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Peters AE, Solomon N, Chiswell K, Fonarow GC, Khouri MG, Baylor L, Alvir J, Bruno M, Huda A, Allen LA, Sharma K, DeVore AD, Greene SJ. Transthyretin amyloid cardiomyopathy among patients hospitalized for heart failure and performance of an adapted wild-type ATTR-CM machine learning model: Findings from GWTG-HF. Am Heart J 2023; 265:22-30. [PMID: 37400049 DOI: 10.1016/j.ahj.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND An 11-factor random forest model has been developed among ambulatory heart failure (HF) patients for identifying potential wild-type amyloidogenic TTR cardiomyopathy (wtATTR-CM). The model has not been evaluated in a large sample of patients hospitalized for HF. METHODS This study included Medicare beneficiaries aged ≥65 years hospitalized for HF in the Get With The Guidelines-HF® Registry from 2008-2019. Patients with and without a diagnosis of ATTR-CM were compared, as defined by inpatient and outpatient claims data within 6 months pre- or post-index hospitalization. Within a cohort matched 1:1 by age and sex, univariable logistic regression was used to evaluate relationships between ATTR-CM and each of the 11 factors of the established model. Discrimination and calibration of the 11-factor model were assessed. RESULTS Among 205,545 patients (median age 81 years) hospitalized for HF across 608 hospitals, 627 patients (0.31%) had a diagnosis code for ATTR-CM. Univariable analysis within the 1:1 matched cohort of each of the 11-factors in the ATTR-CM model found pericardial effusion, carpal tunnel syndrome, lumbar spinal stenosis, and elevated serum enzymes (e.g., troponin elevation) to be strongly associated with ATTR-CM. The 11-factor model showed modest discrimination (c-statistic 0.65) and good calibration within the matched cohort. CONCLUSIONS Among US patients hospitalized for HF, the number of patients with ATTR-CM defined by diagnosis codes on an inpatient/outpatient claim within 6 months of admission was low. Most factors within the prior 11-factor model were associated with greater odds of ATTR-CM diagnosis. In this population, the ATTR-CM model demonstrated modest discrimination.
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Affiliation(s)
- Anthony E Peters
- Division of Cardiology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | | | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles Medical Center, Los Angeles, CA
| | - Michel G Khouri
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | | | | | | | | | - Larry A Allen
- Division of Cardiology & Colorado Cardiovascular Outcomes Research Consortium, University of Colorado School of Medicine, Aurora, CO
| | - Kavita Sharma
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Adam D DeVore
- Division of Cardiology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC.
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Berthelot E, Broussier A, Hittinger L, Donadio C, Rovani X, Salengro E, Megbemado R, Godreuil C, Belmin J, David JP, Genet B, Damy T. Patients with cardiac amyloidosis are at a greater risk of mortality and hospital readmission after acute heart failure. ESC Heart Fail 2023; 10:2042-2050. [PMID: 37051755 DOI: 10.1002/ehf2.14337] [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: 08/22/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 04/14/2023] Open
Abstract
AIMS Cardiac amyloidosis (CA) is an under-diagnosed cause of heart failure (HF) and has a worse prognosis than other forms of HF. The frequency of death or rehospitalization following discharge for acute heart failure (AHF) in CA (relative to other causes) has not been documented. The study aims to compare hospital readmission and death rates 90 days after discharge for AHF in patients with vs. without CA and to identify risk factors associated with these events in each group. METHODS AND RESULTS Patients with HF and CA (HF + CA+) were recruited from the ICREX cohort, after screening of their medical records. The cases were matched 1:5 by sex and age with control HF patients without CA (HF + CA-). There were 27 HF + CA + and 135 HF + CA- patients from the ICREX cohort included in the study. Relative to the HF + CA- group, HF + CA+ patients had a higher heart rate (P = 0.002) and N-terminal prohormone of brain natriuretic peptide levels (P < 0.001) and lower blood pressure (P < 0.001), weight, and body mass index values (P < 0.001) on discharge. Ninety days after discharge, the HF + CA+ group displayed a higher death rate, a higher all-cause hospital readmission rate, and a higher hospital readmission rate for AHF. Death and hospital readmissions occurred sooner after discharge in the HF + CA+ group than in the HF + CA- group. CONCLUSIONS The presence of CA in patients with HF was associated with a three-fold greater risk of death and a two-fold greater risk of all-cause hospital readmission 90 days after discharge. These findings emphasize the importance of close, active management of patients with CA and AHF.
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Affiliation(s)
- Emmanuelle Berthelot
- Université Paris Sud, Paris, France
- Department of Cardiology, AP-HP, Hopital Bicêtre, 78, rue du général Leclerc, Le Kremlin Bicêtre, 94043, Paris, France
| | - Amaury Broussier
- Department of Geriatrics, AP-HP, Henri-Mondor/Emile-Roux Hospitals, Paris, France
- Univsité Paris Est Créteil, INSERM, IMRB, Paris, France
| | - Luc Hittinger
- Department of Cardiology, Heart Failure and Amyloidosis Unit, Referral Center For Cardiac Amyloidosis, Université Paris Est, AP-HP, Henri-Mondor/Albert-Chenevier Hospitals, Paris, France
| | - Cristiano Donadio
- Department of Geriatrics, AP-HP, Hôpital Charles Foix and Sorbonne Université, Paris, France
| | | | | | | | | | - Joel Belmin
- Department of Geriatrics, AP-HP, Hôpital Charles Foix and Sorbonne Université, Paris, France
| | - Jean Philippe David
- Department of Geriatrics, AP-HP, Henri-Mondor/Emile-Roux Hospitals, Paris, France
- Univsité Paris Est Créteil, INSERM, IMRB, Paris, France
| | | | - Thibaud Damy
- Department of Cardiology, Heart Failure and Amyloidosis Unit, Referral Center For Cardiac Amyloidosis, Université Paris Est, AP-HP, Henri-Mondor/Albert-Chenevier Hospitals, Paris, France
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Suero-Abreu GA, Lim P, Patel B, Thomas R. Cardiac AL amyloidosis presenting as recurrent dyspnoea in a patient with cancer: an important clinical clue to an early diagnosis. BMJ Case Rep 2022; 15:e245969. [PMID: 37209004 PMCID: PMC9442486 DOI: 10.1136/bcr-2021-245969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiac amyloidosis (CA) is challenging to diagnose due to its non-specific clinical manifestations early in the disease process. We report the case of a patient who presented with dyspnoea, abdominal distension and leg swelling. Medical history was notable for hypertension, recurrent vulvar squamous cell carcinoma and polysubstance abuse. Over 1 year before the official diagnosis of CA, the patient had multiple hospital readmissions for dyspnoea. Our case illustrates the importance of having a high index of clinical suspicion for an early diagnosis of CA. Furthermore, it highlights the need to re-evaluate a presumed diagnosis when a patient's symptoms recur or do not respond to appropriate treatment and to consider the influence of social factors on diagnostic processes.
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Affiliation(s)
- Giselle Alexandra Suero-Abreu
- Medicine, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
- Cardiovascular Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Phillip Lim
- Medicine, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
| | - Brijesh Patel
- Cardiovascular Medicine, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
| | - Renjit Thomas
- Cardiovascular Medicine, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
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