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Balcioglu O, Ozgocmen C, Ozsahin DU, Yagdi T. The Role of Artificial Intelligence and Machine Learning in the Prediction of Right Heart Failure after Left Ventricular Assist Device Implantation: A Comprehensive Review. Diagnostics (Basel) 2024; 14:380. [PMID: 38396419 PMCID: PMC10888030 DOI: 10.3390/diagnostics14040380] [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: 01/01/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
One of the most challenging and prevalent side effects of LVAD implantation is that of right heart failure (RHF) that may develop afterwards. The purpose of this study is to review and highlight recent advances in the uses of AI in evaluating RHF after LVAD implantation. The available literature was scanned using certain key words (artificial intelligence, machine learning, left ventricular assist device, prediction of right heart failure after LVAD) was scanned within Pubmed, Web of Science, and Google Scholar databases. Conventional risk scoring systems were also summarized, with their pros and cons being included in the results section of this study in order to provide a useful contrast with AI-based models. There are certain interesting and innovative ML approaches towards RHF prediction among the studies reviewed as well as more straightforward approaches that identified certain important predictive clinical parameters. Despite their accomplishments, the resulting AUC scores were far from ideal for these methods to be considered fully sufficient. The reasons for this include the low number of studies, standardized data availability, and lack of prospective studies. Another topic briefly discussed in this study is that relating to the ethical and legal considerations of using AI-based systems in healthcare. In the end, we believe that it would be beneficial for clinicians to not ignore these developments despite the current research indicating more time is needed for AI-based prediction models to achieve a better performance.
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Affiliation(s)
- Ozlem Balcioglu
- Department of Cardiovascular Surgery, Faculty of Medicine, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey;
- Operational Research Center in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey;
| | - Cemre Ozgocmen
- Department of Biomedical Engineering, Faculty of Engineering, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey;
| | - Dilber Uzun Ozsahin
- Operational Research Center in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey;
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir 35100, Turkey
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Kittleson MM. Management of Heart Failure in Hospitalized Patients. Ann Intern Med 2023; 176:ITC177-ITC192. [PMID: 38079639 DOI: 10.7326/aitc202312190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
Heart failure affects more than 6 million people in the United States, and hospitalizations for decompensated heart failure confer a heavy toll in morbidity, mortality, and health care costs. Clinical trials have demonstrated effective interventions; however, hospitalization and mortality rates remain high. Key components of effective hospital care include appropriate diagnostic evaluation, triage and risk stratification, early implementation of guideline-directed medical therapy, adequate diuresis, and appropriate discharge planning.
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Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California (M.M.K.)
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3
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Mohamud MA, Campbell DJT, Wick J, Leung AA, Fabreau GE, Tonelli M, Ronksley PE. 20-year trends in multimorbidity by race/ethnicity among hospitalized patient populations in the United States. Int J Equity Health 2023; 22:137. [PMID: 37488549 PMCID: PMC10367428 DOI: 10.1186/s12939-023-01950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/03/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The challenges presented by multimorbidity continue to rise in the United States. Little is known about how the relative contribution of individual chronic conditions to multimorbidity has changed over time, and how this varies by race/ethnicity. The objective of this study was to describe trends in multimorbidity by race/ethnicity, as well as to determine the differential contribution of individual chronic conditions to multimorbidity in hospitalized populations over a 20-year period within the United States. METHODS This is a serial cross-sectional study using the Nationwide Inpatient Sample (NIS) from 1993 to 2012. We identified all hospitalized patients aged ≥ 18 years old with available data on race/ethnicity. Multimorbidity was defined as the presence of 3 or more conditions based on the Elixhauser comorbidity index. The relative change in the proportion of hospitalized patients with multimorbidity, overall and by race/ethnicity (Black, White, Hispanic, Asian/Pacific Islander, Native American) were tabulated and presented graphically. Population attributable fractions were estimated from modified Poisson regression models adjusted for sex, age, and insurance type. These fractions were used to describe the relative contribution of individual chronic conditions to multimorbidity over time and across racial/ethnic groups. RESULTS There were 123,613,970 hospitalizations captured within the NIS between 1993 and 2012. The prevalence of multimorbidity increased in all race/ethnic groups over the 20-year period, most notably among White, Black, and Native American populations (+ 29.4%, + 29.7%, and + 32.0%, respectively). In both 1993 and 2012, Black hospitalized patients had a higher prevalence of multimorbidity (25.1% and 54.8%, respectively) compared to all other race/ethnic groups. Native American populations exhibited the largest overall increase in multimorbidity (+ 32.0%). Furthermore, the contribution of metabolic diseases to multimorbidity increased, particularly among Hispanic patients who had the highest population attributable fraction values for diabetes without complications (15.0%), diabetes with complications (5.1%), and obesity (5.8%). CONCLUSIONS From 1993 to 2012, the secular increases in the prevalence of multimorbidity as well as changes in the differential contribution of individual chronic conditions has varied substantially by race/ethnicity. These findings further elucidate the racial/ethnic gaps prevalent in multimorbidity within the United States. PRIOR PRESENTATIONS Preliminary finding of this study were presented at the Society of General Internal Medicine (SGIM) Annual Conference, Washington, DC, April 21, 2017.
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Affiliation(s)
- Mursal A Mohamud
- Cumming School of Medicine, Undergraduate Medical Education, University of Calgary, Calgary, AB, Canada
| | - David J T Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James Wick
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alexander A Leung
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gabriel E Fabreau
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Dong X, Xie Y, Xu J, Qin Y, Zheng Q, Hu R, Zhang X, Wang W, Tian J, Yi K. Global historical retrospect and future prospects on biomarkers of heart failure: A bibliometric analysis and science mapping. Heliyon 2023; 9:e13509. [PMID: 36825183 PMCID: PMC9942007 DOI: 10.1016/j.heliyon.2023.e13509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Heart failure is a rapidly growing public health problem and has become a major cause of hospitalization in middle-aged and older adults. Biomarkers are clinically important in managing heart failure and have attracted more attention from researchers in recent years. This study aimed to evaluate the global research of heart failure biomarkers by bibliometrics and to identify the hot spots and perspectives for further advancement. Methods Selection of relevant documents was from the Web of Science Core Collection. Microsoft Excel, VOSviewer, SciMA, and CiteSpace software were used for bibliometric analysis. Results As of October 29, 2021, 5,978 documents for heart failure biomarkers have been identified from 1989 to 2021. European Journal of Heart Failure and Circulation respectively ranked first in terms of the number of publications and the number of co-citations. A total of 5,698 institutions from 90 countries participated in these publications, with the USA leading with 2,045 documents. The most productive institution was Harvard University. Januzzi, J.L. and Maisel, A.S. were the most productive and most cited authors respectively. Natriuretic peptide, copeptin, valsartan, ferric carboxymaltose, empagliflozin, preserved ejection fraction, myocardial fibrosis, and heart transplantation were hot themes. Conclusions Extensive national and inter-institutional collaboration should be enhanced to bridge the gap between developed and less developed countries in heart failure biomarkers research. The research in this field seems to have reached a relatively mature stage, with a decrease in research fervor in recent years. The study of the natriuretic peptide family still has high centrality, with advances in the study of expression products and inflammatory markers. Cardiac fibrosis, cardiac remodeling, and therapies regarding heart failure have become hot spots.
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Affiliation(s)
- Xin Dong
- Department of Ultrasound, Gansu Provincial Hospital, Lanzhou, China,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
| | - Yafei Xie
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China,The First Clinical Medical College of Lanzhou University, Lanzhou, China,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China
| | - Jianguo Xu
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yu Qin
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qingyong Zheng
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Rui Hu
- The First Operating Room, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin Zhang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China,The First School of Clinical Medicine of Gansu University of Chinese Medicine, Lanzhou, China
| | - Wenxin Wang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China,The First School of Clinical Medicine of Gansu University of Chinese Medicine, Lanzhou, China
| | - Jinhui Tian
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China,Corresponding author. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Donggang West Road, Lanzhou City, Gansu Province, 730000, China.
| | - Kang Yi
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China,Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China,Corresponding author. Department of Cardiovascular Surgery, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou City, Gansu Province,730000, China.
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5
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Park H, Son MJ, Jung DW, Lee H, Lee JY. National Trends in Hospitalization for Ambulatory Care Sensitive Conditions among Korean Adults between 2008 and 2019. Yonsei Med J 2022; 63:948-955. [PMID: 36168248 PMCID: PMC9520050 DOI: 10.3349/ymj.2022.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to examine 12-year trends in hospitalization rates for ambulatory care sensitive conditions (ACSC) and factors affecting hospitalization. MATERIALS AND METHODS This study used data on Korean National Health Insurance and Medical Aid patients aged 19 and over who used medical services at least once between January 2008 and December 2019 with an ACSC as their major diagnosis. As of 2019, a total of 12324071 patients were included. To check for any changes in hospitalization, age- and sex-standardized hospitalization rates were obtained for each condition and insurance type, and multiple logistic regression was performed to identify factors affecting hospitalization. RESULTS The collective average ACSC hospitalization rate decreased from 5.0% in 2008 to 4.2% in 2019. Specifically, hospitalization rates for hypertension (1.4% in 2008; 0.8% in 2019), diabetes (5.8% in 2008; 3.3% in 2019), and chronic obstructive pulmonary disease and asthma (4.1% in 2008; 3.2% in 2019) decreased, while rates for pneumonia (24.5% in 2008; 28.1% in 2019) and urinary tract infection (UTI) (5.7% in 2008; 6.4% in 2019) increased. The rate for heart failure decreased 2.3% between 2008 and 2012 and then rebounded. The odds of hospitalization among Medical Aid patients were 1.45-4.20 times higher than those of National Health Insurance patients. CONCLUSION Differences in trends were confirmed for ACSC hospitalization rates among different conditions and insurance types in Korea. These results suggest the need for policy reforms aimed at reducing hospitalization for heart failure, pneumonia, and UTI, especially among Medical Aid patients.
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Affiliation(s)
- Hyeki Park
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jung Son
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Da Won Jung
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
- Department of Health Administration, Yonsei University Graduate School, Wonju, Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Jin Yong Lee
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.
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Relation of Exercise Capacity to Incident Heart Failure Among Men and Women With Coronary Heart Disease (from the Henry Ford Exercise Testing [FIT] Project). Am J Cardiol 2022; 181:66-70. [PMID: 35970629 DOI: 10.1016/j.amjcard.2022.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022]
Abstract
Exercise capacity (EC) is inversely related to the risk of cardiovascular disease and incident heart failure (HF) in healthy subjects. However, there are no present studies that exclusively evaluate EC and the risk of incident HF in patients with known coronary heart disease (CHD). We aimed to determine the relation between EC and incident HF in patients with an established clinical diagnosis of CHD. We retrospectively identified 8,387 patients (age 61 ± 12 years; 30% women; 33% non-White) with a history of myocardial infarction (MI) or coronary revascularization procedure and no history of HF at the time of a clinically indicated exercise stress test completed between 1991 and 2009. EC was quantified in metabolic equivalents of task (METs) estimated from treadmill testing. Incident HF was identified through June 2010 from administrative databases based on ≥3 encounters with International Classification of Diseases, Ninth Revision 428.x. Cox regression analysis was used to evaluate the risk of incident HF associated with METs. Covariates included age; gender; race; hypertension, diabetes, hyperlipidemia, smoking, and MI; medications for CHD and lung diseases; and clinical indication for treadmill testing. During a median follow-up of 8.2 years (interquartile range 4.7 to 12.4 years) after the exercise test, 23% of the cohort experienced a new HF diagnosis. Lower EC categories were associated with higher HF incidence compared with METs ≥12, with nearly fourfold greater adjusted risk among patients with METs <6. Per unit increase in METs of EC was associated with a 12% lower adjusted risk for HF. There was no significant interaction based on race (p = 0.06), gender (p = 0.88), age ≤61 years (p = 0.60), history of MI (p = 0.31), or diabetes (p = 0.38). This study reveals that among men and women with CHD and no history of HF, EC is independently and inversely related to the risk of future HF.
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7
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Herrero-Torrus M, Badosa N, Roqueta C, Ruiz-Bustillo S, Solé-González E, Belarte-Tornero LC, Valdivielso-Moré S, Vázquez O, Farré N. Randomized Controlled Trial Comparing a Multidisciplinary Intervention by a Geriatrician and a Cardiologist to Usual Care after a Heart Failure Hospitalization in Older Patients: The SENECOR Study. J Clin Med 2022; 11:jcm11071932. [PMID: 35407540 PMCID: PMC8999953 DOI: 10.3390/jcm11071932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 12/16/2022] Open
Abstract
Background: The prognosis of older patients after a heart failure (HF) hospitalization is poor. Methods: In this randomized trial, we consecutively assigned 150 patients 75 years old or older with a recent heart failure hospitalization to follow-up by a cardiologist (control) or follow-up by a cardiologist and a geriatrician (intervention). The primary outcome was all-cause hospitalization at a one-year follow-up. Results: All-cause hospitalization occurred in 47 of 75 patients (62.7%) in the intervention group and in 58 of 75 patients (77.3%) in the control group (hazard ratio, 0.67; 95% confidence interval, 0.46 to 0.99; p = 0.046). The number of patients with at least one HF hospitalization was similar in both groups (34.7% in the intervention group vs. 40% in the control group, p = 0.5). There were a total of 236 hospitalizations during the study period. The main reasons for hospitalization were heart failure (38.1%) and infection (14.8%). Mortality was 24.7%. Heart failure was the leading cause of mortality (54.1% of all deaths), without differences between groups. Conclusions: A follow-up by a cardiologist and geriatrician in older patients after an HF hospitalization was superior to a cardiologist’s follow-up in reducing all-cause hospitalization in older patients. (Funded by Beca Primitivo de la Vega, Fundación MAPFRE. ClinicalTrials.gov number, NCT03555318).
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Affiliation(s)
- Marta Herrero-Torrus
- Geriatrics Department, Hospital del Mar, 08003 Barcelona, Spain; (M.H.-T.); (C.R.); (O.V.)
| | - Neus Badosa
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
- Biomedical Research Group on Heart Disease, Hospital del Mar Medical Research Group (IMIM), 08003 Barcelona, Spain
| | - Cristina Roqueta
- Geriatrics Department, Hospital del Mar, 08003 Barcelona, Spain; (M.H.-T.); (C.R.); (O.V.)
- Department of Medicine, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
| | - Sonia Ruiz-Bustillo
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
- Biomedical Research Group on Heart Disease, Hospital del Mar Medical Research Group (IMIM), 08003 Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Eduard Solé-González
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
| | - Laia C. Belarte-Tornero
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
- Biomedical Research Group on Heart Disease, Hospital del Mar Medical Research Group (IMIM), 08003 Barcelona, Spain
| | - Sandra Valdivielso-Moré
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
- Biomedical Research Group on Heart Disease, Hospital del Mar Medical Research Group (IMIM), 08003 Barcelona, Spain
| | - Olga Vázquez
- Geriatrics Department, Hospital del Mar, 08003 Barcelona, Spain; (M.H.-T.); (C.R.); (O.V.)
| | - Núria Farré
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
- Biomedical Research Group on Heart Disease, Hospital del Mar Medical Research Group (IMIM), 08003 Barcelona, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
- Correspondence:
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Chandra A, Skali H, Claggett B, Solomon SD, Rossi JS, Russell SD, Matsushita K, Kitzman DW, Konety SH, Mosley TH, Chang PP, Shah AM. Race- and Gender-Based Differences in Cardiac Structure and Function and Risk of Heart Failure. J Am Coll Cardiol 2022; 79:355-368. [PMID: 35086658 PMCID: PMC8849570 DOI: 10.1016/j.jacc.2021.11.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although heart failure (HF) risk and cardiac structure/function reportedly differ according to race and gender, limited data exist in late life when risk of HF is highest. OBJECTIVES The goal of this study was to evaluate race/gender-based differences in HF risk factors, cardiac structure/function, and incident HF in late life. METHODS This analysis included 5,149 HF-free participants from ARIC (Atherosclerosis Risk In Communities), a prospective epidemiologic cohort study, who attended visit 5 (2011-2013) and underwent echocardiography. Participants were subsequently followed up for a median 5.5 years for incident HF/death. RESULTS Patients' mean age was 75 ± 5 years, 59% were women, and 20% were Black. Male gender and Black race were associated with lower mean left ventricular ejection fraction. Black race was also associated with greater left ventricular wall thickness and concentricity, differences that persisted after adjusting for cardiovascular comorbidities. After adjusting for cardiovascular comorbidities, men were at higher risk for HF and heart failure with reduced ejection fraction (HFrEF) in Black participants compared with White participants (HF: HR of 2.36 [95% CI: 1.37-4.08] vs 1.16 [95% CI: 0.89-1.51], interaction P = 0.016; HFrEF: HR of 3.70 [95% CI: 1.72-7.95] vs 1.55 [95% CI: 1.01-2.37] respectively, interaction P = 0.039). Black race was associated with a higher incidence of HF overall and HFrEF in men only (HF: 1.65 [95% CI: 1.07-2.53] vs 0.76 [95% CI: 0.49-1.17]; HFrEF: HR of 2.55 [95% CI: 1.46-4.44] vs 0.91 [95% CI: 0.46-1.83]). No race/gender-based differences were observed in risk of incident heart failure with preserved ejection fraction. CONCLUSIONS Among older persons free of HF, men and Black participants exhibit worse systolic performance and are at heightened risk for HFrEF, whereas the risk of heart failure with preserved ejection fraction is similar across gender and race groups.
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Affiliation(s)
- Alvin Chandra
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. https://twitter.com/AlvinChandraMD
| | - Hicham Skali
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph S Rossi
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stuart D Russell
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dalane W Kitzman
- Sections of Cardiology and Gerontology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Suma H Konety
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Thomas H Mosley
- Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Patricia P Chang
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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9
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Gingele AJ, Brandts L, Brunner-La Rocca HP, Cleuren G, Knackstedt C, Boyne JJJ. Introduction of a new scoring tool to identify clinically stable heart failure patients. Neth Heart J 2022; 30:402-410. [PMID: 34988879 PMCID: PMC9402836 DOI: 10.1007/s12471-021-01654-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. However, a structured approach to guide patient referral is lacking. Methods The Maastricht Instability Score—Heart Failure (MIS-HF) questionnaire was developed to objectively stratify the clinical status of HF patients: patients with a low MIS-HF (0–2 points, indicating a stable clinical condition) were considered for treatment in primary care, whereas high scores (> 2 points) indicated the need for specialised care. The MIS-HF was evaluated in 637 consecutive HF patients presenting between 2015 and 2018 at Maastricht University Medical Centre. Results Of the 637 patients, 329 (52%) had a low score and 205 of these 329 (62%) patients were referred to primary care. The remaining 124 (38%) patients remained in secondary care. Of the 308 (48%) patients with a high score (> 2 points), 265 (86%) remained in secondary care and 41 (14%) were referred to primary care. The primary composite endpoint (mortality, cardiac hospital admissions) occurred more frequently in patients with a high compared to those with a low MIS-HF after 1 year of follow-up (29.2% vs 10.9%; odds ratio (OR) 3.36, 95% confidence interval (CI) 2.20–5.14). No significant difference in the composite endpoint (9.8% vs 12.9%; OR 0.73, 95% CI 0.36–1.47) was found between patients with a low MIS-HF treated in primary versus secondary care. Conclusion The MIS-HF questionnaire may improve referral policies, as it helps to identify HF patients that can safely be referred to primary care. Supplementary Information The online version of this article (10.1007/s12471-021-01654-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A J Gingele
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - L Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - H P Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - G Cleuren
- Department of Patient and Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - C Knackstedt
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J J J Boyne
- Department of Patient and Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
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10
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Wu S, Alikhil M, Forsyth R, Allen B. Impact of Potentially Unwarranted Intravenous Antibiotics Targeting Pulmonary Infections in Acute Decompensated Heart Failure. J Pharm Technol 2021; 37:298-303. [PMID: 34790967 PMCID: PMC8592242 DOI: 10.1177/87551225211038020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) can present similarly to pulmonary infections. The additional volume and sodium received from intravenous antibiotics (IVAB) can be counterproductive, especially when strong evidence of infection is lacking. OBJECTIVE The objective was to evaluate the impact of potentially unwarranted IVAB on clinical outcomes in patients with ADHF. METHODS This multicenter, retrospective, cohort study evaluated adults admitted with ADHF, a chest radiograph within 24 hours, B-natriuretic peptide >100 pg/mL, and either received no IVAB or IVAB for at least 48 hours. Subjects with recent antibiotics, justification for antibiotics, or transferred to the intensive care unit (ICU) within 24 hours of admission were excluded. The primary outcome was hospital length of stay (LOS). Secondary outcomes included utilization of loop diuretics, administration of fluid and sodium, mortality, and 30-day readmissions. RESULTS Out of 240 subjects included, 120 received IVAB. LOS was significantly longer in the IVAB group (5.12 days vs 3.73 days; P < .001). LOS remained significantly longer in the IVAB group in a propensity score matched cohort (5.26 days vs 3.70 days; P < .001). The IVAB group received more volume and sodium from intravenous fluids (P < .001). ICU admission greater than 24 hours after admission was higher with IVAB (20% vs 7.5%; P = .049). No significant differences in total loop diuretics, intubation rate, mortality, and 30-day readmissions were identified. CONCLUSION ADHF patients who received potentially unwarranted IVAB had longer hospital LOS and were more likely to be admitted to the ICU after 24 hours of hospitalization.
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Affiliation(s)
- Sara Wu
- Ascension St. Vincent’s Riverside, Jacksonville, FL, USA
| | - Maryam Alikhil
- Ascension St. Vincent’s Riverside, Jacksonville, FL, USA
| | | | - Bryan Allen
- Ascension St. Vincent’s Riverside, Jacksonville, FL, USA
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11
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The Impact of Clinical, Biochemical, and Echocardiographic Parameters on the Quality of Life in Patients with Heart Failure with Reduced Ejection Fraction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312448. [PMID: 34886173 PMCID: PMC8657062 DOI: 10.3390/ijerph182312448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022]
Abstract
Despite significant advances in HF diagnosis and treatment over the recent decades, patients still characterize poor long-term prognosis with many recurrent hospitalizations and reduced health-related quality of life (HRQoL). We aimed to check the potential relationship between clinical, biochemical, or echocardiographic parameters and HRQoL in patients with HF with reduced ejection fraction (HFrEF). We included 152 adult patients hospitalized due to chronic HFrEF. We used the WHOQoL-BREF questionnaire to assess HRQoL and GNRI to evaluate nutritional status. We also analyzed several biochemical parameters and left ventricle ejection fraction. Forty (26.3%) patients were hospitalized due to HF exacerbation and 112 (73.7%) due to planned HF evaluation. The median age was 57 (48–62) years. Patients with low somatic HRQoL score had lower transferrin saturation (23.7 ± 11.1 vs. 29.7 ± 12.5%; p = 0.01), LDL (2.40 (1.80–2.92) vs. 2.99 (2.38–3.60) mmol/L; p = 0.001), triglycerides (1.18 (0.91–1.57) vs. 1.48 (1.27–2.13) mmol/L; p = 0.006) and LVEF (20 (15–25) vs. 25 (20–30)%; p = 0.003). TIBC (64.9 (58.5–68.2) vs. 57.7 (52.7–68.6); p = 0.02) was significantly higher in this group. We observed no associations between HRQoL and age or gender. The somatic domain of WHOQoL-BREF in patients with HFrEF correlated with the clinical status as well as biochemical and echocardiographic parameters. Assessment of HRQoL in HFrEF seems important in everyday practice and can identify patients requiring a special intervention
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12
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Abid L, Kammoun I, Ben Halima M, Charfeddine S, Ben Slima H, Drissa M, Mzoughi K, Mbarek D, Riahi L, Antit S, Ben Halima A, Ouechtati W, Allouche E, Mechri M, Yousfi C, Khorchani A, Abid O, Sammoud K, Ezzaouia K, Gtif I, Ouali S, Triki F, Hamdi S, Boudiche S, Chebbi M, Hentati M, Farah A, Triki H, Ghardallou H, Raddaoui H, Zayed S, Azaiez F, Omri F, Zouari A, Ben Ali Z, Najjar A, Thabet H, Chaker M, Mohamed S, Chouaieb M, Ben Jemaa A, Tangour H, Kammoun Y, Bouhlel M, Azaiez S, Letaief R, Maskhi S, Amri A, Naanaa H, Othmani R, Chahbani I, Zargouni H, Abid S, Ayari M, Ben Ameur I, Gasmi A, Ben Halima N, Haouala H, Boughzela E, Zakhama L, Ben Youssef S, Nasraoui W, Boujnah MR, Barakett N, Kraiem S, Drissa H, Ben Khalfallah A, Gamra H, Kachboura S, Bezdah L, Baccar H, Milouchi S, Sdiri W, Ben Omrane S, Abdesselem S, Kanoun A, Hezbri K, Zannad F, Mebazaa A, Kammoun S, Mourali MS, Addad F. Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study. JMIR Res Protoc 2021; 10:e12262. [PMID: 34704958 PMCID: PMC8581756 DOI: 10.2196/12262] [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: 09/21/2018] [Revised: 03/04/2019] [Accepted: 03/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). OBJECTIVE The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. METHODS A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. RESULTS At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. CONCLUSIONS The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. TRIAL REGISTRATION ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12262.
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Affiliation(s)
- Leila Abid
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia
| | - Ikram Kammoun
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia.,Hôpital Abderrahmen Mami-Ariana, Ariana, Tunisia
| | - Manel Ben Halima
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia.,Hôpital La Rabta 2, Tunis, Tunisia
| | - Salma Charfeddine
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Meriem Drissa
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Khadija Mzoughi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Dorra Mbarek
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Leila Riahi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Saoussen Antit
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Afef Ben Halima
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Wejdene Ouechtati
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Emna Allouche
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Mehdi Mechri
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Chedi Yousfi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Ali Khorchani
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Omar Abid
- Centre Hospitalier de Chambéry, Chambéry, France
| | - Kais Sammoud
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Khaled Ezzaouia
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Imen Gtif
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Sana Ouali
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Feten Triki
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Sonia Hamdi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Selim Boudiche
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Marwa Chebbi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Mouna Hentati
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Amani Farah
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Habib Triki
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Houda Ghardallou
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Haythem Raddaoui
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Seifeddine Azaiez
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Aymen Amri
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Iheb Chahbani
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Syrine Abid
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Ali Gasmi
- Hospital Lariboisière, Paris, France
| | | | | | | | - Lilia Zakhama
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Wided Nasraoui
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Sondes Kraiem
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | | | | | | | | | | | | | | | | | - Alifa Kanoun
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | | | - Samir Kammoun
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Faouzi Addad
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia
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13
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Halatchev IG, Wu WC, Heidenreich PA, Djukic E, Balasubramanian S, Ohlms KB, McDonald JR. Inpatient versus outpatient intravenous diuresis for the acute exacerbation of chronic heart failure. IJC HEART & VASCULATURE 2021; 36:100860. [PMID: 34485679 PMCID: PMC8391052 DOI: 10.1016/j.ijcha.2021.100860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We established an IV outpatient diuresis (IVOiD) clinic and conducted a quality improvement project to evaluate safety, effectiveness and costs associated with outpatient versus inpatient diuresis for patients presenting with acute decompensated heart failure (ADHF) to the emergency department (ED). METHODS Patients who were clinically diagnosed with ADHF in the ED, but did not have high-risk features, were either diuresed in the hospital or in the outpatient IVOiD clinic. The dose of IV diuretic was based on their home maintenance diuretic dose. The outcomes measured were the effects of diuresis (urine output, weight, hemodynamic and laboratory abnormalities), 30-90 day readmissions, 30-90 day death and costs. RESULTS In total, 36 patients (22 inpatients and 14 outpatients) were studied. There were no significant differences in the baseline demographics between groups. The average inpatient stay was six days and the average IVOiD clinic days were 1.2. There was no significant difference in diuresis per day of treatment (1159 vs. 944 ml, p = 0.46). There was no significant difference in adverse outcomes, 30-90 day readmissions or 30-90 day deaths. There was a significantly lower cost in the IVOiD group compared to the inpatient group ($839.4 vs. $9895.7, p=<0.001). CONCLUSIONS Outpatient IVOiD clinic diuresis may be a viable alternative to accepted clinical practice of inpatient diuresis for ADHF. Further studies are needed to validate this in a larger cohort and in different sites.
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Affiliation(s)
- Ilia G. Halatchev
- Veterans Affairs St. Louis Health Care System, John Cochran Division, St. Louis, MO, United States
- Washington University School of Medicine, St. Louis, MO, United States
| | - Wen-Chin Wu
- Veterans Affairs Providence Health Care System, Providence Medical Center, Providence, Rhode Island, United States
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States
| | | | - Elma Djukic
- Veterans Affairs St. Louis Health Care System, John Cochran Division, St. Louis, MO, United States
| | - Sumitra Balasubramanian
- Clinical Research and Epidemiology Workgroup at Veterans Affairs St. Louis Health Care System, John Cochran Division, St. Louis, MO, United States
| | - Kelly B. Ohlms
- Clinical Research and Epidemiology Workgroup at Veterans Affairs St. Louis Health Care System, John Cochran Division, St. Louis, MO, United States
| | - Jay R. McDonald
- Veterans Affairs St. Louis Health Care System, John Cochran Division, St. Louis, MO, United States
- Washington University School of Medicine, St. Louis, MO, United States
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14
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Le N, Rahman T, Kapralik JL, Ibrahim Q, Lear SA, Van Spall HG. The Hospital at Home Model vs Routine Hospitalization for Acute Heart Failure: A Survey of Patients’ Preferences. CJC Open 2021; 4:263-270. [PMID: 35386130 PMCID: PMC8978061 DOI: 10.1016/j.cjco.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/15/2021] [Indexed: 10/31/2022] Open
Abstract
Background Methods Results Conclusions
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15
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Liu Y, Yuan X. Efficacy and Renal Tolerability of Ultrafiltration in Acute Decompensated Heart Failure: A Meta-analysis and Systematic Review of 19 Randomized Controlled Trials. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Acute decompensated heart failure (ADHF) is a life-threatening and costly disease. Controversy remains regarding the efficacy and renal tolerability of ultrafiltration for treating ADHF. We therefore performed this meta-analysis to evaluate this clinical issue.Methods:
A search of PubMed, EMBASE, and the Cochrane database of controlled trials was performed from inception to March 2021 for relevant randomized controlled trials. The quality of the included trials and outcomes was evaluated with the use of the risk of bias assessment tool and the Grading of
Recommendations, Assessment, Development and Evaluation (GRADE) approach, respectively. The risk ratio and the standardized mean difference (SMD) or weighted mean difference (WMD) were computed and pooled with fixed-effects or random-effects models.Results: This meta-analysis included
19 studies involving 1281 patients. Ultrafiltration was superior to the control treatments for weight loss (WMD 1.24 kg, 95% confidence interval [CI] 0.38‐2.09 kg, P=0.004) and fluid removal (WMD 1.55 L, 95% CI 0.51‐2.59 l, P=0.003) and was associated with a significant increase
in serum creatinine level compared with the control treatments (SMD 0.15 mg/dL, 95% CI 0.00‐0.30 mg/dL, P=0.04). However, no significant effects were found for serum N-terminal prohormone of brain natriuretic peptide level, length of hospital stay, all-cause mortality, or all-cause
rehospitalization in the ultrafiltration group.Conclusions: The use of ultrafiltration in patients with ADHF is superior to the use of the control treatments for weight loss and fluid removal, but has adverse renal effects and lacks significant effects on long-term prognosis, indicating
that this approach to decongestion in ADHF patients is efficient for fluid management but less safe renally.
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Affiliation(s)
- Yajie Liu
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Yuan
- Department of Nephrology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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16
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Palazzuoli A, Mullens W. Cardiac congestion assessed by natriuretic peptides oversimplifies the definition and treatment of heart failure. ESC Heart Fail 2021; 8:3453-3457. [PMID: 34255914 PMCID: PMC8497212 DOI: 10.1002/ehf2.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/15/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital, University of Siena, Siena, Italy
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Deuse T, Tediashvili G, Hu X, Gravina A, Tamenang A, Wang D, Connolly A, Mueller C, Mallavia B, Looney MR, Alawi M, Lanier LL, Schrepfer S. Hypoimmune induced pluripotent stem cell-derived cell therapeutics treat cardiovascular and pulmonary diseases in immunocompetent allogeneic mice. Proc Natl Acad Sci U S A 2021; 118:e2022091118. [PMID: 34244428 PMCID: PMC8285900 DOI: 10.1073/pnas.2022091118] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The emerging field of regenerative cell therapy is still limited by the few cell types that can reliably be differentiated from pluripotent stem cells and by the immune hurdle of commercially scalable allogeneic cell therapeutics. Here, we show that gene-edited, immune-evasive cell grafts can survive and successfully treat diseases in immunocompetent, fully allogeneic recipients. Transplanted endothelial cells improved perfusion and increased the likelihood of limb preservation in mice with critical limb ischemia. Endothelial cell grafts transduced to express a transgene for alpha1-antitrypsin (A1AT) successfully restored physiologic A1AT serum levels in mice with genetic A1AT deficiency. This cell therapy prevented both structural and functional changes of emphysematous lung disease. A mixture of endothelial cells and cardiomyocytes was injected into infarcted mouse hearts, and both cell types orthotopically engrafted in the ischemic areas. Cell therapy led to an improvement in invasive hemodynamic heart failure parameters. Our study supports the development of hypoimmune, universal regenerative cell therapeutics for cost-effective treatments of major diseases.
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Affiliation(s)
- Tobias Deuse
- Division of Cardiothoracic Surgery, Department of Surgery, Transplant and Stem Cell Immunobiology Laboratory, University of California, San Francisco, CA 94143
| | - Grigol Tediashvili
- Division of Cardiothoracic Surgery, Department of Surgery, Transplant and Stem Cell Immunobiology Laboratory, University of California, San Francisco, CA 94143
- Department of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, Germany
| | - Xiaomeng Hu
- Division of Cardiothoracic Surgery, Department of Surgery, Transplant and Stem Cell Immunobiology Laboratory, University of California, San Francisco, CA 94143
- Department of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Luebeck, 20246 Hamburg, Germany
- Sana Biotechnology Inc., South San Francisco, CA 94080
| | - Alessia Gravina
- Division of Cardiothoracic Surgery, Department of Surgery, Transplant and Stem Cell Immunobiology Laboratory, University of California, San Francisco, CA 94143
| | - Annika Tamenang
- Division of Cardiothoracic Surgery, Department of Surgery, Transplant and Stem Cell Immunobiology Laboratory, University of California, San Francisco, CA 94143
- Department of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, Germany
| | - Dong Wang
- Division of Cardiothoracic Surgery, Department of Surgery, Transplant and Stem Cell Immunobiology Laboratory, University of California, San Francisco, CA 94143
| | - Andrew Connolly
- Department of Pathology, University of California, San Francisco, CA 94143
| | - Christian Mueller
- Horae Gene Therapy Center, University of Massachusetts, Worcester, MA 01605
- Department of Pediatrics, University of Massachusetts, Worcester, MA 01605
| | - Beñat Mallavia
- Department of Medicine, University of California, San Francisco, CA 94143
| | - Mark R Looney
- Department of Medicine, University of California, San Francisco, CA 94143
- Department of Laboratory Medicine, University of California, San Francisco, CA 94143
| | - Malik Alawi
- Bioinformatics Core, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Lewis L Lanier
- Department of Microbiology and Immunology and the Parker Institute for Cancer Immunotherapy, University of California, San Francisco, CA 94143
| | - Sonja Schrepfer
- Division of Cardiothoracic Surgery, Department of Surgery, Transplant and Stem Cell Immunobiology Laboratory, University of California, San Francisco, CA 94143;
- Sana Biotechnology Inc., South San Francisco, CA 94080
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18
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Colburn TD, Weber RE, Schulze KM, Sue Hageman K, Horn AG, Behnke BJ, Poole DC, Musch TI. Sexual dimorphism in vascular ATP-sensitive K + channel function supporting interstitial PO2 via convective and/or diffusive O 2 transport. J Physiol 2021; 599:3279-3293. [PMID: 34101850 PMCID: PMC8451062 DOI: 10.1113/jp281120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/14/2021] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Inhibition of pancreatic ATP-sensitive K+ (KATP ) channels is the intended effect of oral sulphonylureas to increase insulin release in diabetes. However, pertinent to off-target effects of sulphonylurea medication, sex differences in cardiac KATP channel function exist, whereas potential sex differences in vascular KATP channel function remain unknown. In the present study, we assessed vascular KATP channel function (topical glibenclamide superfused onto fast-twitch oxidative skeletal muscle) supporting blood flow and interstitial O2 delivery-utilization matching ( P O 2 is) during twitch contractions in male, female during pro-oestrus and ovariectomized female (F+OVX) rats. Glibenclamide decreased blood flow (convective O2 transport) and interstitial P O 2 in male and female, but not F+OVX, rats. Compared to males, females also demonstrated impaired diffusive O2 transport and a faster fall in interstitial P O 2 . Our demonstration, in rats, that sex differences in vascular KATP channel function exist support the tentative hypothesis that oral sulphonylureas may exacerbate exercise intolerance and morbidity, especially in premenopausal females. ABSTRACT Vascular ATP-sensitive K+ (KATP ) channels support skeletal muscle blood flow ( Q ̇ m ), interstitial O2 delivery ( Q ̇ O 2 )-utilization ( V ̇ O 2 ) matching (i.e. interstitial-myocyte O2 flux driving pressure; P O 2 is) and exercise tolerance. Potential sex differences in skeletal muscle vascular KATP channel function remain largely unexplored. We hypothesized that local skeletal muscle KATP channel inhibition via glibenclamide superfusion (5 mg kg-1 GLI; sulphonylurea diabetes medication) in anaesthetized female Sprague-Dawley rats, compared to males, would demonstrate greater reductions in contracting (1 Hz, 7 V, 180 s) fast-twitch oxidative mixed gastrocnemius (97% type IIA+IID/X+IIB) Q ̇ m (15 μm microspheres) and P O 2 is (phosphorescence quenching), resulting from more compromised convective ( Q ̇ O 2 ) and diffusive ( D O 2 ) O2 conductances. Furthermore, these GLI-induced reductions in ovary-intact females measured during pro-oestrus would be diminished following ovariectomy (F+OVX). GLI similarly impaired mixed gastrocnemius V ̇ O 2 in both males (↓28%) and females (↓33%, both P < 0.032) via reduced Q ̇ m (male: ↓31%, female: ↓35%, both P < 0.020), Q ̇ O 2 (male: 5.6 ± 0.5 vs. 4.0 ± 0.5, female: 6.4 ± 1.1 vs. 4.2 ± 0.6 mL O2 min-1 100 g tissue-1 , P < 0.022) and the resulting P O 2 is, with females also demonstrating a reduced D O 2 (0.40 ± 0.07 vs. 0.30 ± 0.04 mL O2 min-1 100 g tissue-1 , P < 0.042) and a greater GLI-induced speeding of P O 2 is fall (mean response time: Sex × Drug interaction, P = 0.026). Conversely, GLI did not impair the mixed gastrocnemius of F+OVX rats. Therefore, in patients taking sulphonylureas, these results support the potential for impaired vascular KATP channel function to compromise muscle Q ̇ m and therefore exercise tolerance. Such an effect, if present, would likely contribute to adverse cardiovascular events in premenopausal females more than males.
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Affiliation(s)
- Trenton D. Colburn
- Department of Kinesiology, Physiology, Kansas State University, Manhattan, KS, 66506, USA
| | - Ramona E. Weber
- Department of Kinesiology, Physiology, Kansas State University, Manhattan, KS, 66506, USA
| | - Kiana M. Schulze
- Department of Kinesiology, Physiology, Kansas State University, Manhattan, KS, 66506, USA
| | - K. Sue Hageman
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, 66506, USA
| | - Andrew G. Horn
- Department of Kinesiology, Physiology, Kansas State University, Manhattan, KS, 66506, USA
| | - Brad J. Behnke
- Department of Kinesiology, Physiology, Kansas State University, Manhattan, KS, 66506, USA
| | - David C. Poole
- Department of Kinesiology, Physiology, Kansas State University, Manhattan, KS, 66506, USA
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, 66506, USA
| | - Timothy I. Musch
- Department of Kinesiology, Physiology, Kansas State University, Manhattan, KS, 66506, USA
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, 66506, USA
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19
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Nwosu WO, Rajani R, McDonaugh T, Driscoll E, Hughes LD. Patients' and carers' perspective of the impact of heart failure on quality of life: a qualitative study. PSYCHOL HEALTH MED 2021; 27:1381-1396. [PMID: 33947277 DOI: 10.1080/13548506.2021.1922719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Heart failure (HF) is a syndrome associated with high mortality and morbidity. HF patients tend to be at a high risk of poor clinical and psychosocial outcomes. This study aimed to capture patients' and carers perspectives of HF, the impact on their health reported QoL, and the factors associated with their poor health outcomes. To explore HF patients' and carers' views on their QoL since diagnosis. This study used a cross-sectional, qualitative design with semi-structured interviews conducted with participating patients and carers. Thirteen adults (> 18 years) with HF and 21 carers were interviewed over the telephone, following a semi-structured interview schedule. Interviews were transcribed verbatim and analysed using inductive thematic analysis. Three main themes were identified, with an overarching theme . Themes included impact on patients' lifestyle including diet, smoking and inability to part-take in social activities, adjusting to HF diagnosis and co-morbidity management, and psychological/mental health issues such as anxiety and depression. Patients with HF are at high-risk of various issues which can negatively impact their QoL. Additionally, Carers play a vital role in the management of HF patients. Effective patient centred care and better communication between patients, carers and healthcare professionals is vital in HF management.
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Affiliation(s)
- Winifred Onyinyechi Nwosu
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (Ioppn), King's College London, London, UK
| | - Ronak Rajani
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust London, London, UK
| | - Theresa McDonaugh
- Cardiology Department, King's College Hospital NHS Foundation Trust London, London, UK
| | - Elizabeth Driscoll
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (Ioppn), King's College London, London, UK
| | - Lyndsay D Hughes
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (Ioppn), King's College London, London, UK
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20
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Cardiac Contractility Modulation in Patients with Heart Failure with Reduced Left Ventricular Ejection Fraction. HEARTS 2021. [DOI: 10.3390/hearts2010013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Cardiac contractility modulation is an innovative therapy conceived for the treatment of heart failure. It is a device-based therapy, employing multiple electrodes to deliver relatively high-voltage (~7.5 V) biphasic signals to the endocardium of the right ventricular septum, in order to improve heart failure symptoms, exercise capacity and quality of life. Multiple clinical and mechanistic studies have been conducted to investigate the potential usefulness of this technology and, as of now, they suggest that it could have a place in therapy and meet a relevant medical need for a specific sub-category of underserved heart failure patients with reduced left ventricular ejection fraction. More studies are needed to further investigate its effect on outcomes such as mortality and rate of hospitalizations.
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21
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Aburjania N, Hay CM, Sohail MR. Continuous-flow left ventricular assist device systems infections: current outcomes and management strategies. Ann Cardiothorac Surg 2021; 10:233-239. [PMID: 33842217 DOI: 10.21037/acs-2020-cfmcs-26] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Left ventricular assisted devices (LVADs) are increasingly used for management of patients with advanced heart failure. However, infection remains one of the most commonly reported complications. Diagnosis, as well as treatment of LVAD infections is challenging. There are multiple diagnostic modalities that have been used to assist with accurate diagnosis of LVAD infections. Treatment of the infection can be especially challenging in these patients, given the presence of the implantable device that cannot be easily replaced or removed. There are no clinical trials assessing the best approach to diagnosis, treatment or long-term management of LVAD infections. In this article we review the most recent diagnostic modalities and treatment approaches, as well as offer our guidance on diagnosis and treatment of LVAD infections.
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Affiliation(s)
- Nana Aburjania
- Division of Infectious Diseases, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christine M Hay
- Division of Infectious Diseases, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Muhammad R Sohail
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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22
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Kaneko H, Itoh H, Yotsumoto H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Impact of hospital volume on clinical outcomes of hospitalized heart failure patients: analysis of a nationwide database including 447,818 patients with heart failure. BMC Cardiovasc Disord 2021; 21:49. [PMID: 33494701 PMCID: PMC7836495 DOI: 10.1186/s12872-021-01863-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital volume is known to be associated with outcomes of patients requiring complicated medical care. However, the relationship between hospital volume and prognosis of hospitalized patients with heart failure (HF) remains not fully understood. We aimed to clarify the impact of hospital volume on clinical outcomes of hospitalized HF patients using a nationwide inpatient database. METHODS AND RESULTS We studied 447,818 hospitalized HF patients who were admitted from January 2010 and discharged until March 2018 included in the Japanese Diagnosis Procedure Combination database. According to the number of patients, patients were categorized into three groups; those treated in low-, medium-, and high-volume centers. The median age was 81 years and 238,192 patients (53%) were men. Patients who had New York Heart Association class IV symptom and requiring inotropic agent within two days were more common in high volume centers than in low volume centers. Respiratory support, hemodialysis, and intra-aortic balloon pumping were more frequently performed in high volume centers. As a result, length of hospital stay was shorter, and in-hospital mortality was lower in high volume centers. Lower in-hospital mortality was associated with higher hospital volume. Multivariable logistic regression analysis fitted with generalized estimating equation indicated that medium-volume group (Odds ratio 0.91, p = 0.035) and high-volume group (Odds ratio 0.86, p = 0.004) had lower in-hospital mortality compared to the low-volume group. Subgroup analysis showed that this association between hospital volume and in-hospital mortality among overall population was seen in all subgroups according to age, presence of chronic renal failure, and New York Heart Association class. CONCLUSION Hospital volume was independently associated with ameliorated clinical outcomes of hospitalized patients with HF.
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Affiliation(s)
- Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruki Yotsumoto
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tatsuya Kamon
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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23
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Models for Heart Failure Admissions and Admission Rates, 2016 through 2018. Healthcare (Basel) 2020; 9:healthcare9010022. [PMID: 33375483 PMCID: PMC7824516 DOI: 10.3390/healthcare9010022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Approximately 6.5 to 6.9 million individuals in the United States have heart failure, and the disease costs approximately $43.6 billion in 2020. This research provides geographical incidence and cost models of this disease in the U.S. and explanatory models to account for hospitals' number of heart failure DRGs using technical, workload, financial, geographical, and time-related variables. METHODS The number of diagnoses is forecast using regression (constrained and unconstrained) and ensemble (random forests, extra trees regressor, gradient boosting, and bagging) techniques at the hospital unit of analysis. Descriptive maps of heart failure diagnostic-related groups (DRGs) depict areas of high incidence. State- and county-level spatial and non-spatial regression models of heart failure admission rates are performed. Expenditure forecasts are estimated. RESULTS The incidence of heart failure has increased over time with the highest intensities in the East and center of the country; however, several Northern states have seen large increases since 2016. The best predictive model for the number of diagnoses (hospital unit of analysis) was an extremely randomized tree ensemble (predictive R2 = 0.86). The important variables in this model included workload metrics and hospital type. State-level spatial lag models using first-order Queen criteria were best at estimating heart failure admission rates (R2 = 0.816). At the county level, OLS was preferred over any GIS model based on Moran's I and resultant R2; however, none of the traditional models performed well (R2 = 0.169 for the OLS). Gradient-boosted tree models predicted 36% of the total sum of squares; the most important factors were facility workload, mean cash on hand of the hospitals in the county, and mean equity of those hospitals. Online interactive maps at the state and county levels are provided. CONCLUSIONS Heart failure and associated expenditures are increasing. Costs of DRGs in the study increased $61 billion from 2016 through 2018. The increase in the more expensive DRG 291 outpaced others with an associated increase of $92 billion. With the increase in demand and steady-state supply of cardiologists, the costs are likely to balloon over the next decade. Models such as the ones presented here are needed to inform healthcare leaders.
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24
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The impact of the first 24 h of loop diuretic on kidney function in acute decompensated heart failure. Ir J Med Sci 2020; 190:987-992. [PMID: 33222077 DOI: 10.1007/s11845-020-02426-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Because of the uncertainty in the appropriate initial loop diuretic dose in acute decompensated heart failure (ADHF), the risk of acute kidney injury (AKI) is believed to be increased with the high dose of initial intravenous (IV) loop diuretic. AIMS The purpose of this study is to examine the impact of the first 24-h IV diuretic on kidney function in ADHF. METHODS A retrospective cohort study included patients with ADHF. These patients were divided into two groups: the first group received an initial total IV diuretic dose that was equal to or 2.5 times less than the home dose in the first 24 h (low dose), while the second group received 2.5 times more than the home dose in the first 24 h (high dose). The primary outcome was the incidence of developing AKI within 48 h of first IV diuretic. The secondary outcomes were total hospital length of stay and all-cause 30-day readmission rates. RESULTS A total of 252 patients were available for analysis; 172 patients received a low dose in the first 24 h, while 80 patients received a high dose. The incidence of AKI was higher in the high-dose group compared to that in the low-dose group (25% vs. 9.9%, P = 0.002). There was no significant difference between the two groups in terms of hospital stay and all-cause 30-day readmission. CONCLUSION In patients with ADHF, the initial high dose of IV loop diuretics is associated with an increased risk of developing AKI.
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25
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Shin S, Austin PC, Ross HJ, Abdel-Qadir H, Freitas C, Tomlinson G, Chicco D, Mahendiran M, Lawler PR, Billia F, Gramolini A, Epelman S, Wang B, Lee DS. Machine learning vs. conventional statistical models for predicting heart failure readmission and mortality. ESC Heart Fail 2020; 8:106-115. [PMID: 33205591 PMCID: PMC7835549 DOI: 10.1002/ehf2.13073] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/06/2020] [Accepted: 10/05/2020] [Indexed: 01/09/2023] Open
Abstract
Aims This study aimed to review the performance of machine learning (ML) methods compared with conventional statistical models (CSMs) for predicting readmission and mortality in patients with heart failure (HF) and to present an approach to formally evaluate the quality of studies using ML algorithms for prediction modelling. Methods and results Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, we performed a systematic literature search using MEDLINE, EPUB, Cochrane CENTRAL, EMBASE, INSPEC, ACM Library, and Web of Science. Eligible studies included primary research articles published between January 2000 and July 2020 comparing ML and CSMs in mortality and readmission prognosis of initially hospitalized HF patients. Data were extracted and analysed by two independent reviewers. A modified CHARMS checklist was developed in consultation with ML and biostatistics experts for quality assessment and was utilized to evaluate studies for risk of bias. Of 4322 articles identified and screened by two independent reviewers, 172 were deemed eligible for a full‐text review. The final set comprised 20 articles and 686 842 patients. ML methods included random forests (n = 11), decision trees (n = 5), regression trees (n = 3), support vector machines (n = 9), neural networks (n = 12), and Bayesian techniques (n = 3). CSMs included logistic regression (n = 16), Cox regression (n = 3), or Poisson regression (n = 3). In 15 studies, readmission was examined at multiple time points ranging from 30 to 180 day readmission, with the majority of studies (n = 12) presenting prediction models for 30 day readmission outcomes. Of a total of 21 time‐point comparisons, ML‐derived c‐indices were higher than CSM‐derived c‐indices in 16 of the 21 comparisons. In seven studies, mortality was examined at 9 time points ranging from in‐hospital mortality to 1 year survival; of these nine, seven reported higher c‐indices using ML. Two of these seven studies reported survival analyses utilizing random survival forests in their ML prediction models. Both reported higher c‐indices when using ML compared with CSMs. A limitation of studies using ML techniques was that the majority were not externally validated, and calibration was rarely assessed. In the only study that was externally validated in a separate dataset, ML was superior to CSMs (c‐indices 0.913 vs. 0.835). Conclusions ML algorithms had better discrimination than CSMs in most studies aiming to predict risk of readmission and mortality in HF patients. Based on our review, there is a need for external validation of ML‐based studies of prediction modelling. We suggest that ML‐based studies should also be evaluated using clinical quality standards for prognosis research. Registration: PROSPERO CRD42020134867
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Affiliation(s)
- Sheojung Shin
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Peter C Austin
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Heather J Ross
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Husam Abdel-Qadir
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Cassandra Freitas
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - George Tomlinson
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Davide Chicco
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Meera Mahendiran
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Patrick R Lawler
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Filio Billia
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Anthony Gramolini
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Slava Epelman
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Bo Wang
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Douglas S Lee
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
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26
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Krysztofiak H, Wleklik M, Migaj J, Dudek M, Uchmanowicz I, Lisiak M, Kubielas G, Straburzyńska-Migaj E, Lesiak M, Kałużna-Oleksy M. Cardiac Cachexia: A Well-Known but Challenging Complication of Heart Failure. Clin Interv Aging 2020; 15:2041-2051. [PMID: 33173285 PMCID: PMC7646468 DOI: 10.2147/cia.s273967] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient’s prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF (“cardiac cachexia”).
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Affiliation(s)
- Helena Krysztofiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland
| | - Marta Wleklik
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Magdalena Dudek
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | | | - Magdalena Lisiak
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Kubielas
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Marta Kałużna-Oleksy
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
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27
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Martinez-Amezcua P, Haque W, Khera R, Kanaya AM, Sattar N, Lam CSP, Harikrishnan S, Shah SJ, Kandula NR, Jose PO, Narayan KMV, Agyemang C, Misra A, Jenum AK, Bilal U, Nasir K, Cainzos-Achirica M. The Upcoming Epidemic of Heart Failure in South Asia. Circ Heart Fail 2020; 13:e007218. [PMID: 32962410 DOI: 10.1161/circheartfailure.120.007218] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Currently, South Asia accounts for a quarter of the world population, yet it already claims ≈60% of the global burden of heart disease. Besides the epidemics of type 2 diabetes mellitus and coronary heart disease already faced by South Asian countries, recent studies suggest that South Asians may also be at an increased risk of heart failure (HF), and that it presents at earlier ages than in most other racial/ethnic groups. Although a frequently underrecognized threat, an eventual HF epidemic in the densely populated South Asian nations could have dramatic health, social and economic consequences, and urgent interventions are needed to flatten the curve of HF in South Asia. In this review, we discuss recent studies portraying these trends, and describe the mechanisms that may explain an increased risk of premature HF in South Asians compared with other groups, with a special focus on highly relevant features in South Asian populations including premature coronary heart disease, early type 2 diabetes mellitus, ubiquitous abdominal obesity, exposure to the world's highest levels of air pollution, highly prevalent pretransition forms of HF such as rheumatic heart disease, and underdevelopment of healthcare systems. Other rising lifestyle-related risk factors such as use of tobacco products, hypertension, and general obesity are also discussed. We evaluate the prognosis of HF in South Asian countries and the implications of an anticipated HF epidemic. Finally, we discuss proposed interventions aimed at curbing these adverse trends, management approaches that can improve the prognosis of prevalent HF in South Asian countries, and research gaps in this important field.
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Affiliation(s)
- Pablo Martinez-Amezcua
- Johns Hopkins Bloomberg School of Public Health (P.M.-A., W.H.), Johns Hopkins University, Baltimore, MD
| | - Waqas Haque
- Johns Hopkins Bloomberg School of Public Health (P.M.-A., W.H.), Johns Hopkins University, Baltimore, MD.,Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (R.K.).,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (R.K.)
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom (N.S.)
| | - Carolyn S P Lam
- National Heart Centre Singapore (C.S.P.L.).,Duke-National University of Singapore (C.S.P.L.).,University Medical Centre, Groningen, the Netherlands (C.S.P.L.)
| | - Sivadasanpillai Harikrishnan
- Heart Failure Association of India (S.H.).,National Center of Research and Excellence in Heart Failure, ICMR (S.H.).,Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum (S.H.)
| | - Sanjiv J Shah
- Bluhm Cardiovascular Institute and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Namratha R Kandula
- Northwestern University, Feinberg School of Medicine, Chicago, IL (N.R.K.)
| | - Powell O Jose
- Sutter Davis Hospital, Sutter Medical Center, Sacramento, CA (P.O.J.)
| | - K M Venkat Narayan
- Rollins School of Public Health, Emory University and Emory University School of Medicine, Atlanta, GA (K.M.V.N.)
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, the Netherlands (C.A.)
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India (A.M.).,National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India (A.M.).,Diabetes Foundation India, New Delhi, India (A.M.)
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, University of Oslo, Institute of Health and Society, Norway (A.K.J.)
| | - Usama Bilal
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA (U.B.)
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD.,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (K.N., M.C.-A.).,Center for Outcomes Research, Houston Methodist, Houston, TX (K.N., M.C.-A.)
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD.,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (K.N., M.C.-A.).,Center for Outcomes Research, Houston Methodist, Houston, TX (K.N., M.C.-A.)
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28
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Saito Y, Matsumoto N, Aizawa Y, Fukamachi D, Kitano D, Kazuto T, Tamaki T, Fujito H, Sezai A, Okumura Y. Clinical significance of spleen stiffness in patients with acute decompensated heart failure. ESC Heart Fail 2020; 7:4005-4014. [PMID: 32924272 PMCID: PMC7754734 DOI: 10.1002/ehf2.13001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 12/17/2022] Open
Abstract
Aims Congestive splenomegaly is a classic sign of organ congestion in acute decompensated heart failure (ADHF). Shear wave elastography (SWE) allows the measurement of spleen stiffness (SS). We hypothesized that SS could quantify the severity of splenic congestion and predict adverse events in ADHF. Methods and Results This study included two cohorts: a haemodynamic cohort (62 HF patients) and an outcome cohort (115 ADHF patients). SS was measured by two‐dimensional SWE on the same day of right heart catheterization in the haemodynamic cohort. Right atrial pressure (RAP) independently correlated with SS (β = 0.32, P = 0.002). SS was measured in the outcome cohort before discharge. The 115 patients were divided into three groups on the basis of the tertile value of SS. The third tertile SS group had a higher prevalence of severe tricuspid regurgitation, higher N‐terminal B‐type natriuretic peptide (NT pro‐BNP), and larger right ventricular diastolic diameter, than had the first tertile group and the second tertile group. During a median follow‐up period of 105 (77–135) days, adverse events occurred in 25 patients (one death and 24 rehospitalizations for HF). The third tertile SS group had a significantly higher rate of adverse events (P < 0.001). A higher SS was independently associated with adverse events after adjusting for conventional validated risk score, liver function test, liver stiffness, and estimated RAP. Conclusions The degree of SS at discharge can be used as a marker of residual splenic congestion, which is predictive of adverse events in patients with ADHF.
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Affiliation(s)
- Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Naoki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yoshihiro Aizawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Daisuke Kitano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Toyama Kazuto
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takehiro Tamaki
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hidesato Fujito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Akira Sezai
- Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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Lin XX, Gao BB, Huang JY. Prevalence of depressive symptoms in patients with Heart Failure in China: a meta-analysis of comparative studies and epidemiological surveys. J Affect Disord 2020; 274:774-783. [PMID: 32664014 DOI: 10.1016/j.jad.2020.05.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/05/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although depressive symptoms is a frequent psychiatric comorbidity in people with Heart Failure (HF) in China, its prevalence was not estimated. This is a meta-analysis of studies examining depressive symptoms in HF patients in China. METHODS The following databases including PubMed, the Cochrace Library, Embase, China National Knowledge Infrastructure (CNKI), WanFang and VIP were independently and systematically searched from inception until March 31, 2019. Statistical analyses were performed using the Stata 13.0 software. The pooled prevalence of depressive symptoms was performed using a random-effects model. In addition, subgroup analysis was conducted based on the New York Heart Association (NYHA) functional class, the assessment tools of depression and gender. RESULTS Altogether 53 studies (10649 participants) met the inclusion criteria for the analysis. The point prevalence of depressive symptoms in HF was 43%. In subgroup analyses, the prevalence of depressive symptoms was higher in females than in males (46% vs 34%, respectively), and the prevalence of depressive symptoms positively correlated with New York Heart Association functional classes (II 28%, III 46%, IV 52%) . Rates of depression were highest when measured using BDI scale (62%), and lowest when measured using the CES-D (31%). CONCLUSIONS This meta-analysis confirmed that the prevalence of depressive symptoms was common in HF patients in China and it is related to the severity of heart failure, gender and the diversity of assessment tools. Appropriate strategies for prevention and treatment of depressive symptoms in this population need greater attention.
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Affiliation(s)
- Xiao-Xiao Lin
- Department of cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Bei-Bei Gao
- Department of cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Jin-Yu Huang
- Department of cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine.
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30
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Reljin N, Posada-Quintero HF, Eaton-Robb C, Binici S, Ensom E, Ding E, Hayes A, Riistama J, Darling C, McManus D, Chon KH. Machine Learning Model Based on Transthoracic Bioimpedance and Heart Rate Variability for Lung Fluid Accumulation Detection: Prospective Clinical Study. JMIR Med Inform 2020; 8:e18715. [PMID: 32852277 PMCID: PMC7484776 DOI: 10.2196/18715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/10/2020] [Accepted: 07/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background Accumulation of excess body fluid and autonomic dysregulation are clinically important characteristics of acute decompensated heart failure. We hypothesized that transthoracic bioimpedance, a noninvasive, simple method for measuring fluid retention in lungs, and heart rate variability, an assessment of autonomic function, can be used for detection of fluid accumulation in patients with acute decompensated heart failure. Objective We aimed to evaluate the performance of transthoracic bioimpedance and heart rate variability parameters obtained using a fluid accumulation vest with carbon black–polydimethylsiloxane dry electrodes in a prospective clinical study (System for Heart Failure Identification Using an External Lung Fluid Device; SHIELD). Methods We computed 15 parameters: 8 were calculated from the model to fit Cole-Cole plots from transthoracic bioimpedance measurements (extracellular, intracellular, intracellular-extracellular difference, and intracellular-extracellular parallel circuit resistances as well as fitting error, resonance frequency, tissue heterogeneity, and cellular membrane capacitance), and 7 were based on linear (mean heart rate, low-frequency components of heart rate variability, high-frequency components of heart rate variability, normalized low-frequency components of heart rate variability, normalized high-frequency components of heart rate variability) and nonlinear (principal dynamic mode index of sympathetic function, and principal dynamic mode index of parasympathetic function) analysis of heart rate variability. We compared the values of these parameters between 3 participant data sets: control (n=32, patients who did not have heart failure), baseline (n=23, patients with acute decompensated heart failure taken at the time of admittance to the hospital), and discharge (n=17, patients with acute decompensated heart failure taken at the time of discharge from hospital). We used several machine learning approaches to classify participants with fluid accumulation (baseline) and without fluid accumulation (control and discharge), termed with fluid and without fluid groups, respectively. Results Among the 15 parameters, 3 transthoracic bioimpedance (extracellular resistance, R0; difference in extracellular-intracellular resistance, R0 – R∞, and tissue heterogeneity, α) and 3 heart rate variability (high-frequency, normalized low-frequency, and normalized high-frequency components) parameters were found to be the most discriminatory between groups (patients with and patients without heart failure). R0 and R0 – R∞ had significantly lower values for patients with heart failure than for those without heart failure (R0: P=.006; R0 – R∞: P=.001), indicating that a higher volume of fluids accumulated in the lungs of patients with heart failure. A cubic support vector machine model using the 5 parameters achieved an accuracy of 92% for with fluid and without fluid group classification. The transthoracic bioimpedance parameters were related to intra- and extracellular fluid, whereas the heart rate variability parameters were mostly related to sympathetic activation. Conclusions This is useful, for instance, for an in-home diagnostic wearable to detect fluid accumulation. Results suggest that fluid accumulation, and subsequently acute decompensated heart failure detection, could be performed using transthoracic bioimpedance and heart rate variability measurements acquired with a wearable vest.
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Affiliation(s)
- Natasa Reljin
- Department of Biomedical Engineering, University of Connecticut, Mansfield, CT, United States
| | - Hugo F Posada-Quintero
- Department of Biomedical Engineering, University of Connecticut, Mansfield, CT, United States
| | - Caitlin Eaton-Robb
- Department of Biomedical Engineering, University of Connecticut, Mansfield, CT, United States
| | - Sophia Binici
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Emily Ensom
- University of Massachusetts Memorial Hospital Care, Worcester, MA, United States
| | - Eric Ding
- University of Massachusetts Memorial Hospital Care, Worcester, MA, United States
| | - Anna Hayes
- University of Massachusetts Memorial Hospital Care, Worcester, MA, United States
| | | | - Chad Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - David McManus
- University of Massachusetts Memorial Hospital Care, Worcester, MA, United States
| | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, Mansfield, CT, United States
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31
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Adedinsewo D, Carter RE, Attia Z, Johnson P, Kashou AH, Dugan JL, Albus M, Sheele JM, Bellolio F, Friedman PA, Lopez-Jimenez F, Noseworthy PA. Artificial Intelligence-Enabled ECG Algorithm to Identify Patients With Left Ventricular Systolic Dysfunction Presenting to the Emergency Department With Dyspnea. Circ Arrhythm Electrophysiol 2020; 13:e008437. [PMID: 32986471 DOI: 10.1161/circep.120.008437] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Identification of systolic heart failure among patients presenting to the emergency department (ED) with acute dyspnea is challenging. The reasons for dyspnea are often multifactorial. A focused physical evaluation and diagnostic testing can lack sensitivity and specificity. The objective of this study was to assess the accuracy of an artificial intelligence-enabled ECG to identify patients presenting with dyspnea who have left ventricular systolic dysfunction (LVSD). METHODS We retrospectively applied a validated artificial intelligence-enabled ECG algorithm for the identification of LVSD (defined as LV ejection fraction ≤35%) to a cohort of patients aged ≥18 years who were evaluated in the ED at a Mayo Clinic site with dyspnea. Patients were included if they had at least one standard 12-lead ECG acquired on the date of the ED visit and an echocardiogram performed within 30 days of presentation. Patients with prior LVSD were excluded. We assessed the model performance using area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity. RESULTS A total of 1606 patients were included. Median time from ECG to echocardiogram was 1 day (Q1: 1, Q3: 2). The artificial intelligence-enabled ECG algorithm identified LVSD with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.86-0.91) and accuracy of 85.9%. Sensitivity, specificity, negative predictive value, and positive predictive value were 74%, 87%, 97%, and 40%, respectively. To identify an ejection fraction <50%, the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were 0.85 (95% CI, 0.83-0.88), 86%, 63%, and 91%, respectively. NT-proBNP (N-terminal pro-B-type natriuretic peptide) alone at a cutoff of >800 identified LVSD with an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.76-0.84). CONCLUSIONS The ECG is an inexpensive, ubiquitous, painless test which can be quickly obtained in the ED. It effectively identifies LVSD in selected patients presenting to the ED with dyspnea when analyzed with artificial intelligence and outperforms NT-proBNP. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
| | - Rickey E Carter
- Department of Health Sciences Research (R.E.C., P.J.), Mayo Clinic, Jacksonville, FL
| | - Zachi Attia
- Division of Cardiovascular Medicine (Z.A., J.L.D., P.A.F., F.L.-J., P.A.N.), Mayo Clinic, Rochester, MN
| | - Patrick Johnson
- Department of Health Sciences Research (R.E.C., P.J.), Mayo Clinic, Jacksonville, FL
| | | | - Jennifer L Dugan
- Division of Cardiovascular Medicine (Z.A., J.L.D., P.A.F., F.L.-J., P.A.N.), Mayo Clinic, Rochester, MN
| | - Michael Albus
- Department of Emergency Medicine (M.A., J.M.S.), Mayo Clinic, Jacksonville, FL
| | - Johnathan M Sheele
- Department of Emergency Medicine (M.A., J.M.S.), Mayo Clinic, Jacksonville, FL
| | | | - Paul A Friedman
- Division of Cardiovascular Medicine (Z.A., J.L.D., P.A.F., F.L.-J., P.A.N.), Mayo Clinic, Rochester, MN
| | - Francisco Lopez-Jimenez
- Division of Cardiovascular Medicine (Z.A., J.L.D., P.A.F., F.L.-J., P.A.N.), Mayo Clinic, Rochester, MN
| | - Peter A Noseworthy
- Division of Cardiovascular Medicine (Z.A., J.L.D., P.A.F., F.L.-J., P.A.N.), Mayo Clinic, Rochester, MN
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Yetkin E, Cuglan B, Turhan H, Ozturk S. A novel strategy to reduce the readmission rates in congestive heart failure: intermittent empirical intravenous diuretics. Cardiovasc Endocrinol Metab 2020; 9:60-63. [PMID: 32537567 DOI: 10.1097/xce.0000000000000200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/18/2020] [Indexed: 11/25/2022]
Abstract
Improvements in the medical management of heart failure have changed the course of the disease. However, mortality rates, hospitalization rates, and treatment costs are not at desired levels. Diuretics have been widely used in the treatment of congestion in heart failure patients. The following case reports represent a special patient group treated and followed by cardiology clinic. Treatment approach of each case report has been tailored on an individual basis depending on the clinical course and hospitalization rates of patients. Authors have highlighted and discussed the common aspects and future perspectives of their cases in which post-discharge intermittent empirical intravenous diuretic administration dramatically improved the clinical status and readmission number due to decompensated congestive heart failure. This is a relatively new and promising approach, which has been thought to cease the recycle of diuretic resistance and silent increase of fluid congestion in patients with congestive heart failure and frequent hospitalization.
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Affiliation(s)
- Ertan Yetkin
- Department of Cardiology, Istinye University Liv Hospital, Istanbul
| | - Bilal Cuglan
- Department of Cardiology, Istinye University Liv Hospital, Istanbul
| | - Hasan Turhan
- Department of Cardiology, Istinye University Liv Hospital, Istanbul
| | - Selcuk Ozturk
- Ankara Education and Research Hospital, Cardiology Clinic, Ankara, Turkey
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Fernandes ADF, Fernandes GC, Mazza MR, Knijnik LM, Fernandes GS, Vilela ATD, Badiye A, Chaparro SV. A 10-Year Trend Analysis of Heart Failure in the Less Developed Brazil. Arq Bras Cardiol 2020; 114:222-231. [PMID: 32215488 PMCID: PMC7077585 DOI: 10.36660/abc.20180321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Data on heart failure (HF) epidemiology in less developed areas of Brazil are scarce. OBJECTIVE Our aim was to determine the HF morbidity and mortality in Paraiba and Brazil and its 10-year trends. METHODS A retrospective search was conducted from 2008 to 2017 using the DATASUS database and included patients ≥ 15 years old with a primary diagnosis of HF. Data on in-hospital and population morbidity and mortality were collected and stratified by year, gender and age. Pearson correlation and linear-by-linear association test for trends were calculated, with a level of significance of 5%. RESULTS From 2008 to 2017, HF admissions decreased 62% (p = 0.004) in Paraiba and 34% (p = 0.004) in Brazil. The in-hospital mortality rate increased in Paraiba and Brazil [65.1% (p = 0.006) and 30.1% (p = 0.003), respectively], but the absolute in-hospital mortality had a significant decrease only in Paraiba [37.5% (p = 0.013)], which was maintained after age stratification, except for groups 15-19, 60-69 and > 80 years. It was observed an increase in the hospital stay [44% (p = 0.004) in Paraiba and 12.3% (p = 0.004) in Brazil]. From 2008 to 2015, mortality rate for HF in the population decreased 10.7% (p = 0.047) in Paraiba and 7.7% (p = 0.017) in Brazil. CONCLUSIONS Although HF mortality rate has been decreasing in Paraiba and Brazil, an increase in the in-hospital mortality rate and length of stay for HF has been observed. Hospital-based clinical studies should be performed to identify the causes for these trends of increase.
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Affiliation(s)
- Amanda D F Fernandes
- University of Miami Miller School of Medicine - Department of Medicine, Miami, Florida - USA
| | - Gilson C Fernandes
- University of Miami Miller School of Medicine - Division of Cardiology, Miami, Florida - USA
| | - Manuel Rivera Mazza
- University of Miami Miller School of Medicine - Department of Medicine, Miami, Florida - USA
| | - Leonardo M Knijnik
- University of Miami Miller School of Medicine - Department of Medicine, Miami, Florida - USA
| | | | | | - Amit Badiye
- University of Miami Miller School of Medicine - Division of Cardiology, Miami, Florida - USA
| | - Sandra V Chaparro
- University of Miami Miller School of Medicine - Division of Cardiology, Miami, Florida - USA
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18F-FDG PET-Based Imaging of Myocardial Inflammation Following Acute Myocardial Infarction in a Mouse Model. Int J Mol Sci 2020; 21:ijms21093340. [PMID: 32397287 PMCID: PMC7246846 DOI: 10.3390/ijms21093340] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 01/13/2023] Open
Abstract
Cellular inflammation is an integral part of the healing process following acute myocardial infarction and has been under intense investigation for both therapeutic and prognostic approaches. Monocytes and macrophages are metabolically highly active and show increased uptake rates of glucose and its analog, 18F-FDG. Yet, the specific allocation of the radioactivity to the inflammatory cells via positron emission tomography (PET) imaging requires the suppression of glucose metabolism in viable myocardium. In mice, the most important model organism in basic research, this can be achieved by the application of ketamine/xylazine (KX) for anesthesia instead of isoflurane. Yet, while the consensus exists that glucose metabolism is effectively suppressed, a strategy for reproducible image analysis is grossly lacking and causes uncertainty concerning data interpretation. We introduce a simple strategy for systematic image analysis, which is a prerequisite to evaluate therapies targeting myocardial inflammation. Mice underwent permanent occlusion of the left anterior descending artery (LAD), inducing an acute myocardial infarction (MI). Five days after MI induction, 10MBq 18F-FDG was injected intravenously and a static PET/CT scan under ketamine/xylazine anesthesia was performed. For image reconstruction, we used an algorithm based on three-dimensional ordered subsets expectation maximization (3D-OSEM) followed by three-dimensional ordinary Poisson maximum a priori (MAP) reconstruction. Using this approach, high focal tracer uptake was typically located in the border zone of the infarct by visual inspection. To precisely demarcate the border zone for reproducible volume of interest (VOI) positioning, our protocol relies on positioning VOIs around the whole left ventricle, the inferobasal wall and the anterolateral wall guided by anatomical landmarks. This strategy enables comparable data in mouse studies, which is an important prerequisite for using a PET-based assessment of myocardial inflammation as a prognostic tool in therapeutic applications.
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Kashyap R, Sarvottam K, Wilson GA, Jentzer JC, Seisa MO, Kashani KB. Derivation and validation of a computable phenotype for acute decompensated heart failure in hospitalized patients. BMC Med Inform Decis Mak 2020; 20:85. [PMID: 32380983 PMCID: PMC7206747 DOI: 10.1186/s12911-020-1092-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 04/14/2020] [Indexed: 02/07/2023] Open
Abstract
Background With higher adoption of electronic health records at health-care centers, electronic search algorithms (computable phenotype) for identifying acute decompensated heart failure (ADHF) among hospitalized patients can be an invaluable tool to enhance data abstraction accuracy and efficacy in order to improve clinical research accrual and patient centered outcomes. We aimed to derive and validate a computable phenotype for ADHF in hospitalized patients. Methods We screened 256, 443 eligible (age > 18 years and with prior research authorization) individuals who were admitted to Mayo Clinic Hospital in Rochester, MN, from January 1, 2006, through December 31, 2014. Using a randomly selected derivation cohort of 938 patients, several iterations of a free-text electronic search were developed and refined. The computable phenotype was subsequently validated in an independent cohort 100 patients. The sensitivity and specificity of the computable phenotype were compared to the gold standard (expert review of charts) and International Classification of Diseases-9 (ICD-9) codes for Acute Heart Failure. Results In the derivation cohort, the computable phenotype achieved a sensitivity of 97.5%, and specificity of 100%, whereas ICD-9 codes for Acute Heart Failure achieved a sensitivity of 47.5% and specificity of 96.7%. When all Heart Failure codes (ICD-9) were used, sensitivity and specificity were 97.5 and 86.6%, respectively. In the validation cohort, the sensitivity and specificity of the computable phenotype were 100 and 98.5%. The sensitivity and specificity for the ICD-9 codes (Acute Heart Failure) were 42 and 98.5%. Upon use of all Heart Failure codes (ICD-9), sensitivity and specificity were 96.8 and 91.3%. Conclusions Our results suggest that using computable phenotype to ascertain ADHF from the clinical notes contained within the electronic medical record are feasible and reliable. Our computable phenotype outperformed ICD-9 codes for the detection of ADHF.
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Affiliation(s)
- Rahul Kashyap
- Multidisciplinary Epidemiological and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN, USA. .,Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Kumar Sarvottam
- Multidisciplinary Epidemiological and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Pulmonary Critical Care Division, Einstein Medical Center, Philadelphia, PA, USA
| | - Gregory A Wilson
- Multidisciplinary Epidemiological and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN, USA.,Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jacob C Jentzer
- Multidisciplinary Epidemiological and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohamed O Seisa
- Multidisciplinary Epidemiological and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN, USA.,Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kianoush B Kashani
- Multidisciplinary Epidemiological and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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36
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Olchanski N, Vest AR, Cohen JT, DeNofrio D. Two-year outcomes and cost for heart failure patients following discharge from the hospital after an acute heart failure admission. Int J Cardiol 2020; 307:109-113. [DOI: 10.1016/j.ijcard.2019.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/13/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
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37
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Bansal N, Zelnick L, Bhat Z, Dobre M, He J, Lash J, Jaar B, Mehta R, Raj D, Rincon-Choles H, Saunders M, Schrauben S, Weir M, Wright J, Go AS. Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease. J Am Coll Cardiol 2020; 73:2691-2700. [PMID: 31146814 DOI: 10.1016/j.jacc.2019.02.071] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Data on rates of heart failure (HF) hospitalizations, recurrent hospitalizations, and outcomes related to HF hospitalizations in chronic kidney disease (CKD) are limited. OBJECTIVES This study examined rates of HF hospitalizations and re-hospitalizations within a large CKD population and evaluated the burden of HF hospitalizations with the risk of subsequent CKD progression and death. METHODS The prospective CRIC (Chronic Renal Insufficiency Cohort) study measured the estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR) at baseline. The crude rates and rate ratios of HF hospitalizations and 30-day HF re-hospitalizations were calculated using Poisson regression models. Cox regression was used to assess the association of the frequency of HF hospitalizations within the first 2 years of follow-up with risk of subsequent CKD progression and death. RESULTS Among 3,791 participants, the crude rate of HF admissions was 5.8 per 100 person-years (with higher rates of HF with preserved ejection fraction vs. HF with reduced ejection fraction). The adjusted rate of HF was higher with a lower eGFR (vs. eGFR >45 ml/min/1.73 m2); the rate ratios were 1.7 and 2.2 for eGFR 30 to 44 and <30 ml/min/1.73 m2 (vs. >45 ml/min/1.73 m2), respectively. Similarly, the adjusted rates of HF hospitalization were significantly higher in those with higher urine ACR (vs. urine ACR <30 mg/g); the rate ratios were 1.9 and 2.6 for urine ACR 30 to 299 and ≥300 mg/g, respectively. Overall, 20.6% of participants had a subsequent HF re-admission within 30 days. HF hospitalization within 2 years of study entry was associated with greater adjusted risks for CKD progression (1 hospitalization: hazard ratio [HR]: 1.93; 95% confidence interval [CI]: 1.40 to 2.67; 2+ hospitalizations: HR: 2.14; 95% CI: 1.30 to 3.54) and all-cause death (1 hospitalization: HR: 2.20; 95% CI: 1.71 to 2.84; 2+ hospitalizations: HR: 3.06; 95% CI: 2.23 to 4.18). CONCLUSIONS Within a large U.S. CKD population, the rates of HF hospitalizations and re-hospitalization were high, with even higher rates across categories of lower eGFR and higher urine ACR. Patients with CKD hospitalized with HF had greater risks of CKD progression and death. HF prevention and treatment should be a public health priority to improve CKD outcomes.
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Affiliation(s)
- Nisha Bansal
- Department of Medicine, University of Washington, Seattle, Washington.
| | - Leila Zelnick
- Department of Medicine, University of Washington, Seattle, Washington
| | - Zeenat Bhat
- Department of Medicine, Wayne State University, Detroit, Michigan
| | - Mirela Dobre
- Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Jiang He
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | - James Lash
- Department of Medicine, Jesse Brown VAMC and University of Illinois Hospital and Health Sciences Center, Chicago, Illinois
| | - Bernard Jaar
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rupal Mehta
- Department of Medicine, Northwestern University, Evanston, Illinois
| | - Dominic Raj
- Department of Medicine, George Washington University, Washington, DC
| | | | - Milda Saunders
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sarah Schrauben
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Weir
- Department of Medicine, University of Maryland, College Park, Maryland
| | - Julie Wright
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Alan S Go
- Department of Medicine, Kaiser Permanente Northern California, Division of Research, Oakland, California; Department of Medicine, University of California-San Francisco, San Francisco, California; Department of Medicine, Stanford University School of Medicine, Palo Alto, California
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Bosso G, Valvano A, Guarnaccia F, Fimiani B, Carbone V, Cittadini A, Zito GB, Oliviero U. Adherence to guidelines in the management of patients with chronic heart failure follow-up. J Cardiovasc Med (Hagerstown) 2020; 21:216-222. [DOI: 10.2459/jcm.0000000000000940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Comparing inpatient costs of heart failure admissions for patients with reduced and preserved ejection fraction with or without type 2 diabetes. Cardiovasc Endocrinol Metab 2020; 9:17-23. [PMID: 32104787 DOI: 10.1097/xce.0000000000000190] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022]
Abstract
Both heart failure (HF) and diabetes mellitus (DM) account for major healthcare expenditures. We evaluated inpatient expenditures and cost drivers in patients admitted with HF with and without DM. Methods We created a retrospective cohort of acutely decompensated HF patients, using linked data from cost accounting systems and electronic medical records. We stratified patients by LVEF into reduced ejection fraction (HFrEF, LVEF ≤40%) and preserved ejection fraction (HFpEF, LVEF >40%) groups and by DM status at admission. Results Our population had 544 people: 285 HFrEF patients (43.5% with DM) and 259 HFpEF patients (43.6% with DM). Patients with HFrEF and DM had the longest hospital stay (5.10 ± 5.21 days). Patients with HFrEF and DM had the highest hospitalization cost ($11 576 ± 15 818). HFrEF and HFpEF patients with DM had the highest cost, and cost per day alive was highest for HFpEF patients with DM [$3153 (95% CI 2332, 4262)]. Conclusion Overall cost was higher for patients with DM, whether or not they were admitted with acute HF due to HFrEF or HFpEF. Cost per day alive for patients with DM continued to exceed corresponding costs for patients without DM, with HFpEF patients with DM having the highest cost.
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Barrett M, Boyne J, Brandts J, Brunner-La Rocca HP, De Maesschalck L, De Wit K, Dixon L, Eurlings C, Fitzsimons D, Golubnitschaja O, Hageman A, Heemskerk F, Hintzen A, Helms TM, Hill L, Hoedemakers T, Marx N, McDonald K, Mertens M, Müller-Wieland D, Palant A, Piesk J, Pomazanskyi A, Ramaekers J, Ruff P, Schütt K, Shekhawat Y, Ski CF, Thompson DR, Tsirkin A, van der Mierden K, Watson C, Zippel-Schultz B. Artificial intelligence supported patient self-care in chronic heart failure: a paradigm shift from reactive to predictive, preventive and personalised care. EPMA J 2019; 10:445-464. [PMID: 31832118 PMCID: PMC6882991 DOI: 10.1007/s13167-019-00188-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
Heart failure (HF) is one of the most complex chronic disorders with high prevalence, mainly due to the ageing population and better treatment of underlying diseases. Prevalence will continue to rise and is estimated to reach 3% of the population in Western countries by 2025. It is the most important cause of hospitalisation in subjects aged 65 years or more, resulting in high costs and major social impact. The current "one-size-fits-all" approach in the treatment of HF does not result in best outcome for all patients. These facts are an imminent threat to good quality management of patients with HF. An unorthodox approach from a new vision on care is required. We propose a novel predictive, preventive and personalised medicine approach where patients are truly leading their management, supported by an easily accessible online application that takes advantage of artificial intelligence. This strategy paper describes the needs in HF care, the needed paradigm shift and the elements that are required to achieve this shift. Through the inspiring collaboration of clinical and high-tech partners from North-West Europe combining state of the art HF care, artificial intelligence, serious gaming and patient coaching, a virtual doctor is being created. The results are expected to advance and personalise self-care, where standard care tasks are performed by the patients themselves, in principle without involvement of healthcare professionals, the latter being able to focus on complex conditions. This new vision on care will significantly reduce costs per patient while improving outcomes to enable long-term sustainability of top-level HF care.
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Affiliation(s)
- Matthew Barrett
- University College of Dublin, Catherine McAuley Education & Research Centre, Mater Misericordiae University Hospital, Nelson Street, Dublin, 7 Ireland
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202AZ Maastricht, The Netherlands
| | - Julia Brandts
- Department of Cardiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202AZ Maastricht, The Netherlands
| | | | - Kurt De Wit
- Thomas More University of Applied Science, Kleinhoefstraat 4, 2240 Geel, Belgium
| | - Lana Dixon
- Belfast Health and Social Care Trust, A Floor, Belfast City Hospital, Lisburn Rd, Belfast, BT9 7AB UK
| | - Casper Eurlings
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202AZ Maastricht, The Netherlands
| | | | - Olga Golubnitschaja
- Radiological Clinic, Universitätsklinikum Bonn, Excellence University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Arjan Hageman
- Sananet Care BV, Rijksweg Zuid 37, 6131AL Sittard, Netherlands
| | | | - André Hintzen
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202AZ Maastricht, The Netherlands
| | - Thomas M. Helms
- German Foundation for the Chronically Ill, Alexanderstrasse 26, 90762 Fürth, Germany
| | - Loreena Hill
- Queen’s University Belfast, 97 Lisburn Rd, Belfast, BY9 7BL UK
| | | | - Nikolaus Marx
- Department of Cardiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Kenneth McDonald
- University College of Dublin, Catherine McAuley Education & Research Centre, Mater Misericordiae University Hospital, Nelson Street, Dublin, 7 Ireland
| | - Marc Mertens
- Thomas More University of Applied Science, Kleinhoefstraat 4, 2240 Geel, Belgium
| | - Dirk Müller-Wieland
- Department of Cardiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Alexander Palant
- German Foundation for the Chronically Ill, Alexanderstrasse 26, 90762 Fürth, Germany
| | - Jens Piesk
- Nurogames GmbH, Schaafenstrasse 25, 50676 Cologne, Germany
| | | | - Jan Ramaekers
- Sananet Care BV, Rijksweg Zuid 37, 6131AL Sittard, Netherlands
| | - Peter Ruff
- Exploris AG, Tödistrasse 52, 8002 Zürich, Switzerland
| | - Katharina Schütt
- Department of Cardiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Yash Shekhawat
- Nurogames GmbH, Schaafenstrasse 25, 50676 Cologne, Germany
| | - Chantal F. Ski
- Queen’s University Belfast, 97 Lisburn Rd, Belfast, BY9 7BL UK
| | | | | | | | - Chris Watson
- Queen’s University Belfast, 97 Lisburn Rd, Belfast, BY9 7BL UK
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Doshi RP, Yan J, Aseltine RH. Age Differences in Racial/Ethnic Disparities in Preventable Hospitalizations for Heart Failure in Connecticut, 2009-2015: A Population-Based Longitudinal Study. Public Health Rep 2019; 135:56-65. [PMID: 31747337 DOI: 10.1177/0033354919884306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Preventable hospitalizations for heart failure result in a large proportion of hospitalizations. The primary objective of this study was to describe longitudinal trends in the association of race/ethnicity with preventable hospitalizations for heart failure in Connecticut and differences in disparities by age. METHODS We analyzed data on hospitalizations in all civilian acute-care hospitals in Connecticut during a 7-year period, 2009 through 2015. We used raking methodology to weight the nonhospitalized population to create a reference population representative of the state's general population. Multivariate regression models examined racial/ethnic disparities among adults aged 35-64, controlling for age, sex, and type of health insurance. For adults aged ≥65, regression models controlled for age and sex. RESULTS After controlling for age and sex, the non-Hispanic black to non-Hispanic white odds ratio for preventable hospitalizations for heart failure ranged from 5.2-6.4 during the study period among adults aged 35-64. Among adults aged ≥65, non-Hispanic black adults had significantly higher odds (range, 1.2-1.8) of preventable hospitalizations than non-Hispanic white adults. Rates among Hispanic adults were significantly higher than rates among non-Hispanic adults after controlling for age and sex among adults aged ≥65 in 2014 and 2015. CONCLUSIONS This research provides information for clinical and population-based interventions targeting racial/ethnic gaps in heart failure hospitalizations. Demonstrating the persistent black-white disparity and age differences in racial/ethnic disparities, this study emphasizes the need for focused prevention among vulnerable populations. Raking methodology is an innovative approach to eliminating selection bias in hospital discharge data.
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Affiliation(s)
- Riddhi P Doshi
- Center for Population Health, University of Connecticut Health Center, Farmington, CT, USA.,Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USA
| | - Jun Yan
- Center for Population Health, University of Connecticut Health Center, Farmington, CT, USA.,Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Robert H Aseltine
- Center for Population Health, University of Connecticut Health Center, Farmington, CT, USA.,Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USA.,Department of Statistics, University of Connecticut, Storrs, CT, USA
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Méndez-Bailón M, Jiménez-García R, Hernández-Barrera V, Comín-Colet J, Esteban-Hernández J, de Miguel-Díez J, de Miguel-Yanes JM, Muñoz-Rivas N, Lorenzo-Villalba N, López-de-Andrés A. Significant and constant increase in hospitalization due to heart failure in Spain over 15 year period. Eur J Intern Med 2019; 64:48-56. [PMID: 30827807 DOI: 10.1016/j.ejim.2019.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/05/2019] [Accepted: 02/23/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND To examine trends in the incidence, characteristics, and in-hospital outcomes of heart failure (HF) hospitalizations from 2001 to 2015 in Spain. METHODS Using the Spanish National Hospital Discharge Database (SNHDD) we selected admissions with a primary or secondary diagnosis of HF. The primary end points were trends in the incidence of hospitalizations and in-hospital mortality (IHM). Trends with primary and secondary diagnosis of HF were evaluated separately. RESULTS The incidence of HF coding increased significantly from 466.16 cases per 100,000 inhabitants in 2001-03 to 780.4 in 2013-15 (p < .001). Age increased over time (76.33 ± 10.92 years in 2001-03 vs. 79.4 ± 10.78 years in 2013-15; p < .001). We found a decrease in the percentage of women over the study period (53.07% vs. 52%; p < .001). We detected a significant increase in comorbidity according to the Charlson Comorbidity Index over time (mean 2.17 ± 0.98 in 2001-03 vs. 2.46 ± 1.04 in 2013-15). The most common associated comorbidities were atrial fibrillation (42.23%), hypertension (38.87%) and type 2 diabetes (34.3%). For the total time period, IHM was 12.79%. IHM decreased significantly over time from 13.47% in 2001-03 to 12.30% in 2013-15. Patients with HF coded as a secondary diagnosis have 66% higher risk of dying in the hospital that those with HF coded as a primary diagnosis. CONCLUSIONS This research shows an increase of hospitalizations due to HF in Spain, particularly in patients with HF as a secondary diagnosis. Advance age and comorbidity in acute HF has increased in the recent years. However, IHM is decreasing while readmissions remain stable.
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Affiliation(s)
- Manuel Méndez-Bailón
- Internal Medicine Department, Clínico San Carlos University Hospital, Medicine Department, Complutense University of Madrid (UCM), Clínico San Carlos Hospital Biomedical Research Institute (IdISSC), Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Josep Comín-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Jesús Esteban-Hernández
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - José M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Spain
| | - Nuria Muñoz-Rivas
- Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Isobe M. The Heart Failure "Pandemic" in Japan: Reconstruction of Health Care System in the Highly Aged Society. JMA J 2019; 2:103-112. [PMID: 33615020 PMCID: PMC7889807 DOI: 10.31662/jmaj.2018-0049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/21/2019] [Indexed: 12/24/2022] Open
Abstract
An increase in the number of patients with heart failure is an international health-related problem. In advanced countries, the number of such patients has rapidly increased since the beginning of the 21st century, raising an important issue regarding medical practice and public health. In 2010, the concept of “heart failure pandemic” was proposed, and it has been recognized as a global social/economic issue. In particular, the number of elderly patients with heart failure has increased with the rapid aging of society and a decrease in the number of children in Japan. A rapid increase in the number of heart failure patients increases stress and social disease-related/medical economic burdens on individuals and their families. The prognosis of patients with chronic heart failure is unfavorable, and the quality of life markedly reduces. To improve the prognosis of elderly patients with heart failure and reduce the readmission rate, the innovation of a medical-care-providing system for heart failure is required. In addition to the provision of medical practice based on a potent heart failure disease control program, manifold strategies, such as lifestyle improvements, self-care practice, cardiac rehabilitation, and environmental intervention, are essential. It is necessary to innovate hospital-based medical practice to a regional-care-system-based medical care system. In addition, to efficiently promote future heart failure strategies, an investigational study with disease registration must be conducted. Recently a new basic act on countermeasures to cardiovascular diseases has been established which may help the reform for this purpose.
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Blizzard S, Verbosky N, Stein B, Hale G, Patel N, Chau Y, Cave B. Evaluation of Pharmacist Impact Within an Interdisciplinary Inpatient Heart Failure Consult Service. Ann Pharmacother 2019; 53:905-915. [PMID: 30961358 DOI: 10.1177/1060028019842656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Heart failure (HF) is highly prevalent in the Veterans Affairs (VA) health care system and the leading cause of hospital discharges in the VA. Despite guideline-specific recommendations of drug therapy, many patients are not on optimal medication regimens. Objective: To examine and quantify pharmacist impact in an interdisciplinary HF consult (IC) service on increasing use of guideline-directed medical therapy (GDMT). The 30-day readmission rates before and after the implementation of an IC service are reported. Methods: This was a single-center retrospective analysis of veterans admitted with a HF diagnosis between August 2008 and August 2015 in 2 distinctive cohorts: pre-IC (August 2008 to November 2011) and IC (November 2011 to August 2015). Results: Four-hundred patients were included, with 200 in each cohort. All-cause readmissions at 30 days were not different between pre-IC and IC groups: 33.5% versus 28.5%, respectively. Secondary outcomes of HF readmission and 1-year mortality were not different between groups. Significant increases in medication use rates were observed from admission to discharge in both cohorts; however, greater increases were observed in the IC group in which the pharmacist role was clearly defined in recommending GDMT optimization, especially in patients with HF with reduced ejection fraction. Conclusion and Relevance: Although the implementation of an IC service did not significantly change 30-day readmission rates, increases in GDMT use are evident with increased pharmacist involvement. Longer-term outcomes associated with this intervention warrant future investigation.
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Affiliation(s)
| | | | | | - Genevieve Hale
- 2 Nova Southeastern University College of Pharmacy, Davie, FL, USA
| | - Nitin Patel
- 3 Veterans Health Administration, Office of Community Care, Denver, CO, USA
| | - Yen Chau
- 1 James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Brandon Cave
- 4 Methodist University Hospital, Memphis, TN, USA
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Li S, Marcus P, Núñez J, Núñez E, Sanchis J, Levy WC. Validity of the Seattle Heart Failure Model after heart failure hospitalization. ESC Heart Fail 2019; 6:509-515. [PMID: 30825268 PMCID: PMC6487734 DOI: 10.1002/ehf2.12427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/08/2019] [Indexed: 01/06/2023] Open
Abstract
AIMS Heart failure hospitalization is a sentinel event associated with increased mortality risk. Whether long-term heart failure risk models such as the Seattle Heart Failure Model (SHFM) accurately assess risk in the post-hospital setting is unknown. METHODS AND RESULTS The SHFM was applied to a cohort of 2242 consecutive patients (50% women; mean age 73) on discharge after acute heart failure hospitalization and analysed for the primary endpoint of all-cause mortality. Model discrimination and calibration were assessed. Direct patient-level comparison between our study cohort and the original SHFM cohorts was also performed to confirm and quantify the degree and extent of increased mortality risk attributable to post-hospital status. The SHFM demonstrated good overall risk discrimination (area under the receiver operating characteristic curve 0.704) and was well calibrated in patients <65 years old. The SHFM significantly underestimated mortality risk in patients ≥65 years old post-hospitalization. Direct patient-level comparison revealed a stepwise increase in adjusted mortality risk attributable to post-hospital status for each advancing age group ≥65 years old. This heightened mortality risk showed a diminishing trend over 18 months after discharge. CONCLUSIONS The SHFM accurately predicts mortality risk in younger patients after acute heart failure hospitalization. However, patients ≥65 years old had increased adjusted mortality risk for up to 18 months after discharge compared with ambulatory heart failure patients, a pattern consistent with the well-described post-hospital syndrome.
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Affiliation(s)
- Song Li
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Patrick Marcus
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Wayne C Levy
- Division of Cardiology, University of Washington, Seattle, WA, USA
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Dungen HD, Petroni R, Correale M, Coiro S, Monitillo F, Triggiani M, Leone M, Antohi EL, Ishihara S, Sarwar CMS, Sabbah HN, Memo M, Metra M, Butler J, Nodari S, Gheorghiade M. A new educational program in heart failure drug development: the Brescia international master program. J Cardiovasc Med (Hagerstown) 2019; 19:411-421. [PMID: 29952846 DOI: 10.2459/jcm.0000000000000669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
: Despite recent advances in chronic heart failure treatment, prognosis of acute heart failure patients remains poor with a heart failure rehospitalization rate or death reaching approximately 25% during the first 6 months after discharge. In addition, about half of these patients have preserved ejection fraction for which there are no evidence-based therapies. Disappointing results from heart failure clinical trials over the past 20 years emphasize the need for developing novel approaches and pathways for testing new heart failure drugs and devices. Indeed, many trials are being conducted without matching the mechanism and action of the drug with the clinical event. The implementation of these novel approaches should be coupled with the training of a new generation of heart failure physicians and scientists in the art and science of clinical trials. Currently, drug development is led by opinion leaders and experts who, despite their huge personal experience, were never trained systematically on drug development. The aim of this article is to propose a training program of 'drug development in Heart Failure'. A physician attending this course would have to be trained with a major emphasis on heart failure pathophysiology to better match mechanisms of death and rehospitalization with mechanism of action of the drug. Applicants will have to prove their qualifications and special interest in heart failure drug development before enrollment. This article should serve as a roadmap on how to apply emerging general principles in an innovative drug-development-in-heart-failure-process as well as the introduction of a new educational and mentorship program focusing on younger generations of researchers.
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Affiliation(s)
- Hans-Dirk Dungen
- Department of Internal Medicine-Cardiology, Charité Universitäts Medizin, Berlin, Germany
| | - Renata Petroni
- Department of Cardiology, University of L'Aquila, L'Aquila
| | - Michele Correale
- Cardiology Department, Azienda Ospedaliero-Universitaria, Foggia
| | - Stefano Coiro
- Cardiologia e Fisiopatologia Cardiovascolare, University of Perugia, Perugia
| | - Francesco Monitillo
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari
| | - Marco Triggiani
- Cardiology Section, Department of Clinical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marta Leone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari
| | - Elena-Laura Antohi
- ICCU and Cardiology 1st Department, Institute of Emergency for Cardiovascular Diseases 'C.C.Iliescu', Bucharest, Romania
| | - Shiro Ishihara
- Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaky, Japan
| | | | - Hani N Sabbah
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Maurizio Memo
- Section of Pharmacology, Department of Molecular and Translational Medicine
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Javed Butler
- Cardiology Division, Stony Brook University, New York, New York
| | - Savina Nodari
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Iyngkaran P, Liew D, Neil C, Driscoll A, Marwick TH, Hare DL. Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818809358. [PMID: 30618487 PMCID: PMC6299336 DOI: 10.1177/1179546818809358] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
Abstract
This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.
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Affiliation(s)
- Pupalan Iyngkaran
- Northern Territory Medical Program, Flinders University, Darwin, NT, Australia
- Pupalan Iyngkaran, Yellow Building 4 Cnr University Drive North & University Drive West Charles Darwin University, Casuarina, NT 0815, Australia.
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher Neil
- Department of Medicine—Western Precinct, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
| | | | - David L Hare
- Cardiovascular Research, The University of Melbourne, Melbourne, VIC, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC, Australia
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González-Costello J, Comín-Colet J, Lupón J, Enjuanes C, de Antonio M, Fuentes L, Moliner-Borja P, Farré N, Zamora E, Manito N, Pujol R, Bayés-Genis A. Importance of iron deficiency in patients with chronic heart failure as a predictor of mortality and hospitalizations: insights from an observational cohort study. BMC Cardiovasc Disord 2018; 18:206. [PMID: 30382817 PMCID: PMC6211465 DOI: 10.1186/s12872-018-0942-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
Background Iron deficiency (ID) in patients with chronic heart failure (CHF) is considered an adverse prognostic factor. We aimed to evaluate if ID in patients with CHF is associated with increased mortality and hospitalizations. Methods We evaluated ID in patients with CHF at 3 university hospitals. ID was defined as absolute (ferritin < 100 μg/L) or functional (transferrin Saturation index < 20% and ferritin between 100 and 299 μg/L). We excluded patients who received treatment with intravenous Iron or Erythropoietin during follow-up. We evaluated if ID was a predictor of death or hospitalization due to heart failure or any cause using univariate and multivariate cox regression analysis. Results We included 1684 patients, 65% males, 38% diabetics, median age of 72 years, 37% in functional class III-IV and 30% of patients with a left ventricular ejection fraction > 45%. Patients were well treated, with 87% and 88% of patients receiving renin-angiotensin inhibitors and beta-blockers, respectively. Median transferrin saturation index was 20%, median ferritin 155 ng/mL and median haemoglobin 13 g/dL. ID was present in 53% of patients; in 35% it was absolute and in 18% functional. Median follow-up was 20 months. ID was a predictor of death, hospitalization due to heart failure or to any cause in univariate analysis but not after multivariate analysis. No differences were found between absolute or functional ID regarding prognosis. Conclusion In a real life population of patients with CHF and a high prevalence of heart failure with preserved ejection fraction, ID did not predict mortality or hospitalizations after adjustment for comorbidities, functional class and neurohormonal treatment.
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Affiliation(s)
- José González-Costello
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain.
| | - Josep Comín-Colet
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Josep Lupón
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Cristina Enjuanes
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta de Antonio
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Lara Fuentes
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Pedro Moliner-Borja
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Farré
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisabet Zamora
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Nicolás Manito
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Ramón Pujol
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Bayés-Genis
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
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