1
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Patil T, Halsey E, Kaur A, Minchak J, Hobson J, Eppes D. CHAnges in Diuretic Medication Prescribing and Surrogate Laboratory Parameters After Initiating EmpagliflOziN in Veterans (CHAMPION Cohort Study). Clin Drug Investig 2023; 43:61-74. [PMID: 36515856 DOI: 10.1007/s40261-022-01226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Sodium-glucose cotransporter type 2 inhibitors have evolved into a novel drug class utilized for reductions in cardiovascular risk and heart failure hospitalization. We aimed to describe the impact of sodium-glucose cotransporter type 2 inhibitors on diuretic prescribing patterns and intermediate laboratory outcomes in patients with and without diuretic use. METHODS This retrospective cohort study included patients taking empagliflozin as of 1 July, 2021. Patients were assigned to the intervention group if prescribed a diuretic concomitantly or a control group otherwise. The primary outcome was the impact of empagliflozin on diuretic prescribing (i.e., no change, discontinuation, decrease, increase). Secondary outcomes were change in weight, hemoglobin A1c, estimated glomerular filtration rate, hemoglobin, hematocrit, blood pressure, and electrolytes at 90 and 180 days. Mean differences were compared using the t-test between groups or the paired t-test within groups. Patients without diuretic use were matched 1:1 to patients taking diuretics using propensity scores. RESULTS This study included 1189 patients: 750 in the control group and 439 in the intervention group. After propensity score matching, baseline characteristics were well balanced. Of the 439 patients in the intervention group, 118 had changes in the diuretic regimen. There were 131 changes: 109 (83.2%) discontinuations, 13 (9.92%) decreases, and nine (6.87%) increases. The mean furosemide equivalent loop dose was reduced after empagliflozin initiation (50.62 mg vs 43.13 mg; p < 0.001). Among all patients, there was a decrease in weight (p = 0.01), estimated glomerular filtration rate (p < 0.001), and hemoglobin A1c (p < 0.001). There was an increase in hemoglobin (p < 0.001), hematocrit (p < 0.001), and magnesium (p < 0.001). In the propensity score-matched cohort, there was a significant reduction from baseline in mean weight in the intervention group compared with the control group (p < 0.001). CONCLUSIONS This hypothesis-generating study suggests that sodium-glucose cotransporter type 2 inhibitors may lower diuretic requirements, further supported by a reduction in weight in the intervention cohort.
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Affiliation(s)
- Tanvi Patil
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA.
| | - Emily Halsey
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - Alamdeep Kaur
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - John Minchak
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - Jesse Hobson
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - Davida Eppes
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
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2
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Swolinsky JS, Tuvshinbat E, Leistner DM, Edelmann F, Knebel F, Nerger NP, Lemke C, Roehle R, Haase M, Costanzo MR, Rauch G, Mitrovic V, Gasanin E, Meier D, McCullough PA, Eckardt KU, Molitoris BA, Schmidt-Ott KM. Discordance between estimated and measured changes in plasma volume among patients with acute heart failure. ESC Heart Fail 2021; 9:66-76. [PMID: 34881523 PMCID: PMC8788058 DOI: 10.1002/ehf2.13739] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/04/2021] [Accepted: 11/11/2021] [Indexed: 11/08/2022] Open
Abstract
Aims In acute heart failure (AHF), changes of venous haemoglobin (Hb) concentrations, haematocrit (Hct), and estimated plasma volume (ePV) have been proposed as surrogates of decongestion. These estimates are based on the theoretical assumptions that changes of Hb concentrations and Hct are driven by the intravascular volume status and that the intravascular Hb pool remains stable. The objective of this study was to assess the relationship of changes of measured plasma volume (mPV) with changes of Hb, Hct, and ePV in AHF. Methods and results We studied 36 AHF patients, who received two sequential assessments of mPV, measured red cell volume (mRCV) and measured total blood volume (mTBV) (48 h apart), during the course of diuretic therapy using a novel visible fluorescent injectate (VFI) technique based on the indicator dilution principle. Changes of ePV were calculated based on the Kaplan–Hakim or Strauss formula. AHF patients receiving diuretics (median intravenous furosemide equivalent 160 mg/48 h) displayed a wide range of changes of mPV (−25.4% to +37.0%). Changes in mPV were not significantly correlated with changes of Hb concentration [Pearson's r (r) = −0.241, P = 0.157], Hct (r = −0.307, P = 0.069), ePVKaplan–Hakim (r = 0.228, P = 0.182), or ePVStrauss (r = 0.237, P = 0.163). In contrast to theoretical assumptions, changes of mTBV were poorly correlated with changes of Hb concentrations and some patients displayed unanticipated variability of mRCV, suggesting an unstable intravascular red cell pool. Conclusions Changes of Hb or Hct were not reflective of directly measured changes of intravascular volume status in AHF patients. Basing clinical assessment of decongestion on changes of Hb or Hct may misguide clinical decision‐making on an individual patient level.
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Affiliation(s)
- Jutta S Swolinsky
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany
| | - Enkhtuvshin Tuvshinbat
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany
| | - David M Leistner
- Department of Internal Medicine and Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Frank Edelmann
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology, Campus Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Niklas P Nerger
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany
| | - Caroline Lemke
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany
| | - Robert Roehle
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Clinical Study Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Haase
- Medical Faculty, Otto von-Guericke-University Magdeburg, Magdeburg, Germany.,Diaverum Renal Care Center, Potsdam, Germany
| | | | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | | | | | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany
| | - Bruce A Molitoris
- FAST BioMedical, Indianapolis, IN, USA.,Indiana University, Indianapolis, IN, USA
| | - Kai M Schmidt-Ott
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
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3
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Deferrari G, Cipriani A, La Porta E. Renal dysfunction in cardiovascular diseases and its consequences. J Nephrol 2021; 34:137-153. [PMID: 32870495 PMCID: PMC7881972 DOI: 10.1007/s40620-020-00842-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022]
Abstract
It is well known that the heart and kidney and their synergy is essential for hemodynamic homeostasis. Since the early XIX century it has been recognized that cardiovascular and renal diseases frequently coexist. In the nephrological field, while it is well accepted that renal diseases favor the occurrence of cardiovascular diseases, it is not always realized that cardiovascular diseases induce or aggravate renal dysfunctions, in this way further deteriorating cardiac function and creating a vicious circle. In the same clinical field, the role of venous congestion in the pathogenesis of renal dysfunction is at times overlooked. This review carefully quantifies the prevalence of chronic and acute kidney abnormalities in cardiovascular diseases, mainly heart failure, regardless of ejection fraction, and the consequences of renal abnormalities on both organs, making cardiovascular diseases a major risk factor for kidney diseases. In addition, with regard to pathophysiological aspects, we attempt to substantiate the major role of fluid overload and venous congestion, including renal venous hypertension, in the pathogenesis of acute and chronic renal dysfunction occurring in heart failure. Furthermore, we describe therapeutic principles to counteract the major pathophysiological abnormalities in heart failure complicated by renal dysfunction. Finally, we underline that the mild transient worsening of renal function after decongestive therapy is not usually associated with adverse prognosis. Accordingly, the coexistence of cardiovascular and renal diseases inevitably means mediating between preserving renal function and improving cardiac activity to reach a better outcome.
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Affiliation(s)
- Giacomo Deferrari
- Department of Cardionephrology, Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Via Mario Puchoz 25, 16035, Rapallo, GE, Italy.
- Department of Internal Medicine (DiMi), University of Genoa, Genoa, Italy.
| | - Adriano Cipriani
- Grown-Up Congentital Heart Disease Center (GUCH Center), Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Rapallo, GE, Italy
| | - Edoardo La Porta
- Department of Cardionephrology, Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Via Mario Puchoz 25, 16035, Rapallo, GE, Italy
- Department of Internal Medicine (DiMi), University of Genoa, Genoa, Italy
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4
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Yadollahi Farsani A, Vakhshoori M, Mansouri A, Heidarpour M, Nikouei F, Garakyaraghi M, Sarrafzadegan N, Shafie D. Relation between Hemoconcentration Status and Readmission Plus Mortality Rate Among Iranian Individuals with Decompensated Heart Failure. Int J Prev Med 2020; 11:163. [PMID: 33312472 PMCID: PMC7716610 DOI: 10.4103/ijpvm.ijpvm_45_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hemoconcentration (HC) has been suggested to be a useful biomarker for determination of optimum diuretic therapy in acute heart failure (HF), but role of this factor in rehospitalization and death was still controversial. In this study, we aimed to define relation between HC and readmission and mortality rate among Iranian patients with acute HF. METHODS This was a prospective cohort study done from March 2017 to March 2018 using data of a HF section of Persian Registry Of cardioVascular diseasE. From a total number of 390 registered HF individuals aged 18 years or older, 69 ones showed alterations in hemoglobin (Hb) levels. Hb levels were measured at admission and discharge time. HC was defined as any increased level in Hb during hospitalization. The relation of HC with readmission and death rate was done using multiple logistic regression and Cox proportional hazard model, respectively. RESULTS The mean age of study population was 70.5 ± 11.9 years with the dominant percentage of male participants (66.9%). Patients showing HC during admission did not reveal any significant decreased likelihood of rehospitalization compared to negative ones. In comparison to HC negative patients, those showing increments in Hb levels had a borderline significant lower likelihood of mortality (hazard ratio: 0.82, 95% confidence interval, CI = 0.07-1.18, P = 0.08). CONCLUSIONS Our data suggested that HC was associated marginally with reduced mortality rate 6 months post HF attack and could be utilized as a useful biomarker for risk stratification of HF patients. Several prospective longitudinal population-based studies are necessary proving these associations.
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Affiliation(s)
| | - Mehrbod Vakhshoori
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asieh Mansouri
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Heidarpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farnoosh Nikouei
- Heart Failure Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Garakyaraghi
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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5
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Yan Q, Chen S. Hemoconcentration is a valuable predictor of prognosis in patients with acute heart failure. Exp Ther Med 2020; 19:2792-2798. [PMID: 32256762 DOI: 10.3892/etm.2020.8515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/27/2019] [Indexed: 11/06/2022] Open
Abstract
The present study was designed to investigate the value of the hemoconcentration (HCT) in predicting the prognosis of patients with acute heart failure (AHF). A total of 188 patients with AHF were enrolled in the present retrospective study and divided into four groups based on their HCT values. The endpoint was either cardiac-associated death or re-hospitalization due to aggravated HF. The 2-year survival rates of patients in these four groups were compared. The area under the receiver operating characteristic curve (AUC) was determined to evaluate the significance of HCT for assessing the prognosis of patients with AHF. Cox-proportional hazards regression models were performed to determine whether the HCT is an independent factor for predicting the prognosis of patients with AHF in comparison with other traditional predictors, including B-type natriuretic peptide (BNP) and creatinine. Of these 188 patients with AHF, 99 experienced aggravated cardiac HF resulting in death or re-hospitalization within 2 years. The AUC for HCT, as a prognostic criterion, was 0.610 (95% confidence interval: 0.528-0.691, P<0.001) with a sensitivity of 54.5% and a specificity of 65.2%. Kaplan-Meier analysis indicated that patients with a higher HCT had a lower rate of death or re-hospitalization due to cardiogenic events (χ2=9.442, P=0.024). Cox regression analysis revealed that HCT, hemoglobin, BNP, New York Heart Association cardiac function classification and serum creatinine were independent prognostic factors in AHF. HCT may serve as a valuable predictor of prognosis in patients with AHF. Compared with that of BNP, measurement of the HCT is more convenient and economical and may be widely performed at primary hospitals.
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Affiliation(s)
- Qian Yan
- Department of Emergency, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, P.R. China
| | - Sanfeng Chen
- Department of Internal Medicine, Aged Care Hospital of Zhejiang, Hangzhou, Zhejiang 310015, P.R. China
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6
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Sujino Y, Nakano S, Tanno J, Shiraishi Y, Goda A, Mizuno A, Nagatomo Y, Kohno T, Muramatsu T, Nishimura S, Kohsaka S, Yoshikawa T. Clinical implications of the blood urea nitrogen/creatinine ratio in heart failure and their association with haemoconcentration. ESC Heart Fail 2019; 6:1274-1282. [PMID: 31814319 PMCID: PMC6989280 DOI: 10.1002/ehf2.12531] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/02/2019] [Accepted: 09/06/2019] [Indexed: 11/16/2022] Open
Abstract
Aims The blood urea nitrogen (BUN)/creatinine ratio is a strong prognostic indicator in patients with acute decompensated heart failure (ADHF). However, the clinical impact of a high BUN/creatinine ratio at discharge with respect to renal dysfunction, neurohormonal hyperactivity, and different responsiveness to decongestion therapy remains unclear. Herein, we examined (i) the predictive value of a high BUN/creatinine ratio at discharge and (ii) its haemoconcentration‐dependent effects, in patients with ADHF. Methods and results The West Tokyo Heart Failure registry was a multicentre, prospective cohort registry‐based study that enrolled patients hospitalized with a diagnosis of ADHF. The endpoint was post‐discharge all‐cause death. Based on the degree of haemoconcentration, patients (n = 2090) were divided into four subcategories. In multivariate proportional hazard analyses, a higher BUN/creatinine ratio was independently associated with higher all‐cause mortality in the total population and in the extreme haemodilution (ΔHaemoglobin ≤ −0.9 g/dL) and haemoconcentration (0.8 g/dL ≤ ΔHaemoglobin) subcategories, but not in the modest haemodilution/haemoconcentration subcategories. Conclusions A higher BUN/creatinine ratio at discharge was independently associated with higher post‐discharge all‐cause mortality in patients with ADHF. The predictive value of a high BUN/creatinine ratio at discharge was haemoconcentration dependent and may be an unfavourable predictor in patients showing excessive haemoconcentration and haemodilution, but not in those showing modest haemoconcentration/haemodilution.
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Affiliation(s)
- Yasumori Sujino
- Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Jun Tanno
- Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ayumi Goda
- Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Toshihiro Muramatsu
- Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Shigeyuki Nishimura
- Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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7
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Griffin M, Rao VS, Fleming J, Raghavendra P, Turner J, Mahoney D, Wettersten N, Maisel A, Ivey-Miranda JB, Inker L, Tang WHW, Wilson FP, Testani JM. Effect on Survival of Concurrent Hemoconcentration and Increase in Creatinine During Treatment of Acute Decompensated Heart Failure. Am J Cardiol 2019; 124:1707-1711. [PMID: 31601358 PMCID: PMC6959849 DOI: 10.1016/j.amjcard.2019.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 01/11/2023]
Abstract
Hemoconcentration during the treatment of acute decompensated heart failure is a surrogate for plasma volume reduction and is associated with improved survival, but most definitions only allow for hemoconcentration to be determined retrospectively. An increase in serum creatinine can also be a marker of aggressive decongestion, but in isolation is not specific. Our objective was to determine if combined hemoconcentration and worsening creatinine could better identify patients that were aggressively treated and, as such, may have improved postdischarge outcomes. A total of 4,181 patients hospitalized with acute decompensated heart failure were evaluated. Those who experienced both hemoconcentration and worsening creatinine at any point had a profile consistent with aggressive in-hospital treatment and longer length of stay (p <0.01), higher loop diuretic doses (p <0.001), greater weight (p = 0.001), and net fluid loss (p <0.001) compared with the remainder of the cohort. In isolation, neither worsening creatinine (p = 0.11) nor hemoconcentration (p = 0.36) at any time were associated with improved survival. However, patients who experienced both (21%) had significantly better survival (hazard ratio 0.80, 95% confidence interval 0.69 to 0.94, pinteraction = 0.005). In conclusion, this combination of hemoconcentration and worsening creatinine, which can be determined prospectively during patient care, was associated with in-hospital parameters consistent with aggressive diuresis and improved postdischarge survival.
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Affiliation(s)
- Matthew Griffin
- Sections of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - Veena S Rao
- Sections of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - James Fleming
- Sections of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | | | - Jeffrey Turner
- Department of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Devin Mahoney
- Sections of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - Nicholas Wettersten
- Department of Cardiovascular Medicine, Veteran Affairs Medical Center, San Diego, California
| | - Alan Maisel
- Department of Cardiovascular Medicine, Veteran Affairs Medical Center, San Diego, California
| | - Juan B Ivey-Miranda
- Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Lesley Inker
- Tufts University Medical Center, Boston, Massachusetts
| | | | - Francis Perry Wilson
- Department of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey M Testani
- Sections of Cardiovascular Medicine, Yale University, New Haven, Connecticut.
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8
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Kim MC, Kim KH, Cho JY, Lee KH, Sim DS, Yoon HJ, Yoon NS, Hong YJ, Park HW, Kim JH, Ahn Y, Jeong MH, Cho JG, Park JC. Pre-discharge anemia as a predictor of adverse clinical outcomes in patients with acute decompensated heart failure. Korean J Intern Med 2019; 34:549-558. [PMID: 29562736 PMCID: PMC6506743 DOI: 10.3904/kjim.2017.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/30/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND/AIMS The impact of the timing of anemia during hospitalization on future clinical outcomes after surviving discharge from an index heart failure (HF) has been poorly studied in patients with acute decompensated heart failure (ADHF). METHODS A total of 384 surviving patients with acute ADHF were divided into two groups: an anemia group (n = 270, 199 anemia at admission and 71 pre-discharge anemia) and a no anemia group (n = 114). All-cause mortality and HF re-hospitalization were compared between groups. RESULTS During the follow-up period (median, 528 days), death occurred in 60 patients (15.6%) and HF re-hospitalization occurred in 131 patients (34.1%). Overall anemia was associated with increased mortality (hazard ratio [HR], 1.74; 95% confidence interval [CI], 1.03 to 3.01; p = 0.039), but not HF re-hospitalization (HR, 0.92; 95% CI, 0.59 to 1.42; p = 0.707). Pre-discharge anemia was significantly associated with increased mortality (HR, 1.68; 95% CI, 1.01 to 2.82; p = 0.048), but anemia at admission did not predict increased mortality or re-hospitalization. CONCLUSION Pre-discharge anemia, rather than anemia at admission, was identified as an independent predictor of mortality in patients with ADHF after surviving discharge. The results of the present study suggest that the identification and optimal management of anemia during hospitalization are important in patients with ADHF.
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Affiliation(s)
- Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Correspondence to Kye Hun Kim, M.D. Department of Cardiology, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6978 Fax: +82-62-223-3105 E-mail:
| | - Jae Yeong Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ki Hong Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Nam Sik Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Specialized Research Consortium of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
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9
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Escobar Cervantes C. Hemoconcentration and acute heart failure, an emerging predictive factor or already established? Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Grau Amorós J, Formiga F, Aramburu Bodas O, Armengou Arxe A, Conde Martel A, Quesada Simón M, Oropesa Juanes R, Satué Bartolomé J, Dávila Ramos M, Montero Pérez-Barquero M, Anarte L, Aramburu O, Arévalo-Lorido J, Armengou A, Brase A, Carrascosa S, Carrera M, Casado J, Cerqueiro J, Conde A, Dávila M, Díez-Manglano J, Epelde F, Formiga F, Franco J, Gallego J, García-Escrivá D, González-Franco A, Grau J, Guisado M, Herrero A, Llacer P, López-Castellanos G, Manzano L, Martínez-Zapico A, Montero-Pérez-Barquero M, Muela A, Oropesa R, Pérez-Bocanegra C, Pérez-Calvo J, Pérez-Silvestre J, Quesada M, Quirós R, Rodríguez-Ávila E, Ruiz-Laiglesia F, Ruiz-Ortega R, Salamanca P, Sánchez-Marteles M, Satué J, Serrado A, Suárez I, Trullàs J. Hemoconcentración como predictor de supervivencia al año de ingreso por insuficiencia cardiaca aguda en el registro RICA. Rev Clin Esp 2019; 219:1-9. [DOI: 10.1016/j.rce.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 02/04/2023]
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11
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Hemoconcentración e insuficiencia cardiaca aguda, ¿un factor predictor emergente o ya consolidado? Rev Clin Esp 2019; 219:32-33. [DOI: 10.1016/j.rce.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/15/2022]
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12
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Grau Amorós J, Formiga F, Aramburu Bodas O, Armengou Arxe A, Conde Martel A, Quesada Simón M, Oropesa Juanes R, Satué Bartolomé J, Dávila Ramos M, Montero Pérez-Barquero M, Anarte L, Aramburu O, Arévalo-Lorido J, Armengou A, Brase A, Carrascosa S, Carrera M, Casado J, Cerqueiro J, Conde A, Dávila M, Díez-Manglano J, Epelde F, Formiga F, Franco J, Gallego J, García-Escrivá D, González-Franco A, Grau J, Guisado M, Herrero A, Llacer P, López-Castellanos G, Manzano L, Martínez-Zapico A, Montero-Pérez-Barquero M, Muela A, Oropesa R, Pérez-Bocanegra C, Pérez-Calvo J, Pérez-Silvestre J, Quesada M, Quirós R, Rodríguez-Ávila E, Ruiz-Laiglesia F, Ruiz-Ortega R, Salamanca P, Sánchez-Marteles M, Satué J, Serrado A, Suárez I, Trullàs J. Hemoconcentration as a prognostic factor after hospital discharge in acute heart failure in the RICA registry. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Assessment of Discharge Readiness and Readmission Risk in Patients With Acute Decompensated Heart Failure. Am J Cardiol 2018; 122:2086-2094. [PMID: 30389090 DOI: 10.1016/j.amjcard.2018.08.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 12/23/2022]
Abstract
Failure to achieve euvolemia before discharge in patients admitted with acute heart failure (HF) syndromes has gained attention as a marker for increased readmission risk. This study assessed whether variations in discharge documentation practices reflected the readmission risk of patients admitted for decompensated HF. This was a retrospective cohort study of 100 adult patients discharged from an admission for an acute HF syndrome from May 2014 to June 2015. Characteristics at discharge were retrieved from the discharge summaries (DS). Coprimary outcomes were 30-day and 6-month composites of all-cause readmissions or emergency department visits. Mean age was 62.1 years (SD 15.3), and 56% were men. Traditional cardiovascular risk factors were common. All-cause 30-day readmission occurred in 18%, and HF-related 30-day readmission occurred in 12% of the population. A DS physical exam in support of decongestion occurred more often in those not readmitted, for example, a normal jugular venous pulse (53.2 vs 12.5%, p = 0.03). Discussion of jugular venous pulse improvement occurred more frequently in those not readmitted (8.5 vs 0%, p = 0.03). No other markers of volume status reached statistical significance. A clear statement in the DS supporting euvolemia was uncommon, but tended to occur more commonly in those not readmitted (20.7 vs 5.6%, p = 0.13). In conclusion, documenting markers of euvolemia and incorporating these markers into the DS volume status assessment was associated with a reduced rate of 30-day readmission.
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Putting creatinine and hemoconcentration in their place as prognostic predictors in the conundrum of acute heart failure. Rev Port Cardiol 2018; 37:603-605. [DOI: 10.1016/j.repc.2018.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Putting creatinine and hemoconcentration in their place as prognostic predictors in the conundrum of acute heart failure. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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16
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Matsutani D, Sakamoto M, Kayama Y, Takeda N, Horiuchi R, Utsunomiya K. Effect of canagliflozin on left ventricular diastolic function in patients with type 2 diabetes. Cardiovasc Diabetol 2018; 17:73. [PMID: 29788955 PMCID: PMC5963148 DOI: 10.1186/s12933-018-0717-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/17/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) greatly increases the risks of cardiovascular disease and heart failure. In particular, left ventricular diastolic dysfunction that develops from the early stages of T2DM is an important factor in the onset and exacerbation of heart failure. The effect of sodium-glucose cotransporter 2 inhibitors on left ventricular diastolic function has not been elucidated. We have performed the first prospective study on the effects of canagliflozin on left ventricular diastolic function in T2DM. METHODS This study was performed to evaluate the effects of additional treatment with canagliflozin for 3 months on left ventricular diastolic function in patients with T2DM. A total of 38 patients with T2DM were consecutively recruited for this study. Left ventricular diastolic function was assessed by echocardiography. The primary study outcome was a change in the septal E/e' as a parameter of left ventricular diastolic function. RESULTS A total of 37 patients (25 males and 12 females) were included in the analysis. Mean age of participants was 64.2 ± 8.1 years (mean ± SD), mean duration of diabetes was 13.5 ± 8.1 years, and mean HbA1c was 7.9 ± 0.7%. Of the participants, 86.5% had hypertension, 100% had dyslipidemia, and 32.4% had cardiovascular disease. Canagliflozin significantly improved left ventricular diastolic function (septal E/e' ratio 13.7 ± 3.5-12.1 ± 2.8, p = 0.001). Furthermore, among the various parameters that changed through the administration of canagliflozin, only changes in hemoglobin significantly correlated with changes in the septal E/e' ratio (p = 0.002). In multiple regression analysis, changes in hemoglobin were also revealed to be an independent predictive factor for changes in the septal E/e' ratio. CONCLUSIONS This study showed for the first time that canagliflozin could improve left ventricular diastolic function within 3 months in patients with T2DM. The benefit was especially apparent in patients with substantially improved hemoglobin values. Trial registration UMIN Clinical Trials Registry UMIN000028141.
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Affiliation(s)
- Daisuke Matsutani
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaya Sakamoto
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Yosuke Kayama
- Department of Cardiology, Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Norihiko Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Ryuzo Horiuchi
- Department of Pathology, Tsuruoka Kyoritsu Hospital, 9-34, Fumizonomachi, Tsuruoka-shi, Yamagata, 997-0816, Japan
| | - Kazunori Utsunomiya
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Nishigoori S, Uchiyama S, Asai K, Shimizu W. Prognostic benefit of maintaining the hemoglobin level during the acute phase in patients with severely decompensated acute heart failure. Heart Vessels 2017; 33:264-278. [PMID: 28956134 DOI: 10.1007/s00380-017-1057-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/22/2017] [Indexed: 12/19/2022]
Abstract
The optimum method of managing anemia during the acute phase of acute heart failure (AHF) remains to be elucidated. The data from 1109 AHF patients were enrolled in present study. The hemoglobin (Hb) levels were evaluated in all patients at admission (day 1) and 3 days after admission (day 3), and in survival discharge patients (n = 998) before discharge (pre-discharge). The serum hemoglobin levels were significantly lower on day 3 (11.2 (9.6-12.9) g/dl) than on day 1 (12.4 (10.4-14.2) g/dl) and at pre-discharge (11.6 (10.1-13.2) g/dl). A multivariate Cox regression model showed that mild anemia (11.0 ≤ Hb ≤ 12.9 g/dl, n = 316) and severe anemia (Hb ≤ 10.9 g/dl, n = 517) on day 3 were independent predictors of HF event (hazard ratio (HR) 1.542, 95% confidence interval (CI)1.070-2.221, HR 2.026, 95% CI 1.439-2.853), and severe anemia on day 3 were independent predictors of 365-day mortality (HR 2.247, 95% CI 1.376-3.670). The prognosis, including all-cause death and HF events, in patients with non-anemia on day 1 was significantly poorer in severe new-anemia patients on day 3 (n = 44) than in mild new-anemia patients on day 3 (n = 153) and non-anemia patients on day 3 (n = 252). In patients with anemia on day 1, the prognosis was significantly poorer in patients with severe anemia on day 3 (n = 190) than in those with non-anemia or mild anemia on day 3 (n = 482). The hemoglobin level after the initial treatment might be easily influenced by clinical decongestion. Successfully treated decongestion can help maintain the hemoglobin levels. It, therefore, leads to a prognostic benefit in patients with AHF. These findings might underscore the importance of hemoglobin management of the acute phase of AHF.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Noritake Hata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Saori Uchiyama
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Zhou H, Xu T, Huang Y, Zhan Q, Huang X, Zeng Q, Xu D. The top tertile of hematocrit change during hospitalization is associated with lower risk of mortality in acute heart failure patients. BMC Cardiovasc Disord 2017; 17:235. [PMID: 28865437 PMCID: PMC5581412 DOI: 10.1186/s12872-017-0669-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/21/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hemoconcentration has been proposed as surrogate for changes in volume status among patients hospitalized with acute heart failure (AHF) and is associated with a favorable outcome. However, there is a dearth of research assessing the clinical outcomes of hospitalized patients with hemoconcentration, hemodilution and unchanged volume status. METHODS We enrolled 510 consecutive patients hospitalized for AHF from April 2011 to July 2015. Hematocrit (HCT) levels were measured at admission and either at discharge or on approximately the seventh day of admission. Patients were stratified by delta HCT tertitles into hemodilution (ΔHCT ≤ - 1.6%), no change (NC, -1.6% < ΔHCT ≤1.5%) and hemoconcentration (ΔHCT >1.5%) groups. The endpoint was all-cause death, with a median follow-up duration of 18.9 months. RESULTS Hemoconcentration was associated with lower left ventricle ejection fraction, as compared with NC and hemodilution groups, while renal function at entry, New York Heart Association class IV, and in-hospital worsening renal function (WRF) were not significantly different across the three groups. After multivariable adjustment, hemoconcentration had a lower risk of mortality as compared with hemodilution [hazard ratio (HR) 0.39, 95% confidence interval (CI) 0.24-0.63, P < 0.001], or NC (HR 0.54, 95% CI 0.33-0.88, P = 0.015], while hemodilution and NC did not have significantly differ in mortality (HR 0.72, 95% CI 0.48-1.10, P = 0.130). CONCLUSIONS In patients hospitalized with AHF, an increased HCT during hospitalization is associated with a lower risk of all-cause mortality than a decreased or unchanged HCT. Furthermore, all-cause mortality does not differ significantly between patients with unchanged and decreased HCT values.
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Affiliation(s)
- Haobin Zhou
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Tianyu Xu
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.,First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Yuli Huang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Qiong Zhan
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Xingfu Huang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Qingchun Zeng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Dingli Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
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20
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Youn JC, Han S, Ryu KH. Temporal Trends of Hospitalized Patients with Heart Failure in Korea. Korean Circ J 2016; 47:16-24. [PMID: 28154584 PMCID: PMC5287180 DOI: 10.4070/kcj.2016.0429] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/08/2016] [Accepted: 12/15/2016] [Indexed: 11/11/2022] Open
Abstract
Heart failure (HF) is an important cardiovascular disease because of its increasing prevalence, significant morbidity, high mortality and rapidly expanding health care costs. The number of HF patients is increasing worldwide and Korea is no exception. Temporal trends of four representative Korean hospitalized HF registries-the Hallym HF study, the Korean Multicenter HF study, the Korean Heart Failure (KorHF) registry and the Korean Acute Heart Failure (KorAHF) registry showed mild survival improvement reflecting overall HF patient care development in Korea despite the increased severity of enrolled patients with higher incidence of multiple comorbidities. Moreover, device therapies such as implantable cardioverter defibrillator and cardiac resynchronization therapy and definitive treatment such as heart transplantation have been increasing in Korea as well. To prevent HF burden increase, it is essential to set up long term effective prevention strategies for better control of ischemic heart disease, hypertension and diabetes, which might be risk factors for HF development. Moreover, proper HF guidelines, performance measures, and performance improvement programs might be necessary to limit HF burden as well.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Seongwoo Han
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyu-Hyung Ryu
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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21
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The association between in-hospital hemoglobin changes, cardiovascular events, and mortality in acute decompensated heart failure: Results from the ESCAPE trial. Int J Cardiol 2016; 222:531-537. [DOI: 10.1016/j.ijcard.2016.07.264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/12/2016] [Accepted: 07/30/2016] [Indexed: 11/20/2022]
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Chung JE, Noh E, Gwak HS. Evaluation of the predictors of readmission in Korean patients with heart failure. J Clin Pharm Ther 2016; 42:51-57. [PMID: 27791272 DOI: 10.1111/jcpt.12471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 09/21/2016] [Indexed: 12/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Various factors contribute to the high rate of readmission among patients hospitalized with heart failure (HF). Determination of these factors is fundamental to identify potential targets for intervention in hospitalized patients. METHODS The retrospective cohort study used a large national insurance database to identify episodes of HF. Clinical information up to 12 months from the index hospitalization was obtained. Depending on their outcome, eligible patients were classified into a 30-day readmission group after discharge or a non-readmission group. Potential predictors of 30-day readmission were categorized by patient, drug therapy and health system utilization factors. RESULTS AND DISCUSSION Heart failure was identified in 19 128 inpatients. Of these, 27·6% were readmitted within 30 days after discharge. The mean Charlson comorbidity index (CCI) score was 5·2 ± 2·9 for the readmission group and 4·3 ± 2·5 for the non-readmission group. The strongest predictors included paralysis [adjusted odds ratio (AOR) 2·27, 95% confidence interval (CI) 1·97-2·62], followed by metastatic cancer (AOR 2·22, 95% CI 1·81-2·72) and loop diuretic therapy (AOR 1·52, 95% CI 1·29-1·79). A prescription of ACE inhibitor or angiotensin receptor blocker at discharge was associated with a 17% decreased risk (AOR 0·83, 95% CI 0·77-0·89). WHAT IS NEW AND CONCLUSIONS Hospitalized patients with HF have a 30-day all-cause readmission rate exceeding a quarter. Post-discharge care should focus on patients with advanced age, acuity of admission, enrolled medical aid, hospitalization exceeding 14 days, higher CCI score, more than 10 prescription drugs at discharge, presence of several comorbidities and loop diuretic therapy, which are independent predictors for 30-day readmission.
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Affiliation(s)
- J E Chung
- Division of Life and Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul, Korea
| | - E Noh
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - H S Gwak
- Division of Life and Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul, Korea
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Breidthardt T, Weidmann ZM, Twerenbold R, Gantenbein C, Stallone F, Rentsch K, Rubini Gimenez M, Kozhuharov N, Sabti Z, Breitenbücher D, Wildi K, Puelacher C, Honegger U, Wagener M, Schumacher C, Hillinger P, Osswald S, Mueller C. Impact of haemoconcentration during acute heart failure therapy on mortality and its relationship with worsening renal function. Eur J Heart Fail 2016; 19:226-236. [DOI: 10.1002/ejhf.667] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/18/2016] [Accepted: 08/31/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Tobias Breidthardt
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
- Department of Internal MedicineUniversity Hospital Basel Switzerland
| | - Zoraida Moreno Weidmann
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
| | - Claudine Gantenbein
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
| | - Fabio Stallone
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
- Department of Internal MedicineUniversity Hospital Basel Switzerland
| | - Katharina Rentsch
- Department of Laboratory MedicineUniversity Hospital Basel Switzerland
| | - Maria Rubini Gimenez
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
| | - Nikola Kozhuharov
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
| | - Zaid Sabti
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
| | | | - Karin Wildi
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
- Department of Intensive CareUniversity Hospital Basel Switzerland
| | - Christian Puelacher
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
| | - Ursina Honegger
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
| | - Max Wagener
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
- Department of Internal MedicineUniversity Hospital Basel Switzerland
| | - Carmela Schumacher
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
| | - Petra Hillinger
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
- Department of Internal MedicineUniversity Hospital Basel Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel Switzerland
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24
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Scheen A. Reappraisal of the diuretic effect of empagliflozin in the EMPA-REG OUTCOME trial: Comparison with classic diuretics. DIABETES & METABOLISM 2016; 42:224-33. [DOI: 10.1016/j.diabet.2016.05.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 12/23/2022]
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Oh J, Kang SM, Kim IC, Han S, Yoo BS, Choi DJ, Kim JJ, Jeon ES, Cho MC, Oh BH, Chae SC, Lee MM, Ryu KH. The beneficial prognostic value of hemoconcentration is negatively affected by hyponatremia in acute decompensated heart failure: Data from the Korean Heart Failure (KorHF) Registry. J Cardiol 2016; 69:790-796. [PMID: 27590414 DOI: 10.1016/j.jjcc.2016.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/01/2016] [Accepted: 08/06/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hemoconcentration (HC) is associated with reduced mortality, whereas hyponatremia (HN) has been associated with an increased risk of adverse outcomes in patients with acute decompensated heart failure (ADHF). We sought to determine if the presence of HN influences the beneficial prognostic value of HC in ADHF patients. METHODS We analyzed 2046 ADHF patients from the Korean Heart Failure Registry. We defined HC as an increased hemoglobin level from admission to discharge, and HN as sodium <135mmol/L at admission. Our primary composite endpoint was all-cause mortality and/or HF re-hospitalization. RESULTS Overall, HC occurred in 889 (43.5%) patients and HN was observed in 418 patients (20.4%). HC offered higher 2-year event-free survival in patients without HN (73.2% vs. 63.1% for no-HC, log-rank p<0.001), but not in patients with HN (54.2% vs. 58.7% for no-HC, log-rank p=0.879, p for interaction=0.003). In a multiple Cox proportional hazard analysis, HC without HN conferred a significant event-free survival benefit (hazard ratio: 0.703, 95% confidence interval 0.542-0.912, p=0.008) over no-HC with HN. CONCLUSIONS Only HC occurring in ADHF without HN was associated with improved clinical outcomes. These results provide further support for the importance of HN as a challenging therapeutic target in ADHF patients.
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Affiliation(s)
- Jaewon Oh
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Seoul, Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Seoul, Republic of Korea.
| | - In-Cheol Kim
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Seoul, Republic of Korea
| | - Seongwoo Han
- Division of Cardiology, Hallym University Medical Center, Hwaseong, Republic of Korea
| | - Byung-Su Yoo
- Division of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Dong-Ju Choi
- Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Joong Kim
- Division of Cardiology, Ulsan University Asan Medical Center, Seoul, Republic of Korea
| | - Eun-Seok Jeon
- Division of Cardiology, Sungkyunkwan University Samsung Medical Center, Seoul, Republic of Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Byung-Hee Oh
- Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shung Chull Chae
- Division of Cardiology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Myung-Mook Lee
- Division of Cardiology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Kyu-Hyung Ryu
- Division of Cardiology, Hallym University Medical Center, Hwaseong, Republic of Korea
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26
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Darawsha W, Chirmicci S, Solomonica A, Wattad M, Kaplan M, Makhoul BF, Abassi ZA, Azzam ZS, Aronson D. Discordance Between Hemoconcentration and Clinical Assessment of Decongestion in Acute Heart Failure. J Card Fail 2016; 22:680-8. [PMID: 27079674 DOI: 10.1016/j.cardfail.2016.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 03/09/2016] [Accepted: 04/08/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Hemoconcentration has been proposed as a surrogate for successful decongestion in acute heart failure (AHF). The aim of the present study was to evaluate the relationship between hemoconcentration and clinical measures of congestion. METHODS AND RESULTS We studied 704 patients with AHF and volume overload. A composite congestion score was calculated at admission and discharge, with a score >1 denoting persistent congestion. Hemoconcentration was defined as any increase in hematocrit and hemoglobin levels between baseline and discharge. Of 276 patient with hemoconcentration, 66 (23.9%) had persistent congestion. Conversely, of 428 patients without hemoconcentration, 304 (71.0%) had no clinical evidence of congestion. Mean hematocrit changes were similar with and without persistent congestion (0.18 ± 3.4% and -0.19 ± 3.6%, respectively; P = .17). There was no correlation between the decline in congestion score and the change in hematocrit (P = .93). Hemoconcentration predicted lower mortality (hazard ratio 0.70, 95% confidence interval 0.54-0.90; P = .006). Persistent congestion was associated with increased mortality independent of hemoconcentration (Ptrend = .0003 for increasing levels of congestion score). CONCLUSIONS Hemoconcentration is weakly related to congestion as assessed clinically. Persistent congestion at discharge is associated with increased mortality regardless of hemoconcentration. Hemoconcentration is associated with better outcome but cannot substitute for clinically derived estimates of congestion to determine whether decongestion has been achieved.
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Affiliation(s)
- Wisam Darawsha
- Department of Cardiology, Rambam Medical Center, Haifa, Israel
| | - Stefan Chirmicci
- Department of Internal Medicine D, Rambam Medical Center, Haifa, Israel
| | - Amir Solomonica
- Department of Cardiology, Rambam Medical Center, Haifa, Israel
| | - Malak Wattad
- Department of Cardiology, Rambam Medical Center, Haifa, Israel
| | - Marielle Kaplan
- Laboratory of Clinical Biochemistry, Department of Physiology and Biophysics, Rambam Medical Center, Haifa, Israel
| | - Badira F Makhoul
- Department of Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - Zaid A Abassi
- Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Zaher S Azzam
- Laboratory of Clinical Biochemistry, Department of Physiology and Biophysics, Rambam Medical Center, Haifa, Israel
| | - Doron Aronson
- Department of Cardiology, Rambam Medical Center, Haifa, Israel.
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27
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Mecklai A, Subačius H, Konstam MA, Gheorghiade M, Butler J, Ambrosy AP, Katz SD. In-Hospital Diuretic Agent Use and Post-Discharge Clinical Outcomes in Patients Hospitalized for Worsening Heart Failure: Insights From the EVEREST Trial. JACC-HEART FAILURE 2016; 4:580-588. [PMID: 27039131 DOI: 10.1016/j.jchf.2016.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of this study was to characterize the association between decongestion therapy and 30-day outcomes in patients hospitalized for heart failure (HF). BACKGROUND Loop diuretic agents are commonly prescribed for the treatment of symptomatic congestion in patients hospitalized for HF, but the association between loop diuretic agent dose response and post-discharge outcomes has not been well characterized. METHODS Cox proportional hazards models were used to estimate the association among average loop diuretic agent dose, congestion status at discharge, and 30-day post-discharge all-cause mortality and HF rehospitalization in 3,037 subjects hospitalized with worsening HF enrolled in the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study With Tolvaptan) study. RESULTS In univariate analysis, subjects exposed to high-dose diuretic agents (≥160 mg/day) had greater risk for the combined outcome than subjects exposed to low-dose diuretic agents (18.9% vs. 10.0%; hazard ratio: 2.00; 95% confidence interval: 1.64 to 2.46; p < 0.0001). After adjustment for pre-specified covariates of disease severity, the association between diuretic agent dose and outcomes was not significant (hazard ratio: 1.11; 95% confidence interval: 0.89 to 1.38; p = 0.35). Of the 3,011 subjects with clinical assessments of volume status, 2,063 (69%) had little or no congestion at hospital discharge. Congestion status at hospital discharge did not modify the association between diuretic agent exposure and the combined endpoint (p for interaction = 0.84). CONCLUSIONS Short-term diuretic agent exposure during hospital treatment for worsening HF was not an independent predictor of 30-day all-cause mortality and HF rehospitalization in multivariate analysis. Congestion status at discharge did not modify the association between diuretic agent dose and clinical outcomes.
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Affiliation(s)
- Alicia Mecklai
- Weill Cornell Medical College, New York, New York; New York University School of Medicine, New York, New York
| | - Haris Subačius
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marvin A Konstam
- The CardioVascular Center of Tufts Medical Center and Tufts Medical Center, Boston, Massachusetts
| | - Mihai Gheorghiade
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Javed Butler
- Stony Brook School of Medicine, Stony Brook, New York
| | | | - Stuart D Katz
- New York University School of Medicine, New York, New York.
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28
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Abstract
The latest findings from the EMPA-REG OUTCOME trial show a 34% reduction in hospitalization for heart failure or cardiovascular death in patients receiving empagliflozin, a sodium/glucose cotransporter 2 (SGLT2) inhibitor, compared with placebo. These outstanding results call for discussion of the clinical implications, and in-depth studies of the mechanisms of action of SGLT2 inhibitors.
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29
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Abstract
The hospitalized heart failure (HF) population is becoming a significant economic burden to Asian countries because of the growing elderly population, increased prevalence of HF, and recurrent rehospitalization. A targeted treatment strategy is needed with prognostic factors that can reduce mortality or rehospitalization after discharge. The accepted prognostic factors include age, low systolic blood pressure, ischemic heart disease, reduced left ventricular function, hyponatremia, and renal dysfunction. Prognostic factors for clinical outcomes in hospitalized patients with HF may be different in Asian people. Further research leading to better understanding of the characteristics of Asian patients hospitalized with HF is warranted.
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Affiliation(s)
- Seok-Min Kang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Chan Cho
- Cardiology Division, Department of Internal Medicine, College of Medicine, Chungbuk National University, 776 Sunhwan-1-Ro, Seowon-Gu, Cheongju 362-711, Korea.
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30
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Oh J, Kang SM, Song MK, Hong N, Youn JC, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, Chae SC, Oh BH, Choi DJ, Lee MM, Ryu KH. Clinical benefit of spironolactone in patients with acute decompensated heart failure and severe renal dysfunction: Data from the Korean Heart Failure Registry. Am Heart J 2015; 169:713-720.e3. [PMID: 25965719 DOI: 10.1016/j.ahj.2015.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 01/17/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUNDS We investigated the relationship between spironolactone use and all-cause mortality in acute decompensated heart failure (ADHF) patients with severe renal dysfunction. The clinical benefit of spironolactone in the treatment of heart failure (HF) has been described in several large randomized clinical trials. However, its clinical benefits have not been studied in hospitalized ADHF patients with severe renal dysfunction (estimated glomerular filtration rate [eGFR] <45 mL/min per 1.73 m(2)). METHODS AND RESULTS We retrospectively analyzed data from the Korean Heart Failure Registry. We included 1,035 ADHF patients with severe renal dysfunction. In Kaplan-Meier survival analysis, all-cause mortality in the spironolactone-treated group was significantly lower than that in the nonspironolactone group (18.1% vs 24.9%, respectively, log rank P = .028). However, spironolactone use was not an independent predictor after adjusting other HF risk factors (hazard ratio 0.974, 95% CI 0.681-1.392, P = .884) and after propensity score matching (P = .115). In subgroup analysis, the clinical benefit of spironolactone use was preserved in women, prehospital spironolactone use, the chronic kidney disease stage 3b (eGFR 30-44 mL/min per 1.73 m(2)), and the appropriate spironolactone use (eGFR ≥30 mL/min per 1.73 m(2) and K ≤5.0 mmol/L). CONCLUSION The spironolactone therapy was not beneficial in ADHF patients with severe renal dysfunction after multivariable adjusting and propensity score matching. However, we reassured the current HF guidelines for spironolactone use and the clinical benefit in chronic kidney disease stage 3b should be assessed in future clinical trial.
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Affiliation(s)
- Jaewon Oh
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Min Kang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Mi Kyung Song
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Namki Hong
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Chan Youn
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seongwoo Han
- Cardiology Division, Hallym University Medical Center, Hwaseong, Korea
| | - Eun-Seok Jeon
- Cardiology Division, Sungkyunkwan University Samsung Medical Center, Seoul, Republic of Korea
| | - Myeong-Chan Cho
- Cardiology Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jae-Joong Kim
- Cardiology Division, Ulsan University Asan Medical Center, Seoul, Republic of Korea
| | - Byung-Su Yoo
- Cardiology Division, Yonsei University Wonju Christian Hospital, Wonju, Republic of Korea
| | - Shung Chull Chae
- Cardiology Division, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Byung-Hee Oh
- Cardiology Division, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Ju Choi
- Cardiology Division, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myung-Mook Lee
- Cardiology Division, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Kyu-Hyung Ryu
- Cardiology Division, Hallym University Medical Center, Hwaseong, Korea
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31
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Hemoconcentration-guided diuresis in heart failure. Am J Med 2014; 127:1154-9. [PMID: 24937157 DOI: 10.1016/j.amjmed.2014.06.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/01/2014] [Accepted: 06/02/2014] [Indexed: 11/21/2022]
Abstract
One quarter of patients hospitalized for heart failure are readmitted within 30 days, perhaps related to ineffective decongestion. Limited data exist guiding the extent and duration of diuresis in patients hospitalized for heart failure. The objective of this review was to determine the prognostic value of hemoconcentration, or the relative increase in the cellular elements in blood, in patients hospitalized for heart failure and to clarify its role in guiding inpatient diuretic practices. Six post hoc retrospective studies from 2010 to 2013 were available for review. Hemoconcentration was consistently associated with markers of aggressive fluid removal, including higher diuretic dosing and reduced body weight, but increased risk of in-hospital worsening renal function. Despite this, hemoconcentration was associated with improved short-term mortality and rehospitalization. Hemoconcentration is a practical, readily available, noninvasive, economically feasible strategy to help guide diuresis and monitor congestion relief in patients hospitalized for worsening heart failure. Clinicians should strongly consider using changes in hemoglobin and hematocrit as an adjunct to other available measures of decongestion and clinical acumen in inpatient heart failure care.
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32
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Liu LCY, Voors AA, Valente MAE, van der Meer P. A novel approach to drug development in heart failure: towards personalized medicine. Can J Cardiol 2013; 30:288-95. [PMID: 24565253 DOI: 10.1016/j.cjca.2013.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/10/2013] [Accepted: 12/11/2013] [Indexed: 12/31/2022] Open
Abstract
Evidence-based treatment has succeeded in improving clinical outcomes in heart failure. Nevertheless, morbidity, mortality, and the economic burden associated with the syndrome remain unsatisfactorily high. Most landmark heart failure studies included broad study populations, and thus current recommendations dictate standardized, universal therapy. While most patients included in recent trials benefit from this background treatment, exceeding this already significant gain has proven to be a challenge. The early identification of responders and nonresponders to treatment could result in improved therapeutic effectiveness, while reduction of unnecessary exposure may limit harmful and unpleasant side effects. In this review, we examine the potential value of currently available information on differential responses to heart failure therapy-a first step toward personalized medicine in the management of heart failure.
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Affiliation(s)
- Licette C Y Liu
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, Groningen, The Netherlands.
| | - Mattia A E Valente
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
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