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Nonaka Y, Oike T, Tanaka S, Tabira K. Characteristics of Older Patients with Heart Failure Readmitted due to Acute Exacerbations within the Past Year. Phys Ther Res 2022; 26:17-23. [PMID: 37181482 PMCID: PMC10169309 DOI: 10.1298/ptr.e10187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/03/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We aimed to examine the relationship between physical performance and readmission among older patients with heart failure (HF) over the past year. METHODS This retrospective cohort study included 325 patients with HF who were aged ≥65 years and were hospitalized for acute exacerbation between November 2017 and December 2021. We investigated age, sex, body mass index, length of hospital stay, initiation of rehabilitation, New York Heart Association (NYHA) class, Charlson comorbidity index (CCI) score, medications, cardiac/renal function, nutrition, maximal quadriceps isometric strength, grip strength, and Short Physical Performance Battery (SPPB) score. Data were analyzed using the χ2 test, Mann-Whitney U test, and logistic regression analysis. RESULTS Altogether, 108 patients met the inclusion criteria and were divided into the non-readmission (n = 76) and readmission (n = 32) groups. The readmission group exhibited longer hospital stay, more severe NYHA class, higher CCI score, higher brain natriuretic peptide (BNP) levels, lower muscle strength, and lower SPPB score compared to the non-readmission group. In the logistic regression model, BNP level and SPPB score were independent factors associated with readmission. CONCLUSION BNP level and SPPB score were associated with readmission in patients with HF within the past year.
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Affiliation(s)
- Yuki Nonaka
- Graduate School of Health Science, Kio University, Japan
- Musashigaoka Clinical Research Center, Musashigaoka Hospital, Medical Corporation Tanakakai, Japan
- Department of Rehabilitation, Musashigaoka Hospital, Medical Corporation Tanakakai, Japan
| | - Takayuki Oike
- Department of Rehabilitation, Kyushu University of Nursing and Social Welfare, Japan
| | - Shinichiro Tanaka
- Musashigaoka Clinical Research Center, Musashigaoka Hospital, Medical Corporation Tanakakai, Japan
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Brain natriuretic peptide levels and short physical performance battery scores independently influence short-term readmission rates in older patients with heart failure. Heart Vessels 2022; 38:653-661. [PMID: 36484815 DOI: 10.1007/s00380-022-02216-7] [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: 10/24/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
The Short Physical Performance Battery (SPPB) is a well-established tool to assess the lower extremity physical performance status. The purpose of this study is to examine the impact of brain natriuretic peptide (BNP) levels and SPPB scores on short-term readmission in older patients with heart failure (HF). This prospective cohort study enrolled 325 patients with HF who were hospitalized for acute decompensated HF between November 2017 and December 2021. Variables were analyzed using the Cox proportional hazards model, receiver operating characteristic (ROC) curve, and Kaplan-Meier analysis. The 107 patients who met the inclusion criteria were divided into readmission (within 90 days of discharge; n = 25) and non-readmission (n = 82) groups. Multivariate analysis revealed that BNP level and SPPB score were independent risk factors for readmission within 90 days after discharge. Patients were classified into three groups according to the BNP and SPPB cutoff values calculated using ROC curves. The risk of readmission was significantly higher in Group 3 (BNP ≥ 384 pg/mL and SPPB ≤ 7 points) than in Group 1 (BNP < 384 pg/mL and SPPB > 7 points; hazard ratio: 27.68, 95% confidence interval: 3.672 - 208.700, P = 0.0012). Our study showed that HF patients with high BNP levels and low SPPB scores have a dramatically increased risk of readmission within 90 days of discharge.
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Shinoda R, Shinoda Y, Mori T, Yoshimura T. [Retrospective Observational Study on Predictors of Body Weight and BNP Teduction in Cases of Tolvaptan Induction for Heart Failure]. YAKUGAKU ZASSHI 2021; 141:281-288. [PMID: 33518649 DOI: 10.1248/yakushi.20-00221] [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: 11/22/2022]
Abstract
Tolvaptan (TLV) carries the risk of serious side effects, and its introduction requires hospitalization. Therefore, it is important from the viewpoints of safety and medical economics to predict in advance, the patients for whom it will be effective and introduce it. The purpose of this study was to investigate the noninvasive and simple predictors for identifying TLV responders. We conducted a retrospective observational study of patients with heart failure who had TLV introduced at our hospital from January 1, 2017, to December 31, 2018. By using the body weight and BNP reduction as the effect indices, predictors of body weight and BNP reduction were extracted by logistic analysis. The sensitivity and specificity at the cutoff value obtained by ROC analysis were also examined. Among 85 subjects, urine sodium concentration >63 mEq/L [odds ratio (OR): 6.11, 95% confidence interval (CI): 1.36-27.4] was detected as a predictor of body weight reduction. The sensitivity at this cutoff value was 81%, and the specificity was 70%. Serum osmolarity>291 mOsm/L (OR: 3.76, 95% CI: 1.00-14.2), urine potassium concentration<21 mEq/L (OR: 4.45, 95% CI: 1.09-18.2), and urine sodium concentration>71 mEq/L (OR: 7.38, 95% CI: 2.05-26.6) were detected as predictors of BNP reduction. The sensitivities were 62%, 53%, and 73%, and the specificities were 58%, 68%, and 68%, respectively. Therefore, it was suggested that urine sodium concentration may be useful as a predictor of body weight and BNP decrease after TLV induction.
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Affiliation(s)
- Rie Shinoda
- Department of Pharmacy, Ogaki Municipal Hospital
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Trojahn MM, Barilli SLS, Bernardes DDS, Pedraza LL, Aliti GB, Rabelo-Silva ER. B-type natriuretic peptide levels and diagnostic accuracy: excess fluid volume. Rev Gaucha Enferm 2020; 41:e20190095. [DOI: 10.1590/1983-1447.2020.20190095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/06/2019] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Aim: To analyze the behavior of B-type natriuretic peptide (BNP) in the presence of defining characteristics (DCs) of the nursing diagnosis Excess fluid volume (00026) in patients hospitalized for acute decompensated heart failure. Methods: Cohort study of patients admitted with acute decompensated heart failure (September 2015 to September 2016) defined by Boston Criteria. Patients hospitalized for up to 36 h with BNP values ≥ 100 pg/ml were included; BNP values at baseline-final assessment were compared by Wilcoxon test, the number of DCs at baseline-final assessment was compared by paired t-test. Results: Sixty-four patients were included; there was a significant positive correlation between delta of BNP and the number of DCs present at initial clinical assessment. Conclusions: The behavior of BNP was correlated to the DCs indicating congestion. With clinical compensation, DCs and BNP decreased. The use of this biomarker may provide additional precision to the nursing assessment.
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Okuhara Y, Asakura M, Orihara Y, Morisawa D, Matsumoto Y, Naito Y, Tsujino T, Ishihara M, Masuyama T. Reduction in Left Ventricular Ejection Fraction is Associated with Subsequent Cardiac Events in Outpatients with Chronic Heart Failure. Sci Rep 2019; 9:17271. [PMID: 31754155 PMCID: PMC6872762 DOI: 10.1038/s41598-019-53697-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/05/2019] [Indexed: 12/28/2022] Open
Abstract
Left ventricular ejection fraction (LVEF) is critical for determining the prognosis and treatment of patients with heart failure (HF). However, the influence of serial LVEF changes in patients with stable chronic HF (CHF) has not yet been completely investigated. We analyzed data of 263 outpatients with CHF from the J-MELODIC study cohort and evaluated the frequency of cardiac events. We stratified patients into tertiles based on the relative difference in LVEF in 1 year and that at baseline. We found a significant difference in the cardiac event rate among the three groups (log-rank test, p = 0.042). We identified a relative 11% LVEF reduction as the optimal cutoff value based on the receiver operating characteristics analysis. LVEF (OR, 1.04; 95% CI, 1.01–1.07; p = 0.015) and E/e′ (OR, 1.06; 95% CI, 1.01–1.12; p = 0.023) at baseline were predictors of >11% LVEF reduction. After adjusting the variables including age and sex, >11% LVEF reduction was an independent predictor of subsequent cardiac events (HR, 5.79; 95% CI, 2.49–13.2; p < 0.001). In conclusion, patients with 1-year relative >11% LVEF reduction may have subsequent worsening outcomes. Such patients should be carefully followed-up as high risk population for development of cardiac events.
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Affiliation(s)
- Yoshitaka Okuhara
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
| | - Masanori Asakura
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshiyuki Orihara
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Daisuke Morisawa
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yuki Matsumoto
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshiro Naito
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Tsujino
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan
| | - Masaharu Ishihara
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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Elucidation of the Strongest Predictors of Cardiovascular Events in Patients with Heart Failure. EBioMedicine 2018; 33:185-195. [PMID: 29936136 PMCID: PMC6085496 DOI: 10.1016/j.ebiom.2018.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In previous retrospective studies, we identified the 50 most influential clinical predictors of cardiovascular outcomes in patients with heart failure (HF). The present study aimed to use the novel limitless-arity multiple-testing procedure to filter these 50 clinical factors and thus yield combinations of no more than four factors that could potentially predict the onset of cardiovascular events. A Kaplan-Meier analysis was used to investigate the importance of the combinations. METHODS In a multi-centre observational trial, we prospectively enrolled 213 patients with HF who were hospitalized because of exacerbation, discharged according to HF treatment guidelines and observed to monitor cardiovascular events. After the observation period, we stratified patients according to whether they experienced cardiovascular events (rehospitalisation or cardiovascular death). FINDINGS Among 77,562 combinations of fewer than five clinical parameters, we identified 151 combinations that could potentially explain the occurrence of cardiovascular events. Of these, 145 combinations included the use of inotropic agents, whereas the remaining 6 included the use of diuretics without bradycardia or tachycardia, suggesting that the high probability of cardiovascular events is exclusively determined by these two clinical factors. Importantly, Kaplan-Meier curves demonstrated that the use of inotropes or of diuretics without bradycardia or tachycardia were independent predictors of a markedly worse cardiovascular prognosis. INTERPRETATION Patients treated with either inotropic agents or diuretics without bradycardia or tachycardia were at a higher risk of cardiovascular events. The uses of these drugs, regardless of heart rate, are the strongest clinical predictors of cardiovascular events in patients with HF.
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Sako H, Miyazaki M, Suematsu Y, Koyoshi R, Shiga Y, Kuwano T, Kitajima K, Iwata A, Yorinaga K, Fujimi K, Miura SI. A Case of Multifaceted Assessment in an Elderly Patient With Acute Decompensated Heart Failure. Cardiol Res 2017; 8:339-343. [PMID: 29317979 PMCID: PMC5755668 DOI: 10.14740/cr640w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/12/2017] [Indexed: 01/19/2023] Open
Abstract
Heart failure (HF) is a common health problem worldwide, including in Japan. Unfortunately, patient outcomes remain poor, with a 5-year survival rate of approximately 50%. Therefore, we need to assess the precise conditions, including cardiac function, in patients with HF, particularly in the elderly. We performed a multifaceted assessment in an elderly patient with HF on admission and at discharge using eight different evaluations (the mean life expectancy using the Seattle Heart Failure Model (SHFM), the severity of dementia, nutrition, medication adherence, biomarker (the level of brain natriuretic peptide in blood), sociality, performance and comorbidity). Each parameter was scored on a 5-point scale (excellent = 5 points; good = 4 points; fair (average) = 3 points; poor = 2 points; failure = 1 point; maximum total points of 40) (Fukuoka University Heart Failure Scoring System, FUFS). An 86-year-old male patient who complained of dyspnea and lower-leg edema was admitted to our university hospital due to acute decompensated HF. After treatment, his symptoms improved, as did his cardiothoracic ratio, plural effusion and pulmonary congestion, and he exhibited compensated HF. His total score improved from 28 to 32 points, and his mean life expectancy using SHFM increased from 4.9 to 5.4 years. We evaluated the precise conditions using a multifaceted assessment strategy in an elderly patient with HF. The strategy was useful for evaluate the patient's condition in this case.
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Affiliation(s)
- Hideto Sako
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Midori Miyazaki
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Rie Koyoshi
- Division of Medical Safety Management, Fukuoka University Hospital, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Katsura Yorinaga
- Division of Nursing, Fukuoka University Hospital, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Division of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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Shiba A, Kurata H, Sasaki H, Naoe M, Kunitomo K, Yamakami A. N-terminal Pro-brain Natriuretic Peptide Level as a Prognostic Predictor in Elderly Patients in a Convalescent Rehabilitation Ward. Prog Rehabil Med 2017; 2:20170018. [PMID: 32789225 PMCID: PMC7365169 DOI: 10.2490/prm.20170018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/17/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Atsushi Shiba
- Department of Rehabilitation Medicine, Naruto-Yamakami Hospital, Naruto, Tokushima, Japan
| | - Hiromitsu Kurata
- Department of Rehabilitation Medicine, Nakazu-Yagi Hospital, Tokushima, Tokushima, Japan
| | - Hirokazu Sasaki
- Department of Rehabilitation Medicine, Naruto-Yamakami Hospital, Naruto, Tokushima, Japan
| | - Mitsugu Naoe
- Department of Rehabilitation Medicine, Naruto-Yamakami Hospital, Naruto, Tokushima, Japan
| | - Kazufumi Kunitomo
- Department of Rehabilitation Medicine, Naruto-Yamakami Hospital, Naruto, Tokushima, Japan
| | - Atsuko Yamakami
- Department of Rehabilitation Medicine, Naruto-Yamakami Hospital, Naruto, Tokushima, Japan
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