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Sun H, Wang B, An G, Zhang Y, Ma L. Association of lactate/albumin ratio with 3-month readmission risk in heart failure patients: a retrospective study. ESC Heart Fail 2024; 11:2182-2190. [PMID: 38613427 PMCID: PMC11287303 DOI: 10.1002/ehf2.14788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024] Open
Abstract
AIMS The predictive value of the lactate/albumin ratio (LAR) in mortality is established in various conditions, yet its relevance to 3-month readmission risk in Chinese adults with heart failure (HF) remains unclear. METHOD AND RESULTS Analysing data from 957 patients with HF at Zigong Fourth People's Hospital, Sichuan, China (December 2016 to June 2019), we assessed baseline characteristics, vital signs, comorbidities, and prescriptions. LAR demonstrated a linear correlation with 3-month readmission risk (HR = 1.60, 95% CI: 1.19-2.16). Tertile 3 (≥-0.48) exhibited higher risk than tertile 1 (<-0.83) and tertile 2 [-0.83, -0.48), with HRs and 95% CI of 1.49 (1.06-2.10), 1.43 (1.01-2.02), 1.48 (1.03-2.12), respectively. Subgroup and sensitivity analyses affirmed consistent influence of LAR on 3-month readmission risk for HF. CONCLUSIONS Higher LAR significantly correlates with increased 3-month readmission risk in Chinese adult patients with HF, suggesting LAR is a valuable predictor for early readmission.
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Affiliation(s)
- Hui Sun
- Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical SciencesQilu Hospital of Shandong UniversityJinanChina
- Department of Cardiology, Qilu Hospital (Qingdao)Qilu Hospital of Shandong UniversityQingdaoChina
| | - Baiqiang Wang
- Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical SciencesQilu Hospital of Shandong UniversityJinanChina
| | - Guipeng An
- Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical SciencesQilu Hospital of Shandong UniversityJinanChina
| | - Yun Zhang
- Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical SciencesQilu Hospital of Shandong UniversityJinanChina
| | - Lianyue Ma
- Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical SciencesQilu Hospital of Shandong UniversityJinanChina
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Xanthopoulos A, Katsiadas N, Giamouzis G, Vangelakou K, Balaskas D, Papamichalis M, Bourazana A, Chrysakis N, Kiokas S, Kourek C, Briasoulis A, Skopeliti N, Makaritsis KP, Parissis J, Stefanidis I, Magouliotis D, Athanasiou T, Triposkiadis F, Skoularigis J. Contemporary Use of Sodium Glucose Co-Transporter 2 Inhibitors in Hospitalized Heart Failure Patients: A "Real-World" Experience. J Clin Med 2024; 13:3562. [PMID: 38930091 PMCID: PMC11204975 DOI: 10.3390/jcm13123562] [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: 05/10/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: The aim of this study was to examine the association between in-hospital initiation of sodium glucose co-transporter 2 inhibitors (SGLT2is) and outcomes in hospitalized heart failure (HHF) patients utilizing data from a Greek center. Methods: The present work was a single-center, retrospective, observational study of consecutive HF patients hospitalized in a tertiary center. The study endpoint was all-cause mortality or HF rehospitalization. Univariate and multivariate Cox proportional-hazard models were conducted to investigate the association between SGLT2i administration at discharge and the study endpoint. Results: Sample consisted of 171 patients, 55 of whom (32.2%) received SGLT2is at discharge. Overall, mean follow-up period was 6.1 months (SD = 4.8 months). Patients who received SGLT2is at discharge had a 43% lower probability of the study endpoint compared to those who did not receive SGLT2is at discharge (HR = 0.57; 95% CI: 0.36-0.91; p = 0.018). After adjusting for age, gender, smoking, hemoglobin (Hgb), use of SGLT2is at admission, use of Angiotensin-Converting Enzyme Inhibitors (ACEI-Is)/Angiotensin Receptor Blockers (ARBs) at discharge and Sacubitril/Valsartan at discharge, the aforementioned result remained significant (HR = 0.38; 95% CI: 0.19-0.73; p = 0.004). The 55 patients who received SGLT2is at discharge were propensity score matched with the 116 patients who did not receive SGLT2is at discharge. Receiving SGLT2is at discharge continued to be significantly associated with a lower probability of the study endpoint (HR= 0.43; 95% CI: 0.20-0.89; p = 0.024). Conclusions: Initiation of SGLT2is in HHF patients may be associated with better outcomes.
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Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 41100 Larissa, Greece; (G.G.); (K.V.); (D.B.); (M.P.); (A.B.); (N.C.); (N.S.); (F.T.); (J.S.)
| | - Nikolaos Katsiadas
- Department of Cardiology, Konstantopouleio General Hospital of Athens, 14233 Athens, Greece;
| | - Grigorios Giamouzis
- Department of Cardiology, University Hospital of Larissa, 41100 Larissa, Greece; (G.G.); (K.V.); (D.B.); (M.P.); (A.B.); (N.C.); (N.S.); (F.T.); (J.S.)
| | - Kleoniki Vangelakou
- Department of Cardiology, University Hospital of Larissa, 41100 Larissa, Greece; (G.G.); (K.V.); (D.B.); (M.P.); (A.B.); (N.C.); (N.S.); (F.T.); (J.S.)
| | - Dimitris Balaskas
- Department of Cardiology, University Hospital of Larissa, 41100 Larissa, Greece; (G.G.); (K.V.); (D.B.); (M.P.); (A.B.); (N.C.); (N.S.); (F.T.); (J.S.)
| | - Michail Papamichalis
- Department of Cardiology, University Hospital of Larissa, 41100 Larissa, Greece; (G.G.); (K.V.); (D.B.); (M.P.); (A.B.); (N.C.); (N.S.); (F.T.); (J.S.)
| | - Angeliki Bourazana
- Department of Cardiology, University Hospital of Larissa, 41100 Larissa, Greece; (G.G.); (K.V.); (D.B.); (M.P.); (A.B.); (N.C.); (N.S.); (F.T.); (J.S.)
| | - Nikolaos Chrysakis
- Department of Cardiology, University Hospital of Larissa, 41100 Larissa, Greece; (G.G.); (K.V.); (D.B.); (M.P.); (A.B.); (N.C.); (N.S.); (F.T.); (J.S.)
| | - Sotirios Kiokas
- Department of Cardiology, General Hospital of Larissa, 41221 Larissa, Greece;
| | - Christos Kourek
- Department of Clinical Therapeutic, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (C.K.); (A.B.)
| | - Alexandros Briasoulis
- Department of Clinical Therapeutic, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (C.K.); (A.B.)
| | - Niki Skopeliti
- Department of Cardiology, University Hospital of Larissa, 41100 Larissa, Greece; (G.G.); (K.V.); (D.B.); (M.P.); (A.B.); (N.C.); (N.S.); (F.T.); (J.S.)
| | - Konstantinos P. Makaritsis
- Department of Medicine & Research Laboratory of Internal Medicine, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece;
- National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, 41110 Larissa, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece;
| | - Ioannis Stefanidis
- Department of Nephrology, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece;
| | - Dimitrios Magouliotis
- Department of Cardiothoracic Surgery, University Hospital of Larissa, 41110 Larissa, Greece; (D.M.); (T.A.)
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, University Hospital of Larissa, 41110 Larissa, Greece; (D.M.); (T.A.)
| | - Filippos Triposkiadis
- Department of Cardiology, University Hospital of Larissa, 41100 Larissa, Greece; (G.G.); (K.V.); (D.B.); (M.P.); (A.B.); (N.C.); (N.S.); (F.T.); (J.S.)
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, 41100 Larissa, Greece; (G.G.); (K.V.); (D.B.); (M.P.); (A.B.); (N.C.); (N.S.); (F.T.); (J.S.)
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Nakamaru R, Shiraishi Y, Kohno T, Nagatomo Y, Akiyama H, Motoya Y, Fukui M, Yajima T, Yoshikawa T, Kohsaka S. Treatment patterns and trajectories in patients after acute heart failure hospitalization. ESC Heart Fail 2024; 11:692-701. [PMID: 38098210 DOI: 10.1002/ehf2.14635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/28/2023] [Accepted: 11/28/2023] [Indexed: 03/28/2024] Open
Abstract
AIMS The trajectories of systolic function after admission for acute heart failure (HF) and their effect on clinical outcomes have not been fully elucidated. We aimed to assess changes in left ventricular ejection fraction (LVEF) between the index and 1 year after discharge and to examine their prognostic implications. METHODS AND RESULTS We extracted data from a prospective multicentre registry of patients hospitalized for acute HF and identified 1636 patients with LVEF data at admission and 1 year after discharge. We categorized them into five groups based on LVEF changes: HF with unchanged-preserved EF [HFunc-pEF (EF ≥ 50%); N = 527, 32.2%], unchanged-mildly reduced EF [HFunc-mrEF (EF 41-49%); N = 86, 5.3%], unchanged-reduced EF [HFunc-rEF (EF ≤ 40%); N = 377, 23.0%], worsened EF (HFworEF; N = 83, 5.1%), and improved EF (HFimpEF; N = 563, 34.4%). We then evaluated the subsequent composite outcome of cardiovascular death and HF readmission. During 1 year after discharge, 53% of patients with HF with reduced EF and 67% of those with HF with mildly reduced EF (HFmrEF) transitioned to other categories, whereas 92% of those with HF with preserved EF (HFpEF) remained within the same category. Patients with HFimpEF were more likely to be younger and had relatively preserved renal function, whereas those with HFworEF were the oldest and had more comorbidities among the five groups. After multivariable adjustment, patients with HFimpEF and HFunc-pEF had a lower risk for composite outcomes when referenced to patients with HFunc-rEF [hazard ratio (95% confidence interval), P-value: 0.28 (0.16-0.49), P < 0.001, and 0.40 (0.25-0.63), P < 0.001, respectively]. Conversely, patients with HFunc-mrEF and HFworEF had a comparable risk [0.44 (0.18-1.07), P = 0.07, and 0.63 (0.29-1.39), P = 0.26, respectively]. CONCLUSIONS A substantial number of patients with HF experienced transitions to other categories after discharge. Notably, patients with decreased EF experienced a worse prognosis, even with slight decreases (e.g. HFpEF transitioning to HFmrEF). These findings emphasize the significance of longitudinal assessments of systolic function to better manage patients following acute decompensation.
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Affiliation(s)
- Ryo Nakamaru
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Healthcare Quality Assessment, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa, Japan
| | | | | | | | | | | | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Ohata T, Niimi N, Shiraishi Y, Nakatsu F, Umemura I, Kohno T, Nagatomo Y, Takei M, Ono T, Sakamoto M, Nakano S, Fukuda K, Kohsaka S, Yoshikawa T. Initiation and Up-Titration of Guideline-Based Medications in Hospitalized Acute Heart Failure Patients - A Report From the West Tokyo Heart Failure Registry. Circ J 2023; 88:22-30. [PMID: 37914282 DOI: 10.1253/circj.cj-23-0356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Despite recommendations from clinical practice guidelines to initiate and titrate guideline-directed medical therapy (GDMT) during their hospitalization, patients with acute heart failure (AHF) are frequently undertreated. In this study we aimed to clarify GDMT implementation and titration rates, as well as the long-term outcomes, in hospitalized AHF patients. METHODS AND RESULTS Among 3,164 consecutive hospitalized AHF patients included in a Japanese multicenter registry, 1,400 (44.2%) with ejection fraction ≤40% were analyzed. We assessed GDMT dosage (β-blockers, renin-angiotensin inhibitors, and mineralocorticoid-receptor antagonists) at admission and discharge, examined the contributing factors for up-titration, and evaluated associations between drug initiation/up-titration and 1-year post-discharge all-cause death and rehospitalization for HF via propensity score matching. The mean age of the patients was 71.5 years and 30.7% were female. Overall, 1,051 patients (75.0%) were deemed eligible for GDMT, based on their baseline vital signs, renal function, and electrolyte values. At discharge, only 180 patients (17.1%) received GDMT agents up-titrated to >50% of the maximum titrated dose. Up-titration was associated with a lower risk of 1-year clinical outcomes (adjusted hazard ratio: 0.58, 95% confidence interval: 0.35-0.96). Younger age and higher body mass index were significant predictors of drug up-titration. CONCLUSIONS Significant evidence-practice gaps in the use and dose of GDMT remain. Considering the associated favorable outcomes, further efforts to improve its implementation seem crucial.
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Affiliation(s)
- Takanori Ohata
- Department of Cardiology, Keio University School of Medicine
| | - Nozomi Niimi
- General Internal Medicine, National Hospital Organization Tokyo Medical Center
| | | | | | | | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital
| | - Makoto Takei
- Department of Cardiology, Saiseikai Central Hospital
| | - Tomohiko Ono
- Department of Cardiology, National Hospital Organization Saitama National Hospital
| | - Munehisa Sakamoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
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Nakamaru R, Kohsaka S, Shiraishi Y, Kohno T, Goda A, Nagatomo Y, Kitamura M, Nakano S, Takei M, Mizuno A, Yoshikawa T. Temporal Trends in Heart Failure Management and Outcomes: Insights From a Japanese Multicenter Registry of Tertiary Care Centers. J Am Heart Assoc 2023; 12:e031179. [PMID: 37929712 PMCID: PMC10727373 DOI: 10.1161/jaha.123.031179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
Background The management of heart failure (HF) has markedly changed, due to changes in demographics and the emergence of novel pharmacotherapies. However, detailed analyses on the temporal trends in characteristics and outcomes among patients with HF are scarcely available. This study aimed to assess the temporal trends over 11 years in clinical management and outcomes in patients with HF. Methods and Results We analyzed data from a multicenter registry of hospitalized patients with acute HF, including 6877 patients registered from 2011 to 2021. Age-adjusted mortality was calculated using standardized mortality ratios. During the study period, mean age increased from 75.2 years in 2011 to 2012 to 76.4 years in 2020 to 2021 (P for trend <0.001). The proportion of HF with reduced ejection fraction (HFrEF, left ventricular ejection fraction <40%) remained constant (from 43.4% to 42.7%, P for trend=0.38). The median duration of hospital stays (from 15 to 17 days, P for trend<0.001) had increased. As for the implementation of guideline-directed medical therapy, the use of mineralocorticoid receptor antagonist at discharge increased in patients with HFrEF (from 44.3% to 60.2%, P for trend<0.001). There was also an increase in the use of sodium-glucose cotransporter-2 inhibitors following their approval for use. The age-adjusted 1-year mortality decreased in patients with HFrEF (from 18.0% to 9.3%, P for trend<0.001) but not in patients with non-HFrEF (left ventricular ejection fraction ≥40%; from 9.2% to 9.5%, P for trend=0.79). Conclusions Hospitalized patients with HF have been aging over the past decade. Their long-term outcomes after discharge have improved predominantly because of decreased mortality in patients with HFrEF.
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Affiliation(s)
- Ryo Nakamaru
- Department of CardiologyKeio University School of MedicineTokyoJapan
- Department of Healthcare Quality AssessmentThe University of TokyoJapan
| | - Shun Kohsaka
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | | | - Takashi Kohno
- Department of Cardiovascular MedicineKyorin University Faculty of MedicineTokyoJapan
| | - Ayumi Goda
- Department of Cardiovascular MedicineKyorin University Faculty of MedicineTokyoJapan
| | - Yuji Nagatomo
- Department of CardiologyNational Defense Medical CollegeTokorozawaJapan
| | | | - Shintaro Nakano
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Makoto Takei
- Department of CardiologyTokyo Saiseikai Central HospitalTokyoJapan
| | - Atsushi Mizuno
- Department of CardiologySt Luke’s International HospitalTokyoJapan
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Ichihara YK, Shiraishi Y, Kohsaka S, Nakano S, Nagatomo Y, Ono T, Takei M, Sakamoto M, Mizuno A, Kitamura M, Niimi N, Kohno T, Yoshikawa T. Association of pre-hospital precipitating factors with short- and long-term outcomes of acute heart failure patients: A report from the WET-HF2 registry. Int J Cardiol 2023; 389:131161. [PMID: 37437664 DOI: 10.1016/j.ijcard.2023.131161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Interest in clinical course preceding heart failure (HF) exacerbation has grown, with a greater emphasis placed on patients' clinical factors including precipitant factor (PF). Large-scale studies with precise PF documentation and temporal-outcome variation remain limited. METHODS We reviewed prospectively collected 2412 consecutive patient-level records from a multicenter Japanese registry of hospitalized patients with HF (West Tokyo Heart Failure2 Registry: 2018-2020). Patients were categorized based on PFs: behavioral (i.e., poor adherence to physical activity, medicine, or diet regimen), treatment-required (i.e., anemia, arrhythmia, ischemia, infection, thyroid dysfunction or other conditions as suggested exacerbating factors), and no-PF. The composite outcomes of HF rehospitalization and death within 1 year after discharge and HF rehospitalization were individually assessed. RESULTS Median patient age was 78 years (interquartile range: 68-85 years), and 1468 (61%) patients had documented PFs, of which 356 (15%) were considered behavioral. The behavioral PF group were younger, more male and had past HF hospitalization history compared to those in the other groups (all p < 0.05). Although risk of in-hospital death was lower in the behavioral PF group, their risk of composite outcome was not significantly different from the treatment-required group (hazard ratio [HR] 1.19 [95% confidence interval {CI} 0.93-1.51]) and the no-PF group (HR 1.28 [95%CI 1.00-1.64]). Furthermore, the risk of HF rehospitalization was higher in the behavioral PF group than in the other two groups (HR 1.40 [95%CI 1.07-1.83] and HR 1.39 [95%CI 1.06-1.83], respectively). CONCLUSION Despite a better in-hospital prognosis, patients with behavioral PFs were at significantly higher risk of HF rehospitalization.
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Affiliation(s)
- Yumiko Kawakubo Ichihara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Tomohiko Ono
- Department of Cardiology, National Hospital Organization Saitama National Hospital, Saitama, Japan
| | - Makoto Takei
- Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Munehisa Sakamoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | | | - Nozomi Niimi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
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7
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CHEN Y, YIN M, FAN L, JIANG X, ZHANG T, ZHU X, XU H. Mirror-like tongue is an important predictor of acute heart failure: a cohort study of acute heart failure in Chinese patients. J TRADIT CHIN MED 2023; 43:1243-1251. [PMID: 37946487 PMCID: PMC10623249 DOI: 10.19852/j.cnki.jtcm.20230904.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/14/2022] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To reveal that mirror-like tongue, observed via a noninvasive inspection, is a powerful indicator of the severity and prognosis of patients with acute heart failure (AHF). METHODS This was an observational, prospective study. A total of 408 patients who met the inclusion criteria and were diagnosed with AHF for the first time at Taicang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from August 2019 to January 2021 were selected as the research subjects. According to their tongue fur, the patients were divided into group A (mirror-like tongue group) and group B (non-mirror-like tongue group). The clinical characteristics and incidence of major adverse cardiovascular events (MACEs) within 1 year of follow-up were systematically compared between the two groups. RESULTS Sixty-five patients were included in group A, and 343 patients were included in group B. There were 32 males and 33 females in group A and 168 males and 175 females in group B. The average age of the overall population was 64 years old, and the average age of group A was significantly higher than that of group B (74 vs 62 years, P < 0.001). Compared with that in group B, the left ventricular ejection fraction (LVEF) in group A was significantly lower (35% vs 42%, P < 0.001), and the log N-terminal pro B-type natriuretic peptide (NT-proBNP) level was significantly higher (4.0 vs 3.4, P < 0.001). The proportion of the combined application of vasoactive drugs in group A was significantly higher than that in group B (64% vs 38%, P < 0.001). Group B had a higher proportion of coronary angiography (29.5% vs 16.9%, P = 0.038). Group A was more inclined to require mechanical ventilation than group B (33.9% vs 22.5%, P = 0.049). The length of hospital stay in group A was significantly longer than that in group B (13.1 vs 7.6, P < 0.001). The incidence of MACEs, such as recurrence of AHF, new myocardial infarction and stroke, in group A within one year was higher than that in group B (P = 0.007, 0.009, < 0.001). The incidence of cumulative MACEs in group A was significantly higher than that in group B [hazard ratio = 2.76, 95% confidence interval (1.73, 4.41), P < 0.001]. Univariate and multivariate Cox regression analyses showed that mirror-like tongue, age, length of stay, LVEF and log NT-proBNP were independent predictors of MACEs in patients with AHF within one year. CONCLUSIONS Noninvasive tongue inspection technology can be used as a powerful tool for assessing the severity of illness and predicting prognosis in patients with AHF. A mirror-like tongue is an independent risk factor for MACEs in patients with AHF during the first year and has a combination effect with age, length of hospital stay, ejection fraction and NT-proBNP on the occurrence of MACEs.
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Affiliation(s)
- Yunhu CHEN
- 1 Department of Cardiology, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215400, China
| | - Moqing YIN
- 1 Department of Cardiology, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215400, China
| | - Lihua FAN
- 1 Department of Cardiology, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215400, China
| | - Xuechun JIANG
- 1 Department of Cardiology, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215400, China
| | - Tao ZHANG
- 2 Department of Cardiology, Changzhou Hospital affiliated with Nanjing University of Chinese Medicine, Changzhou 213003, China
| | - Xingyu ZHU
- 3 Department of Clinical Pharmacy, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215400, China
| | - Hongfeng XU
- 1 Department of Cardiology, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215400, China
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8
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Ono M, Mizuno A, Kohsaka S, Shiraishi Y, Kohno T, Nagatomo Y, Goda A, Nakano S, Komiyama N, Yoshikawa T. Geriatric Nutritional Risk Index at Hospital Admission or Discharge in Patients with Acute Decompensated Heart Failure. J Clin Med 2023; 12:jcm12051891. [PMID: 36902677 PMCID: PMC10003647 DOI: 10.3390/jcm12051891] [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: 12/18/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
Geriatric Nutritional Risk Index (GNRI) is known both as a reliable indicator of nutritional status and a predictor of long-term survival among patients with acute decompensated heart failure (ADHF). However, the optimal timing to evaluate GNRI during hospitalization remains unclear. In the present study, we retrospectively analyzed patients hospitalized with ADHF in the West Tokyo Heart Failure (WET-HF) registry. GNRI was assessed at hospital admission (a-GNRI) and discharge (d-GNRI). Out of 1474 patients included in the present study, 568 (40.1%) and 796 (57.2%) patients had lower GNRI (<92) at hospital admission and discharge, respectively. After the follow-up (median 616 days), 290 patients died. The multivariable analysis showed that all-cause mortality was independently associated with d-GNRI (per 1 unit decrease, adjusted hazard ratio [aHR]: 1.06, 95% confidence interval [CI]: 1.04-1.09, p < 0.001), but not with a-GNRI (aHR: 0.99, 95% CI: 0.97-1.01, p = 0.341). The predictability of GNRI for long-term survival was more pronounced when evaluated at hospital discharge than at hospital admission (area under the curve 0.699 vs. 0.629, DeLong's test p < 0.001). Our study suggested that GNRI should be evaluated at hospital discharge, regardless of the assessment at hospital admission, to predict the long-term prognosis for patients hospitalized with ADHF.
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Affiliation(s)
- Masafumi Ono
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan
- Correspondence:
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo 108-8345, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo 108-8345, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Shintaro Nakano
- Department of Cardiology, International Medical Center, Saitama Medical University, Saitama 350-1298, Japan
| | - Nobuyuki Komiyama
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Tsutomu Yoshikawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan
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9
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Shiraishi Y, Kurita Y, Matsukawa M, Mori H. Real-World Intravenous Diuretic Use to Treat Congestion in Patients With Heart Failure - An Observational Study Using a Research Database. Circ Rep 2023; 5:27-37. [PMID: 36818522 PMCID: PMC9908529 DOI: 10.1253/circrep.cr-22-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/16/2022] [Accepted: 12/25/2022] [Indexed: 01/19/2023] Open
Abstract
Background: Intravenous (IV) diuretics are key in the treatment of acute heart failure, but the time of administration can affect outcomes. Using a medical database, we assessed the real-world usage and clinical impact of IV diuretics after admission. Methods and Results: This observational study included hospitalized patients with heart failure who received IV diuretics. Relationships between IV diuretic use and clinical outcomes (duration of hospitalization, in-hospital mortality, readmission) were evaluated using analysis of variance or logistic regression. Overall, 9,653 patients (51.1% male) were assessed (mean age 80.9 years). Most (89.1%) patients had IV loop diuretic treatment initiated on Day 1 of hospitalization and 68.0% achieved the maximum dose on that day. The median duration of hospitalization was 17.0 days. In-hospital mortality was 9.2%; 13.7% of patients were readmitted within 3 months after discharge. There were prognostic relationships between IV diuretic usage and both duration of hospitalization and in-hospital mortality. On multivariable analysis, the time of maximum dose had the biggest impact on outcomes. Duration of hospitalization was prolonged and in-hospital mortality rates increased when the time of maximum dose was delayed. There was little correlation between IV diuretic use and readmission following discharge. Conclusions: Short-term outcomes (duration of hospitalization, in-hospital mortality) correlated with the time of maximum IV diuretic dose; thus, early initiation and subsequent modification of appropriate congestion treatment is critical for prognostic improvement.
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Affiliation(s)
| | - Yuka Kurita
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd.TokyoJapan
| | | | - Hiromasa Mori
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd.TokyoJapan
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10
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Nakamaru R, Shiraishi Y, Niimi N, Kohno T, Nagatomo Y, Takei M, Ikoma T, Nishikawa K, Sakamoto M, Nakano S, Kohsaka S, Yoshikawa T. Phenotyping of Elderly Patients With Heart Failure Focused on Noncardiac Conditions: A Latent Class Analysis From a Multicenter Registry of Patients Hospitalized With Heart Failure. J Am Heart Assoc 2023; 12:e027689. [PMID: 36695300 PMCID: PMC9973643 DOI: 10.1161/jaha.122.027689] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Abstract
Background The burden of noncardiovascular conditions is becoming increasingly prevalent in patients with heart failure (HF). We aimed to identify novel phenogroups incorporating noncardiovascular conditions to facilitate understanding and risk stratification in elderly patients with HF. Methods and Results Data from a total of 1881 (61.2%) patients aged ≥65 years were extracted from a prospective multicenter registry of patients hospitalized for acute HF (N=3072). We constructed subgroups of patients with HF with preserved ejection fraction (HFpEF; N=826, 43.9%) and those with non-HFpEF (N=1055, 56.1%). Latent class analysis was performed in each subgroup using 17 variables focused on noncardiovascular conditions (including comorbidities, Clinical Frailty Scale, and Geriatric Nutritional Risk Index). The latent class analysis revealed 3 distinct clinical phenogroups in both HFpEF and non-HFpEF subgroups: (1) robust physical and nutritional status (Group 1: HFpEF, 41.2%; non-HFpEF, 46.0%); (2) multimorbid patients with renal impairment (Group 2: HFpEF, 40.8%; non-HFpEF, 41.9%); and (3) malnourished patients (Group 3: HFpEF, 18.0%; non-HFpEF, 12.1%). After multivariable adjustment, compared with Group 1, patients in Groups 2 and 3 had a higher risk for all-cause death over the 1-year postdischarge period (hazard ratio [HR], 2.79 [95% CI, 1.64-4.81] and HR, 2.73 [95% CI, 1.39-5.35] in HFpEF; HR, 1.96 [95% CI, 1.22-3.14] and HR, 2.97 [95% CI, 1.64-5.38] in non-HFpEF; respectively). Conclusions In elderly patients with HF, the phenomapping focused on incorporating noncardiovascular conditions identified 3 phenogroups, each representing distinct clinical outcomes, and the discrimination pattern was similar for both patients with HFpEF and non-HFpEF. This classification provides novel risk stratification and may aid in clinical decision making.
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Affiliation(s)
- Ryo Nakamaru
- Department of CardiologyKeio University School of MedicineTokyoJapan
- Department of Healthcare Quality AssessmentThe University of TokyoTokyoJapan
| | | | - Nozomi Niimi
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Takashi Kohno
- Department of Cardiovascular MedicineKyorin University Faculty of MedicineTokyoJapan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical CollegeTokorozawaJapan
| | - Makoto Takei
- Department of CardiologySaiseikai Central HospitalTokyoJapan
| | - Takenori Ikoma
- Division of Cardiology, Internal Medicine IIIHamamatsu University School of MedicineHamamatsuJapan
| | - Kei Nishikawa
- Department of CardiologySakakibara Heart InstituteTokyoJapan
| | - Munehisa Sakamoto
- Department of CardiologyNational Hospital Organization Tokyo Medical CenterTokyoJapan
| | - Shintaro Nakano
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Shun Kohsaka
- Department of CardiologyKeio University School of MedicineTokyoJapan
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11
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Chen YH, Yin MQ, Fan LH, Jiang XC, Xu HF, Zhang T, Zhu XY. Bibliometric analysis of traditional Chinese medicine research on heart failure in the 21st century based on the WOS database. Heliyon 2023; 9:e12770. [PMID: 36691539 PMCID: PMC9860440 DOI: 10.1016/j.heliyon.2022.e12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/28/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Heart Failure (HF) is a key area of research in human medicine, and traditional Chinese medicine (TCM) is an important branch of this field. This study aimed to use bibliometric methods to sort out the trajectory of TCM research on HF in this century (2000-2022) from a high dimension and to analyze its characteristics, hotspots and frontiers. Methods In this study, the search formula "TS=(("traditional Chinese medicine") OR ("Chinese medicine")) AND TS=("heart failure")" was used to find relevant studies included in the Web of Science Core Collection from 2000 to 2022. Targeted literature records were analyzed and mapped using CiteSpace and VOSviewer. Results The authors and collaborators of this study were still in the formation process, but several well-known scholars were included: YONG WANG, WEI WANG, etc. The main research institutions in this research area were Beijing Univ Chinese Med, China Acad Chinese Med Sc, etc. The main country of study was China. Current research hotspots and frontiers were Qili Qiangxin capsules, extracts (Tanshinone ⅡA, Panax ginseng, etc.), cardiac hypertrophy, ventricular remodeling, oxidative stress, signaling pathways, network pharmacology, etc. Influential journals that publish papers in this field were the Journal of Ethnopharmacology, Scientific Reports, Biomedicine & Pharmacotherapy, etc. The top 3 co-cited journals were Circulation, J ethnopharmacol, and J am coll cardiol. Conclusions We analyzed valuable details in TCM research on HF in the 21st century, which may help researchers identify potential collaborators and partner institutions, hotspots, and frontiers in the field.
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Affiliation(s)
- Yun-Hu Chen
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, 215400, China,Corresponding author.
| | - Mo-Qing Yin
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, 215400, China
| | - Li-Hua Fan
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, 215400, China,Corresponding author.
| | - Xue-Chun Jiang
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, 215400, China
| | - Hong-Feng Xu
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, 215400, China
| | - Tao Zhang
- Cardiovascular Department, Changzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, 213003, China
| | - Xing-Yu Zhu
- Department of Clinical Pharmacy, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China
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12
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Gu F, Wu H, Jin X, Kong C, Zhao W. Association of red cell distribution width with the risk of 3-month readmission in patients with heart failure: A retrospective cohort study. Front Cardiovasc Med 2023; 10:1123905. [PMID: 36960473 PMCID: PMC10028279 DOI: 10.3389/fcvm.2023.1123905] [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: 12/14/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023] Open
Abstract
Background In recent years, red cell distribution width (RDW) has been found to be associated with the prognosis of patients with heart failure (HF) in Western countries. However, evidence from Asia is limited. We aimed to investigate the relationship between RDW and the risk of 3-month readmission in hospitalized Chinese HF patients. Methods We retrospectively analyzed HF data from the Fourth Hospital of Zigong, Sichuan, China, involving 1,978 patients admitted for HF between December 2016 and June 2019. The independent variable in our study was RDW, and the endpoint was the risk of readmission within 3 months. This study mainly used a multivariable Cox proportional hazards regression analysis. Smoothed curve fitting was then used to assess the dose-response relationship between RDW and the risk of 3-month readmission. Results In the original cohort of 1,978 patients with HF (42% male and 73.1% aged ≥70 years), 495 patients (25.0%) were readmitted within 3 months after discharge. Smoothed curve fitting showed a linear correlation between RDW and the risk of readmission within 3 months. In the multivariable-adjusted model, every 1% increase in RDW was associated with a 9% increased risk of readmission within 3 months (hazard ratio = 1.09, 95% confidence interval: 1.00-1.15; P < 0.005). Conclusions A higher RDW value was significantly associated with a greater risk of 3-months readmission in hospitalized patients with HF.
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Affiliation(s)
- Fang Gu
- Center for Reproductive Medicine, Department of Pediatrics, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Han Wu
- Department of Clinical Laboratory Medicine, Sir Run Run Shaw Hospital Xiasha Campus, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoli Jin
- Center for Reproductive Medicine, Department of Pediatrics, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Cheng Kong
- Department of Neurosurgery, People’s Hospital of Pan’an County, Jinhua, China
- Correspondence: Wenyan Zhao Cheng Kong
| | - Wenyan Zhao
- Center for General Practice Medicine, Department of General Practice Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
- Correspondence: Wenyan Zhao Cheng Kong
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13
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Low blood pressure and guideline-directed medical therapy in patients with heart failure with reduced ejection fraction. Int J Cardiol 2023; 370:255-262. [PMID: 36270494 DOI: 10.1016/j.ijcard.2022.10.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/23/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with heart failure (HF) presenting with low blood pressure (BP) have been underrepresented in large-scale clinical trials. We investigated the characteristics and implementation of conventional guideline-directed medical therapy (GDMT; renin-angiotensin system inhibitors and β-blockers) in patients with low BP hospitalized for HF with systolic dysfunction. METHODS Conventional GDMT was evaluated by discharge BP among 2043 consecutive patients with HF and left ventricular ejection fraction (LVEF) < 50% in the WET-HF registry. Among the 708 (34.7%) patients with lower discharge BP (≤ 100 mmHg; the lower tertiles), exploratory subgroups included patients with previous HF hospitalization, inotrope use, New York Heart Association (NYHA) III-IV class, and lower estimated glomerular filtration rate (eGFR) and LVEF (lower than median value). We evaluated the risk-adjusted association between GDMT implementation and 2-year adverse events (all-cause mortality or HF rehospitalization). RESULTS Among the 2043 patients (age 74 [63-82] years), the median systolic BP was 108 (98-120) mmHg. Among patients with lower BP, GDMT prescription rate was 62.7%, and GDMT use was associated with decreased adverse events (HR:0.74, 95%CI:0.58-0.94). GDMT prescription rates were lower among higher-NYHA class and lower-eGFR subgroups compared with their reference subgroups, and directionally similar outcomes were noted in all subgroups (favoring GDMT use); however, this association was somewhat attenuated in the lower-eGFR group (HR:0.87, 95%CI:0.64-1.17). CONCLUSIONS Conventional GDMT use was associated with decreased adverse outcomes in most patients with HF compounded by systolic dysfunction and low BP, albeit caution is warranted in patients with renal dysfunction.
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14
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Hashimoto S, Kitakata H, Kohsaka S, Fujisawa D, Shiraishi Y, Nakano N, Sekine O, Kishino Y, Katsumata Y, Yuasa S, Fukuda K, Kohno T. Confidence in self-care after heart failure hospitalization. J Cardiol 2023; 81:42-48. [PMID: 36241046 DOI: 10.1016/j.jjcc.2022.10.001] [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] [Received: 06/02/2022] [Revised: 09/02/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Understanding patient perspectives of self-care is critical for improving multidisciplinary education programs and adherence to such programs. However, perspectives of self-care for patients with heart failure (HF) as well as the association between patient perspectives and patient-physician communication remain unclear. METHODS Confidence levels regarding self-care behaviors (eight lifestyle behaviors and four consulting behaviors) and self-monitoring were assessed using a self-administered questionnaire survey, which was directly distributed by dedicated physicians and nurses to consecutive patients hospitalized with HF in a tertiary-level hospital. Patient-physician communication was evaluated according to the quality of physician-provided information regarding "treatment and treatment choices" and "prognosis" using the Prognosis and Treatment Perception Questionnaire. Out of 202 patients, 187 (92.6 %) agreed to participate, and 176 completed the survey [valid response rate, 87.1 %; male, 67.0 %; median age, 73 (63-81) years]. Multivariate logistic regression analyses were conducted to predict low confidence in self-care (score in the lowest quartile). RESULTS High confidence (confident or completely confident >75 % of patients) was observed for all self-care behavior categories except low-salt diet (63.1 %), regular exercise (63.1 %), and flu vaccination (65.9 %). Lower confidence in self-care behavior was associated with low quality of patient-physician communication. With regard to self-monitoring, 62.5 % of patients were not confident in distinguishing worsening symptoms of HF from other diseases; non-confidence was also associated with low quality of patient-physician communication. CONCLUSIONS Hospitalized patients with HF had low confidence regarding regular exercise, salt restriction, and flu vaccination. The results also suggest patient-physician communication affects patient confidence.
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Affiliation(s)
- Shun Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Kitakata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Naomi Nakano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Otoya Sekine
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshikazu Kishino
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan.
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15
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Nakamaru R, Shiraishi Y, Sandhu AT, Heidenreich PA, Shoji S, Kohno T, Takei M, Nagatomo Y, Nakano S, Kohsaka S, Yoshikawa T. Cardiovascular vs. non-cardiovascular deaths after heart failure hospitalization in young, older, and very old patients. ESC Heart Fail 2022; 10:673-684. [PMID: 36436825 PMCID: PMC9871708 DOI: 10.1002/ehf2.14245] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS The long-term outcome in patients with heart failure (HF) after hospitalization may vary substantially depending on their age and left ventricular ejection fraction (LVEF). We aimed to assess the relative rates of cardiovascular death (CVD) and non-CVD based on the age and how the rates differ under the updated LVEF classification system. METHODS AND RESULTS Consecutively registered hospitalized patients with HF (N = 3558; 39.7% women with a mean age of 73.9 ± 13.3 years) were followed for a median of 2 (interquartile range, 0.8-3.1) years. The CVDs and non-CVDs were evaluated based on age [young (<65 years), older (65-84 years), and very old (≥85 years)] and LVEF classification [HF with preserved EF (HFpEF; LVEF ≥50%) and non-HFpEF (LVEF <50%)]. The adverse clinical events were adjudicated independently by a central committee. Overall, 1505 (42.3%) had HFpEF [young: n = 182 (12.1%), older: n = 894 (59.4%), very old: n = 429 (28.5%)], and 2053 (57.7%) had non-HFpEF [young: n = 575 (28.0%), older: n = 1159 (56.5%), very old: n = 319 (15.5%)]. During the follow-up, the crude incidence of all-cause death was higher in non-HFpEF than in HFpEF across all age groups (non-HFpEF vs. HFpEF, young: 10.4% vs. 5.5%, log-rank P = 0.10; older: 26.6% vs. 20.9%, log-rank P = 0.002; very old: 36.7% vs. 31.7%, log-rank P = 0.043). CVDs accounted for more than half of all deaths in non-HFpEF (young 65.0%, older 64.2%, and very old 55.6%), whereas the proportion of CVDs remained less than half in HFpEF (young 50.0%, older 41.2%, very old 38.2%). HF readmission was associated with subsequent all-cause death in non-HFpEF [hazard ratio (HR): 1.72, 95% confidence interval (CI): 1.41-2.09, P < 0.001], but not in HFpEF (HR: 1.12, 95% CI: 0.87-1.43, P = 0.39). CONCLUSIONS The probability of a non-CVD increases in both LVEF categories with advancing age, but that it is greater in the HFpEF category. The findings indicate that mitigating CV-related outcomes alone may be insufficient for treating HF in older population, particularly in the HFpEF category.
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Affiliation(s)
- Ryo Nakamaru
- Department of CardiologyKeio University School of MedicineTokyoJapan,Department of Healthcare Quality AssessmentThe University of TokyoTokyoJapan
| | | | - Alexander T. Sandhu
- Division of Cardiology, Department of MedicineStanford UniversityStanfordCAUSA
| | - Paul A. Heidenreich
- Division of Cardiology, Department of MedicineStanford UniversityStanfordCAUSA
| | - Satoshi Shoji
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Takashi Kohno
- Department of Cardiovascular MedicineKyorin University Faculty of MedicineTokyoJapan
| | - Makoto Takei
- Department of CardiologySaiseikai Central HospitalTokyoJapan
| | - Yuji Nagatomo
- Department of CardiologyNational Defense Medical CollegeTokorozawaJapan
| | - Shintaro Nakano
- Department of CardiologySaitama Medical University, International Medical CenterSaitamaJapan
| | - Shun Kohsaka
- Department of CardiologyKeio University School of MedicineTokyoJapan
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16
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Valika A, Sulemanjee N, Pedersen R, Heidenreich D. Reduction in 90 day readmission rates utilizing ambulatory pulmonary pressure monitoring. ESC Heart Fail 2022; 10:685-690. [PMID: 36436826 PMCID: PMC9871649 DOI: 10.1002/ehf2.14253] [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: 08/26/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS In the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association Functional Class III Heart Failure Patients) trial, heart failure hospitalization (HFH) rates were lower in patients with ambulatory pulmonary artery pressure (PAP) monitoring guidance. We investigated the effect of ambulatory haemodynamic monitoring on 90 day readmission rates after HFH. METHODS AND RESULTS We retrospectively analysed patients across the Advocate Aurora Health hospital network who had undergone PAP sensor implantation between 1 October 2015 and 31 October 2019. Patients with a ventricular assist device (VAD) or transplant prior to implantation were excluded. Rates of total HFH and 30 and 90 day all-cause readmission up to 12 months after implantation were collected, while censoring for an endpoint of heart transplantation, VAD, or death. Event rates were compared using Poisson regression. Of 459 patients included, there were 404 HFHs before and 179 after implantation. Compared with pre-implantation, 30 day all-cause readmission [incidence rate ratio (IRR): 0.55 (0.39-0.77), P = 0.0006] and 90 day all cause readmission rates were lower post-implantation [IRR: 0.45 (0.35-0.58), P < 0.0001]. The effect of PAP sensor implantation on 90 day all-cause readmission incidence rates was consistent across multiple subgroups. CONCLUSIONS Across a large hospital network, ambulatory haemodynamic monitoring was associated with lower HFH rates, as well as 30 and 90 day all-cause readmission rates. This supports the utility of ambulatory PAP monitoring to improve HF management in the era of value-based medicine.
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Affiliation(s)
- Ali Valika
- Advocate Heart InstituteAdvocate Good Samaritan Hospital, Advocate Aurora HealthTower 2, 3825 Highland Ave., Ste 400Downers GroveIL60515USA
| | - Nasir Sulemanjee
- Aurora Cardiovascular and Thoracic ServicesAurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health2801 W. Kinnickinnic River Parkway, Ste. 880MilwaukeeWI53215USA
| | - Rachel Pedersen
- Aurora Cardiovascular and Thoracic ServicesAurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health2801 W. Kinnickinnic River Parkway, Ste. 880MilwaukeeWI53215USA
| | - Debra Heidenreich
- Advocate Heart InstituteAdvocate Good Samaritan Hospital, Advocate Aurora HealthTower 2, 3825 Highland Ave., Ste 400Downers GroveIL60515USA
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17
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Kitakata H, Kohno T, Kohsaka S, Fujisawa D, Nakano N, Sekine O, Shiraishi Y, Kishino Y, Katsumata Y, Yuasa S, Fukuda K. Social Isolation and Implementation of Advanced Care Planning Among Hospitalized Patients With Heart Failure. J Am Heart Assoc 2022; 11:e026645. [DOI: 10.1161/jaha.122.026645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
The implementation of advance care planning (ACP) in heart failure management is insufficient. Social isolation (SI) could be a barrier to ACP initiation, albeit the relationship between SI and patients' preference for ACP or end‐of‐life care remains unknown.
Methods and Results
We conducted a questionnaire survey, including assessments of SI using the 6‐item Lubben Social Network Scale as well as patients' perspectives on ACP and end‐of‐life care. Of the 160 patients approached by our multidisciplinary heart failure team during admission, 120 patients (75.0%) completed the survey (median age, 73.0 years; men, 74.2%). A Cox proportional hazard model was constructed to elucidate the short‐term (180‐day) prognostic impact of SI. Overall, 28.3% of participants were at high risk for SI (6‐item Lubben Social Network Scale score <12). High‐risk patients had more negative attitudes toward ACP than those without (61.8% versus 80.2%;
P
=0.035). The actual performance of ACP conversation in patients with and without high risk were 20.6% and 30.2%, respectively. Regarding preference in end‐of‐life care, “Saying what one wants to tell loved ones” (73.5% versus 90.6%;
P
=0.016) and “Spending enough time with family” (58.8% versus 77.9%;
P
=0.035) were less important in high‐risk patients. High risk for SI was associated with higher 180‐day risk‐adjusted all‐cause mortality (hazard ratio, 7.89 [95% CI, 1.53–40.75]).
Conclusions
In hospitalized patients with heart failure, high risk for SI was frequently observed. High‐risk patients were associated with a negative attitude toward ACP, despite higher mortality. Further research is required to establish an ideal approach to provide ACP in socially vulnerable patients.
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Affiliation(s)
- Hiroki Kitakata
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Takashi Kohno
- Department of Cardiology Keio University School of Medicine Tokyo Japan
- Department of Cardiovascular Medicine Kyorin University Faculty of Medicine Tokyo Japan
| | - Shun Kohsaka
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry Keio University School of Medicine Tokyo Japan
| | - Naomi Nakano
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Otoya Sekine
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | | | - Yoshikazu Kishino
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | | | - Shinsuke Yuasa
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Keiichi Fukuda
- Department of Cardiology Keio University School of Medicine Tokyo Japan
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Oh GC, An S, Lee H, Cho H, Jeon E, Lee SE, Kim J, Kang S, Hwang K, Cho M, Chae SC, Choi D, Yoo B, Kim KH, Park SK, Baek SH. Modified reverse shock index predicts early outcomes of heart failure with reduced ejection fraction. ESC Heart Fail 2022; 9:3232-3240. [PMID: 35775109 PMCID: PMC9715832 DOI: 10.1002/ehf2.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/16/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Increased blood pressure (BP) and decreased heart rate (HR) are signs of stabilization in patients admitted for acute HF. Changes in BP and HR during admission and their correlation with outcomes were assessed in hospitalized patients with heart failure (HF) with reduced ejection fraction (HFrEF). METHODS A novel modified reverse shock index (mRSI), defined as the ratio between changes in systolic BP and HR during admission, was devised, and its prognostic value in the early outcomes of acute HF was assessed using the Korean Acute HF registry. RESULTS Among 2697 patients with HFrEF (mean age 65.8 ± 14.9 years, 60.6% males), patients with mRSI ≥1.25 at discharge were significantly younger and were more likely to have de novo HF. An mRSI ≥1.25 was associated with a significantly lower incidence of 60-day and 180-day all-cause mortality [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.31-0.77; HR 0.62, 95% CI 0.45-0.85, respectively], compared with 1 ≤ mRSI < 1.25 (all P < 0.001). Conversely, an mRSI <0.75 was associated with a significantly higher incidence of 60-day and 180-day all-cause mortality (adjusted HR 2.08, 95% CI 1.19-3.62; HR 2.24, 95% CI 1.53-3.27; all P < 0.001). The benefit associated with mRSI ≥1.25 was consistent in sub-group analyses. The correlation of mRSI and outcomes were also consistent regardless of admission SBP, presence of atrial fibrillation, or use of beta blockers at discharge. CONCLUSIONS In patients hospitalized for HFrEF, the mRSI was a significant predictor of early outcomes. The mRSI could be used as a tool to assess patient status and guide physicians in treating patients with HFrEF.
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Affiliation(s)
- Gyu Chul Oh
- Department of Internal Medicine, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of MedicineThe Catholic University of KoreaSeoulSouth Korea
| | - Seokyung An
- Department of Biomedical ScienceSeoul National University Graduate SchoolSeoulSouth Korea
- Cancer Research InstituteSeoul National UniversitySeoulSouth Korea
| | - Hae‐Young Lee
- Department of Internal MedicineSeoul National University HospitalSeoulSouth Korea
| | - Hyun‐Jai Cho
- Department of Internal MedicineSeoul National University HospitalSeoulSouth Korea
| | - Eun‐Seok Jeon
- Department of Internal MedicineSungkyunkwan University College of MedicineSeoulSouth Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Jae‐Joong Kim
- Department of Internal Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Seok‐Min Kang
- Department of Internal MedicineYonsei University College of MedicineSeoulSouth Korea
| | - Kyung‐Kuk Hwang
- Department of Internal MedicineChungbuk National University College of MedicineCheongjuSouth Korea
| | - Myeong‐Chan Cho
- Department of Internal MedicineChungbuk National University College of MedicineCheongjuSouth Korea
| | - Shung Chull Chae
- Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguSouth Korea
| | - Dong‐Ju Choi
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Byung‐Su Yoo
- Department of Internal MedicineYonsei University Wonju College of MedicineWonjuSouth Korea
| | - Kye Hun Kim
- Department of Internal MedicineHeart Research Center of Chonnam National UniversityGwangjuSouth Korea
| | - Sue K. Park
- Cancer Research InstituteSeoul National UniversitySeoulSouth Korea
- Department of Integrated Major in Innovative Medical ScienceSeoul National University Graduate SchoolSeoulSouth Korea
| | - Sang Hong Baek
- Department of Internal Medicine, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
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19
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Benito-Lozano M, López-Ayala P, Rodríguez S, Gil V, Llorens P, Yufera A, Jacob J, Travería-Becker L, Strebel I, Lucas-Imbernon FJ, Tost J, López-Hernández Á, Rodríguez B, Fuentes M, Sánchez-Ramón S, Herrera-Mateo S, Aguirre A, Alonso MI, Pavón J, López-Grima ML, Espinosa B, Mueller C, Burillo-Putze G, Miró Ò. Ambient temperature and atmospheric pressure at discharge as precipitating factors in immediate adverse events in patients treated for decompensated heart failure. Intern Emerg Med 2022; 17:2045-2056. [PMID: 36050571 DOI: 10.1007/s11739-022-03078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 08/07/2022] [Indexed: 11/29/2022]
Abstract
To investigate the relationship of ambient temperature and atmospheric pressure (AP) at patient discharge after an episode of acute heart failure (AHF) with very early post-discharge adverse outcomes. We analyzed 14,656 patients discharged after an AHF episode from 26 hospitals in 16 Spanish cities. The primary outcome was the 7-day post-discharge combined adverse event (emergency department -ED- revisit or hospitalization due to AHF, or all-cause death), and secondary outcomes were these three adverse events considered individually. Associations (adjusted for patient and demographic conditions, and length of stay -LOS- during the AHF index episode) of temperature and AP with the primary and secondary outcomes were investigated. We used restricted cubic splines to model the continuous non-linear association of temperature and AP with each endpoint. Some sensitivity analyses were performed. Patients were discharged after a median LOS of 5 days (IQR = 1-10). The highest temperature at discharge ranged from - 2 to 41.6 °C, and AP was from 892 to 1037 hPa. The 7-day post-discharge combined event occurred in 1242 patients (8.4%), with percentages of 7-day ED-revisit, hospitalization and death of 7.8%, 5.1% and 0.9%, respectively. We found no association between the maximal temperature and AP on the day of discharge and the primary or secondary outcomes. Similarly, there were no significant associations when the analyses were restricted to hospitalized patients (median LOS = 7 days, IQR = 4-11) during the index event, or when lag-1, lag-2 or the mean of the 3 post-discharge days (instead of point estimation) of ambient temperature and AP were considered. Temperature and AP on the day of patient discharge are not independently associated with the risk of very early adverse events during the vulnerable post-discharge period in patients discharged after an AHF episode.
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Affiliation(s)
| | - Pedro López-Ayala
- Cardiology Department, Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
| | - Sergio Rodríguez
- Estación Experimental de Zonas Áridas (EEZA), Centro Superior de Investigaciones Científicas, Almería, Spain
- Centro Superior de Investigaciones Científicas, Institute of Natural Products and Agrobiology, IPNA, Tenerife, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, c/ Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Ana Yufera
- Cardiology Department, Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | | | - Ivo Strebel
- Cardiology Department, Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
| | | | - Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | | | - Beatriz Rodríguez
- Emergency Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Marta Fuentes
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Sergio Herrera-Mateo
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Catalonia, Spain
| | - Alfons Aguirre
- Emergency Department, Hospital del Mar, Barcelona, Catalonia, Spain
| | - M Isabel Alonso
- Emergency Department, Hospital Virgen de Valme, Seville, Spain
| | - José Pavón
- Emergency Department, Hospital Doctor Negrín, Las Palmas, Spain
| | | | - Begoña Espinosa
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Christian Mueller
- Cardiology Department, Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
- The GREAT Network, Rome, Italy
| | | | - Òscar Miró
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, c/ Villarroel 170, 08036, Barcelona, Catalonia, Spain.
- The GREAT Network, Rome, Italy.
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20
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Chaudhury P, Alvarez P, Michael M, Saad M, Bishop GJ, Hanna M, Menon V, Starling RC, Spyropoulos AC, Desai M, Mentias A. Incidence and Prognostic Implications of Readmissions Caused by Thrombotic Events After a Heart Failure Hospitalization. J Am Heart Assoc 2022; 11:e025342. [PMID: 35535610 PMCID: PMC9238557 DOI: 10.1161/jaha.122.025342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Readmission occurs in 1 out of 3 patients with heart failure (HF). We aimed to study the incidence and prognostic implications of rehospitalizations because of arterial thromboembolism events (ATEs) and venous thromboembolism events (VTEs) after discharge in patients with HF. Methods and Results We identified Medicare beneficiaries who were admitted with a primary diagnosis of HF from 2014 to 2019, with a hospital stay ranging between 3 and10 days, followed by discharge to home. We calculated incidence of ATEs (myocardial infarction, ischemic stroke, or systemic embolism) and VTEs (deep venous thrombosis and pulmonary embolism) up to 90 days after discharge. Out of 2 953 299 patients admitted with HF during the study period, a total of 585 353 patients met the inclusion criteria, and 36.6% were readmitted within 90 days of discharge. The incidence of readmission due ATEs, VTEs, HF, and all other reasons was 3.4%, 0.5%, 13.2%, and 19.5%, respectively. Incidence of thromboembolic events was highest within 14 days after discharge. Factors associated with ATEs included prior coronary, peripheral, or cerebrovascular disease and for VTEs included malignancy and prior liver or lung disease. ATE/VTE readmission had a 30-day mortality of 19.9%. After a median follow-up period of 25.6 months, ATE and VTE readmissions were associated with higher risk of mortality (hazard ratio, 2.76 [95% CI, 2.71-2.81] and 2.17 [95% CI, 2.08-2.27], respectively; P<0.001 for both) compared with no readmission on time-dependent Cox regression. Conclusions After a HF hospitalization, 3.9% of patients were readmitted with a thromboembolic event that was associated with 2- to 3-fold greater risk of mortality in follow-up.
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Affiliation(s)
- Pulkit Chaudhury
- Heart, Thoracic and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Paulino Alvarez
- Heart, Thoracic and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Madonna Michael
- Heart, Thoracic and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Marwan Saad
- Division of CardiologyWarren Alpert Medical School of Brown UniversityLifespan Cardiovascular InstituteProvidenceRI
| | - G. Jay Bishop
- Heart, Thoracic and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Mazen Hanna
- Heart, Thoracic and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Venu Menon
- Heart, Thoracic and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Randall C. Starling
- Heart, Thoracic and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Alex C. Spyropoulos
- Feinstein Institutes for Medical Research and The Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNY
- Department of MedicineNorthwell Health at Lenox Hill HospitalNew YorkNY
| | - Milind Desai
- Heart, Thoracic and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Amgad Mentias
- Heart, Thoracic and Vascular InstituteCleveland Clinic FoundationClevelandOH
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21
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Tamaki S, Yamada T, Watanabe T, Morita T, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kayama K, Sakamoto D, Ueda K, Kogame T, Tamura Y, Fujita T, Nishigaki K, Fukuda Y, Kokubu Y, Fukunami M. Usefulness of the 2-year iodine-123 metaiodobenzylguanidine-based risk model for post-discharge risk stratification of patients with acute decompensated heart failure. Eur J Nucl Med Mol Imaging 2022; 49:1906-1917. [PMID: 34997293 DOI: 10.1007/s00259-021-05663-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/15/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE A four-parameter risk model that included cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging and readily available clinical parameters was recently developed for prediction of 2-year cardiac mortality risk in patients with chronic heart failure. We sought to validate the ability of this risk model to predict post-discharge clinical outcomes in patients with acute decompensated heart failure (ADHF) and to compare its prognostic value with that of the Acute Decompensated Heart Failure National Registry (ADHERE) and Get With The Guidelines-Heart Failure (GWTG-HF) risk scores. METHODS We studied 407 consecutive patients who were admitted for ADHF and survived to discharge, with definitive 2-year outcomes (death or survival). Cardiac MIBG imaging was performed just before discharge. The 2-year cardiac mortality risk was calculated using four parameters, namely age, left ventricular ejection fraction, New York Heart Association functional class, and cardiac MIBG heart-to-mediastinum ratio on delayed images. Patients were stratified into three groups based on the 2-year cardiac mortality risk: low- (< 4%), intermediate- (4-12%), and high-risk (> 12%) groups. The ADHERE and GWTG-HF risk scores were also calculated. RESULTS There was a significant difference in the incidence of cardiac death among the three groups stratified using the 2-year cardiac mortality risk model (p < 0.0001). The 2-year cardiac mortality risk model had a higher C-statistic (0.732) for the prediction of cardiac mortality than the ADHERE and GWTG-HF risk scores. CONCLUSION The 2-year MIBG-based cardiac mortality risk model is useful for predicting post-discharge clinical outcomes in patients with ADHF. TRIAL REGISTRATION NUMBER UMIN000015246, 25 September 2014.
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Affiliation(s)
- Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan.
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Masato Kawasaki
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Tsutomu Kawai
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Masahiro Seo
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Jun Nakamura
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Kiyomi Kayama
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Daisuke Sakamoto
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Kumpei Ueda
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Takehiro Kogame
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Yuto Tamura
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Takeshi Fujita
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Keisuke Nishigaki
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Yuto Fukuda
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Yuki Kokubu
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Masatake Fukunami
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
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22
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Prevalence, Related Factors and Association of Left Bundle Branch Block With Prognosis in Patients With Acute Heart Failure: a Simultaneous Analysis in 3 Independent Cohorts. J Card Fail 2022; 28:1104-1115. [PMID: 34998702 DOI: 10.1016/j.cardfail.2021.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/13/2021] [Accepted: 11/19/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the prevalence, characteristics and association with prognosis of left bundle branch block (LBBB) in 3 different cohorts of patients with acute heart failure (AHF). METHODS AND RESULTS We retrospectively analyzed 12,950 patients with AHF who were included in the EAHFE (Epidemiology Acute Heart Failure Emergency), RICA (National Heart Failure Registry of the Spanish Internal Medicine Society), and BASEL-V (Basics in Acute Shortness of Breath Evaluation of Switzerland) registries. We independently analyzed the relationship between baseline and clinical characteristics and the presence of LBBB and the potential association of LBBB with 1-year all-cause mortality and a 90-day postdischarge combined endpoint (Emergency Department reconsultation, hospitalization or death). The prevalence of LBBB was 13.5% (95% confidence interval: 12.9%-14.0%). In all registries, patients with LBBB more commonly had coronary artery disease and previous episodes of AHF, were taking chronic spironolactone treatment, had lower left ventricular ejection fraction and systolic blood pressure values and higher NT-proBNP levels. There were no differences in risk for patients with LBBB in any cohort, with adjusted hazard ratios (95% confidence interval) for 1-year mortality in EAHFE/RICA/BASEL-V cohorts of 1.02 (0.89-1.17), 1.15 (0.95-1.38) and 1.32 (0.94-1.86), respectively, and for 90-day postdischarge combined endpoint of 1.00 (0.88-1.14), 1.14 (0.92-1.40) and 1.26 (0.84-1.89). These results were consistent in sensitivity analyses. CONCLUSIONS Less than 20% of patients with AHF present LBBB, which is consistently associated with cardiovascular comorbidities, reduced left ventricular ejection fraction and more severe decompensations. Nonetheless, after taking these factors into account, LBBB in patients with AHF is not associated with worse outcomes.
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23
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Wei X, Min Y, Yu J, Wang Q, Wang H, Li S, Su L. The Value of Admission Serological Indicators for Predicting 28-Day Mortality in Intensive Care Patients With Acute Heart Failure: Construction and Validation of a Nomogram. Front Cardiovasc Med 2021; 8:741351. [PMID: 34926602 PMCID: PMC8678052 DOI: 10.3389/fcvm.2021.741351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/04/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Acute heart failure (AHF) is a severe clinical syndrome characterized as rapid onset or worsening of symptoms of chronic heart failure (CHF). Risk stratification for patients with AHF in the intensive care unit (ICU) may help clinicians to predict the 28-day mortality risk in this subpopulation and further raise the quality of care. Methods: We retrospectively reviewed and analyzed the demographic characteristics and serological indicators of patients with AHF in the Medical Information Mart for Intensive Care III (MIMIC III) (version 1.4) between June 2001 and October 2012 and our medical center between January 2019 and April 2021. The chi-squared test and the Fisher's exact test were used for comparison of qualitative variables among the AHF death group and non-death group. The clinical variables were selected by using the least absolute shrinkage and selection operator (LASSO) regression. A clinical nomogram for predicting the 28-day mortality was constructed based on the multivariate Cox proportional hazard regression analysis and further validated by the internal and external cohorts. Results: Age > 65 years [hazard ratio (HR) = 2.47], the high Sequential Organ Failure Assessment (SOFA) score (≥3 and ≤8, HR = 2.21; ≥9 and ≤20, HR = 3.29), lactic acid (Lac) (>2 mmol/l, HR = 1.40), bicarbonate (HCO3-) (>28 mmol/l, HR = 1.59), blood urea nitrogen (BUN) (>21 mg/dl, HR = 1.75), albumin (<3.5 g/dl, HR = 2.02), troponin T (TnT) (>0.04 ng/ml, HR = 4.02), and creatine kinase-MB (CK-MB) (>5 ng/ml, HR = 1.64) were the independent risk factors for predicting 28-day mortality of intensive care patients with AHF (p < 0.05). The novel nomogram was developed and validated with a promising C-index of 0.814 (95% CI: 0.754–0.882), 0.820 (95% CI: 0.721–0.897), and 0.828 (95% CI: 0.743–0.917), respectively. Conclusion: This study provides a new insight in early predicting the risk of 28-day mortality in intensive care patients with AHF. The age, the SOFA score, and serum TnT level are the leading three predictors in evaluating the short-term outcome of intensive care patients with AHF. Based on the nomogram, clinicians could better stratify patients with AHF at high risk and make adequate treatment plans.
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Affiliation(s)
- Xiaoyuan Wei
- Department of Cardiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yu Min
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangchuan Yu
- Department of Cardiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qianli Wang
- Department of Cardiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Han Wang
- Department of Cardiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Shuang Li
- Department of Cardiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Li Su
- Department of Cardiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Abstract
As an indicator of healthcare quality and performance, hospital readmission incurs major costs for healthcare systems worldwide. Understanding the relationships between readmission factors, such as input features and readmission length, is challenging following intricate hospital readmission procedures. This study discovered the significant correlation between potential readmission factors (threshold of various settings for readmission length) and basic demographic variables. Association rule mining (ARM), particularly the Apriori algorithm, was utilised to extract the hidden input variable patterns and relationships among admitted patients by generating supervised learning rules. The mined rules were categorised into two outcomes to comprehend readmission data; (i) the rules associated with various readmission length and (ii) several expert-validated variables related to basic demographics (gender, race, and age group). The extracted rules proved useful to facilitate decision-making and resource preparation to minimise patient readmission.
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25
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Temporal trends in tolvaptan use after revision of national heart failure guidelines in Japan. Sci Rep 2021; 11:19360. [PMID: 34588492 PMCID: PMC8481277 DOI: 10.1038/s41598-021-98173-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/19/2021] [Indexed: 11/08/2022] Open
Abstract
Within no definite diuretic protocol for acute heart failure (AHF) patients and its variation in regional clinical guidelines, the latest national guidelines in Japan commends use of tolvaptan in diuretic-resistant patients. This study aimed to examine trends in tolvaptan usage and associated outcomes of AHF patients requiring hospitalization. Between April, 2018 and October, 2019, 1343 consecutive AHF patients (median 78 [69-85] year-old) were enrolled in a prospective, multicenter registry in Japan. Trends over time in tolvaptan usage, along with the severity of heart failure status based on the Get With The Guideline-Heart Failure [GWTG-HF] risk score, and in-hospital outcomes were investigated. During the study period, tolvaptan usage has increased from 13.0 to 28.7% over time (p for trend = 0.07), and 49.4% started tolvaptan within 3 days after admission. The GWTG-HF risk score in the tolvaptan group has significantly decreased over time, while that in the non-tolvaptan group has unchanged. There were no differences in the in-hospital mortality rate between the patients with and without tolvaptan (6.7% vs. 5.8%). After revision of the Japanese clinical practice guidelines for AHF in March 2018, tolvaptan usage for AHF patients has steadily increased. However, in-hospital outcomes including mortality do not seem to be affected.
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Kitakata H, Kohno T, Kohsaka S, Fujisawa D, Nakano N, Shiraishi Y, Katsumata Y, Nagatomo Y, Yuasa S, Fukuda K. Preferences on advance care planning and end-of-life care in patients hospitalized for heart failure. ESC Heart Fail 2021; 8:5102-5111. [PMID: 34480526 PMCID: PMC8712895 DOI: 10.1002/ehf2.13578] [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: 01/28/2021] [Revised: 07/07/2021] [Accepted: 08/11/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS Early engagement in advance care planning (ACP) is recommended in heart failure (HF) management. We investigated the preferences of patients with HF regarding ACP and end-of-life (EOL) care, including their desired timing of ACP initiation. METHODS AND RESULTS Data were collected using a 92-item questionnaire survey, which was directly distributed to hospitalized patients by dedicated physicians and nurses in a university hospital setting. One-hundred eighty-seven patients agreed to participate (response rate: 92.6%), and 171 completed the survey [valid response rate: 84.7%; men: 67.3%; median age: 73.0 (63.0-81.0) years]. Logistic regression analyses were conducted to identify the predictors of positive attitudes towards ACP. Most recognized ACP as important for their care (n = 127, 74.3%), 48.1% stated that ACP should be initiated after repeated HF hospitalizations in the past year, and 29.0% preferred ACP to begin during the first or second HF hospitalization. Only 21.7% of patients had previously engaged in ACP conversations during HF management. Positive attitudes towards ACP were associated with lower depressive symptoms [two-item Patient Health Questionnaire; odds ratio (OR): 0.75, 95% confidence interval (CI): 0.61-0.92, P-value: 0.006], marriage (OR: 2.53, 95% CI: 1.25-5.12, P-value: 0.010), and a high educational level (OR: 2.66, 95% CI: 1.28-5.56, P-value: 0.009), but not with severity of HF (represented by Seattle Heart Failure Model risk score). Regarding EOL care, while 'Saying what one wants to tell loved ones' (83.4%), 'Dying a natural death' (81.8%), and 'Being able to stay at one's favorite place' (75.6%) were the three most important factors for patients, preferences for 'Receiving sufficient treatment' (56.5%) and 'Knowing what to expect about future condition' (50.3%) were divergent. CONCLUSIONS Despite patients' preferences for ACP conversations, there was a discrepancy between preference and engagement in ACP among patients hospitalized for HF. Patients' preferences regarding EOL care may differ; physicians need to consider the appropriate ACP approach to align with patients' care goals.
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Affiliation(s)
- Hiroki Kitakata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Naomi Nakano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Vulnerable Phase of Acute Heart Failure and its Association with Hospital Readmissions Reduction Program. Curr Probl Cardiol 2021; 47:100904. [PMID: 34172317 DOI: 10.1016/j.cpcardiol.2021.100904] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/20/2021] [Indexed: 11/20/2022]
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Abstract
Acute decompensated heart failure (ADHF) is one of the leading admission diagnoses worldwide, yet it is an entity with incompletely understood pathophysiology and limited therapeutic options. Patients admitted for ADHF have high in-hospital morbidity and mortality, as well as frequent rehospitalizations and subsequent cardiovascular death. This devastating clinical course is partly due to suboptimal medical management of ADHF with persistent congestion upon hospital discharge and inadequate predischarge initiation of life-saving guideline-directed therapies. While new drugs for the treatment of chronic HF continue to be approved, there has been no new therapy approved for ADHF in decades. This review will focus on the current limited understanding of ADHF pathophysiology, possible therapeutic targets, and current limitations in expanding available therapies in light of the unmet need among these high-risk patients.
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Affiliation(s)
- Joyce N. Njoroge
- Division of Cardiology, School of Medicine, University of California San Francisco (J.N.N., J.R.T.), San Francisco, CA
| | - John R. Teerlink
- Division of Cardiology, School of Medicine, University of California San Francisco (J.N.N., J.R.T.), San Francisco, CA
- Section of Cardiology, San Francisco Veterans Affairs Medical Center (J.R.T.), San Francisco, CA
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Suksatan W, Tankumpuan T. Depression and Rehospitalization in Patients With Heart Failure After Discharge From Hospital to Home: An Integrative Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/1084822320986965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with heart failure are known to be particularly vulnerable to depression resulting in adverse health outcomes. However, there has been no literature review on current evidence regarding the relationship between depression and rehospitalization. This review aims to explore the relationship between depression and rehospitalization in patients with heart failure. A systematic review employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included articles published between 2001 and 2019 taken from Scopus, PubMed, CINAHL, and PsycINFO databases. We identified 12 relevant studies with participants ranging from 115 to 160,169 patients. Heart failure patients with depression were more likely to be rehospitalized than those without. To explain this, few reasons have been proposed. First, depression could disrupt the regulation of autonomic nervous system, neurohormonal activation, and body’s natural rhythm. Second, depressed patients tend to have poor adherence to medication. Healthcare providers should not only focus on drug and dietary management but also on implementing effective interventions to manage depression, in order to reduce the risk of rehospitalization. Moreover, palliative care should start at the stage of heart failure diagnosis to improve quality of life, better outcomes, and lower cost of care for the patients.
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Affiliation(s)
- Wanich Suksatan
- HRH Princess Chulabhorn College of Medical Science Faculty of Nursing, Chulabhorn Royal Academy, Bangkok, Thailand
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Kitakata H, Kohno T, Kohsaka S, Shiraishi Y, Parizo JT, Niimi N, Goda A, Nishihata Y, Heidenreich PA, Yoshikawa T. Prognostic Implications of Early and Midrange Readmissions After Acute Heart Failure Hospitalizations: A Report From a Japanese Multicenter Registry. J Am Heart Assoc 2020; 9:e014949. [PMID: 32378443 PMCID: PMC7660881 DOI: 10.1161/jaha.119.014949] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Although 30‐day readmission is thought to be an important quality indicator in patients with hospitalized heart failure, its prognostic impact and comparison of patients who were readmitted beyond 30 days has not been investigated. We assessed early (0–30 days) versus midrange (31–90 days) readmission in terms of incidence and distribution, and elucidated whether the timing of readmission could have a different prognostic significance. Methods and Results We examined patients with hospitalized heart failure registered in the WET‐HF (West Tokyo Heart Failure) registry. The primary outcomes analyzed were all‐cause death and HF readmission. Data of 3592 consecutive patients with hospitalized heart failure (median follow‐up, 2.0 years [interquartile range, 0.8–3.1 years]; 39.6% women, mean age 73.9±13.3 years) were analyzed. Within 90 days after discharge, HF readmissions occurred in 11.1% patients. Of them, patients readmitted within 30 and 31 to 90 days after discharge accounted for 43.1% and 56.9%, respectively. Independent predictors of 30‐ and 90‐day readmission were almost identical, and after adjustment, readmission for HF within 90 days (including both early and midrange readmission) was an independent predictor of subsequent all‐cause death (hazard ratio, 2.36; P<0.001). Among 90‐day readmitted patients, the time interval from discharge to readmission was not significantly associated with subsequent all‐cause death. Conclusions Among patients readmitted within 90 days after index hospitalization discharge, ≈60% of readmission events occurred beyond 30 days. Patients readmitted within 90 days had a higher risk of long‐term mortality, regardless of the temporal proximity of readmission to the index hospitalization.
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Affiliation(s)
- Hiroki Kitakata
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Takashi Kohno
- Department of Cardiology Keio University School of Medicine Tokyo Japan.,Department of Cardiovascular Medicine Kyorin University School of Medicine Tokyo Japan
| | - Shun Kohsaka
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | | | - Justin T Parizo
- Division of Cardiovascular Medicine, Stanford University Stanford CA
| | - Nozomi Niimi
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Ayumi Goda
- Department of Cardiovascular Medicine Kyorin University School of Medicine Tokyo Japan
| | | | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Stanford University Stanford CA.,VA Palo Alto Health Care System Palo Alto CA
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