase-associated lipocalin (NGAL and cystatin c). The basal alterations of the renal function, as well as the acute alterations, transient or not, are related to a worse prognosis in AHF, it is therefore necessary to always have baseline, acute and evolutive renal function parameters.
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Affiliation(s)
- Lluís Llauger
- Servicio de Urgencias, Hospital Universitari de Vic, Vic (Barcelona), España.
| | - Javier Jacob
- Servicio de Urgencias, Hospital Clínic de Barcelona, Barcelona, España
| | - Òscar Miró
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
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Vijayakumar S, Vaduganathan M, Butler J. Exploring heart failure events in contemporary cardiovascular outcomes trials in type 2 diabetes mellitus. Expert Rev Cardiovasc Ther 2018; 16:123-131. [PMID: 29298108 DOI: 10.1080/14779072.2018.1423962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Type 2 diabetes mellitus (DM) and heart failure (HF) are closely related, with the onset of one serving as an independent risk factor for the development or progression of the other. The true impact of their relationship is poorly understood. Since various classes of glucose-lowering therapies have been shown to have differing impact on cardiovascular outcomes, cardiovascular effects of such therapies have been increasingly formally evaluated. Areas covered: With the increasing prevalence of concomitant HF and type 2 DM, HF outcomes serve as important endpoints in trials of glucose-lowering therapies. A thorough literature search of recent cardiovascular outcome trials of glucose-lowering therapies was performed. The authors focus on the availability and extent of ascertainment of data related to HF outcomes in these contemporary clinical trial experiences. Expert commentary: Although early cardiovascular outcome trials did not focus on HF events, these outcomes have been increasingly recognized as meaningful end points in cardiovascular outcome trials. The ascertainment of HF end point data needs to become routine and standardized.
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Affiliation(s)
- Shilpa Vijayakumar
- a Department of Medicine , Stony Brook University , Stony Brook , NY , USA
| | - Muthiah Vaduganathan
- b Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School , Boston , MA , USA
| | - Javed Butler
- c Division of Cardiology , Stony Brook University , Stony Brook , NY , USA
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Crespo-Leiro MG, Anker SD, Maggioni AP, Coats AJ, Filippatos G, Ruschitzka F, Ferrari R, Piepoli MF, Delgado Jimenez JF, Metra M, Fonseca C, Hradec J, Amir O, Logeart D, Dahlström U, Merkely B, Drozdz J, Goncalvesova E, Hassanein M, Chioncel O, Lainscak M, Seferovic PM, Tousoulis D, Kavoliuniene A, Fruhwald F, Fazlibegovic E, Temizhan A, Gatzov P, Erglis A, Laroche C, Mebazaa A. European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Fail 2017; 18:613-25. [PMID: 27324686 DOI: 10.1002/ejhf.566] [Citation(s) in RCA: 517] [Impact Index Per Article: 73.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/17/2016] [Accepted: 03/03/2016] [Indexed: 12/17/2022] Open
Abstract
AIMS The European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT-R) was set up with the aim of describing the clinical epidemiology and the 1-year outcomes of patients with heart failure (HF) with the added intention of comparing differences between participating countries. METHODS AND RESULTS The ESC-HF-LT-R is a prospective, observational registry contributed to by 211 cardiology centres in 21 European and/or Mediterranean countries, all being member countries of the ESC. Between May 2011 and April 2013 it collected data on 12 440 patients, 40.5% of them hospitalized with acute HF (AHF) and 59.5% outpatients with chronic HF (CHF). The all-cause 1-year mortality rate was 23.6% for AHF and 6.4% for CHF. The combined endpoint of mortality or HF hospitalization within 1 year had a rate of 36% for AHF and 14.5% for CHF. All-cause mortality rates in the different regions ranged from 21.6% to 36.5% in patients with AHF, and from 6.9% to 15.6% in those with CHF. These differences in mortality between regions are thought reflect differences in the characteristics and/or management of these patients. CONCLUSION The ESC-HF-LT-R shows that 1-year all-cause mortality of patients with AHF is still high while the mortality of CHF is lower. This registry provides the opportunity to evaluate the management and outcomes of patients with HF and identify areas for improvement.
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Affiliation(s)
- Maria G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC, La Coruna, Spain
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France.,ANMCO Research Centre, Florence, Italy
| | - Andrew J Coats
- Monash University, Australia and University of Warwick, Coventry, UK
| | | | - Frank Ruschitzka
- Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Centre Zurich, Zurich, Switzerland
| | - Roberto Ferrari
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care and Research, ES Health Science Foundation, Cotignola, Italy
| | | | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Candida Fonseca
- Heart Failure Unit, S Francisco Xavier Hospital/CHLO NOVA Medical School, Faculdade de Ciências Medicas, Universidade Nova de Lisboa, Portugal
| | - Jaromir Hradec
- 3rd Department of Medicine, Faculty General Hospital, Charles University, Prague, Czech Republic
| | - Offer Amir
- Poriya Medical Centre and Faculty of Medicine Bar Ilan University, Israel
| | - Damien Logeart
- Assistance Publique Hôpitaux Paris, Hôpital Lariboisière, Université Paris Diderot, Inserm 942, Paris, France
| | - Ulf Dahlström
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Bela Merkely
- Semmelweis University, Heart Centre, Budapest, Hungary
| | - Jaroslaw Drozdz
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Eva Goncalvesova
- Department of Heart Failure/Transplantation, National Cardiovascular Institute, Bratislava, Slovakia
| | | | - Ovidiu Chioncel
- Institutul De Urgente Boli Cardiovasculare CC Iliescu, Universitatea de Medicina Carol Davila, Bucuresti, Romania
| | - Mitja Lainscak
- Department of Cardiology, General Hospital Celje, Celje, Slovenia
| | - Petar M Seferovic
- University of Belgrade, School of Medicine, Department of Cardiology, Clinical Centre of Serbia
| | - Dimitris Tousoulis
- 1st Cardiology Department, Athens University Medical School, Athens, Greece
| | - Ausra Kavoliuniene
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Emir Fazlibegovic
- Department of Internal Medicine, Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ahmet Temizhan
- Turkey Yüksek Ihtisas Hospital, Cardiology Clinic, Ankara, Turkey
| | | | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
| | - Alexandre Mebazaa
- Hôpital Lariboisière, Université Paris Diderot, Inserm 942, Paris, France
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Russo G, Cioffi G, Pulignano G, Barbati G, Tarantini L, Del Sindaco D, Mazzone C, Cherubini A, Faganello G, Stefenelli C, Senni M, Di Lenarda A. Reasons why patients suffering from chronic heart failure at very low risk for mortality die. Int J Cardiol 2016; 223:947-952. [PMID: 27589042 DOI: 10.1016/j.ijcard.2016.08.326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/19/2016] [Accepted: 08/20/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND A proper prognostic stratification is crucial for organizing an effective clinical management and treatment decision-making in patients with chronic heart failure (CHF). In this study, we selected and characterized a sub-group of CHF patients at very low risk for death aiming to assess predictors of death in subjects with an expected probability of 1-year mortality near to 5%. METHODS We used the Cardiac and Comorbid Conditions HF (3C-HF) Score to identify CHF patients with the best mid-term prognosis. We selected patients belonging to the lowest quartile of 3C-HF score (≤9 points). RESULTS We recruited 1777 consecutive CHF patients at 3 Italian Cardiology Units (age 76±10years, 43% female, 32% with preserved ejection fraction). Subjects belonging to the lowest quartile of 3C-HF score were 609. During a median follow-up of 21 [12-40] months, 48 of these patients (8%) died, and 561 (92%) survived. The variables that contributed to death prediction by Cox regression multivariate analysis were older age (HR 1.03[CI 1.00-1.07]; p=0.04), male gender (HR 2.93[CI 1.50-5.51]; p=0.002) and a higher degree of renal dysfunction (HR 0.96[CI 0.94-0.98]; p<0.001). CONCLUSIONS The prognostic stratification of CHF patients by 3C-HF score allows one to select patients at different outcome and to identify the factors associated with death in outliers with a very low mortality risk at mid-term follow-up. The reasons why these patients do not outlive the matching part of subjects who expectedly survive are related to a declined renal function and unmodifiable conditions including older age and male gender.
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Affiliation(s)
| | | | - Giovanni Pulignano
- Heart Failure Clinic, Division of Cardiology/C.C.U. San Camillo Hospital, Rome, Italy
| | | | - Luigi Tarantini
- Cardiology Department, St. Martino Hospital. Azienda Sanitaria Locale n. 1, Belluno, Italy
| | - Donatella Del Sindaco
- Department of Cardiocirculatory Diseases, San Giovanni-Addolorata Hospital, Rome, Italy
| | | | | | | | | | - Michele Senni
- Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy
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Early administration of tolvaptan preserves renal function in elderly patients with acute decompensated heart failure. J Cardiol 2016; 67:399-405. [DOI: 10.1016/j.jjcc.2015.09.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/10/2015] [Accepted: 09/25/2015] [Indexed: 11/23/2022]
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9
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Association of serum chloride level with mortality and cardiovascular events in chronic kidney disease: the CKD-ROUTE study. Clin Exp Nephrol 2016; 21:104-111. [DOI: 10.1007/s10157-016-1261-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/14/2016] [Indexed: 12/17/2022]
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10
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Armeni P, Boscolo PR, Tarricone R, Capodanno D, Maggioni AP, Grasso C, Tamburino C, Maisano F. Real-world cost effectiveness of MitraClip combined with Medical Therapy Versus Medical therapy alone in patients with moderate or severe mitral regurgitation. Int J Cardiol 2016; 209:153-60. [PMID: 26894467 DOI: 10.1016/j.ijcard.2016.01.212] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/07/2016] [Accepted: 01/31/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND We evaluated the real-world cost-effectiveness of the MitraClip system (Abbott Vascular Inc., Menlo Park, CA) plus medical therapy for patients with moderate/severe mitral regurgitation, as compared with medical therapy (MT) alone. METHODS Clinical records of patients with moderate to severe functional mitral regurgitation treated with MitraClip (N=232) or with MT (N=151) were collected and outcome analyzed with propensity score adjustment to reduce selection bias. Twelve-month outcomes were modeled over a lifetime horizon to conduct a cost-effectiveness analysis, in the payer's perspective. Costs and benefits were discounted at an annual rate of 3.5%. RESULTS After propensity score adjustment, the average treatment effect was -9.5% probability of dying at 12months and, following lifetime modeling, 3.35±0.75 incremental life years and 3.01±0.57 incremental quality-adjusted life years. MitraClip contributed to a higher decrease in re-hospitalizations at 12months (difference=-0.54±0.08) and generated a more likely improvement in the New York Heart Association (NYHA) class at 12months versus NYHA at enrollment. Incremental costs, adapted to five possible scenarios, ranged from 14,493 to 29,795 € contributing to an incremental cost-effectiveness ratio ranging from 4796 to 7908 €. CONCLUSIONS Compared to MT alone and given conventional threshold values, MitraClip can be considered a cost-effective procedure. The cost-effectiveness of MitraClip is in line or superior to the one of other non-pharmaceutical strategies for heart failure.
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Affiliation(s)
- Patrizio Armeni
- CERGAS (Centre for Research on Social and Healthcare Management) Bocconi University, Milan, Italy
| | - Paola R Boscolo
- CERGAS (Centre for Research on Social and Healthcare Management) Bocconi University, Milan, Italy
| | - Rosanna Tarricone
- CERGAS (Centre for Research on Social and Healthcare Management) Bocconi University, Milan, Italy; Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | | | | | - Carmelo Grasso
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Francesco Maisano
- Cardiovascular Surgery Department, University Hospital of Zurich, Switzerland
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Parrinello G, Torres D, Testani JM, Almasio PL, Bellanca M, Pizzo G, Cuttitta F, Pinto A, Butler J, Paterna S. Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction. Intern Emerg Med 2015; 10:965-72. [PMID: 26037394 DOI: 10.1007/s11739-015-1261-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Abstract
Renal dysfunction (RD) and venous congestion are related and common in heart failure (HF). Studies suggest that venous congestion may be the primary driver of RD in HF. In this study, we sought to investigate retrospectively the relationship between common measures of renal function with caval congestion and mortality among outpatients with HF and RD. We reviewed data from 103 HF outpatients (45 males, mean age 74 years, ejection fraction 41.8 ± 11.6 %) with estimated glomerular filtration rate (eGFR) of < 60 ml/min in a single centre. During an ambulatory visit, all patients underwent blood test and ultrasonography of the inferior vena cava (IVC). Caval congestion was defined as IVC with both dilatation and impaired collapsibility. The best values of renal metrics in predicting caval congestion were determined with receiver-operating characteristic analysis. The BUN/Cr ratio is moderately correlated with IVC expiratory maximum diameter (r = 0.31, p < 0.0007). In a multiple logistic regression model, BUN/Cr > 25.5 (adjusted OR 2.98, p 0.015) and eGFR ≤ 45.8 (adjusted OR 5.38, p 0.002) identify patients at risk for caval congestion; a BUN/Cr > 23.7 was the best predictor of impaired collapsibility (adjusted OR 4.41, p 0.001). a BUN/Cr > 25.5 (HR 2.19, 95 % CI 1.21-3.94, p < 0.001) and NYHA class 3 (HR 2.91, 95 % CI 1.60-5.31, p < 0.0005) were independent risk factors associated with all-cause death during a median follow-up of 31 months. In outpatients with HF and RD, a higher BUN/Cr and lower eGFR are reliable renal biomarkers for caval congestion. The BUN/Cr is associated with long-term mortality and may help to stratify HF severity.
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Affiliation(s)
- Gaspare Parrinello
- Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
| | - Daniele Torres
- Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Jeffrey M Testani
- Department of Internal Medicine and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, USA
| | - Piero Luigi Almasio
- Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Michele Bellanca
- Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Giuseppina Pizzo
- Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Francesco Cuttitta
- Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Antonio Pinto
- Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Javed Butler
- Cardiology Division, Stony Brook University, Stony Brook, NY, USA
| | - Salvatore Paterna
- Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
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12
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Di Tano G, De Maria R, Gonzini L, Aspromonte N, Di Lenarda A, Feola M, Marini M, Milli M, Misuraca G, Mortara A, Oliva F, Pulignano G, Russo G, Senni M, Tavazzi L. The 30-day metric in acute heart failure revisited: data from IN-HF Outcome, an Italian nationwide cardiology registry. Eur J Heart Fail 2015; 17:1032-41. [PMID: 26018852 DOI: 10.1002/ejhf.290] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/17/2015] [Accepted: 04/27/2015] [Indexed: 11/11/2022] Open
Abstract
AIMS Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short-term post-discharge mortality is substantial. METHODS AND RESULTS Using data from the prospective, nationwide Registry IN-HF Outcome, we analysed the incidence and predictors of 30-day mortality or readmissions and associated days-alive-out-of-hospital (DAOH) in 1520 patients discharged alive after admission for acute heart failure. Within 30 days after discharge, 94 patients (6.2%) were readmitted (91% for cardiovascular causes; 60% recurrent heart failure) and 42 (2.8%) died, 10 of which occurred during readmission. Overall, 126 patients (8.3%) met the combined endpoint. By multivariable logistic regression, worsening chronic heart failure as clinical presentation [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21-2.77, P = 0.005), inotropes during admission (OR 2.19, 95% CI 1.40-3.43, P = 0.0006), length of stay (OR 1.02, 95% CI 1.01-1.04, P = 0.002) and renin-angiotensin system inhibitors at discharge (OR 0.52, 95%CI 0.35-0.77, P = 0.001) independently predicted 30-day all-cause mortality and/or readmission (c-statistic = 0.695). Per cent 30-day DAOH was lower in patients with in-hospital inotrope use, no renin-angiotensin system inhibitors prescription at discharge, New York Heart Association III-IV class at discharge, and correlated inversely with length of stay and age. CONCLUSION A clinical and biohumoral profile consistent with chronic advanced heart failure and end-organ damage identifies acute heart failure patients discharged home from cardiology units, who are at highest risk of early death and/or readmission. These findings have practical implications for tailoring specific follow-up.
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Affiliation(s)
| | - Renata De Maria
- CNR Clinical Physiology Institute, Cardiothoracic and Vascular Department, Azienda Ospedaliera Niguarda Ca' Granda, Milan, Italy
| | | | | | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority n. 1 and University of Trieste, Trieste, Italy
| | - Mauro Feola
- Cardiovascular Rehabilitation, Heart Failure Unit, Ospedale Maggiore SS, Trinità, Fossano, Italy
| | - Marco Marini
- Cardiology Department, Ospedali Riuniti, Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Massimo Milli
- Cardiology, Ospedale Santa Maria Nuova, Florence, Italy
| | | | - Andrea Mortara
- Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Fabrizio Oliva
- Cardiologia 2 Heart Failure and Heart Transplant Programme, 'A. De Gasperis' Cardiothoracic and Vascular Department, Azienda Ospedaliera Niguarda Ca' Granda, Milan, Italy
| | - Giovanni Pulignano
- Heart Failure Clinic, 1st Cardiology/CCU Unit, Cardiovascular Department, San Camillo Hospital, Rome, Italy
| | - Giulia Russo
- Cardiovascular Center, Health Authority n. 1 and University of Trieste, Trieste, Italy
| | - Michele Senni
- Cardiovascular Department, Cardiology 1, Papa Giovanni XXIII Hospital, Bergamo
| | - Luigi Tavazzi
- Maria Cecilia Hospital-GVM Care&Research-E.S. Health Science Foundation, Cotignola, Italy
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13
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Palmieri V, Baldi C, Di Blasi PE, Citro R, Di Lorenzo E, Bellino E, Preziuso F, Ranaudo C, Sauro R, Rosato G. Impact of DRG billing system on health budget consumption in percutaneous treatment of mitral valve regurgitation in heart failure. J Med Econ 2015; 18:89-95. [PMID: 25350644 DOI: 10.3111/13696998.2014.980502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Percutaneous correction of mitral regurgitation (MR) by MitraClip (Abbot Vascular, Abbot Park, Illinois, USA) trans-catheter procedure (MTP) may represent a treatment for an unmet need in heart failure (HF), but with a largely unclear economic impact. RESEARCH DESIGN AND METHODS This study estimated the economic impact of the MTP in common practice using the disease-related group (DRG) billing system, duration and average cost per day of hospitalization as main drivers. Life expectancy was estimated based on the Seattle Heart Failure Model. Quality-of-life was derived by standard questionnaires to compute quality-adjusted year-life costs. RESULTS Over 5535 discharges between 2012-2013, HF as DRG 127 was the main diagnosis in 20%, yielding a reimbursement of €3052.00/case; among the DRG 127, MR by ICD-9 coding was found in 12%. Duration of hospitalization was longer for DRG 127 with than without MR (9 vs 8 days, p < 0.05). HF in-hospital management generated most frequently deficit, in particular in the presence of MR, due to the high costs of hospitalization, higher than reimbursement. MTP to treat MR allowed DRG 104-related reimbursement of €24,675.00. In a cohort of 34 HF patients treated for MR by MTP, the global budget consumption was 2-fold higher compared to that simulated for those cases medically managed at 2-year follow-up. Extrapolated cost per quality-adjusted-life-years (QALY) for MTP at year-2 follow-up was ∼ €16,300. CONCLUSIONS Based on DRG and hospitalization costing estimates, MTP might be cost-effective in selected HF patients with MR suitable for such a specific treatment, granted that those patients have a clinical profile predicting high likelihood of post-procedural clinical stability in sufficiently long follow-up.
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Affiliation(s)
- Vittorio Palmieri
- Cardiology Unit of the Heart and Vessels Department, AORN 'S.G. Moscati' Hospital , Avellino , Italy
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14
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Cioffi G, Pulignano G, Barbati G, Tarantini L, Del Sindaco D, Mazzone C, Russo G, Cherubini A, Faganello G, Stefenelli C, Ognibeni F, Senni M, Di Lenarda A. Reasons why patients suffering from chronic heart failure at very high risk for death survive. Int J Cardiol 2014; 177:213-8. [PMID: 25499382 DOI: 10.1016/j.ijcard.2014.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/20/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND An accurate prognostic stratification is essential for optimizing the clinical management and treatment decision-making of patients with chronic heart failure (HF). Among the best available models, we used the Cardiac and Comorbid Conditions HF (3C-HF) Score, to predict all-cause mortality in patients with CHF. METHODS we selected and characterized the subgroup of patients at very high risk with the worst mid-term prognosis belonging to the highest decile of 3C-HF score with the aim to assess predictors of survival in subjects with an expected probability of 1-year mortality near to 45%. METHODS AND RESULTS We recruited 1777 consecutive chronic HF patients at 3 Italian Cardiology Units. Median age was 76 ± 10 years, 43% were female, and 32% had preserved ejection fraction. Subjects belonging to the highest decile of 3C-HF score were 246 (13.8% of total population). During a median follow-up of 21 [12-40] months, 110 of these patients (45%) survived and 136 (55%) died. The variables that contributed to survival prediction emerged by Cox regression multivariate analysis were the lower degree of renal dysfunction and higher body mass index. CONCLUSIONS The prognostic stratification of chronic HF patients allows in daily practice to select patients at different risk for death and identify prognosticators of survival in outliers at very high risk of death. The reasons why these patients outlive the matching part of subjects who expectedly die are related to the maintenance of a satisfactory renal function and body mass index.
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Affiliation(s)
| | - Giovanni Pulignano
- Heart Failure Clinic, Division of Cardiology/C.C.U. San Camillo Hospital, Rome, Italy
| | - Giulia Barbati
- Cardiovascular Center, Health Authority no. 1 and University of Trieste, Italy
| | - Luigi Tarantini
- Cardiology Department, St. Martino Hospital Azienda Sanitaria Locale n. 1, Belluno, Italy
| | - Donatella Del Sindaco
- Department of Cardiocirculatory Diseases, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Carmine Mazzone
- Cardiovascular Center, Health Authority no. 1 and University of Trieste, Italy
| | - Giulia Russo
- Cardiovascular Center, Health Authority no. 1 and University of Trieste, Italy
| | - Antonella Cherubini
- Cardiovascular Center, Health Authority no. 1 and University of Trieste, Italy
| | - Giorgio Faganello
- Cardiovascular Center, Health Authority no. 1 and University of Trieste, Italy
| | | | | | - Michele Senni
- Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy
| | - Andrea Di Lenarda
- Heart Failure Clinic, Division of Cardiology/C.C.U. San Camillo Hospital, Rome, Italy
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15
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Inohara T, Kohsaka S, Sato N, Kajimoto K, Keida T, Mizuno M, Takano T. Prognostic impact of renal dysfunction does not differ according to the clinical profiles of patients: insight from the acute decompensated heart failure syndromes (ATTEND) registry. PLoS One 2014; 9:e105596. [PMID: 25197833 PMCID: PMC4157767 DOI: 10.1371/journal.pone.0105596] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/22/2014] [Indexed: 11/19/2022] Open
Abstract
Background Renal dysfunction associated with acute decompensated heart failure (ADHF) is associated with impaired outcomes. Its mechanism is attributed to renal arterial hypoperfusion or venous congestion, but its prognostic impact based on each of these clinical profiles requires elucidation. Methods and Results ADHF syndromes registry subjects were evaluated (N = 4,321). Logistic regression modeling calculated adjusted odds ratios (OR) for in-hospital mortality for patients with and without renal dysfunction. Renal dysfunction risk was calculated for subgroups with hypoperfusion-dominant (eg. cold extremities, a low mean blood pressure or a low proportional pulse pressure) or congestion-dominant clinical profiles (eg. peripheral edema, jugular venous distension, or elevated brain natriuretic peptide) to evaluate renal dysfunction's prognostic impact in the context of the two underlying mechanisms. On admission, 2,150 (49.8%) patients aged 73.3±13.6 years had renal dysfunction. Compared with patients without renal dysfunction, those with renal dysfunction were older and had dominant ischemic etiology jugular venous distension, more frequent cold extremities, and higher brain natriuretic peptide levels. Renal dysfunction was associated with in-hospital mortality (OR 2.36; 95% confidence interval 1.75–3.18, p<0.001), and the prognostic impact of renal dysfunction was similar in subgroup of patients with hypoperfusion- or congestion-dominant clinical profiles (p-value for the interaction ranged from 0.104–0.924, and was always >0.05). Conclusions Baseline renal dysfunction was significantly associated with in-hospital mortality in ADHF patients. The prognostic impact of renal dysfunction was the same, regardless of its underlying etiologic mechanism.
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Affiliation(s)
- Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Naoki Sato
- Internal Medicine, Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | | | - Takehiko Keida
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Masayuki Mizuno
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Teruo Takano
- Department of Internal Medicine, Nippon Medical University, Tokyo, Japan
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17
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Cioffi G, Mortara A, Maggioni AP, Tavazzi L. Predictors of mortality in acute heart failure and severe renal dysfunction. Does formula for glomerular filtration rate have any impact? Data from IN-HF outcome registry. Int J Cardiol 2014; 172:e96-7. [PMID: 24461992 DOI: 10.1016/j.ijcard.2013.12.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/22/2013] [Indexed: 11/16/2022]
Affiliation(s)
| | - Andrea Mortara
- Dept. of Clinical Cardiology and Heart Failure, Policlinico di Monza, Monza, Italy
| | | | - Luigi Tavazzi
- GVM Hospitals of Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy
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18
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Balta S, Demirkol S, Kucuk U, Arslan Z, Unlu M. Renal failure in patients with acute heart failure. Int J Cardiol 2013; 168:e131. [PMID: 23993728 DOI: 10.1016/j.ijcard.2013.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 08/03/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Sevket Balta
- Department of Cardiology, Gulhane Medical Academy Ankara, Turkey.
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