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Zheng D, Liu Y, Li Y, Jin J, He Q, Shen X. Lung Ultrasound and Bioelectrical Impedance Analysis for Fluid Status Assessing Patients Undergoing Maintenance Hemodialysis. Int J Clin Pract 2024; 2024:1232211. [PMID: 38229934 PMCID: PMC10791474 DOI: 10.1155/2024/1232211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 01/18/2024] Open
Abstract
Background Volume overload is a fatal complication for people undergoing hemodialysis. Therefore, regulating a patient's "dry weight" based on their fluid status is imperative. Clinical experiences are too subjective to accurately judge a patient's fluid status, but techniques have emerged for improved fluid control in the two decades. Specifically, lung ultrasonography (LUS) uses a unique aspect of ultrasound images, the B-lines, to evaluate extravascular lung water, which has increasingly attracted attention. However, the role of B-line quantification in predicting short-mid-term death and/or cardiovascular complications is unclear. Methods Patients undergoing MHD at the hemodialysis center of Zhejiang Provincial People's Hospital from October 1, 2020, to February 28, 2021, were examined using LUS and a bioelectrical impedance analysis before and after dialysis, and related clinical data were collected. All patients were followed up for one year after the examination, and deaths and first cardiovascular events (e.g., stroke, myocardial infarction, and heart failure) during this period were recorded. Results 98 patients were enrolled and divided into three groups in relation to their mild (<16 B-lines), moderate (16-30 B-lines), or severe (>30 B-lines) hypervolemia, defined by the number of B-lines. The long-term survival rate was significantly lower in the severe group than in the mild and moderate groups. LUS and bioelectrical impedance-related parameters (e.g., extracellular water-to-water ratio) were closely related to cardiac ultrasound parameters (left ventricular ejection fraction) (P < 0.001). The optimal B-line cutoff value on LUS for predicting fluid overload (defined clinically) in patients on hemodialysis was 11.5 lines (AUC = 0.840, 95% confidence interval 0.735-0.945, P < 0.001), and the diagnostic sensitivity and specificity were both 76.5%. During the one-year follow-up period, ten deaths and six cardiovascular events occurred. The survival rate was significantly lower in the severe group than in the mild group (log-rank test χ2 = 10.050, P=0.002) but did not differ between the severe and moderate groups (χ2 = 2.629, P=0.105). Conclusion LUS is a cheap, noninvasive, simple, and repeatable volume-monitoring method that can assist with individualized fluid volume management in patients undergoing MHD. LUS results may also help to predict the short-mid-term survival rate of patients to a certain extent.
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Affiliation(s)
- Danna Zheng
- Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yueming Liu
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yuting Li
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Juan Jin
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qiang He
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiaogang Shen
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Crespo-Aznarez S, Campos-Sáenz de Santamaría A, Sánchez-Marteles M, Garcés-Horna V, Josa-Laorden C, Giménez-López I, Pérez-Calvo JI, Rubio-Gracia J. The Association Between Intra-abdominal Pressure and Diuretic Response in Heart Failure. Curr Heart Fail Rep 2023; 20:390-400. [PMID: 37515668 DOI: 10.1007/s11897-023-00617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE OF THE REVIEW An efficient diuretic response is vital during cardiac decompensation in heart failure (HF) patients. The increase in intra-abdominal pressure (IAP) could be one of the keys for understanding cardiorenal syndrome and guiding diuretic treatment during hospitalization. In this review, we analyze the relationship between IAP and diuretic response in HF patients. RECENT FINDINGS Increased IAP is associated with worsening renal function (WRF) in patients with advanced HF. Furthermore, the persistence of a rise in IAP after the first 72 h of intravenous diuretic treatment has been correlated with a worse diuretic response, a higher degree of congestion, and an impaired prognosis. The rise in IAP in HF patients has been associated with impaired renal function and a lower diuretic response. Nonetheless, more studies are needed to elucidate the actual role of IAP in congestive nephropathy and whether it may help guide diuretic therapy during acute decompensations.
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Affiliation(s)
- S Crespo-Aznarez
- Internal Medicine Department, Hospital Clínico Universitario "Lozano Blesa", Avda. San Juan Bosco N° 15, 50009, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - A Campos-Sáenz de Santamaría
- Internal Medicine Department, Hospital Clínico Universitario "Lozano Blesa", Avda. San Juan Bosco N° 15, 50009, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - M Sánchez-Marteles
- Internal Medicine Department, Hospital Clínico Universitario "Lozano Blesa", Avda. San Juan Bosco N° 15, 50009, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - V Garcés-Horna
- Internal Medicine Department, Hospital Clínico Universitario "Lozano Blesa", Avda. San Juan Bosco N° 15, 50009, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - C Josa-Laorden
- Internal Medicine Department, Hospital Clínico Universitario "Lozano Blesa", Avda. San Juan Bosco N° 15, 50009, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - I Giménez-López
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
- Aragonese Institute of Health Sciences, Zaragoza, Spain
| | - J I Pérez-Calvo
- Internal Medicine Department, Hospital Clínico Universitario "Lozano Blesa", Avda. San Juan Bosco N° 15, 50009, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
| | - J Rubio-Gracia
- Internal Medicine Department, Hospital Clínico Universitario "Lozano Blesa", Avda. San Juan Bosco N° 15, 50009, Zaragoza, Spain.
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain.
- University of Zaragoza, Zaragoza, Spain.
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Banjade P, Subedi A, Ghamande S, Surani S, Sharma M. Systemic Venous Congestion Reviewed. Cureus 2023; 15:e43716. [PMID: 37724234 PMCID: PMC10505504 DOI: 10.7759/cureus.43716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Accurate determination of intravascular volume status is challenging in acutely ill patients. Favorable patient outcome is vital to correctly identify intravascular volume depletion and avoid systemic venous congestion. Most of the conventional means of hemodynamic monitoring in the acute healthcare setting are geared toward addressing the cardiac output and maintaining an optimum mean arterial pressure. While assessing and maintaining cardiac output in an acutely ill patient is very important, a venous congestion cascade is often overlooked, which can negatively affect the intraabdominal end organs. The prospect of using point-of-care ultrasound (POCUS) to determine systemic venous congestion could be a potentially handy tool for clinicians. Venous excess ultrasound score (VExUS) has also been utilized by clinicians as a semi-quantitative assessment tool to assess fluid status. This review aims to discuss the potential role of POCUS and VExUS scores in determining systemic venous congestion through a narrative review of recently published literature.
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Affiliation(s)
- Prakash Banjade
- Department of General Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | - Ashish Subedi
- Department of Internal Medicine, Gandaki Medical College, Kathmandu, NPL
| | - Shekhar Ghamande
- Department of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White Medical Center, Temple, USA
| | - Salim Surani
- Department of Anesthesiology, Mayo Clinic, Rochester, USA
- Department of Medicine, Texas Agricultural and Mechanical (A&M) University, College Station, USA
- Department of Medicine, University of North Texas, Dallas, USA
- Department of Internal Medicine, Pulmonary Associates, Corpus Christi, USA
- Department of Clinical Medicine, University of Houston, Houston, USA
| | - Munish Sharma
- Department of Pulmonary and Critical Care Medicine, Baylor Scott and White Medical Center, Temple, USA
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Shahnazaryan S, Pepoyan S, Sisakian H. Heart Failure with Reduced Ejection Fraction: The Role of Cardiovascular and Lung Ultrasound beyond Ejection Fraction. Diagnostics (Basel) 2023; 13:2553. [PMID: 37568916 PMCID: PMC10416843 DOI: 10.3390/diagnostics13152553] [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: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) is considered a major health care problem with frequent decompensations, high hospitalization and mortality rates. In severe heart failure (HF), the symptoms are refractory to medical treatment and require advanced therapeutic strategies. Early recognition of HF sub- and decompensation is the cornerstone of the timely treatment intensification and, therefore, improvement in the prognosis. Echocardiography is the gold standard for the assessment of systolic and diastolic functions. It allows one to obtain accurate and non-invasive measurements of the ventricular function in HF. In severely compromised HF patients, advanced cardiovascular ultrasound modalities may provide a better assessment of intracardiac hemodynamic changes and subclinical congestion. Particularly, cardiovascular and lung ultrasound allow us to make a more accurate diagnosis of subclinical congestion in HFrEF. The aim of this review was to summarize the advantages and limitations of the currently available ultrasound modalities in the ambulatory monitoring of patients with HFrEF.
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Affiliation(s)
| | | | - Hamayak Sisakian
- Clinic of General and Invasive Cardiology, “Heratsi” Hospital Complex #1, Yerevan State Medical University, 2 Koryun Street, Yerevan 375025, Armenia; (S.S.); (S.P.)
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Gil-Martínez P, Curbelo J, Roy-Vallejo E, Mesado-Martínez D, Ciudad-Sañudo M, Suárez-Fernández C. Assessment of clinical and hemodynamic congestion as predictors of mortality in elderly outpatients with heart failure. Rev Clin Esp 2022; 222:377-384. [PMID: 35537991 DOI: 10.1016/j.rceng.2021.12.005] [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] [Received: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This work aims to evaluate whether a clinical examination and measurement of N-terminal pro-brain natriuretic peptide can predict poor prognosis in outpatients with heart failure. PATIENTS AND METHODS We carried out a retrospective study from 2010 to 2018 in 238 patients diagnosed with heart failure. At baseline, we evaluated the presence of pulmonary rales and bilateral leg edema (clinical congestion) together with N-terminal pro-brain natriuretic peptide ≥ 1500 pg/mL (hemodynamic congestion). Patients were classified into 4 groups depending on their congestion pattern: no congestion (G1) (n = 50); clinical congestion (G2) (n = 43); hemodynamic congestion (G3) (n = 73); and clinical and hemodynamic congestion (G4) (n = 72). The primary outcome was all-cause mortality at one year of follow-up. RESULTS A total of 238 patients were included. The mean age was 82 years, 61.8% were women, and 20.7% had reduced left ventricular ejection fraction. Thirty patients died in the first year of follow-up (12.6%). After controlling for confounding variables (sex, recent discharge for heart failure, estimated glomerular filtration rate, and left ventricular ejection fraction), the independent risk of death in each group compared to G1 as the reference group was: G2: HR 4.121 (95%CI 1.131-15.019); G3: HR 2.511 (95%CI 1.007-6.263); and G4: HR 7.418 (95%CI 1.630-33.763). CONCLUSION Congestion in outpatients with heart failure correlates with prognosis. Patients with both clinical and hemodynamic congestion had the highest risk of all-cause death at one year.
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Affiliation(s)
- P Gil-Martínez
- Servicio de Medicina Interna, Hospital Universitario de la Princesa. Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain; Grupo de trabajo de Insuficiencia Cardíaca de la Sociedad Española de Medicina Interna, Madrid, Spain.
| | - J Curbelo
- Servicio de Medicina Interna, Hospital Universitario de la Princesa. Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain; Grupo de trabajo de Insuficiencia Cardíaca de la Sociedad Española de Medicina Interna, Madrid, Spain
| | - E Roy-Vallejo
- Servicio de Medicina Interna, Hospital Universitario de la Princesa. Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain; Grupo de trabajo de Insuficiencia Cardíaca de la Sociedad Española de Medicina Interna, Madrid, Spain
| | - D Mesado-Martínez
- Grupo de trabajo de Insuficiencia Cardíaca de la Sociedad Española de Medicina Interna, Madrid, Spain; Servicio de Medicina Interna, Hospital Universitario General de Villalba, Villalba, Madrid, Spain
| | - M Ciudad-Sañudo
- Servicio de Medicina Interna, Hospital Universitario de la Princesa. Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain
| | - C Suárez-Fernández
- Servicio de Medicina Interna, Hospital Universitario de la Princesa. Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain
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Evaluación del grado de congestión clínica y hemodinámica como predictores de mortalidad en pacientes ambulatorios con insuficiencia cardíaca de edad avanzada. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Heart disease is the leading cause of death in the United States with an estimated 6 million adults living with heart failure. In patients with heart failure, the physical examination can provide important prognostic information and is also used to guide both diagnosis and management, including determining the need for inpatient versus outpatient management. Presenting symptoms include dyspnea, peripheral edema, orthopnea, paroxysmal nocturnal dyspnea, and bendopnea. In patients with suspected heart failure, a "head-to-toe" physical examination approach is recommended with the addition of special maneuvers such as the measurement of jugular venous pressure, valsalva maneuver, and hepatojugular reflux as needed.
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Affiliation(s)
- Jennifer Chen
- Department of Internal Medicine, University of California, Davis, 4860 Y Street Suite 0100, Sacramento, CA 95817, USA.
| | - Paul Aronowitz
- Department of Internal Medicine, University of California, Davis, 4150 V Street Suite 3100 PSSB, Sacramento, CA 95817, USA
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8
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Reduction of Hospitalization and Mortality by Echocardiography-Guided Treatment in Advanced Heart Failure. J Cardiovasc Dev Dis 2022; 9:jcdd9030074. [PMID: 35323622 PMCID: PMC8953534 DOI: 10.3390/jcdd9030074] [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: 01/18/2022] [Revised: 02/19/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
In advanced heart failure (AHF) clinical evaluation fails to detect subclinical HF deterioration in outpatient settings. The aim of the study was to determine whether the strategy of intensive outpatient echocardiographic monitoring, followed by treatment modification, reduces mortality and re-hospitalizations at 12 months. Methods: 214 patients with ejection fraction < 30% and >1 hospitalization during the last year underwent clinical evaluation and echocardiography at discharge and were divided into intensive (IMG; N = 143) or standard monitoring group (SMG; N = 71). In IMG, volemic status and left ventricular filling pressure were assessed 14, 30, 90, 180 and 365 days after discharge. HF treatment, particularly diuretic therapy, was temporarily intensified when HF deterioration signs and E/e’ > 15 were detected. In SMG, standard outpatient monitoring without obligatory echocardiography at outpatient visits was performed. Results: We observed lower hospitalization (absolute risk reduction [ARR]-0.343, CI-95%: 0.287−0.434, p < 0.05; number needed to treat [NNT]-2.91) and mortality (ARR-0.159, CI 95%: 0.127−0.224, p < 0.05; NNT-6.29) in IMG at 12 months. One-year survival was 88.8% in IMG and 71.8% in SMG (p < 0.05). Conclusion: In AHF, outpatient monitoring of volemic status and intracardiac filling pressures to individualize treatment may potentially reduce hospitalizations and mortality at 12 months follow-up. Echocardiography-guided outpatient therapy is feasible and clinically beneficial, providing evidence for the larger application of this approach.
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9
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Rubio-Gracia J, Josa-Laorden C, Sánchez-Marteles M, Giménez-López I, Garcés Horna V, Morales Rull JL, Pérez-Calvo JI. Prognostic value of malnutrition in patients with acute heart failure and its influence on the interpretation of markers of systemic venous congestion. Med Clin (Barc) 2021; 157:371-379. [PMID: 33309049 DOI: 10.1016/j.medcli.2020.06.066] [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: 04/28/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Malnutrition is frequent in patients with heart failure (HF) and contributes to increased systemic congestion, but also hinders its correct assessment, especially during decompensations. Estimating the degree of malnutrition and its relationship with systemic congestion is important to optimize treatment during decompensations. MATERIAL AND METHODS Retrospective cohort study in patients with acute HF. The population was stratified according to CONUT (Controlling Nutritional Status) and PNI (Prognostic Nutritional Index) nutrition indices in order to analyse their relationship with objective parameters of congestion and the prognostic value of malnutrition. RESULTS 309 patients were included. More than half presented some degree of malnutrition upon admission. The degree of congestion was significantly higher in malnourished patients, with a higher proportion of «comet tail artifacts» and a higher relative plasma volume. NT-proBNP concentrations, both on admission and at discharge, were also significantly higher in malnourished patients, regardless of the scale used. The univariate analysis identified the CONUT and PNI index as factors associated with one-year mortality from any cause (HR 1.62 [1.22-2.14]; p = 0.001) and PNI (HR 65 [0.53-0.80]; p = < 0.001), respectively. CONCLUSIONS A higher degree of malnutrition (determined by means of the CONUT and PNI indices) in patients with acute HF was associated with a higher presence of objective parameters of congestion and a higher one-year all-cause mortality.
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Affiliation(s)
- Jorge Rubio-Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, España.
| | - Claudia Josa-Laorden
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, España
| | - Marta Sánchez-Marteles
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, España
| | - Ignacio Giménez-López
- Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, España; Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España; Instituto Aragonés de Ciencias de la Salud, Zaragoza, España
| | - Vanesa Garcés Horna
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, España
| | | | - Juan Ignacio Pérez-Calvo
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, España; Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
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Damy T, Chouihed T, Delarche N, Berrut G, Cacoub P, Henry P, Lamblin N, Andrès E, Hanon O. Diagnosis and Management of Heart Failure in Elderly Patients from Hospital Admission to Discharge: Position Paper. J Clin Med 2021; 10:jcm10163519. [PMID: 34441815 PMCID: PMC8396904 DOI: 10.3390/jcm10163519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/07/2023] Open
Abstract
Multidisciplinary management of worsening heart failure (HF) in the elderly improves survival. To ensure patients have access to adequate care, the current HF and French health authority guidelines advise establishing a clearly defined HF patient pathway. This pathway involves coordinating multiple disciplines to manage decompensating HF. Yet, recent registry data indicate that insufficient numbers of patients receive specialised cardiology care, which increases the risk of rehospitalisation and mortality. The patient pathway in France involves three key stages: presentation with decompensated HF, stabilisation within a hospital setting and transitional care back out into the community. In each of these three phases, HF diagnosis, severity and precipitating factors need to be promptly identified and managed. This is particularly pertinent in older, frail patients who may present with atypical symptoms or coexisting comorbidities and for whom geriatric evaluation may be needed or specific geriatric syndrome management implemented. In the transition phase, multi-professional post-discharge management must be coordinated with community health care professionals. When the patient is discharged, HF medication must be optimised, and patients educated about self-care and monitoring symptoms. This review provides practical guidance to clinicians managing worsening HF in the elderly.
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Affiliation(s)
- Thibaud Damy
- Service de Cardiologie, CHU H. Mondor, 94000 Créteil, France
- Correspondence:
| | - Tahar Chouihed
- Service des SAMU-SMUR-Urgences, Centre d’Investigations Cliniques-1433, INSERM UMR_S 1116, Université de Lorraine, CHRU Nancy, F-CRIN INI-CRCT, 541000 Nancy, France;
| | | | - Gilles Berrut
- CHU Nantes, Pôle Hospitalo-Universitiare de Gérontologie Clinique, 44000 Nantes, France;
| | - Patrice Cacoub
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, AP-HP, 75000 Paris, France;
| | - Patrick Henry
- Service de Cardiologie, APHP, Hôpital Lariboisière, 75000 Paris, France;
| | - Nicholas Lamblin
- Service de Cardiologie, Institut Pasteur de Lille, CHU de Lille, Université de Lille, U1167, 59000 Lille, France;
| | - Emmanuel Andrès
- Service Méd. Interne, Diabète, Maladies Métaboliques, Clinique Médicale B, CHU Strasbourg, 67000 Strasbourg, France;
| | - Olivier Hanon
- Service de Gériatrie, APHP, Hôpital Broca, Université de Paris, 54 Rue Pascal, 75013 Paris, France;
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Cheng CW, Liu MH, Wang CH. Predictors of infection-related rehospitalization in heart failure patients and its impact on long-term survival. J Cardiovasc Med (Hagerstown) 2021; 21:889-896. [PMID: 32576750 PMCID: PMC7752229 DOI: 10.2459/jcm.0000000000001025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infection is the most common non-cardiovascular cause of re-hospitalizations for heart failure patients. We therefore investigated the predictors of infection-related re-hospitalization (IRRH) in heart failure patients and its impact on long-term survival. METHODS AND RESULTS We prospectively recruited 622 patients after the index hospitalization for decompensated heart fail with primary endpoints of IRRH and all-cause mortality. During follow-up of 3.9 ± 2.7 years, IRRHs occurred in 104 (16.7%) patients. Of the 104 patients who experienced IRRHs, the time from the index hospitalization to IRRH was 1.0 (interquartile range: 0.4-2.6) years. Independent predictors of IRRH were age (hazard ratio: 1.02, 95% confidence interval: 1.01-1.04), diabetes mellitus (2.12, 1.42-3.17), not taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (1.67, 1.01-2.78), needing maintenance therapy with a loop diuretic (2.10, 1.36-3.26), hemoglobin levels (0.87, 0.79-0.96), and estimated glomerular filtration rates (eGFRs) (0.99, 0.98-0.99). IRRH independently predicted all-cause mortality (1.99, 1.32-2.98) after adjusting for age, body mass index, New York Heart Association functional class, chronic obstructive pulmonary disease, brain natriuretic peptide, hemoglobin, and eGFR. The increased risk of death associated with IRRHs was predominantly for lower respiratory tract infections (3.71, 2.28-6.04), urogenital tract infections (2.83, 1.32-6.10), and sepsis (3.26, 1.20-8.85). CONCLUSION IRRHs in patients discharged for acute decompensated heart fail independently predicted worse long-term survival. We further identified independent predictors of IRRHs. These findings warrant future studies for tackling IRRH.
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Affiliation(s)
- Chi-Wen Cheng
- Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung City.,Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C
| | - Min-Hui Liu
- Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung City
| | - Chao-Hung Wang
- Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung City.,Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C
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12
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Elhassan MG, Chao PW, Curiel A. The Conundrum of Volume Status Assessment: Revisiting Current and Future Tools Available for Physicians at the Bedside. Cureus 2021; 13:e15253. [PMID: 34188992 PMCID: PMC8231469 DOI: 10.7759/cureus.15253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Assessment of patients’ volume status at the bedside is a very important clinical skill that physicians need in many clinical scenarios. Hypovolemia with hypotension and tissue under-perfusion are usually more alarming to physicians, but hypervolemia is also associated with poor outcomes, making euvolemia a crucial goal in clinical practice. Nevertheless, the assessment of volume status can be challenging, especially in the absence of a gold standard test that is reliable and easily accessible to assist with clinical decision-making. Physicians need to have a broad knowledge of the individual non-invasive clinical tools available for them at the bedside to evaluate volume status. In this review, we will discuss the strengths and limitations of the traditional tools, which include careful history taking, physical examination, and basic laboratory tests, and also include the relatively new tool of point-of-care ultrasound.
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Affiliation(s)
| | - Peter W Chao
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
| | - Argenis Curiel
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
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Mhanna M, Beran A, Nazir S, Sajdeya O, Srour O, Ayesh H, Eltahawy EA. Lung ultrasound-guided management to reduce hospitalization in chronic heart failure: a systematic review and meta-analysis. Heart Fail Rev 2021; 27:821-826. [PMID: 33835332 DOI: 10.1007/s10741-021-10085-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
Pulmonary edema is a leading cause of hospital admissions, morbidity, and mortality in heart failure (HF) patients. A point-of-care lung ultrasound (LUS) is a useful tool to detect subclinical pulmonary edema. We performed a comprehensive literature search of multiple databases for studies that evaluated the clinical utility of LUS-guided management versus standard care for HF patients in the outpatient setting. The primary outcome of interest was HF hospitalization. The secondary outcomes were all-cause mortality, urgent visits for HF worsening, acute kidney injury (AKI), and hypokalemia rates. Pooled risk ratio (RR) and corresponding 95% confidence intervals (CIs) were calculated and combined using random-effect model meta-analysis. A total of 3 randomized controlled trials including 493 HF patients managed in the outpatient setting (251 managed with LUS plus physical examination (PE)-guided therapy vs. 242 managed with PE-guided therapy alone) were included in the final analysis. The mean follow-up period was 5 months. There was no significant difference in HF hospitalization rate between the two groups (RR 0.65; 95% CI 0.34-1.22; P = 0.18). Similarly, there was no significant difference in all-cause mortality (RR 1.39; 95% CI 0.68-2.82; P = 0.37), AKI (RR 1.27; 95% CI 0.60-2.69; P = 0.52), and hypokalemia (RR 0.72; 95% CI 0.21-2.44; P = 0.59). However, LUS-guided therapy was associated with a lower rate for urgent care visits (RR 0.32; 95% CI 0.18-0.59; P = 0.0002). Our study demonstrated that outpatient LUS-guided diuretic therapy of pulmonary congestion reduces urgent visits for worsening symptoms of HF. Further studies are needed to evaluate LUS utility in the outpatient treatment of HF.
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Affiliation(s)
- Mohammed Mhanna
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA.
| | - Azizullah Beran
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Salik Nazir
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Omar Sajdeya
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Omar Srour
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Hazem Ayesh
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Ehab A Eltahawy
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
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Rubio-Gracia J, Giménez-López I, Josa-Laorden C, Sánchez-Marteles MM, Garcés-Horna V, Ruiz-Laiglesia F, Sampériz Legarre P, Bueno Juana E, Amores-Arriaga B, Pérez-Calvo JI. Prognostic value of multimodal assessment of congestion in acute heart failure. Rev Clin Esp 2021; 221:198-206. [PMID: 32199625 DOI: 10.1016/j.rce.2019.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/14/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND A physical examination has limited performance in estimating systemic venous congestion and predicting mortality in patients with heart failure. We have evaluated the usefulness of the N-terminal prohormone of brain natriuretic peptide (NT-proBNP), cancer antigen 125 (CA125), lung ultrasound findings, relative plasma volume (rPV) estimation, and the urea/creatinine ratio as surrogate parameters of venous congestion and predictors of mortality. METHODS This work is a retrospective study of 203 patients admitted for acute heart failure in a tertiary hospital's internal medicine department with follow-up in a specialized outpatient clinic between 2013 and 2018. Clinical data were collected from hospital records. Treatment was decided upon according to the clinical judgment of each patient's attending physician. The main outcome measure was all-cause mortality at one year of follow-up. RESULTS Patients' mean age was 78.8 years and 47% were male. A total of 130 (65%) patients had chronic heart failure, 51 (26.2%) patients were in New York Heart Association class III-IV, and 116 (60%) patients had preserved left ventricular ejection fraction. During follow-up, 42 (22%) patients died. Values ??of NT-proBNP≥3,804pg/mL (HR 2.78 [1.27-6.08]; p=.010) and rPV ≥-4.54% (HR 2.74 [1.18-6.38]; p=.019) were independent predictors of all-cause mortality after one year of follow-up. CONCLUSIONS NT-proBNP and rPV are independent predictors of one-year mortality among patients hospitalized for decompensated heart failure.
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Affiliation(s)
- J Rubio-Gracia
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, España.
| | - I Giménez-López
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, España; Universidad de Zaragoza, Zaragoza, España; Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, España
| | - C Josa-Laorden
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, España
| | - M M Sánchez-Marteles
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, España
| | - V Garcés-Horna
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, España
| | - F Ruiz-Laiglesia
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, España
| | - P Sampériz Legarre
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, España
| | - E Bueno Juana
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, España
| | - B Amores-Arriaga
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, España
| | - J I Pérez-Calvo
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, España; Universidad de Zaragoza, Zaragoza, España
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15
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Burden of Heart Failure Signs and Symptoms, Prognosis, and Response to Therapy: The PARAGON-HF Trial. JACC-HEART FAILURE 2021; 9:386-397. [PMID: 33714741 DOI: 10.1016/j.jchf.2021.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study investigated the prognostic importance of heart failure (HF) signs and symptoms in patients with heart failure and preserved ejection fraction (HFpEF), and the effect of sacubitril/valsartan on HF signs and symptoms. BACKGROUND In patients with HFpEF, worsening of HF symptoms, as a marker of cardiac decompensation, is frequently the reason for hospitalization. In this heterogenous disease entity, the prognostic value of HF signs and symptoms with regard to cardiovascular (CV) outcomes is poorly defined. METHODS The authors examined the association between baseline HF signs and symptoms (rest dyspnea, exertional dyspnea, paroxysmal nocturnal dyspnea, orthopnea, fatigue, edema, jugular venous distension, rales, and third heart sound) as well as burden of these HF signs and symptoms (classified as ≤2 and ≥3 HF signs and symptoms) and the primary composite of total HF hospitalizations and CV death, its components, and all-cause death in 4,725 patients enrolled in PARAGON-HF (Prospective Comparison of ARNI With ARB Global Outcomes in HFpEF) with available signs and symptoms at randomization. Response to sacubitril/valsartan on the basis of the presence of signs and symptoms was evaluated. Effects of sacubitril/valsartan on signs and symptoms over time were assessed using binary repeated-measures logistic regression. RESULTS Patients with high (≥3) burden of HF signs and symptoms (n = 1,772 [38%]) were more commonly women, had slightly lower left ventricular ejection fractions, higher body mass index, and more advanced New York Heart Association functional class compared with patients with low (≤2) burden (n = 2,953 [62%]) (p < 0.001 for all). Levels of N-terminal pro-B-type natriuretic peptide did not differ significantly between groups (p = 0.14). Greater burden of signs and symptoms was associated with higher risk for total HF hospitalizations and CV death (rate ratio [RR]: 1.50; 95% confidence interval [CI]: 1.30 to 1.74) and all-cause death (RR: 1.41; 95% CI: 1.21 to 1.65). Among individual signs and symptoms, orthopnea (RR: 1.29; 95% CI: 1.04 to 1.61) and rales (RR: 1.52; 95% CI: 1.10 to 2.10) were most predictive of the primary endpoint. Treatment response to sacubitril/valsartan was not significantly modified by burden of HF signs and symptoms (p for interaction = 0.08), though patients with orthopnea appeared to derive greater benefit from sacubitril/valsartan (RR: 0.67; 95% CI: 0.49 to 0.90) than those without orthopnea (RR: 0.97; 95% CI: 0.82 to 1.14; p for interaction = 0.04). Compared with valsartan, sacubitril/valsartan did not significantly decrease overall burden of HF signs and symptoms over time (odds ratio: 0.84; 95% CI: 0.67 to 1.07) but did reduce exertional dyspnea (odds ratio: 0.76; 95% CI: 0.63 to 0.93). CONCLUSIONS High burden of HF signs and symptoms, particularly the presence of orthopnea and rales, portends a higher risk for adverse CV events in patients with HF with preserved ejection fraction. Sacubitril/valsartan did not significantly decrease the burden of HF signs and symptoms over time but did reduce exertional dyspnea relative to valsartan. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711).
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16
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Rubio-Gracia J, Giménez-López I, Josa-Laorden C, Sánchez-Marteles MM, Garcés-Horna V, Ruiz-Laiglesia F, Sampériz Legarre P, Bueno Juana E, Amores-Arriaga B, Pérez-Calvo JI. Prognostic value of multimodal assessment of congestion in acute heart failure. Rev Clin Esp 2021; 221:198-206. [PMID: 33998498 DOI: 10.1016/j.rceng.2019.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/30/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND A physical examination has limited performance in estimating systemic venous congestion and predicting mortality in patients with heart failure. We have evaluated the usefulness of the N-terminal prohormone of brain natriuretic peptide (NT-proBNP), cancer antigen 125 (CA125), lung ultrasound findings, relative plasma volume (rPV) estimation, and the urea/creatinine ratio as surrogate parameters of venous congestion and predictors of mortality. METHODS This work is a retrospective study of 203 patients admitted for acute heart failure in a tertiary hospital's internal medicine department with follow-up in a specialized outpatient clinic between 2013 and 2018. Clinical data were collected from hospital records. Treatment was decided upon according to the clinical judgment of each patient's attending physician. The main outcome measure was all-cause mortality at one year of follow-up. RESULTS Patients' mean age was 78.8 years and 47% were male. A total of 130 (65%) patients had chronic heart failure, 51 (26.2%) patients were in New York Heart Association class III-IV, and 116 (60%) patients had preserved left ventricular ejection fraction. During follow-up, 42 (22%) patients died. Values of NT-proBNP≥3804pg/mL (HR 2.78 [1.27-6.08]; p=.010) and rPV≥-4.54% (HR 2.74 [1.18-6.38]; p=.019) were independent predictors of all-cause mortality after one year of follow-up. CONCLUSIONS NT-proBNP and rPV are independent predictors of one-year mortality among patients hospitalized for decompensated heart failure.
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Affiliation(s)
- J Rubio-Gracia
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, Spain.
| | - I Giménez-López
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain; Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - C Josa-Laorden
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, Spain
| | - M M Sánchez-Marteles
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, Spain
| | - V Garcés-Horna
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, Spain
| | - F Ruiz-Laiglesia
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, Spain
| | - P Sampériz Legarre
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, Spain
| | - E Bueno Juana
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, Spain
| | - B Amores-Arriaga
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, Spain
| | - J I Pérez-Calvo
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sociosanitario de Aragón (IIS), Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain
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17
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Marini C, Fragasso G, Italia L, Sisakian H, Tufaro V, Ingallina G, Stella S, Ancona F, Loiacono F, Innelli P, Costantino MF, Sahakyan L, Gabrielyan S, Avetisyan M, Margonato A, Agricola E. Lung ultrasound-guided therapy reduces acute decompensation events in chronic heart failure. Heart 2020; 106:1934-1939. [PMID: 32571960 DOI: 10.1136/heartjnl-2019-316429] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Pulmonary congestion is the main cause of hospital admission in patients with heart failure (HF). Lung ultrasound (LUS) is a useful tool to identify subclinical pulmonary congestion. We evaluated the usefulness of LUS in addition to physical examination (PE) in the management of outpatients with HF. METHODS In this randomised multicentre unblinded study, patients with chronic HF and optimised medical therapy were randomised in two groups: 'PE+LUS' group undergoing PE and LUS and 'PE only' group. Diuretic therapy was modified according to LUS findings and PE, respectively. The primary endpoint was the reduction in hospitalisation rate for acute decompensated heart failure (ADHF) at 90-day follow-up. Secondary endpoints were reduction in NT-proBNP, quality-of-life test (QLT) and cardiac mortality at 90-day follow-up. RESULTS A total of 244 patients with chronic HF and optimised medical therapy were enrolled and randomised in 'PE+LUS' group undergoing PE and LUS, and in 'PE only' group. Thirty-seven primary outcome events occurred. The hospitalisation for ADHF at 90 day was significantly reduced in 'PE+LUS' group (9.4% vs 21.4% in 'PE only' group; relative risk=0.44; 95% CI 0.23 to 0.84; p=0.01), with a reduction of risk for hospitalisation for ADHF by 56% (p=0.01) and a number needed to treat of 8.4 patients (95% CI 4.8 to 34.3). At day 90, NT-proBNP and QLT score were significantly reduced in 'PE+LUS' group, whereas in 'PE only' group both were increased. There were no differences in mortality between the two groups. CONCLUSIONS LUS-guided management reduces hospitalisation for ADHF at mid-term follow-up in outpatients with chronic HF.
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Affiliation(s)
- Claudia Marini
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Fragasso
- Heart Failure Clinic, Clinical Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Italia
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Hamayak Sisakian
- Department of Cardiology, Yerevan State Medical University, University Hospital 1, Yerevan, Armenia
| | - Vincenzo Tufaro
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Ferdinando Loiacono
- Heart Failure Clinic, Clinical Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Innelli
- SSD Imaging Cardiovascular Department, San Carlo Hospital, Potenza, Italy
| | | | - Laura Sahakyan
- Department of Cardiology, Yerevan State Medical University, University Hospital 1, Yerevan, Armenia
| | - Sirvard Gabrielyan
- Department of Cardiology, Yerevan State Medical University, University Hospital 1, Yerevan, Armenia
| | - Mariam Avetisyan
- Department of Cardiology, Yerevan State Medical University, University Hospital 1, Yerevan, Armenia
| | - Alberto Margonato
- Heart Failure Clinic, Clinical Cardiology, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Rivas‐Lasarte M, Álvarez‐García J, Fernández‐Martínez J, Maestro A, López‐López L, Solé‐González E, Pirla MJ, Mesado N, Mirabet S, Fluvià P, Brossa V, Sionis A, Roig E, Cinca J. Lung ultrasound‐guided treatment in ambulatory patients with heart failure: a randomized controlled clinical trial (LUS‐HF study). Eur J Heart Fail 2019; 21:1605-1613. [DOI: 10.1002/ejhf.1604] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Mercedes Rivas‐Lasarte
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Jesús Álvarez‐García
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Juan Fernández‐Martínez
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Alba Maestro
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Laura López‐López
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Eduard Solé‐González
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Maria J. Pirla
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Nuria Mesado
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Sonia Mirabet
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Paula Fluvià
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Vicens Brossa
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Eulàlia Roig
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
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Monzo L, Kotrc M, Benes J, Sedlacek K, Jurcova I, Franekova J, Jarolim P, Kautzner J, Melenovsky V. Clinical and Humoral Determinants of Congestion in Heart Failure: Potential Role of Adiponectin. Kidney Blood Press Res 2019; 44:1271-1284. [PMID: 31553971 DOI: 10.1159/000502975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Some patients with heart failure (HF) are more prone to systemic congestion than others. The goal of this study was to identify clinical and humoral factors linked to congestion and its prognostic impact in HF patients. METHODS A total of 371 advanced HF patients underwent physical examination, echocardiography, right heart catheterization, blood samplings, and Minnesota Living with HF Questionnaire. Subjects were followed-up for adverse events (death, urgent transplantation, or assist device implantation without heart transplantation). RESULTS Thirty-one percent of patients were classified as prone to congestion. During a median follow-up of 1,093 days, 159 (43%) patients had an adverse event. In the Cox analysis, the congestion-prone (CP) status was associated with a 43% higher event risk. The CP status was strongly (p ˂ 0.001) associated with body weight loss, right ventricular dysfunction (RVD), dilated inferior vena cava (IVC), diuretics, and beta-blockers prescription and the majority of tested hormones in the univariate analysis. In the multivariate analysis, the only independent variables associated with the CP status were adiponectin, albumin, IVC diameter, and RVD. Adiponectin by itself was predictive of adverse events. In a multivariate model, CP status was no longer predictive of adverse events, in contrast to adiponectin. CONCLUSIONS CP patients experienced more severe symptoms and had shorter survival. Potential role of adiponectin, a new independent predictor of CP status, should be further examined.
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Affiliation(s)
- Luca Monzo
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia, .,Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, "Sapienza" University, Rome, Italy,
| | - Martin Kotrc
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Jan Benes
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Kamil Sedlacek
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Ivana Jurcova
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Janka Franekova
- Department of Laboratory Methods, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Josef Kautzner
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Vojtech Melenovsky
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
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20
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Selvaraj S, Claggett B, Shah SJ, Anand IS, Rouleau JL, Desai AS, Lewis EF, Vaduganathan M, Wang SY, Pitt B, Sweitzer NK, Pfeffer MA, Solomon SD. Utility of the Cardiovascular Physical Examination and Impact of Spironolactone in Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2019; 12:e006125. [PMID: 31220936 DOI: 10.1161/circheartfailure.119.006125] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prognostic value of physical examination, its relation to quality of life, and influence of therapy in heart failure with preserved ejection fraction is not well known. METHODS AND RESULTS We studied participants from the Americas with available physical examination (jugular venous distention, rales, and edema) at baseline in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist). The association of the number of signs of congestion with the primary outcome (cardiovascular death or heart failure hospitalization), its individual components, and all-cause mortality was assessed using time-updated, multivariable-adjusted Cox regression analyses. We evaluated whether spironolactone improved congestion at 4 months and whether improvement in congestion was related to quality of life as assessed by Kansas City Cardiomyopathy Questionnaire overall summary scores and to outcomes. Among 1644 participants, 22%, 54%, 20%, and 4% had 0, 1, 2, and 3 signs of congestion, respectively, at baseline. After multivariable adjustment, each additional increase in sign of congestion was associated with a 30% to 60% increased risk of each outcome ( P<0.001). Spironolactone reduced the total number of signs of congestion by -0.10 ( P=0.005) signs, jugular venous distention (odds ratio, 0.60; P=0.01), and edema (odds ratio, 0.74; P=0.006) at 4 months compared with placebo. Each reduction in sign of congestion was independently associated with a 4.0 (95% CI, 2.4-5.6) point improvement in Kansas City Cardiomyopathy Questionnaire overall summary score. When assessed simultaneously, time-updated, but not baseline congestion, predicted outcomes. CONCLUSIONS In heart failure with preserved ejection fraction, the physical exam provides independent prognostic value for adverse outcomes. Spironolactone improved congestion compared with placebo. Reducing congestion was independently associated with improved quality of life and outcomes and is a modifiable risk factor. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00094302.
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Affiliation(s)
- Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (S.S.)
| | - Brian Claggett
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.C., A.S.D., E.F.L., M.V., S.Y.W., M.A.P., S.D.S.)
| | - Sanjiv J Shah
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Inder S Anand
- VA Medical Center, University of Minnesota, Minneapolis (I.S.A)
| | - Jean L Rouleau
- Department of Medicine, Montreal Heart Institute, University of Montreal, QC, Canada (J.L.R.)
| | - Akshay S Desai
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.C., A.S.D., E.F.L., M.V., S.Y.W., M.A.P., S.D.S.)
| | - Eldrin F Lewis
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.C., A.S.D., E.F.L., M.V., S.Y.W., M.A.P., S.D.S.)
| | - Muthiah Vaduganathan
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.C., A.S.D., E.F.L., M.V., S.Y.W., M.A.P., S.D.S.)
| | - Stephen Y Wang
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.C., A.S.D., E.F.L., M.V., S.Y.W., M.A.P., S.D.S.)
| | - Bertram Pitt
- Division of Cardiology, Department of Medicine, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Nancy K Sweitzer
- The Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.)
| | - Marc A Pfeffer
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.C., A.S.D., E.F.L., M.V., S.Y.W., M.A.P., S.D.S.)
| | - Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.C., A.S.D., E.F.L., M.V., S.Y.W., M.A.P., S.D.S.)
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Rubio-Gracia J, Giménez-López I, Damman K, Sánchez-Marteles M, Garcés-Horna V, Josa-Laorden C, de la Rica-Escuin M, Pérez-Calvo J. Presión intraabdominal y empeoramiento de la función renal durante las descompensaciones de la insuficiencia cardiaca. Un informe preliminar del estudio PIA. Rev Clin Esp 2019; 219:229-235. [DOI: 10.1016/j.rce.2018.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/13/2018] [Accepted: 09/04/2018] [Indexed: 12/20/2022]
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Intraabdominal pressure and worsening renal function during decompensations of heart failure. A preliminary report from the PIA study. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF. Clin Res Cardiol 2018. [PMID: 29532155 DOI: 10.1007/s00392-018-1221-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) can be used to assess pulmonary congestion by imaging B-lines ('comets') for patients with acute heart failure (AHF). OBJECTIVES Investigate relationship of B-lines, plasma concentrations of B-type natriuretic peptide (BNP), and echocardiographic left ventricular (LV) function measured at admission and discharge and their relationship to prognosis for AHF with preserved (HFpEF) or reduced (HFrEF) LV ejection fraction. METHODS Patients with AHF had the above tests done at admission and discharge. The primary outcome was re-hospitalization for heart failure or death at 6 months. RESULTS Of 162 patients enrolled, 95 had HFrEF and 67 had HFpEF, median age was 80 [77-85] years, and 85 (52%) were women. The number of B-lines at admission (median 31 [27-36]) correlated with respiratory rate (r = 0.75; p < 0.001), BNP (r = 0.43; p < 0.001), clinical congestion score (r = 0.25; p = 0.001), and systolic pulmonary artery pressure (r = 0.42; p < 0.001). At discharge, B-lines were also correlated with BNP (r = 0.69; p < 0.001) and congestion score (r = 0.57; p < 0.001). B-line count at discharge predicted outcome (AUC 0.83 [0.77-0.90]; univariate HR 1.12 [1.09-1.16]; p < 0.001; multivariable HR 1.16 [1.11-1.21]; p < 0.001). Results were similar for HFpEF and HFrEF. CONCLUSIONS LUS appears a useful method to assess severity and monitor the resolution of lung congestion. At hospital admission, B-lines are strongly related to respiratory rate, which may be a key component of the sensation of dyspnea. Measurement of lung congestion at discharge provides prognostic information for patients with either HFpEF or HFrEF.
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Verdú-Rotellar JM, Frigola-Capell E, Alvarez-Pérez R, da Silva D, Enjuanes C, Domingo M, Mena A, Muñoz MA. Validation of heart failure diagnosis registered in primary care records in two primary care centres in Barcelona (Spain) and factors related. A cross-sectional study. Eur J Gen Pract 2017; 23:107-113. [PMID: 28376668 PMCID: PMC5774267 DOI: 10.1080/13814788.2017.1305104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart failure (HF) diagnosis as reported in primary care medical records is not always properly confirmed and could result in over-registration. OBJECTIVES To determine the proportion of registered HF that can be confirmed with information from primary care medical records and to analyse related factors. METHODS A cross-sectional study. The medical records of 595 HF patients attended in two primary healthcare centres in Barcelona (Spain) were revised and validated by a team of experts who classified diagnosis into confirmed, unconfirmed, and misdiagnosis. Variables potentially related to the confirmation of the diagnosis were analysed. The revision of medical records and data collection took place from 15 January to 31 March 2014. RESULTS Mean (standard deviation) age was 78 (10) years and 58% were women. The diagnosis could be confirmed in 53.6% of patients. Factors associated with a greater probability of having a confirmed diagnosis were age (yearly OR: 0.97, 95%CI: 0.95-0.99), cardiologist follow-up (OR: 3.66, 95%CI: 2.46-5.48), history of ischaemic heart disease (OR: 2.18, 95%CI: 1.36-2.48), atrial fibrillation (OR: 2.01, 95%CI: 1.34-3.03), and prescription of loop diuretics (OR: 3.24, 95%CI: 2.14-4.89). CONCLUSION Only in half of the patients labelled as HF in primary care medical records could this diagnosis be further confirmed. Variables regularly registered in clinical practice could help general practitioners identify those patients requiring a revision of their HF diagnosis.
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Affiliation(s)
- Jose María Verdú-Rotellar
- a Centro de Atención Primaria Sant Martí de Provençals , Institut Català de la Salut , Barcelona , Spain
- b Institut d'Investigació en Atenció Primaria IDIAP-Jordi Gol , Barcelona , Spain
- c Departament de Medicina, Facultat de Medicina , Universitat Autónoma de Barcelona , Bellaterra , Spain
- d Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar , Servei Català de la Salut , Barcelona , Spain
| | - Eva Frigola-Capell
- b Institut d'Investigació en Atenció Primaria IDIAP-Jordi Gol , Barcelona , Spain
| | - Rosa Alvarez-Pérez
- b Institut d'Investigació en Atenció Primaria IDIAP-Jordi Gol , Barcelona , Spain
| | - Daniela da Silva
- b Institut d'Investigació en Atenció Primaria IDIAP-Jordi Gol , Barcelona , Spain
| | - Cristina Enjuanes
- d Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar , Servei Català de la Salut , Barcelona , Spain
- e Parc de Salut MAR, Servicio de Cardiologıa , Hospital del Mar , Barcelona , Spain
| | - Mar Domingo
- f Centro de Atención Primaria Sant Roc , Institut Català de la Salut , Badalona , Spain
| | - Amparo Mena
- g Centro de Atención Primaria Congres , Institut Català de la Salut , Barcelona , Spain
| | - Miguel-Angel Muñoz
- b Institut d'Investigació en Atenció Primaria IDIAP-Jordi Gol , Barcelona , Spain
- h Departament de Obstericia, Ginecologia i Medicina Preventiva, Facultat de Medicina , Universidad Autónoma de Barcelona , Bellaterra , Spain
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Rodriguez-Cillero C, Menu D, d'Athis P, Perrin S, Dipanda M, Asgassou S, Guepet H, Mazen E, Manckoundia P, Putot A. Potentially inappropriate use of furosemide in a very elderly population: An observational study. Int J Clin Pract 2017; 71. [PMID: 28618134 DOI: 10.1111/ijcp.12975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 05/14/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Little is known about furosemide prescription modalities in elderly people. We describe furosemide prescription in ambulatory elderly patients. METHODS All patients aged over 80 years, affiliated to Mutualité Sociale Agricole de Bourgogne, a French regional health insurance plan, with a medical prescription delivered in March 2015, were retrospectively included. RESULTS Among 15 141 patients with a median age of 86 years, comprising 61.3% of women, 3937 patients (26%) had a prescription for furosemide. Severe heart failure was the most common chronic comorbidity (27.7%). Furosemide was considered a long-term therapy for almost all patients (98.7% with prescriptions for 3 months or more). Recommended indications for long-term furosemide therapy included severe heart failure (50.9%), chronic nephropathy (3%) and cirrhosis (0.1%). The furosemide prescription rate increased with age (81-85: 20.4%, 86-90: 28.5%, 91-95: 35.6%, >95: 42.7%, P<.001), and the increase was associated with a decrease in recommended heart failure therapeutics (beta-blockers, angiotensin-conversion-enzyme-inhibitors or angiotensin-receptor-blockers). Prescribers were mostly general practitioners (81.3%). Plasma electrolytes were controlled in less than a half of the patients with furosemide. CONCLUSIONS In this large study, long-course furosemide was prescribed in a quarter of ambulatory patients. Half of those taking furosemide suffered from severe heart failure. Age was associated with a linear increase in furosemide use and a decrease in recommended heart failure therapeutic prescriptions. A large part of these prescriptions do not seem to be in accordance with recommendations.
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Affiliation(s)
| | - Didier Menu
- "Mutualité Sociale Agricole de Bourgogne", Dijon, France
| | - Philippe d'Athis
- Department of Biostatistics and Medical Computing, University Hospital, Dijon, France
| | - Sophie Perrin
- Department of Geriatric Medicine, University Hospital, Dijon, France
| | - Mélanie Dipanda
- Department of Geriatric Medicine, University Hospital, Dijon, France
| | - Sanaa Asgassou
- Department of Geriatric Medicine, University Hospital, Dijon, France
| | - Hélène Guepet
- Department of Geriatric Medicine, University Hospital, Dijon, France
| | - Emmanuel Mazen
- Department of Geriatric Medicine, University Hospital, Dijon, France
| | - Patrick Manckoundia
- Department of Geriatric Medicine, University Hospital, Dijon, France
- UMR Inserm/U1093 Cognition, Action, Sensorimotor Plasticity, University of Burgundy Franche Comté, Dijon, France
| | - Alain Putot
- Department of Geriatric Medicine, University Hospital, Dijon, France
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Lung ultrasound predicts decompensation in heart failure outpatients: Another piece to the puzzle but still an incomplete picture. Int J Cardiol 2017; 240:324-325. [DOI: 10.1016/j.ijcard.2017.04.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 04/19/2017] [Indexed: 01/19/2023]
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Pellicori P, Clark AL, Kallvikbacka-Bennett A, Zhang J, Urbinati A, Monzo L, Dierckx R, Anker SD, Cleland JG. Non-invasive measurement of right atrial pressure by near-infrared spectroscopy: preliminary experience. A report from the SICA-HF study. Eur J Heart Fail 2017; 19:883-892. [DOI: 10.1002/ejhf.825] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/13/2017] [Accepted: 02/28/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Andrew L. Clark
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Anna Kallvikbacka-Bennett
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Jufen Zhang
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Alessia Urbinati
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Luca Monzo
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Riet Dierckx
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Stefan D. Anker
- University of Göttingen Medical School; Department of Cardiology and Pneumology; Göttingen Germany
| | - John G.F. Cleland
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
- National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit; Royal Brompton & Harefield Hospitals, Imperial College; London UK
- Robertson Centre for Biostatistics and Clinical Trials; University of Glasgow; Glasgow UK
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28
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Involvement of systemic venous congestion in heart failure. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2016.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cardiac Dysfunction, Congestion and Loop Diuretics: their Relationship to Prognosis in Heart Failure. Cardiovasc Drugs Ther 2017; 30:599-609. [PMID: 27819111 DOI: 10.1007/s10557-016-6697-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diuretics are the mainstay of treatment for congestion but concerns exist that they adversely affect prognosis. We explored whether the relationship between loop diuretic use and outcome is explained by the underlying severity of congestion amongst patients referred with suspected heart failure. METHOD AND RESULTS Of 1190 patients, 712 had a left ventricular ejection fraction (LVEF) ≤50 %, 267 had LVEF >50 % with raised plasma NTproBNP (>400 ng/L) and 211 had LVEF >50 % with NTproBNP ≤400 ng/L; respectively, 72 %, 68 % and 37 % of these groups were treated with loop diuretics including 28 %, 29 % and 10 % in doses ≥80 mg furosemide equivalent/day. Compared to patients with cardiac dysfunction (either LVEF ≤50 % or NT-proBNP >400 ng/L) but not taking a loop diuretic, those taking a loop diuretic were older and had more clinical evidence of congestion, renal dysfunction, anaemia and hyponatraemia. During a median follow-up of 934 (IQR: 513-1425) days, 450 patients were hospitalized for HF or died. Patients prescribed loop diuretics had a worse outcome. However, in multi-variable models, clinical, echocardiographic (inferior vena cava diameter), and biochemical (NTproBNP) measures of congestion were strongly associated with an adverse outcome but not the use, or dose, of loop diuretics. CONCLUSIONS Prescription of loop diuretics identifies patients with more advanced features of heart failure and congestion, which may account for their worse prognosis. Further research is needed to clarify the relationship between loop diuretic agents and outcome; imaging and biochemical measures of congestion might be better guides to diuretic dose than symptoms or clinical signs.
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Rubio Gracia J, Sánchez Marteles M, Pérez Calvo JI. Involvement of systemic venous congestion in heart failure. Rev Clin Esp 2016; 217:161-169. [PMID: 27979306 DOI: 10.1016/j.rce.2016.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/05/2016] [Accepted: 10/31/2016] [Indexed: 12/17/2022]
Abstract
Systemic venous congestion has gained significant importance in the interpretation of the pathophysiology of acute heart failure, especially in the development of renal function impairment during exacerbations. In this study, we review the concept, clinical characterisation and identification of venous congestion. We update current knowledge on its importance in the pathophysiology of acute heart failure and its involvement in the prognosis. We pay special attention to the relationship between abdominal congestion, the pulmonary interstitium as filtering membrane, inflammatory phenomena and renal function impairment in acute heart failure. Lastly, we review decongestion as a new therapeutic objective and the measures available for its assessment.
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Affiliation(s)
- J Rubio Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España.
| | - M Sánchez Marteles
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - J I Pérez Calvo
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España; Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
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31
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Sani MU, Cotter G, Davison BA, Mayosi BM, Damasceno A, Edwards C, Ogah OS, Mondo C, Dzudie A, Ojji DB, Kouam Kouam C, Suliman A, Yonga G, Abdou Ba S, Maru F, Alemayehu B, Sliwa K. Symptoms and Signs of Heart Failure at Admission and Discharge and Outcomes in the Sub-Saharan Acute Heart Failure (THESUS-HF) Registry. J Card Fail 2016; 23:739-742. [PMID: 27664511 DOI: 10.1016/j.cardfail.2016.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 09/02/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Symptoms and signs of heart failure (HF) are the most common reasons for admission to hospital for acute HF (AHF) and are used routinely throughout admission to assess the severity of disease and response to therapy. METHODS AND RESULTS The data were collected in The Sub-Saharan Africa Survey on Heart Failure (THESUS-HF) study, a prospective, multicenter, observational survey of AHF from 9 countries in sub-Saharan Africa. A total of 1006 patients, ≥12 years of age, hospitalized for AHF were recruited. Symptoms and signs of HF and changes in dyspnea and well-being, relative to admission, were assessed at entry and on days 1, 2, and 7 (or on discharge if earlier) and included oxygen saturation, degree of edema and rales, body weight, and level of orthopnea. The patient determined dyspnea and general well-being, whereas the physician determined symptoms and signs of HF, as well as improvements in vital sign measurement, throughout the admission. After multivariable adjustment, baseline rales and changes to day 7 or discharge in general well-being predicted death or HF hospitalization through day 60, and baseline orthopnea, edema, rales, oxygen saturation, and changes to day 7 or on discharge in respiratory rate and general well-being were predictive of death through day 180. CONCLUSIONS In AHF patients in sub-Saharan Africa, symptoms and signs of HF improve throughout admission, and simple assessments, including edema, rales, oxygen saturation, respiratory rate, and asking the patient about general well-being, are valuable tools in patients' clinical assessment.
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Affiliation(s)
- Mahmoud U Sani
- Department of Medicine, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria.
| | - Gad Cotter
- Momentum Research, Durham, North Carolina, United States
| | - Beth A Davison
- Momentum Research, Durham, North Carolina, United States
| | - Bongani M Mayosi
- Department of Medicine, GF Jooste and Groote Schuur Hospitals, University of Cape Town, Cape Town, South Africa
| | | | | | - Okechukwu S Ogah
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Anastase Dzudie
- Department of Internal Medicine, Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon
| | - Dike B Ojji
- Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Charles Kouam Kouam
- Department of Internal Medicine, Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon
| | - Ahmed Suliman
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Gerald Yonga
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | - Sergine Abdou Ba
- Service de Cardiologie, Faculté de Médecine de Dakar, Dakar, Senegal
| | - Fikru Maru
- Addis Cardiac Hospital, Addis Ababa, Ethiopia
| | | | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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32
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New ways to visualize and combat congestion in heart failure. Rev Clin Esp 2016; 216:202-4. [PMID: 27129360 DOI: 10.1016/j.rce.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 11/20/2022]
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Prognostic value of measuring the diameter and inspiratory collapse of the inferior vena cava in acute heart failure. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Platz E, Lewis EF, Uno H, Peck J, Pivetta E, Merz AA, Hempel D, Wilson C, Frasure SE, Jhund PS, Cheng S, Solomon SD. Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients. Eur Heart J 2016; 37:1244-51. [PMID: 26819225 DOI: 10.1093/eurheartj/ehv745] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/15/2015] [Indexed: 12/21/2022] Open
Abstract
AIMS Pulmonary congestion is a common and important finding in heart failure (HF). While clinical examination and chest radiography are insensitive, lung ultrasound (LUS) is a novel technique that may detect and quantify subclinical pulmonary congestion. We sought to independently relate LUS and clinical findings to 6-month HF hospitalizations and all-cause mortality (composite primary outcome). METHODS We used LUS to examine 195 NYHA class II-IV HF patients (median age 66, 61% men, 74% white, ejection fraction 34%) during routine cardiology outpatient visits. Lung ultrasound was performed in eight chest zones with a pocket ultrasound device (median exam duration 2 min) and analysed offline. RESULTS In 185 patients with adequate LUS images in all zones, the sum of B-lines (vertical lines on LUS) ranged from 0 to 13. B-lines, analysed by tertiles, were associated with clinical and laboratory markers of congestion. Thirty-two per cent of patients demonstrated ≥3 B-lines on LUS, yet 81% of these patients had no findings on auscultation. During the follow-up period, 50 patients (27%) were hospitalized for HF or died. Patients in the third tertile (≥3 B-lines) had a four-fold higher risk of the primary outcome (adjusted HR 4.08, 95% confidence interval, CI 1.95, 8.54; P < 0.001) compared with those in the first tertile and spent a significantly lower number of days alive and out of the hospital (125 days vs. 165 days; adjusted P < 0.001). CONCLUSIONS Pulmonary congestion assessed by ultrasound is prevalent in ambulatory patients with chronic HF, is associated with other features of clinical congestion, and identifies those who have worse prognosis.
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Affiliation(s)
- Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA Harvard Medical School, Boston, USA
| | - Eldrin F Lewis
- Harvard Medical School, Boston, USA Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - Hajime Uno
- Harvard Medical School, Boston, USA Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA
| | - Julie Peck
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, Cancer Epidemiology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, Torino, Italy University of Turin, Turin, Italy
| | - Allison A Merz
- Department of Emergency Medicine and Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - Dorothea Hempel
- Department of Cardiology, Angiology and Intensive Care, University Medical Center Mainz, Mainz, Germany
| | - Christina Wilson
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, USA
| | - Sarah E Frasure
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA Harvard Medical School, Boston, USA
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Susan Cheng
- Harvard Medical School, Boston, USA Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - Scott D Solomon
- Harvard Medical School, Boston, USA Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
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Josa-Laorden C, Giménez-López I, Rubio-Gracia J, Ruiz-Laiglesia F, Garcés-Horna V, Pérez-Calvo JI. [Prognostic value of measuring the diameter and inspiratory collapse of the inferior vena cava in acute heart failure]. Rev Clin Esp 2016; 216:183-90. [PMID: 26774759 DOI: 10.1016/j.rce.2015.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/24/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the utility of measuring the diameter and collapse of the inferior vena cava (IVC) in acute heart failure (AHF), its relationship with the prognosis and serum biomarkers of congestion. PATIENTS AND METHODS An observational prospective study was conducted that included 85 patients with AHF, classifying them into 4 groups according to IVC diameter (≤ or >20mm) and inspiratory collapse (< or ≥50%) at admission. The endpoints were mortality due to HF and the combined event of mortality and readmission for HF at 180 days. RESULTS Some 24.7% of the patients had an undilated IVC and ≥50% collapse (group 1); 20% had an undilated IVC and <50% collapse (group 2), 5.9% had a dilated IVC and ≥50% collapse (group 3); and 49.4% had a dilated IVC and <50% collapse (group 4). The lack of inspiratory collapse but not IVC dilation was related to higher concentrations of urea (P=.007), creatinine (P=.004), uric acid (P=.008), NT-proBNP (P=.009) and CA125 (P=.005). Survival free of the combined event at 180 days was lower in those patients with no IVC collapse. CONCLUSIONS Dilation and the absence of the inspiratory collapse of the IVC are common in the context of AHF. The lack of inspiratory collapse of the IVC during the decompensation phase identifies a subgroup of patients with poorer prognosis at 6 months.
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Affiliation(s)
- C Josa-Laorden
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España.
| | - I Giménez-López
- Departamento de Fisiología, Facultad de Medicina, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - J Rubio-Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - F Ruiz-Laiglesia
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - V Garcés-Horna
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - J I Pérez-Calvo
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
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Kataoka H. Clinical significance of bilateral leg edema and added value of monitoring weight gain during follow-up of patients with established heart failure. ESC Heart Fail 2015; 2:106-115. [PMID: 28834618 PMCID: PMC5746968 DOI: 10.1002/ehf2.12043] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/12/2015] [Accepted: 05/10/2015] [Indexed: 12/26/2022] Open
Abstract
PURPOSE This study evaluated the clinical characteristics of bilateral leg edema during follow-up of heart failure (HF) patients and determined the added value of monitoring fluid weight gain for deciding whether this non-specific sign is a more clinically relevant sign. METHODS Retrospective analysis was performed on 1826 visits from 83 ambulatory patients with established mild-to-moderate HF. Evaluated HF-related signs included leg edema, pulmonary crackles, S3, weight gain, and ultrasound pleural effusion. RESULTS During follow-up, 75 patients with 161 visits had at least one of the following HF-related events: weight gain (n = 107), leg edema (n = 90), ultrasound pleural effusion (n = 85), pulmonary crackles (n = 29), and S3 (n = 16). Compared with the events of sole leg edema (n = 23), leg edema events with additional HF-related sign(s) (n = 67) accompanied more symptomatic worsening (7% vs. 55%, P < 0.0001), and a higher incidence (61% vs. 96%, P = 0.0002) and magnitude of increased serum B-type natriuretic peptide. Sole leg edema events rarely progressed to worsening HF before the next regular clinic visit. Patients with the event of both leg edema and weight gain more often experienced worsening HF requiring extra clinic visits and/or hospitalization. Amongst a total of 67 leg edema events with additional HF-related signs, 56 (84%) coexisted with weight gain. Therefore, additional monitoring of weight gain efficiently distinguished the clinically significant leg edema events from insignificant sole leg edema events. CONCLUSIONS During follow-up of mild-to-moderate HF patients, sole leg edema appeared around 30% of the leg edema events, which is considered clinically insignificant. Additional checking for weight gain could be useful for determining whether this sign is a clinically relevant HF-related sign. The appearance of these both signs during follow-up of established HF patients should be intentionally watched or treated by extra diuretics and/or drug adjustment to prevent worsening of HF.
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Affiliation(s)
- Hajime Kataoka
- Internal MedicineNishida HospitalTsuruoka‐Nishi‐MachiSaiki‐City, Oita876‐0047Japan
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Pellicori P, Kaur K, Clark AL. Fluid Management in Patients with Chronic Heart Failure. Card Fail Rev 2015; 1:90-95. [PMID: 28785439 PMCID: PMC5490880 DOI: 10.15420/cfr.2015.1.2.90] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
Congestion, or fluid overload, is a classic clinical feature of patients presenting with heart failure patients, and its presence is associated with adverse outcome. However, congestion is not always clinically evident, and more objective measures of congestion than simple clinical examination may be helpful. Although diuretics are the mainstay of treatment for congestion, no randomised trials have shown the effects of diuretics on mortality in chronic heart failure patients. Furthermore, appropriate titration of diuretics in this population is unclear. Research is required to determine whether a robust method of detecting - and then treating - subclinical congestion improves outcomes.
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Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| | - Kuldeep Kaur
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
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Pellicori P, Kallvikbacka-Bennett A, Dierckx R, Zhang J, Putzu P, Cuthbert J, Boyalla V, Shoaib A, Clark AL, Cleland JGF. Prognostic significance of ultrasound-assessed jugular vein distensibility in heart failure. Heart 2015; 101:1149-58. [PMID: 26006717 DOI: 10.1136/heartjnl-2015-307558] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/29/2015] [Indexed: 11/03/2022] Open
Abstract
AIMS Jugular venous distension is a classical sign of heart failure (HF) but it can be difficult to assess clinically. METHODS AND RESULTS Outpatients with HF and control subjects were assessed. Internal jugular vein diameter (JVD) was measured using a linear high-frequency ultrasound probe (10 MHz) at rest, after a Valsalva manoeuvre and during deep inspiration. JVD ratio was calculated as the maximum diameter during Valsalva to that measured at rest. 311 patients (mean age 71 years, mean left ventricular EF 42%, median (IQR) amino-terminal pro-brain natriuretic peptide 979 (441-2007) ng/L) and 66 controls were included. JVD (median and IQR range) at rest was smaller in controls (0.16 (0.14-0.20) cm) than in patients with HF (0.23 (0.17-0.33) cm; p<0.001) but similar during Valsalva (1.03 (0.90-1.16) cm vs 1.08 (0.90-1.25) cm; p=0.28). Consequently, JVD ratio was greater in controls (6.3 (4.9-7.6)) than in patients (4.5 (2.9-6.1); p<0.001). During a median follow-up of 516 (IQR 335-622) days, 48 patients (15%) with HF died or were hospitalised for HF. In multivariable models, among clinical, echocardiographic or biochemical variables, only increasing NT-proBNP and ultrasound assessment of internal jugular vein were independently associated with prognosis. Comparing top and bottom tertiles of JVD ratio (2.3 (IQR 1.7-2.9) versus 6.8 (6.1-7.7)), the tertile with lower values had a 10-fold greater risk of an adverse event (HR 10.05, 95% CI 3.07 to 32.93). CONCLUSIONS Ultrasound assessment of the internal jugular vein identifies outpatients with HF who have a higher risk of an adverse outcome. CLINICAL TRIAL REGISTRATION NCT01872299.
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Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Anna Kallvikbacka-Bennett
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Riet Dierckx
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Jufen Zhang
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Paola Putzu
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Joe Cuthbert
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Vennela Boyalla
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Ahmed Shoaib
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Andrew L Clark
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - John G F Cleland
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College, London, UK
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Dicken B, Cleland JG. Is the Way to a Man’s Heart Through His Stomach? J Am Coll Cardiol 2014; 64:1103-5. [DOI: 10.1016/j.jacc.2014.06.1180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 11/26/2022]
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40
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Caldentey G, Khairy P, Roy D, Leduc H, Talajic M, Racine N, White M, O'Meara E, Guertin MC, Rouleau JL, Ducharme A. Prognostic Value of the Physical Examination in Patients With Heart Failure and Atrial Fibrillation. JACC-HEART FAILURE 2014; 2:15-23. [DOI: 10.1016/j.jchf.2013.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 11/28/2022]
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Kataoka H. Clinical characteristics of lower-extremity edema in stage A cardiovascular disease status defined by the ACC/AHA 2001 Chronic Heart Failure Guidelines. Clin Cardiol 2013; 36:555-9. [PMID: 23843030 DOI: 10.1002/clc.22159] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 05/07/2013] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Checking for lower-extremity edema is important for diagnosing, monitoring, and managing heart failure (HF). However, the characteristics of this sign in the early stages of cardiovascular disease (stage A, as defined by the American College of Cardiology/American Heart Association 2001 chronic HF guidelines) have not been adequately explored. HYPOTHESIS We hypothesized that stage A HF patients (at risk for HF) are free from leg edema. METHODS After the exclusion of patients with high serum creatinine levels (≥1.2 mg/dL), abnormal electrocardiogram rhythm, and/or comorbid critical disease(s), we studied the prevalence and predictors for leg edema in 274 subjects at risk for heart failure but without structural heart disease or symptoms of HF. RESULTS The overall prevalence of lower-extremity edema was 33 of 274 patients (12.0%; 95% confidence interval: 8.2%-15.9%). In most patients (29/33, 88%), the leg edema involved only the ankle and foot. Compared with patients without leg edema (n = 241), those with leg edema (n = 33) were older (age, 74 ± 11 7 vs 69 ± 12 years, P = 0.006), more likely to present with pulmonary crackles (52% vs 31%, P < 0.03), and more likely to have varicose veins (55% vs 15%, P < 0.001). Leg edema and varicose veins coexisted in 19 (58%) patients, of whom 16 patients were women. On multivariate analysis, the presence of varicose veins was the only independent predictor of the appearance of bilateral leg edema (odds ratio: 8.18, 95% confidence interval: 3.92-17.1, P < 0.001). CONCLUSIONS A mild degree of leg edema is not uncommon in patients at risk for HF. Recognition of this phenomenon might be important for evaluation, monitoring, and self-care of HF patients.
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Affiliation(s)
- Hajime Kataoka
- Division of Internal Medicine, Nishida Hospital, Oita, Japan
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Pellicori P, Carubelli V, Zhang J, Castiello T, Sherwi N, Clark AL, Cleland JGF. IVC diameter in patients with chronic heart failure: relationships and prognostic significance. JACC Cardiovasc Imaging 2013; 6:16-28. [PMID: 23328557 DOI: 10.1016/j.jcmg.2012.08.012] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 08/01/2012] [Accepted: 08/02/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess the relation between inferior vena cava (IVC) diameter, clinical variables, and outcome in patients with chronic heart failure (HF). BACKGROUND The IVC distends as right atrial pressure rises. Therefore it might represent an index of HF severity independent of left ventricular ejection fraction (LVEF). The relation between IVC diameter and other clinical variables and its prognostic significance in patients with HF has not been explored. METHODS Outpatients attending a community HF service between 2008 and 2010 were enrolled. Heart failure was defined as the presence of relevant symptoms and signs and objective evidence of cardiac dysfunction: either LVEF <45% or the combination of both left atrial dilation (≥4 cm) and raised amino-terminal pro-brain natriuretic peptide (NT-proBNP) ≥400 pg/ml. Patients were followed for a median of 567 (interquartile range: 413 to 736) days. The primary composite endpoint was cardiovascular death and HF hospitalization. RESULTS Among the 693 patients enrolled, median age was 73 years, 33% were women, and 568 had HF. Patients with HF in the highest tertile of IVC diameter were older; had lower body mass index; were more likely to have atrial fibrillation and to be treated with diuretics; and had larger left atrial volumes, higher pulmonary pressures, and less negative values for global longitudinal strain. The LVEF and systolic blood pressure were similar across tertiles of IVC diameter. The IVC diameter and log [NT-proBNP] were correlated (r = 0.55, p < 0.001). During follow-up, 158 patients reached a primary endpoint. In a multivariable Cox regression model, including NT-proBNP, only increasing IVC diameter, urea, and the trans-tricuspid systolic gradient independently predicted a poor outcome. Neither global longitudinal strain nor LVEF were adverse predictors. CONCLUSIONS In patients with chronic HF with or without a reduced LVEF, increasing IVC diameter identifies patients with an adverse outcome.
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Affiliation(s)
- Pierpaolo Pellicori
- Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, United Kingdom.
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