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Solela G, Yimer YS. Clinical characteristics, treatment patterns, and outcomes of hospitalized patients with acute heart failure in central Ethiopia: a retrospective observational study. BMC Cardiovasc Disord 2024; 24:241. [PMID: 38773412 PMCID: PMC11110373 DOI: 10.1186/s12872-024-03905-z] [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: 12/02/2023] [Accepted: 04/29/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Acute heart failure is the rapid onset of new or worsening symptoms and signs of heart failure. Despite the increasing burden of heart failure in developing countries like Ethiopia, there is a paucity of comprehensive data regarding the clinical characteristics, treatment patterns, and outcomes of acute heart failure, especially in the selected study area. Therefore, this study aimed to assess the clinical characteristics, treatment patterns, and outcomes of hospitalized patients with acute heart failure at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia. METHODS This is a retrospective cross-sectional study of 303 acute heart failure patients who were admitted to the medical wards and intensive care unit of Yekatit 12 Hospital Medical College, Addis Ababa, central Ethiopia, from July 1, 2022, to July 1, 2023. A pretested data abstraction format was used for data extraction from electronic medical records, and SPSS version 26 was used for data analysis. Descriptive analysis was used to summarize sociodemographic data, clinical characteristics, treatment patterns, and outcomes of acute heart failure. Bivariate and multivariate logistic regression models were fitted to identify factors associated with in-hospital mortality. The odds ratio (OR) with the corresponding 95% confidence interval (CI) was calculated to show the strength of the association. RESULTS Of the 303 patients, 51.5% were females, and the mean age was 56.7 years. The most frequent symptom and sign were dyspnea (98.7%) and peripheral edema (79%), respectively. The commonest underlying cause and precipitating factor of acute heart failure were cor pulmonale (22.8%) and pneumonia (35.3%), respectively. The commonest anti-remodeling medications prescribed on discharge were beta-blockers (47.9%), followed by mineralocorticoid receptor antagonists (42.8%) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (38.6%), and the least prescribed were sodium-glucose cotransporter 2 inhibitors (8.3%). The in-hospital mortality rate was 8.6%, and the median length of hospital stay was 9 days. Based on the multivariate logistic regression analysis, the most important predictors of in-hospital mortality were systolic blood pressure (SBP) < 115 mmHg (adjusted odds ratio [AOR] = 6.28; 95% CI: 1.99, 19.78), chloride level < 96 mg/dL (AOR = 4.88; 95% CI: 1.30, 18.33), blood urea nitrogen (BUN) > 20 mg/dl (AOR = 5.48; 95% CI: 1.47, 20.49), and presence of dyslipidemia (AOR = 3.73, 95% CI: 1.15, 12.07). CONCLUSIONS This study has shown that systolic blood pressure (SBP) < 115 mmHg, blood urea nitrogen (BUN) > 20 mg/dL, chloride (Cl) level < 96 mg/dL, and the presence of dyslipidemia were statistically significant factors associated with in-hospital mortality among patients with acute heart failure. Hence, healthcare providers should stratify patients with acute heart failure upon admission based on their risk of in-hospital mortality and address those potential negative prognostic indicators accordingly.
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Affiliation(s)
- Gashaw Solela
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
| | - Yimer Seid Yimer
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Bass GA, Stephen C, Forssten MP, Bailey JA, Mohseni S, Cao Y, Chreiman K, Duffy C, Seamon MJ, Cannon JW, Martin ND. Admission Triage With Pain, Inspiratory Effort, Cough Score can Predict Critical Care Utilization and Length of Stay in Isolated Chest Wall Injury. J Surg Res 2022; 277:310-318. [DOI: 10.1016/j.jss.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/04/2022] [Accepted: 04/01/2022] [Indexed: 02/02/2023]
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de Los Ángeles Fernández-Rodríguez M, Prieto-García B, Vázquez-Álvarez J, Jacob J, Gil V, Miró O, Llorens P, Martín-Sánchez FJ, Alquézar-Arbé A, Rodríguez-Adrada E, Romero-Pareja R, López-Diez P, Herrero-Puente P. Prognostic implications of Anemia in patients with acute heart failure in emergency departments. ANEM-AHF Study. Int J Clin Pract 2021; 75:e13712. [PMID: 32955782 DOI: 10.1111/ijcp.13712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/22/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The presence of anaemia leads to a worse prognosis in patients with heart failure (HF). There are few data on the impact of anaemia on mortality in patients with acute heart failure (AHF), and the studies available are mainly retrospective, and include hospitalised patients. OBJECTIVE Evaluate the role of anaemia on 30-day and 1-year mortality in patients with AHF attended in hospital emergency departments (HEDs). METHODS We performed a multicentre, observational study of prospective cohorts of patients with AHF. The study variables were: Anaemia (haemoglobin < 12g/dL in women and <13g/dL in men), mortality at 30 days and at 1 year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnoea, chronic and acute treatment, clinical and analytical data of the episode, and patient destination. STATISTICAL ANALYSIS Bivariate analysis and survival analyses using Cox regression. RESULTS A total of 13 454 patients were included, 7662 (56.9%) of whom had anaemia. Those with anaemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment, and more hyponatraemia. The mortality was higher in patients with anaemia at 30 days and 1 year: 7.5% vs 10.7% (P < .001) and 21.2% vs 31.4% (P < .001), respectively. The crude and adjusted hazard ratios of anaemia for 30-day mortality were: 1.46 (confidence interval [CI] 95% 1.30-1.64); P < .001 and 1.20 (CI 95% 1.05-1.38); P = .009, respectively, and 1.57 (CI 95% 1.47-1.68) and 1.30 (CI 95% 1.20-1.40) for mortality at 1 year. The weight of anaemia on mortality was different in each follow-up period. CONCLUSIONS Anaemia is an independent predictor of mortality at 30 days and 1 year in patients with AHF attended in HEDs. It is important to study the aetiology of AHF since adequate treatment would reduce mortality.
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Affiliation(s)
- M de Los Ángeles Fernández-Rodríguez
- Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Spain
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - B Prieto-García
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Área de Gestión Clínica del Laboratorio de Medicina, Hospital Universitario Central de Asturias, Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
| | - J Vázquez-Álvarez
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Jacob
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - V Gil
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - O Miró
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias-Corta Estancia y Hospitalización a domicilio, Hospital General Universitario de Alicante, Alicante, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
| | - E Rodríguez-Adrada
- Servicio de Urgencias, Hospital Rey Juan Carlos de Móstoles, Madrid, Spain
| | - R Romero-Pareja
- Servicio de Urgencias, Hospital Universitario de Getafe, Madrid, Spain
| | - P López-Diez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain
| | - P Herrero-Puente
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
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Alegria S. Acute Hemodynamic Index Predicts In-Hospital Mortality in Acute Decompensated Heart Failure. Arq Bras Cardiol 2021; 116:87-88. [PMID: 33566970 PMCID: PMC8159497 DOI: 10.36660/abc.20201294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sofia Alegria
- Hospital Garcia de Orta EPE - Cardiologia, Almada - Portugal
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Piccirillo G, Moscucci F, Bertani G, Lospinuso I, Mastropietri F, Fabietti M, Sabatino T, Zaccagnini G, Crapanzano D, Di Diego I, Corrao A, Rossi P, Magrì D. Short-Period Temporal Dispersion Repolarization Markers Predict 30-Days Mortality in Decompensated Heart Failure. J Clin Med 2020; 9:E1879. [PMID: 32560151 PMCID: PMC7356287 DOI: 10.3390/jcm9061879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Electrocardiographic (ECG) markers of the temporal dispersion of the myocardial repolarization phase have been shown able to identify chronic heart failure (CHF) patients at high mortality risk. The present prospective single-center study sought to investigate in a well-characterized cohort of decompensated heart failure (HF) patients the ability of short-term myocardial temporal dispersion ECG variables in predicting the 30-day mortality, as well as their relationship with N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) plasmatic values. METHOD One hundred and thirteen subjects (male: 59, 67.8%) with decompensated CHF underwent 5 min of ECG recording, via a mobile phone. We obtained QT end (QTe), QT peak (QTp) and T peak to T end (Te) and calculated the mean, standard deviation (SD), and normalized index (VN). RESULTS Death occurred for 27 subjects (24%) within 30 days after admission. Most of the repolarization indexes (QTe mean (p < 0.05), QTeSD (p < 0.01), QTpSD (p < 0.05), mean Te (p < 0.05), TeSD (p < 0.001) QTeVN (p < 0.05) and TeVN (p < 0.01)) were significantly higher in those CHF patients with the highest NT-proBNP (>75th percentile). In all the ECG data, only TeSD was significantly and positively related to the NT-proBNP levels (r: 0.471; p < 0.001). In the receiver operating characteristic (ROC) analysis, the highest accuracy for 30-day mortality was found for QTeSD (area under curve, AUC: 0.705, p < 0.01) and mean Te (AUC: 0.680, p < 0.01), whereas for the NT-proBNP values higher than the 75th percentile, the highest accuracy was found for TeSD (AUC: 0.736, p < 0.001) and QTeSD (AUC: 0.696, p < 0.01). CONCLUSION Both mean Te and TeSD could be considered as reliable markers of worsening HF and of 30-day mortality. Although larger and possibly interventional studies are needed to confirm our preliminary finding, these non-invasive and transmissible ECG parameters could be helpful in the remote monitoring of advanced HF patients and, possibly, in their clinical management. (ClinicalTrials.gov number, NCT04127162).
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Affiliation(s)
- Gianfranco Piccirillo
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Federica Moscucci
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Gaetano Bertani
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Ilaria Lospinuso
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Fabiola Mastropietri
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Marcella Fabietti
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Teresa Sabatino
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Giulia Zaccagnini
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Davide Crapanzano
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Ilaria Di Diego
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Andrea Corrao
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Pietro Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita, Isola Tiberina, 00186 Rome, Italy;
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy;
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Cameli M, Pastore MC, De Carli G, Henein MY, Mandoli GE, Lisi E, Cameli P, Lunghetti S, D’Ascenzi F, Nannelli C, Rizzo L, Valente S, Mondillo S. ACUTE HF score, a multiparametric prognostic tool for acute heart failure: A real-life study. Int J Cardiol 2019; 296:103-108. [DOI: 10.1016/j.ijcard.2019.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 12/20/2022]
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Owczarek AJ, Smertka M, Jędrusik P, Gębska-Kuczerowska A, Chudek J, Wojnicz R. Computerized Systems Supporting Clinical Decision in Medicine. STUDIES IN LOGIC, GRAMMAR AND RHETORIC 2018; 56:107-120. [DOI: 10.2478/slgr-2018-0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Abstract
Statistics is the science of collection, summarizing, presentation and interpretation of data. Moreover, it yields methods used in the verification of research hypotheses. The presence of a statistician in a research group remarkably improves both the quality of design and research and the optimization of financial resources. Moreover, the involvement of a statistician in a research team helps the physician to effectively utilize the time and energy spent on diagnosing, which is an important aspect in view of limited healthcare resources. Precise, properly designed and implemented Computerized Clinical Decision Support Systems certainly lead to the improvement of healthcare and the quality of medical services, which increases patient satisfaction and reduces financial burdens on healthcare systems.
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Affiliation(s)
- Aleksander J. Owczarek
- Department of Statistics, Department of Instrumental Analysis , School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec , Medical University of Silesia in Katowice , Poland
| | - Mike Smertka
- Pathophysiology Unit, Department of Pathophysiology , School of Medicine in Katowice , Medical University of Silesia in Katowice , Poland
| | - Przemysław Jędrusik
- Department of Computer Biomedical Systems, Institute of Computer Science , University of Silesia , Poland
| | | | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical Faculty in Katowice , Medical University of Silesia in Katowice , Poland
| | - Romuald Wojnicz
- Department of Histology and Embryology , School of Medicine with the Division of Dentistry in Zabrze , Medical University of Silesia in Katowice , Poland
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Abeya FC, Lumori BAE, Akello SJ, Annex BH, Buda AJ, Okello S. Incidence and predictors of 6 months mortality after an acute heart failure event in rural Uganda: The Mbarara Heart Failure Registry (MAHFER). Int J Cardiol 2018; 264:113-117. [PMID: 29655949 PMCID: PMC6743717 DOI: 10.1016/j.ijcard.2018.03.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/11/2018] [Accepted: 03/21/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to estimate the incidence and predictors of all-cause mortality 6 months after heart failure hospitalization in Uganda. METHODS Mbarara Heart Failure Registry is a cohort of patients hospitalized with a clinical diagnosis of heart failure at Mbarara Regional Referral Hospital, Uganda. We measured serum electrolytes, cardiac markers, and echocardiograms. All participants were followed until death or end of 6 months. We used Fine and Gray models to estimate the incidence and predictors all-cause mortality. RESULTS A total of 215 participants were enrolled, 141 (66%) were women, and mean age 53 (standard deviation 22) years. Nineteen (9%) had diabetes, 40 (19%) had HIV, and 119 (55%) had hypertension. The overall incidence of all-cause mortality was 3.58 (95% CI 2.92, 4.38) per 1000 person-days. Men had higher incidence of death compared to women (4.02 vs 3.37 per 1000 person-days). The incidence of all-cause mortality during hospitalization was almost twice that of in the community (27.5 vs 14.77 per 1000 person-days). In adjusted analysis, increasing age, NYHA class IV, decreasing renal function, smoking, each unit increase in serum levels of Potassium, BNP, and Creatine kinase-MB predicted increased incidence of 6 months all-cause death whereas taking beta-blockers and having an index admission on a weekend compared to a week day predicted survival. CONCLUSIONS AND INTERPRETATION There is a high incidence of all-cause mortality occurring in-hospital among patients hospitalized with heart failure in rural Uganda. Heart failure directed therapies should be instituted to curb heart failure-related mortality.
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Affiliation(s)
- Fardous Charles Abeya
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | | | - Suzan Joan Akello
- Department of Educational Foundations and Psychology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian H Annex
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Andrew J Buda
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Samson Okello
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA; Bernard Lown Scholars in Cardiovascular Health Program, Department of Global Health and Populations, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Presenting phenotypes of acute heart failure patients in the ED: Identification and implications. Am J Emerg Med 2017; 35:536-542. [DOI: 10.1016/j.ajem.2016.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/20/2016] [Accepted: 12/06/2016] [Indexed: 01/27/2023] Open
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Jacob J, Miró Ò, Herrero P, Martín-Sánchez F, Gil V, Tost J, Aguirre A, Escoda R, Alquézar A, Andueza J, Llorens P. Predicción de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada: escala EAHFE-3D. Med Intensiva 2016; 40:348-55. [DOI: 10.1016/j.medin.2015.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 02/01/2023]
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Abstract
Heat stroke is a life-threatening condition clinically diagnosed as a severe elevation in body temperature with central nervous system dysfunction that often includes combativeness, delirium, seizures, and coma. Classic heat stroke primarily occurs in immunocompromised individuals during annual heat waves. Exertional heat stroke is observed in young fit individuals performing strenuous physical activity in hot or temperature environments. Long-term consequences of heat stroke are thought to be due to a systemic inflammatory response syndrome. This article provides a comprehensive review of recent advances in the identification of risk factors that predispose to heat stroke, the role of endotoxin and cytokines in mediation of multi-organ damage, the incidence of hypothermia and fever during heat stroke recovery, clinical biomarkers of organ damage severity, and protective cooling strategies. Risk factors include environmental factors, medications, drug use, compromised health status, and genetic conditions. The role of endotoxin and cytokines is discussed in the framework of research conducted over 30 years ago that requires reassessment to more clearly identify the role of these factors in the systemic inflammatory response syndrome. We challenge the notion that hypothalamic damage is responsible for thermoregulatory disturbances during heat stroke recovery and highlight recent advances in our understanding of the regulated nature of these responses. The need for more sensitive clinical biomarkers of organ damage is examined. Conventional and emerging cooling methods are discussed with reference to protection against peripheral organ damage and selective brain cooling.
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Affiliation(s)
- Lisa R Leon
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Abderrezak Bouchama
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Experimental Medicine Department-King Abdulaziz Medical City-Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Abstract
Acute cardiorenal syndrome, also known as cardiorenal syndrome type 1, is defined as an abrupt worsening of cardiac function that occurs in at least 30 % of patients with acute decompensated heart failure and can lead to the development of acute kidney injury. The changes in renal function that occur in this setting have variable prognostic implications, as both poorer and better outcomes have been reported when renal function worsens during treatment of heart failure decompensation. Furthermore, it remains unclear when worsening renal function is actually a manifestation of true acute kidney injury or simply an indicator of hemoconcentration. Given these gaps in the understanding of the significance of renal function changes in the setting of decompensated heart failure, it is not surprising that studies on the effects of available therapies, including diuretics, vasoactive drugs, and mechanical fluid removal have yielded inconsistent results. The purpose of this review is to analyze critically the current knowledge on the pathophysiology, epidemiology, prognosis, and treatment of acute cardiorenal syndrome.
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Cowie MR, Anker SD, Cleland JGF, Felker GM, Filippatos G, Jaarsma T, Jourdain P, Knight E, Massie B, Ponikowski P, López-Sendón J. Improving care for patients with acute heart failure: before, during and after hospitalization. ESC Heart Fail 2015; 1:110-145. [PMID: 28834628 DOI: 10.1002/ehf2.12021] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Acute heart failure (AHF) is a common and serious condition that contributes to about 5% of all emergency hospital admissions in Europe and the USA. Here, we present the recommendations from structured discussions among an author group of AHF experts in 2013. The epidemiology of AHF and current practices in diagnosis, treatment, and long-term care for patients with AHF in Europe and the USA are examined. Available evidence indicates variation in the quality of care across hospitals and regions. Challenges include the need for rapid diagnosis and treatment, the heterogeneity of precipitating factors, and the typical repeated episodes of decompensation requiring admission to hospital for stabilization. In hospital, care should involve input from an expert in AHF and auditing to ensure that guidelines and protocols for treatment are implemented for all patients. A smooth transition to follow-up care is vital. Patient education programmes could have a dramatic effect on improving outcomes. Information technology should allow, where appropriate, patient telemonitoring and sharing of medical records. Where needed, access to end-of-life care and support for all patients, families, and caregivers should form part of a high-quality service. Eight evidence-based consensus policy recommendations are identified by the author group: optimize patient care transitions, improve patient education and support, provide equity of care for all patients, appoint experts to lead AHF care across disciplines, stimulate research into new therapies, develop and implement better measures of care quality, improve end-of-life care, and promote heart failure prevention.
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Affiliation(s)
- Martin R Cowie
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Stefan D Anker
- Charité-University Medical Centre, Campus Virchow-Klinikum, Berlin, Germany
| | - John G F Cleland
- National Heart and Lung Institute, Imperial College London and Harefield Hospital, London, UK.,University of Hull, Hull, UK
| | | | | | - Tiny Jaarsma
- Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Patrick Jourdain
- René Dubos Hospital, Pontoise, France.,Paris Descartes University, Paris, France
| | | | - Barry Massie
- San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | | | - José López-Sendón
- Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
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Nowak RM, Nanayakkara P, DiSomma S, Levy P, Schrijver E, Huyghe R, Autunno A, Sherwin RL, Divine G, Moyer M. Noninvasive hemodynamic monitoring in emergency patients with suspected heart failure, sepsis and stroke: the PREMIUM registry. West J Emerg Med 2014; 15:786-94. [PMID: 25493119 PMCID: PMC4251220 DOI: 10.5811/westjem.2014.8.21357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 08/21/2014] [Indexed: 11/14/2022] Open
Abstract
Introduction Noninvasive hemodynamic (HD) assessments in the emergency department (ED) might assist in the diagnosis, therapeutic plan development and risk stratification of acutely ill patients. This multinational observational study was designed to initiate noninvasive HD measurements prior to any ED patient therapeutic interventions and broadly evaluate them for potential diagnostic, therapeutic and predictive value. Methods We enrolled patients with suspected acute heart failure (AHF), sepsis or stroke. Continuous noninvasive HD monitoring was begun using the Nexfin finger cuff device (Edwards LifeSciences, BMEYE, Amsterdam, Netherlands). Beat-to-beat HD measurements were averaged for the initial 15 minutes, prior to therapeutic intervention. We performed suspected disease group comparisons and evaluated HD predictors of 30-day mortality. Results Of 510 patients enrolled: 185 (36%) AHF, 194 (38%) sepsis and 131 (26%) stroke. HD variables were significantly different (p<0.05) amongst the groups. Cardiac output and index and stroke volume index (SVI) were highest in sepsis (6.5, 3.5, 36), followed by stroke (5.5, 2.7, 35.8), and lowest in AHF (5.4, 2.7, 33.6). The in-group HD standard deviations and ranges measurements were large, indicating heterogeneous underlying HD profiles. Presenting SVI predicted 30-day mortality for all groups. Conclusion Presenting ED noninvasive HD data has not been previously reported in any large patient population. Our data suggest a potential role for early noninvasive HD assessments aiding in diagnosing of patients, individualizing therapy based on each person’s unique HD values and predicting 30-day mortality. Further studies and analyses are needed to determine how HD assessments should be best used in the ED.
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Affiliation(s)
- Richard M Nowak
- Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan
| | - Prabath Nanayakkara
- VU University Medical Center, Department of Emergency Medicine, Amsterdam, Netherlands
| | - Salvatore DiSomma
- Sant' Andrea Hospital, Department of Emergency Medicine, Rome, Italy
| | - Phillip Levy
- Wayne State University, Department of Emergency Medicine and Cardiovascular Research Institute, Detroit, Michigan
| | - Edmée Schrijver
- VU University Medical Center, Department of Emergency Medicine, Amsterdam, Netherlands
| | - Rebecca Huyghe
- Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan
| | | | - Robert L Sherwin
- Wayne State University, Department of Emergency Medicine and Cardiovascular Research Institute, Detroit, Michigan
| | - George Divine
- Henry Ford Health System, Department of Biostatistics, Detroit, Michigan
| | - Michele Moyer
- Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan
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15
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The growth of acute kidney injury: a rising tide or just closer attention to detail? Kidney Int 2014; 87:46-61. [PMID: 25229340 PMCID: PMC4281297 DOI: 10.1038/ki.2014.293] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/21/2014] [Accepted: 01/31/2014] [Indexed: 12/11/2022]
Abstract
Acute kidney injury (AKI), previously termed acute renal failure, is associated with increased mortality, prolonged hospital stay, and accelerated chronic kidney disease (CKD). Over the past 2 decades, dramatic rises in the incidences of AKI have been reported, particularly within the United States. The question arises as to whether these changes reflect actual increases in disease incidence, or are potentially explained by the introduction of consensus definitions that rely on small standardized changes in serum creatinine, changes in coding and reimbursement, or increasingly available and more liberal use of dialysis. In this review, we explore the secular trends in AKI incidence in North America and Western Europe and its potential contributors.
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Ogah OS, Stewart S, Falase AO, Akinyemi JO, Adegbite GD, Alabi AA, Durodola A, Ajani AA, Sliwa K. Short-term outcomes after hospital discharge in patients admitted with heart failure in Abeokuta, Nigeria: data from the Abeokuta Heart Failure Registry. Cardiovasc J Afr 2014; 25:217-23. [PMID: 25210973 PMCID: PMC4241595 DOI: 10.5830/cvja-2014-040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 07/01/2014] [Indexed: 01/20/2023] Open
Abstract
Background Compared to other regions of the world, there is a paucity of data on the short-term outcome of acute heart failure (AHF) in Africa’s most populous country, Nigeria. We examined the six-month outcomes (including case fatalities) in 285 of 309 AHF subjects admitted with HF to a tertiary hospital in Abeokuta, Nigeria. Methods The study cohort of 285 subjects comprised 150 men (52.6%) and 135 women (47.4%) with a mean age of 56.3 ± 15.6 years and the majority in NYHA class III (75%). Results There were a number of differences according to the subject’s gender; men being older and more likely to present with hypertensive heart disease (with greater left ventricular mass) while also having greater systolic dysfunction. Mean length of stay was 10.5 ± 5.9 days. Mean follow up was 205 days, with 23 deaths and 20 lost to follow up. At 30 days, 4.2% (95% CI: 2.4–7.3%) had died and by 180 days this had increased to 7.5% (95% CI: 4.7–11.2%); with those subjects with pericardial disease demonstrating the highest initial mortality rate. Over the same period, 13.9% of the cohort was re-admitted at least once. Conclusions The characteristics of this AHF cohort in Nigeria were different from those reported in high-income countries. Cases were relatively younger and presented with non-ischaemic aetiological risk factors for HF, especially hypertensive heart disease. Moreover, mortality and re-admission rates were relatively lower, suggesting region-specific strategies are required to improve health outcomes.
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Affiliation(s)
- Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Simon Stewart
- NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Ayodele O Falase
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Gali D Adegbite
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
| | - Albert A Alabi
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
| | - Amina Durodola
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Akinlolu A Ajani
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa and IIDMM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
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17
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Ogah OS, Stewart S, Falase AO, Akinyemi JO, Adegbite GD, Alabi AA, Ajani AA, Adesina JO, Durodola A, Sliwa K. Contemporary profile of acute heart failure in Southern Nigeria: data from the Abeokuta Heart Failure Clinical Registry. JACC-HEART FAILURE 2014; 2:250-9. [PMID: 24952692 DOI: 10.1016/j.jchf.2013.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to determine the contemporary profile, clinical characteristics, and intrahospital outcomes of acute heart failure (AHF) in an African urban community. BACKGROUND There are limited data on the current burden and characteristics of AHF in Nigerian Africans. METHODS Comprehensive and detailed clinical and sociodemographic data were prospectively collected from 452 consecutive patients presenting with AHF to the only tertiary hospital in Abeokuta, Nigeria (population about 1 million) over a 2-year period. RESULTS The mean age was 56.6 ± 15.3 years (57.3 ± 13.4 years for men, 55.7 ± 17.1 years for women), and 204 patients (45.1%) were women. Overall, 415 subjects (91.8%) presented with de novo AHF. The most common risk factor for heart failure was hypertension (pre-existing in 64.3% of patients). Type 2 diabetes mellitus was present in 41 patients (10.0%). Hypertensive heart failure was the most common etiological cause of heart failure, responsible for 78.5% of cases. Dilated cardiomyopathy (7.5%), cor pulmonale (4.4%), pericardial disease (3.3%), rheumatic heart disease (2.4%), and ischemic heart disease were less common (0.4%) causes. The majority of subjects (71.2%) presented with left ventricular dysfunction (mean left ventricular ejection fraction 43.9 ± 9.0%), with valvular dysfunction and abnormal left ventricular geometry frequently documented. The mean duration of hospital stay was 11.4 ± 9.1 days, and intrahospital mortality was 3.8%. CONCLUSIONS Compared with those in high-income countries, patients presenting with AHF in Abeokuta, Nigeria, are relatively younger and still of working age. It is also more common in men and associated with severe symptoms because of late presentation. Intrahospital mortality is similar to that in other parts of the world.
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Affiliation(s)
- Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Simon Stewart
- NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Ayodele O Falase
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gail D Adegbite
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokua, Nigeria
| | - Albert A Alabi
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokua, Nigeria
| | - Akinlolu A Ajani
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Julius O Adesina
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Amina Durodola
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Karen Sliwa
- Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hatter Institute for Cardiovascular Research in Africa & IIDMM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Desmoulin F, Galinier M, Trouillet C, Berry M, Delmas C, Turkieh A, Massabuau P, Taegtmeyer H, Smih F, Rouet P. Metabonomics analysis of plasma reveals the lactate to cholesterol ratio as an independent prognostic factor of short-term mortality in acute heart failure. PLoS One 2013; 8:e60737. [PMID: 23573279 PMCID: PMC3616116 DOI: 10.1371/journal.pone.0060737] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 03/01/2013] [Indexed: 11/23/2022] Open
Abstract
Objective Mortality in heart failure (AHF) remains high, especially during the first days of hospitalization. New prognostic biomarkers may help to optimize treatment. The aim of the study was to determine metabolites that have a high prognostic value. Methods We conducted a prospective study on a training cohort of AHF patients (n = 126) admitted in the cardiac intensive care unit and assessed survival at 30 days. Venous plasmas collected at admission were used for 1H NMR–based metabonomics analysis. Differences between plasma metabolite profiles allow determination of discriminating metabolites. A cohort of AHF patients was subsequently constituted (n = 74) to validate the findings. Results Lactate and cholesterol were the major discriminating metabolites predicting 30-day mortality. Mortality was increased in patients with high lactate and low total cholesterol concentrations at admission. Accuracies of lactate, cholesterol concentration and lactate to cholesterol (Lact/Chol) ratio to predict 30-day mortality were evaluated using ROC analysis. The Lact/Chol ratio provided the best accuracy with an AUC of 0.82 (P < 0.0001). The acute physiology and chronic health evaluation (APACHE) II scoring system provided an AUC of 0.76 for predicting 30-day mortality. APACHE II score, Cardiogenic shock (CS) state and Lact/Chol ratio ≥ 0.4 (cutoff value with 82% sensitivity and 64% specificity) were significant independent predictors of 30-day mortality with hazard ratios (HR) of 1.11, 4.77 and 3.59, respectively. In CS patients, the HR of 30-day mortality risk for plasma Lact/Chol ratio ≥ 0.4 was 3.26 compared to a Lact/Chol ratio of < 0.4 (P = 0.018). The predictive power of the Lact/Chol ratio for 30-day mortality outcome was confirmed with the independent validation cohort. Conclusion This study identifies the plasma Lact/Chol ratio as a useful objective and simple parameter to evaluate short term prognostic and could be integrated into quantitative guidance for decision making in heart failure care.
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Affiliation(s)
- Franck Desmoulin
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
| | - Michel Galinier
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
| | - Charlotte Trouillet
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
| | - Matthieu Berry
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
| | - Clément Delmas
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
| | - Annie Turkieh
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
| | - Pierre Massabuau
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
| | - Heinrich Taegtmeyer
- Division of Cardiology, Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, Texas, United States of America
| | - Fatima Smih
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
| | - Philippe Rouet
- INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse, France
- CHU de Rangueil, Service de Cardiologie A, Toulouse, France
- * E-mail:
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Identifying patients at risk of death or hospitalisation due to worsening heart failure using decision tree analysis: evidence from the Trans-European Network-Home-Care Management System (TEN-HMS) study. Int J Cardiol 2011; 163:149-56. [PMID: 21726908 DOI: 10.1016/j.ijcard.2011.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 04/06/2011] [Accepted: 06/03/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To stratify patients recently discharged from hospital with heart failure (HF) according to their risk of death and/or hospitalisation for worsening HF (WHF), to enable timely and appropriate monitoring and intervention. METHODS Data from the TEN-HMS study were used in this analysis. Chi-square automatic interaction detector (CHAID) decision trees were constructed using a 10-fold cross-validation to predict events at 1-year and compared with logistic regression (LR) models using ROC curve analysis. RESULTS 284 patients were used for training and 160 patients available at 4-month for validation. Amino-terminal pro-brain natriuretic peptide (NT-proBNP) was the strongest predictor of mortality identifying groups with high (>13,492 pg/ml), medium (3127-13,492 pg/ml) and low (≤ 3127 pg/ml) risk, followed by MI, systolic blood pressure, age, heart rhythm, study randomisation group and serum sodium. NT-proBNP was also the strongest predictor for death or hospitalization for WHF identifying groups with high (>13,492 pg/ml), medium (584-13,492 pg/ml), and low (≤ 584 pg/ml), followed by MI, creatinine, heart rhythm, potassium and urea. CHAID trees tended to perform better than LR-models (prediction of the composite outcome: ROC area with 95% CI, 0.797 (0.745-0.849) for CHAID and 0.738 (0.680-0.796) for LR-model; p=0.041; prediction of mortality: 0.892 (0.853-0.931) for CHAID and 0.858 (0.813-0.904) for LR; p=0.15). CONCLUSIONS Decision trees are an alternative classification method used to differentiate risk in patients with HF. The resultant models are concise, free of subjective variables and understood easily by clinicians. Further exploration of their potential and validation in other data-sets is justified.
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Miró O, Llorens P, Martín-Sánchez FJ, Herrero P, Pavón J, Pérez-Durá MJ, Bella Alvarez A, Jacob J, González C, González-Armengol JJ, Gil V, Alonso H. Short-term prognostic factors in elderly patients seen in emergency departments for acute heart failure. Rev Esp Cardiol 2009; 62:757-64. [PMID: 19709511 DOI: 10.1016/s1885-5857(09)72356-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND OBJECTIVES To investigate factors associated with short-term mortality in elderly patients seen in emergency departments for an episode of acute heart failure. METHODS A prospective, non-interventional, multicenter, cohort study was carried out in patients aged 65 years and older who were treated in the emergency department of one of eight tertiary hospitals in Spain. Twenty-eight independent variables that could influence mortality at 30 days were assessed. They covered epidemiological and clinical factors and daily functioning. Data were obtained by reviewing medical records or by interviewing the patient or a relative. Multivariate logistic regression analysis was performed. RESULTS The study included 623 patients, 42 of whom (6.7%) died within 30 days of visiting the emergency department. Four variables were significantly associated with higher mortality: functional dependence at baseline (i.e., Barthel index=60; odds ratio [OR]=2.9; 95% confidence interval [CI], 1.2-6.5), New York Heart Association class III-IV (OR=3; 95% CI, 1.3-7), systolic blood pressure <100 mmHg (OR=4.8; 95% CI, 1.6-14.5) and blood sodium <135 mEq/l (OR=4.2; 95% CI, 1.8-9.6). CONCLUSIONS Several factors evaluated on initial assessment in the emergency department, including the level of functional dependence, were found to determine a poor short-term prognosis in elderly patients who present with an episode of acute heart failure.
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Affiliation(s)
- Oscar Miró
- Area de Urgencias, Hospital Clínic, Barcelona, España
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Miró Ò, Llorens P, Javier Martín-Sánchez F, Herrero P, Pavón J, José Pérez-Durá M, Bella Álvarez A, Jacob J, González C, Jorge González-Armengol J, Gil V, Alonso H. Factores pronósticos a corto plazo en los ancianos atendidos en urgencias por insuficiencia cardiaca aguda. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)71689-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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