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Liu L, Huang P, Wang C, Liu Y, Gao Y, Yu K. Causal Association Between Heart Failure and Sepsis: Insights from Mendelian Randomization and Observational Studies. Clin Epidemiol 2024; 16:755-767. [PMID: 39524502 PMCID: PMC11550685 DOI: 10.2147/clep.s487118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024] Open
Abstract
Purpose We aimed to identify the association between heart failure (HF) with sepsis and its mortality through Mendelian randomization (MR) and observational studies. Patients and Methods In MR study, we utilized public summary statistics from genome-wide association studies (GWAS). We conducted univariable, multivariable and network MR analyses to investigate causal relationships between HF and sepsis, and mediating roles of cytokines and growth factors. We performed an observational analysis using the MIMIC-IV database. Propensity score matching (PSM) and logistic regression models were employed to explore causal relationships between HF and sepsis, besides short-, medium-, and long-term mortality associated with sepsis. Results In univariable MR analysis, there was a causal relationship between genetically predicted HF (OR = 1.15, 95% CI = 1.02-1.29, P = 0.025) and sepsis. In multivariable and network MR analyses, βNGF was independently associated with sepsis. And it mediated 17.6% (95% CI 2.45-30.72%) of HF effect on sepsis. In the real-world observational study, acute on chronic diastolic (congestive) heart failure (DCHF) (OR = 1.59, 95% CI = 1.31-1.93, P < 0.001), acute DCHF (OR = 2.52, 95% CI = 1.61-3.95, P = 0.010), and acute diastolic heart failure (DHF) (OR = 1.52, 95% CI = 1.06-2.19, P = 0.024) after PSM were associated with occurrence of sepsis. Chronic systolic (congestive) heart failure (SCHF) was associated with increased 28-day (OR = 1.75, 95% CI = 1.06-2.91, P = 0.030), 1-year (OR = 1.80, 95% CI = 1.08-3.00, P = 0.023), and 2-year (OR = 1.86, 95% CI = 1.12-3.10, P = 0.018) mortality in sepsis. Conclusion Observational and MR analyses showed a causal relationship between HF and sepsis. Chronic SCHF was related to increased short/long-term mortality in sepsis. Our study indicated βNGF a key factor in HF-induced sepsis.
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Affiliation(s)
- Linqiong Liu
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- Heilongjiang Provincial Key Laboratory of Critical Care Medicine, Harbin Medical University, Harbin, People’s Republic of China
- Departments of Critical Care Medicine, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Pengfei Huang
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- Heilongjiang Provincial Key Laboratory of Critical Care Medicine, Harbin Medical University, Harbin, People’s Republic of China
| | - Changsong Wang
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- Heilongjiang Provincial Key Laboratory of Critical Care Medicine, Harbin Medical University, Harbin, People’s Republic of China
| | - Yuxi Liu
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- Heilongjiang Provincial Key Laboratory of Critical Care Medicine, Harbin Medical University, Harbin, People’s Republic of China
- Departments of Critical Care Medicine, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Yan Gao
- Departments of Critical Care Medicine, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Kaijiang Yu
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- Heilongjiang Provincial Key Laboratory of Critical Care Medicine, Harbin Medical University, Harbin, People’s Republic of China
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Liu J, He XY, Yang KL, Zhao Y, Dai EY, Chen WJ, Raj AK, Li D, Zhuang M, Yin XH, Ling H. Oropharyngeal microbiome profiling and its association with age and heart failure in the elderly population from the northernmost province of China. Microbiol Spectr 2024; 12:e0021624. [PMID: 39162522 PMCID: PMC11448084 DOI: 10.1128/spectrum.00216-24] [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: 01/23/2024] [Accepted: 07/07/2024] [Indexed: 08/21/2024] Open
Abstract
Respiratory tract infections are the most common triggers for heart failure in elderly people. The healthy respiratory commensal microbiota can prevent invasion by infectious pathogens and decrease the risk of respiratory tract infections. However, upper respiratory tract (URT) microbiome in the elderly is not well understood. To comprehend the profiles of URT microbiota in the elderly, and the link between the microbiome and heart failure, we investigated the oropharyngeal (OP) microbiome of these populations in Heilongjiang Province, located in the North-East of China, a high-latitude and cold area with a high prevalence of respiratory tract infection and heart failure. Taxonomy-based analysis showed that six dominant phyla were represented in the OP microbial profiles. Compared with young adults, the OP in the elderly exhibited a significantly different microbial community, mainly characterized by highly prevalent Streptococcus, unidentified_Saccharibacteria, Veillonella, unidentified_Pre votellaceae, and Neisseria. While unidentified_Prevotellaceae dominated in the young OP microbiome. There was competition for niche dominance between Streptococcus and member of Prevotellaceae in the OP. Correlation analysis revealed that the abundance of unidentified_Saccharibacteria was positive, while Streptococcus was negatively correlated to age among healthy elderly. The bacterial structure and abundance in the elderly with heart failure were much like healthy controls. Certain changes in microbial diversity indicated the potential OP microbial disorder in heart failure patients. These results presented here identify the respiratory tract core microbiota in high latitude and cold regions, and reveal the robustness of OP microbiome in the aged, supplying the basis for microbiome-targeted interventions.IMPORTANCETo date, we still lack available data on the oropharyngeal (OP) microbial communities in healthy populations, especially the elderly, in high latitude and cold regions. A better understanding of the significantly changed respiratory tract microbiota in aging can provide greater insight into characteristics of longevity and age-related diseases. In addition, determining the relationship between heart failure and OP microbiome may provide novel prevention and therapeutic strategies. Here, we compared OP microbiome in different age groups and elderly people with or without heart failure in northeastern China. We found that OP microbial communities are strongly linked to healthy aging. And the disease status of heart failure was not a powerful factor affecting OP microbiome. The findings may provide basic data to reveal respiratory bacterial signatures of individuals in a cold geographic region.
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Affiliation(s)
- Jian Liu
- Department of Microbiology, Harbin Medical University, Harbin, China
| | - Xiao-Yu He
- Department of Microbiology, Harbin Medical University, Harbin, China
| | - Ke-Laier Yang
- Department of Endocrinology and Metabolism, Shenzhen University General Hospital, Shenzhen, China
| | - Yue Zhao
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - En-Yu Dai
- Department of Microbiology, Harbin Medical University, Harbin, China
| | - Wen-Jia Chen
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Aditya Kumar Raj
- Department of Microbiology, Harbin Medical University, Harbin, China
| | - Di Li
- Department of Microbiology, Harbin Medical University, Harbin, China
- Wu Lien-Teh Institute, Harbin Medical University, Harbin, China
- Heilongjiang Provincial Key Laboratory of Infection and Immunity, Harbin, China
| | - Min Zhuang
- Department of Microbiology, Harbin Medical University, Harbin, China
- Wu Lien-Teh Institute, Harbin Medical University, Harbin, China
- Heilongjiang Provincial Key Laboratory of Infection and Immunity, Harbin, China
| | - Xin-Hua Yin
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
- Department of Cardiology, Shenzhen University General Hospital, Shenzhen, China
| | - Hong Ling
- Department of Microbiology, Harbin Medical University, Harbin, China
- Wu Lien-Teh Institute, Harbin Medical University, Harbin, China
- Heilongjiang Provincial Key Laboratory of Infection and Immunity, Harbin, China
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Zhang Q, Xu L, He W, Lai X, Huang X. Survival prediction for heart failure complicated by sepsis: based on machine learning methods. Front Med (Lausanne) 2024; 11:1410702. [PMID: 39421876 PMCID: PMC11484001 DOI: 10.3389/fmed.2024.1410702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 09/17/2024] [Indexed: 10/19/2024] Open
Abstract
Background Heart failure is a cardiovascular disorder, while sepsis is a common non-cardiac cause of mortality. Patients with combined heart failure and sepsis have a significantly higher mortality rate and poor prognosis, making early identification of high-risk patients and appropriate allocation of medical resources critically important. Methods We constructed a survival prediction model for patients with heart failure and sepsis using the eICU-CRD database and externally validated it using the MIMIC-IV database. Our primary outcome is the 28-day all-cause mortality rate. The Boruta method is used for initial feature selection, followed by feature ranking using the XGBoost algorithm. Four machine learning models were compared, including Logistic Regression (LR), eXtreme Gradient Boosting (XGBoost), Adaptive Boosting (AdaBoost), and Gaussian Naive Bayes (GNB). Model performance was assessed using metrics such as area under the curve (AUC), accuracy, sensitivity, and specificity, and the SHAP method was utilized to visualize feature importance and interpret model results. Additionally, we conducted external validation using the MIMIC-IV database. Results We developed a survival prediction model for heart failure complicated by sepsis using data from 3891 patients in the eICU-CRD and validated it externally with 2928 patients from the MIMIC-IV database. The LR model outperformed all other machine learning algorithms with a validation set AUC of 0.746 (XGBoost: 0.726, AdaBoost: 0.744, GNB: 0.722), alongside accuracy (0.685), sensitivity (0.666), and specificity (0.712). The final model incorporates 10 features: age, ventilation, norepinephrine, white blood cell count, total bilirubin, temperature, phenylephrine, respiratory rate, neutrophil count, and systolic blood pressure. We employed the SHAP method to enhance the interpretability of the model based on the LR algorithm. Additionally, external validation was conducted using the MIMIC-IV database, with an external validation AUC of 0.699. Conclusion Based on the LR algorithm, a model was constructed to effectively predict the 28-day all-cause mortality rate in patients with heart failure complicated by sepsis. Utilizing our model predictions, clinicians can promptly identify high-risk patients and receive guidance for clinical practice.
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Affiliation(s)
- Qitian Zhang
- Department of Cardiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Lizhen Xu
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Weibin He
- Department of Cardiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Xinqi Lai
- Department of Cardiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Xiaohong Huang
- Department of Cardiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
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Makhoul GW, Mustafa A, Wei C, Ling J, Khan S, Rizvi T, Grovu R, Asogwa N, Lee S, Weinberg M, Lafferty J. Heart failure - An unexplored risk factor for infective endocarditis after pacemaker implantation. J Cardiol 2024; 84:161-164. [PMID: 38583663 DOI: 10.1016/j.jjcc.2024.04.002] [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: 11/18/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND With the widespread use of permanent pacemakers (PPM), and increased mortality associated with pacemaker endocarditis, it is essential to evaluate comorbidities that could potentially increase the risk of infective endocarditis (IE). Heart failure (HF), a common comorbidity, has not been well studied as an independent risk factor for development of IE in individuals with PPM. METHODS The US National Inpatient Sample database was used to sample individuals with PPM. Patients with concomitant implantable cardioverter defibrillator, acute heart failure, history of endocarditis, intravenous drug use, prosthetic heart valves, or central venous catheter infection were excluded. Propensity matching was performed to match patients with and without HF. Pre- and post-match logistic regression was performed to assess HF as an independent risk factor for IE. A subgroup analysis was performed comparing IE rates between patients with HF with reduced (HFrEF) vs preserved (HFpEF) ejection fraction. RESULTS Out of 333,571 patients with PPM included in the study, 121,862 (37 %) had HF. HF patients were older and had a higher prevalence of females. All comorbidities except for dental disease and cancer were more prevalent in the HF group. Patients with HF were 1.30 times more likely to develop IE [OR: 1.30 (1.16-1.47); p < 0.001]. The two cohorts were then matched for age, gender, and 20 comorbidities using a 1:1 propensity score matching algorithm. After matching, HF was still independently associated with increased risk of IE [OR: 1.62 (1.36-1.93); p < 0.001]. In our sub-group analysis, HFrEF and HFpEF patients had similar IE rates. CONCLUSION In PPM population, HF was associated with an increased risk of IE compared to those without HF. We hypothesize that HF being a low-flow and high-inflammatory state might have contributed to this increased risk. Larger studies are required to corroborate our findings and evaluate the need for antimicrobial prophylaxis for this population.
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Affiliation(s)
- Gennifer Wahbah Makhoul
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Ahmad Mustafa
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA.
| | - Chapman Wei
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Joanne Ling
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Shahkar Khan
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Taqi Rizvi
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Radu Grovu
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Nnedi Asogwa
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Samantha Lee
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Mitchell Weinberg
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - James Lafferty
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
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Mohamoud A, Abdallah N, Wardhere A, Teeri S, Ismayl M. Sepsis and septic shock outcomes and 90-day readmissions in heart failure with reduced ejection fraction: A national readmission database study. Curr Probl Cardiol 2024; 49:102696. [PMID: 38852912 DOI: 10.1016/j.cpcardiol.2024.102696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Patients with heart failure with reduced ejection fraction (HFrEF) are at increased risk for sepsis/septic shock. METHOD A retrospective study was conducted using the Nationwide Readmission Database (2016-2020). Adult patients admitted with sepsis or septic shock were identified and stratified based on the presence of underlying HFrEF. Multivariable logistic regression assessed the association between HFrEF and in-hospital mortality, 90-day readmission, and other complications. RESULTS Among 7,326,930 sepsis/septic shock admissions, 6.2 % had HFrEF. HFrEF patients had higher in-hospital mortality (17 % vs. 9.6 %, p < 0.01) and 90-day readmission rates (30.2 % vs. 22.5 %, p < 0.01) compared to those without HFrEF. These differences persisted after adjustment with increased risk of in-hospital mortality (aOR 1.40, 95 %CI 1.38-1.42) and 90-day readmission (aOR 1.15, 95 %CI 1.13-1.16). CONCLUSION HFrEF patients admitted with sepsis/septic shock have significantly higher rates of in-hospital mortality, complications, and 90-day readmissions compared to those without HFrEF.
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Affiliation(s)
- Abdilahi Mohamoud
- Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA.
| | - Nadhem Abdallah
- Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | | | - Samira Teeri
- Department of Internal Medicine, MedStar Washington Hospital Center, Georgetown University, Washington DC, USA
| | - Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Beagle AJ, Prasad PA, Hubbard CC, Walderich S, Oreper S, Abe-Jones Y, Fang MC, Kangelaris KN. Associations Between Volume of Early Intravenous Fluid and Hospital Outcomes in Septic Patients With and Without Heart Failure: A Retrospective Cohort Study. Crit Care Explor 2024; 6:e1082. [PMID: 38694845 PMCID: PMC11057813 DOI: 10.1097/cce.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVES To evaluate the relationship between early IV fluid volume and hospital outcomes, including death in-hospital or discharge to hospice, in septic patients with and without heart failure (HF). DESIGN A retrospective cohort study using logistic regression with restricted cubic splines to assess for nonlinear relationships between fluid volume and outcomes, stratified by HF status and adjusted for propensity to receive a given fluid volume in the first 6 hours. An ICU subgroup analysis was performed. Secondary outcomes of vasopressor use, mechanical ventilation, and length of stay in survivors were assessed. SETTING An urban university-based hospital. PATIENTS A total of 9613 adult patients were admitted from the emergency department from 2012 to 2021 that met electronic health record-based Sepsis-3 criteria. Preexisting HF diagnosis was identified by the International Classification of Diseases codes. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 1449 admissions from patients with HF. The relationship between fluid volume and death or discharge to hospice was nonlinear in patients without HF, and approximately linear in patients with HF. Receiving 0-15 mL/kg in the first 6 hours was associated with lower likelihood of death or discharge to hospice compared with 30-45 mL/kg (odds ratio = 0.61; 95% CI, 0.41-0.90; p = 0.01) in HF patients, but no significant difference for non-HF patients. A similar pattern was identified in ICU admissions and some secondary outcomes. Volumes larger than 15-30 mL/kg for non-HF patients and 30-45 mL/kg for ICU-admitted non-HF patients were not associated with improved outcomes. CONCLUSIONS Early fluid resuscitation showed distinct patterns of potential harm and benefit between patients with and without HF who met Sepsis-3 criteria. Restricted cubic splines analysis highlighted the importance of considering nonlinear fluid outcomes relationships and identified potential points of diminishing returns (15-30 mL/kg across all patients without HF and 30-45 mL/kg when admitted to the ICU). Receiving less than 15 mL/kg was associated with better outcomes in HF patients, suggesting small volumes may be appropriate in select patients. Future studies may benefit from investigating nonlinear fluid-outcome associations and a focus on other conditions like HF.
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Affiliation(s)
- Alexander J Beagle
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Priya A Prasad
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Colin C Hubbard
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sven Walderich
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sandra Oreper
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Yumiko Abe-Jones
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Margaret C Fang
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Kirsten N Kangelaris
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
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Amdani S, Lopez R, Schold JD, Tang WHW. 30- and 60-Day Readmission Rates for Children With Heart Failure in the United States. JACC. HEART FAILURE 2024; 12:83-96. [PMID: 37943220 DOI: 10.1016/j.jchf.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Studies on readmission for pediatric heart failure (HF) patients is sparse. OBJECTIVES This study evaluated 30- and 60-day readmission rates in pediatric HF patients from 2010 to 2019. METHODS The authors used data from the Nationwide Readmission Database to evaluate trends in 30- and 60-day hospital readmissions among pediatric patients with HF and compare them with adults with HF. Readmissions were also stratified by sex, diagnosis, neighborhood income, and hospital volume. RESULTS There were 84,731 hospital admissions for HF. Compared with children without HF, those with HF were older, had Medicare/Medicaid insurance, and resided in micropolitan areas and low-income neighborhoods. The 30- (19.5% vs 3.1%) and 60-day (27.5% vs 4.3%) all-cause readmission rates were higher for children with HF compared with those without HF. Compared with children without HF, lengths of stay, deaths, and costs related to their readmission were higher for children readmitted with HF (P < 0.05 for all). There was no significant decline in pediatric HF-related 30- or 60- day readmissions during the study period overall, or for those with congenital heart disease (P > 0.05), unlike adult HF readmissions (P < 0.01). Infants were at highest risk, and readmission rates for teenagers are rising. CONCLUSIONS The 30- and 60-day readmission rates for pediatric patients with HF in the current era is high (∼20% and 30%, respectively). Unlike adult HF, pediatric HF readmission rates have not declined. Pediatric HF patients readmitted to the hospital have higher death rates and greater resource utilization than patients without HF. National measures to decrease readmissions for pediatric patients with HF is warranted.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA.
| | - Rocio Lopez
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jesse D Schold
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Shivamadhu S, Jalal AM, Sandhu AS, Persad N, Satram C, Nalajala N, Osorio Tapia LM, Vera E, Sunkara SM, Salazar EF, Khan A, Ehsan M, Swed S. Immunizing hearts: exploring the vaccination frontier in heart failure management. Ann Med Surg (Lond) 2024; 86:300-307. [PMID: 38222749 PMCID: PMC10783278 DOI: 10.1097/ms9.0000000000001486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/30/2023] [Indexed: 01/16/2024] Open
Abstract
Heart failure (HF) is a widespread clinical condition that affects numerous individuals globally and is a leading cause of hospitalization, particularly in the elderly population. Despite efforts to manage HF using various pharmacological and nonpharmacological interventions, mortality and hospitalization rates remain alarmingly high. Preventive vaccination has emerged as a key measure endorsed by cardiology societies for reducing the morbidity and mortality associated with HF. This study undertakes an extensive review of existing literature to explore the role of vaccination in managing HF, focusing specifically on the immunological pathways involved and potential benefits offered by immunization in this context. This article highlights the role of various vaccines, including influenza, pneumococcal, and COVID-19 vaccines, in reducing HF-related hospitalization, mortality, and overall disease burden. Additionally, this article will delve into specific vaccines that have shown promise in HF management, such as influenza, pneumococcal, and COVID-19 vaccines, along with the rationale for their use, clinical trials, meta-analyses, and real-world data supporting their effectiveness in patients with HF. This article also considers potential challenges and obstacles to widespread vaccination in individuals with HF, which include vaccine hesitancy, accessibility, and adverse events related to vaccines.
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Affiliation(s)
| | - Aysha M. Jalal
- Department of Internal Medicine, Royal College of Surgeons in Ireland, Busaiteen, Bahrain
| | - Arshbeer S. Sandhu
- Department of Internal Medicine, Shaheed Bhai Mani Singh Civil Hospital, Bathinda, India
| | - Narendra Persad
- Department of General Surgery, Sangre Grande Hospital, Sangre Grande, Trinidad and Tobago, Caribbean
| | - Christena Satram
- Department of Surgery, Lincoln American University, Georgetown, Guyana
| | - Navya Nalajala
- Department of Geriatric Medicine, University of Arkansas for Medical Sciences, Little Rock
| | | | - Emiliano Vera
- Department of Internal Medicine, Universidad Autónoma de Guadalajara, Guadalajara, Mexico
| | - Sree M. Sunkara
- Master of Public Health (MPH), University of New Haven, West Haven
| | | | - Anila Khan
- Behavioral Health Program Manager, Asia American Health Coalition dba HOPE Clinic, Houston, USA
| | - Muhammad Ehsan
- Department of Internal Medicine, Mayo Hospital, Lahore, Pakistan
| | - Sarya Swed
- Department of Medicine, Aleppo University, Aleppo, Syria
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9
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Chen Y, Lu L, Li X, Liu B, Zhang Y, Zheng Y, Zeng Y, Wang K, Pan Y, Liang X, Wu Z, Fu Y, Huang Y, Li Y. Association between chronic obstructive pulmonary disease and 28-day mortality in patients with sepsis: a retrospective study based on the MIMIC-III database. BMC Pulm Med 2023; 23:435. [PMID: 37946194 PMCID: PMC10633936 DOI: 10.1186/s12890-023-02729-5] [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: 06/09/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Sepsis is a common cause of mortality in critically ill patients, and chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities in septic patients. However, the impact of COPD on patients with sepsis remained unclear. Therefore, the purpose of this study aimed to assess the effect of COPD on the prognosis of septic patients based on Medical Information Mart for Intensive Care (MIMIC-III) database. METHODS In this retrospective study based on the (MIMIC)-III database version 1.4 (v1.4), we collected clinical data and 28-day all-cause mortality from patients with sepsis in intensive care unit (ICU) and these patients met the diagnostic criteria of Sepsis 3 on ICU admission between 2008 and 2012. International Classification of Diseases (ICD-9) (4660, 490, 4910, 4911, 49120, 49121, 4918, 4919, 4920, 4928, 494, 4940, 4941, 496) was used to identified COPD. We applied Kaplan-Meier analysis to compare difference of 28-day all-cause mortality between septic patients with and without COPD. Cox proportional-hazards model was applied to explore the risk factor associated with 28-day all-cause mortality in patients with sepsis. RESULTS Six thousand two hundred fifty seven patients with sepsis were included in this study, including 955 (15.3%) patients with COPD and 5302 patients without COPD (84.7%). Compared with patients without COPD, patients with COPD were older (median: 73.5 [64.4, 82.0] vs 65.8 [52.9, 79.1], P < 0.001), had higher simplified acute physiology score II (SAPSII) (median: 40.0 [33.0, 49.0] vs 38.0 [29.0,47.0], P < 0.001) and greater proportion of mechanical ventilatory support (MV) (55.0% vs 48.9%, P = 0.001). In our study, septic patients with COPD had higher 28-day all-cause mortality (23.6% vs 16.4%, P < 0.001) than patients without COPD. After adjusting for covariates, the results showed that COPD was an independent risk factor for the 28-day all-cause mortality of patients with sepsis (HR 1.30, 95%CI: 1.12-1.50, P = 0.001). CONCLUSIONS COPD was an independent risk factor of 28-day all-cause mortality in septic patients. Clinically, septic patients with COPD should be given additional care.
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Affiliation(s)
- Yubiao Chen
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Lifei Lu
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Xicong Li
- Department of Cardiology, Kunming Medical University, the 920th Hospital, Kunming, 650032, Yunnan, China
| | - Baiyun Liu
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Yu Zhang
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Yongxin Zheng
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Yuan Zeng
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Ke Wang
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Yaru Pan
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Xiangning Liang
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Zhongji Wu
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
| | - Yutian Fu
- Hubei University of Medicine, Shiyan, Hubei, 442000, China
| | - Yongbo Huang
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China.
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China.
| | - Yimin Li
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China.
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China.
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10
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Maire A, Chapet N, Aguilhon S, Laugier ML, Laffont-Lozes P, Rigoni M, Mathieu B, Audurier Y, Breuker C, de Barry G, Jalabert A, Leclercq F, Pasquié JL, Roubille F, Castet-Nicolas A. Evaluation of vaccination coverage in heart failure patients in a tertiary center. Heliyon 2023; 9:e18080. [PMID: 37519644 PMCID: PMC10372228 DOI: 10.1016/j.heliyon.2023.e18080] [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: 02/10/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023] Open
Abstract
Background Despite current recommendation, vaccination coverage (VC) for patients with heart failure (HF) remains far too limited. Aims To evaluate the VC of HF patients followed in our hospital center and investigate the barriers to vaccination and the ways to address them. Methods This was a cross-sectional monocentric descriptive study conducted between December 2019 and January 2021 at the University Hospital of Montpellier, France. Patients with HF history hospitalized in cardiology unit (CU) and patients in a HF telemonitoring program (TP) were included. An interview was conducted by a pharmacist to find out the patient's vaccination status against influenza and pneumococcus. For non-vaccinated patients, opinion and willingness to be vaccinated were also obtained. Results Data from 335 patients were collected (185 in CU, 150 in TP). The mean age was 69.3 years and the proportion of males was 72%. About 65% were vaccinated against influenza in the last year (60% in CU, 72% in TP, p = 0.022) and 22% were up to date with pneumococcal vaccination (11% in CU, 35% in TP, p < 0.001). Among patients not vaccinated, 17% refused vaccination. Among unvaccinated patients who consider vaccination, 69% wanted to be vaccinated by their general practitioner (GP). Conclusions The VC of HF patients remains insufficient. Patients in TP are more vaccinated than patients in CU, which could involve better management. The low rate of vaccinated patients is mainly explained by a lack of awareness. The medical team, including the clinical pharmacist by his dedicated time during medication reconciliation may play a major role in the management of hospitalized patients as well as GP's as local actors.
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Affiliation(s)
- Adrien Maire
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Chapet
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Sylvain Aguilhon
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Marie-Lucie Laugier
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | | | - Mélinda Rigoni
- Department of Pharmacy, University Hospital of Nimes, Nimes, France
| | - Betty Mathieu
- Department of Pharmacy, University Hospital of Nimes, Nimes, France
| | | | - Cyril Breuker
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Gaëlle de Barry
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Jean-Luc Pasquié
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - François Roubille
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
- Cancer Research Institute of Montpellier (IRCM), INSERM U1194, ICM, University of Montpellier, Montpellier, France
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11
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Jain A, Arora S, Patel V, Raval M, Modi K, Arora N, Desai R, Bozorgnia B, Bonita R. Etiologies and Predictors of 30-Day Readmission in Heart Failure: An Updated Analysis. INTERNATIONAL JOURNAL OF HEART FAILURE 2023; 5:159-168. [PMID: 37554694 PMCID: PMC10406555 DOI: 10.36628/ijhf.2023.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/16/2023] [Accepted: 05/13/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Readmissions in heart failure (HF), historically reported as 20%, contribute to significant patient morbidity and high financial cost to the healthcare system. The changing population landscape and risk factor dynamics mandate periodic epidemiologic reassessment of HF readmissions. METHODS National Readmission Database (NRD, 2019) was used to identify HF-related hospitalizations and evaluated for demographic, admission characteristics, and comorbidity differences between patients readmitted vs. those not readmitted at 30-days. Causes of readmission and predictors of all-cause, HF-specific, and non-HF-related readmissions were analyzed. RESULTS Of 48,971 HF patients, the readmitted cohort was younger (mean 67.4 vs. 68.9 years, p≤0.001), had higher proportion of males (56.3% vs. 53.7%), lowest income quartiles (33.3% vs. 28.9%), Charlson comorbidity index (CCI) ≥3 (61.7% vs. 52.8%), resource utilization including large bed-size hospitalizations, Medicaid enrollees, mean length of stay (6.2 vs. 5.4 days), and disposition to other facilities (23.9% vs. 20%) than non-readmitted. Readmission (30-day) rate was 21.2% (10,370) with cardiovascular causes in 50.3% (HF being the most common: 39%), and non-cardiac in 49.7%. Independent predictors for readmission were male sex, lower socioeconomic status, nonelective admissions, atrial fibrillation, chronic obstructive pulmonary disease, chronic kidney disease, anemia, and CCI ≥3. HF-specific readmissions were significantly associated with prior coronary artery disease and Medicaid enrollment. CONCLUSIONS Our analysis revealed cardiac and noncardiac causes of readmission were equally common for 30-day readmissions in HF patients with HF itself being the most common etiology highlighting the importance of addressing the comorbidities, both cardiac and non-cardiac, to mitigate the risk of readmission.
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Affiliation(s)
- Akhil Jain
- Department of Internal Medicine, Mercy Fitzgerald Hospital, Darby, PA, USA
| | - Shilpkumar Arora
- Department of Interventional Cardiology, Houston Methodist Hospital, Houston, TX, USA
| | - Viral Patel
- Department of Internal Medicine, New York Presbyterian Hospital, Queens, NY, USA
| | - Maharshi Raval
- Department of Internal Medicine, Landmark Medical Center, Woonsocket, RI, USA
| | - Karnav Modi
- Division of Research, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Nirav Arora
- Department of Data Science, Lamar University, Beaumont, TX, USA
| | - Rupak Desai
- Division of Cardiology. Atlanta VA Medical Center, Atlanta, GA, USA
| | - Behnam Bozorgnia
- Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Raphael Bonita
- Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
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12
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Zhang AB, Wang CC, Zhao P, Tong KT, He Y, Zhu XL, Fu HX, Wang FR, Mo XD, Wang Y, Zhao XY, Zhang YY, Han W, Chen H, Chen Y, Yan CH, Wang JZ, Han TT, Sun YQ, Chen YH, Chang YJ, Xu LP, Liu KY, Huang XJ, Zhang XH. A Prognostic Model Based on Clinical Biomarkers for Heart Failure in Adult Patients Following Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2023; 29:240.e1-240.e10. [PMID: 36634739 DOI: 10.1016/j.jtct.2022.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/05/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023]
Abstract
Heart failure (HF) is an uncommon but serious cardiovascular complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Unfortunately, knowledge about early mortality prognostic factors in patients with HF after allo-HSCT is limited, and an easy-to-use prognostic model is not available. This study aimed to develop and validate a clinical-biomarker prognostic model capable of predicting HF mortality following allo-HSCT that uses a combination of variables readily available in clinical practice. To investigate this issue, we conducted a retrospective analysis at our center with 154 HF patients who underwent allo-HSCT between 2008 and 2021. The patients were separated according to the time of transplantation, with 100 patients composing the derivation cohort and the other 54 patients composing the external validation cohort. We first calculated the univariable association for each variable with 2-month mortality in the derivation cohort. We then included the variables with a P value <.1 in univariate analysis as candidate predictors in the multivariate analysis using a backward stepwise logistic regression model. Variables remaining in the final model were identified as independent prognostic factors. To predict the prognosis of HF, a scoring system was established, and scores were assigned to the prognostic factors based on the regression coefficient. Finally, 4 strongly significant independent prognostic factors for 2-month mortality from HF were identified using multivariable logistic regression methods with stepwise variable selection: pulmonary infection (P = .005), grade III to IV acute graft-versus-host disease (severe aGVHD; P = .033), lactate dehydrogenase (LDH) >426 U/L (P = .049), and brain natriuretic peptide (BNP) >1799 pg/mL (P = .026). A risk grading model termed the BLIPS score (for BNP, LDH, cardiac troponin I, pulmonary infection, and severe aGVHD) was constructed according to the regression coefficients. The validated internal C-statistic was .870 (95% confidence interval [CI], .798 to .942), and the external C-statistic was .882 (95% CI, .791-.973). According to the calibration plots, the model-predicted probability correlated well with the actual observed frequencies. The clinical use of the prognostic model, according to decision curve analysis, could benefit HF patients. The BLIPS model in our study can serve to identify HF patients at higher risk for mortality early, which might aid designing timely targeted therapies and eventually improving patients' survival and prognosis.
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Affiliation(s)
- Ao-Bei Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Chen-Cong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Peng Zhao
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Ke-Ting Tong
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yun He
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Lu Zhu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Hai-Xia Fu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Feng-Rong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Dong Mo
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiang-Yu Zhao
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yuan-Yuan Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Wei Han
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Huan Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yao Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Chen-Hua Yan
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Jing-Zhi Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Ting-Ting Han
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu-Qian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu-Hong Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Ying-Jun Chang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Kai-Yan Liu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.
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13
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Bendary A, Hassanein M, Bendary M, Smman A, Hassanin A, Elwany M. The predictive value of precipitating factors on clinical outcomes in hospitalized patients with decompensated heart failure: insights from the Egyptian cohort in the European Society of Cardiology Heart Failure long-term registry. Egypt Heart J 2023; 75:16. [PMID: 36884155 PMCID: PMC9995627 DOI: 10.1186/s43044-023-00342-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/25/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Knowledge of the frequency of precipitating factors for acute heart failure (AHF) is important (either new-onset heart failure [NOHF] or worsening heart failure [WHF]), as this can guide strategies for prevention and treatment. Most data come only from Western Europe and North America; nevertheless, geographic differences do exist. We set out to study the prevalence of precipitating factors of AHF and their connection to patient characteristics and in-hospital and long-term mortality in patients from Egypt hospitalized for decompensated HF. Using the ESC-HF-LT Registry which is a prospective, multicenter, observational study of patients confessed to cardiology centers in the nations of Europe and the Mediterranean, patients presenting with AHF were recruited from 20 centers all over Egypt. Enrolling physicians were requested to report possible precipitants from among several predefined reasons. RESULTS We included 1515 patients (mean age 60 ± 12 years, 69% males). The mean LVEF was 38 ± 11%. Seventy-seven percent of the total population had HFrEF, 9.8% had HFmrEF, and 13.3% had HFpEF. The commonly reported precipitating factors for AHF hospitalization among study population were as follows (in decreasing order of frequency): infection in 30.3% of patients, acute coronary syndrome/myocardial ischemia (ACS/MI) in 26%, anemia in 24.3%, uncontrolled hypertension in 24.2%, atrial fibrillation (AF) in 18.3%, renal dysfunction in 14.6%, and non-compliance in 6.5% of patients. HFpEF patients had significantly higher rates of AF, uncontrolled hypertension, and anemia as precipitants for acute decompensation. ACS/MI were significantly more frequent in patients with HFmrEF. WHF patients had significantly higher rates of infection and non-compliance, whereas new-onset HF patients showed significantly higher rates of ACS/MI and uncontrolled hypertension. One-year follow-up revealed that patients with HFrEF had a significantly higher rate of mortality compared to patients with HFmrEF and HFpEF (28.3%, 19.5, and 19.4%, P = 0.004). Patients with WHF had a significantly higher rates of 1-year mortality when compared to those with NOHF (30.0% vs. 20.3%, P < 0.001). Renal dysfunction, anemia, and infection were independently connected to worse long-term survival. CONCLUSIONS Precipitating factors of AHF are frequent and substantially influence outcomes after hospitalization. They should be considered goals for avoiding AHF hospitalization and depicting those at highest risk for short-term mortality.
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Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt.
| | | | - Mohamed Bendary
- Biostatistics Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Smman
- Alexandria University Students' Hospital, Alexandria, Egypt
| | - Ahmed Hassanin
- Division of Cardiology, University of Arkansas for Medical Sciences, Arkansas, NY, USA
| | - Mostafa Elwany
- Cardiology Department, Alexandria University, Alexandria, Egypt
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14
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Taylor A, Jones T, Forehand CC, Smith SE, Dykes H, Newsome AS. Vasopressor Discontinuation Order in Septic Shock With Reduced Left Ventricular Function. J Pharm Pract 2022; 35:879-885. [PMID: 33977793 PMCID: PMC8586033 DOI: 10.1177/08971900211015080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The optimal vasopressor management for septic patients with left ventricular (LV) dysfunction has not been well established, and current evidence is conflicting regarding the optimal vasopressor discontinuation order. OBJECTIVE The objective was to evaluate the impact of LV dysfunction on the hemodynamic management of septic shock by assessing the incidence of clinically significant hypotension after vasopressor discontinuation. METHODS In this single-center, retrospective cohort study, adult patients were included if they met the Sepsis-3 definition of septic shock, had LV dysfunction (defined as an ejection fraction ≤40%), and received norepinephrine and vasopressin as the last vasopressors discontinued. The primary outcome was the incidence of clinically significant hypotension following discontinuation of vasopressin or norepinephrine. Clinically significant hypotension was defined as a MAP less than 60 mmHg and the need for either: 1) the reinstitution of the previously discontinued agent at any dosage, 2) the receipt of at least 500 mL of a crystalloid at a rate of at least 500 mL/hour, 3) or the receipt of at least 25 grams of albumin 5% at a rate of at least 25 gram/hour. Secondary outcomes included intensive care unit (ICU) and hospital lengths of stay, and ICU and hospital mortality. RESULTS A total of 78 patients met inclusion criteria, with 37 patients having vasopressin discontinued first and 41 having norepinephrine discontinued first. Clinically significant hypotension occurred in 28 patients (76%) following the discontinuation of vasopressin, compared to 28 patients (81%) following the discontinuation of norepinephrine (p = 0.61). ICU length of stay was 9 days in the vasopressin discontinued first cohort, compared to 15 days in the norepinephrine discontinued first cohort (p = 0.01). There was no statistically significant difference in mortality observed. CONCLUSION The discontinuation order of norepinephrine and vasopressin did not impact the incidence of clinically significant hypotension in patients with septic shock and LV dysfunction, but may influence ICU length of stay, although other factors may have impacted this finding.
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Affiliation(s)
- Ashley Taylor
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
- Department of Clinical and Administrative Pharmacy, The University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Timothy Jones
- Department of Clinical and Administrative Pharmacy, The University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Christy Cecil Forehand
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
- Department of Clinical and Administrative Pharmacy, The University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Susan E. Smith
- Department of Clinical and Administrative Pharmacy, The University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Hannah Dykes
- Department of Clinical and Administrative Pharmacy, The University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Andrea Sikora Newsome
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
- Department of Clinical and Administrative Pharmacy, The University of Georgia College of Pharmacy, Augusta, GA, USA
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15
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Szylińska A, Bott-Olejnik M, Wańkowicz P, Karoń D, Rotter I, Kotfis K. A Novel Index in the Prediction of Pneumonia Following Acute Ischemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192215306. [PMID: 36430028 PMCID: PMC9690571 DOI: 10.3390/ijerph192215306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND The aim of our study was to search for predictive factors and to develop a model (index) for the risk of pneumonia following acute ischemic stroke. MATERIAL AND METHODS This study is an analysis of prospectively collected data from the neurology department of a district general hospital in Poland, comprising 1001 patients suffering from an acute ischemic stroke. Based on the medical data, the formula for the prediction of pneumonia was calculated. RESULTS Multivariate assessment for pneumonia occurrence was performed using the new PNEUMOINDEX. The study showed a significant increase in pneumonia risk with an increasing PNEUMOINDEX (OR non-adjusted = 2.738, p < 0.001). After accounting for age and comorbidities as confounders, the effect of the Index on pneumonia changed marginally (OR = 2.636, p < 0.001). CONCLUSIONS This study presents factors that show a significant association with the occurrence of pneumonia in patients with acute ischemic stroke. The calculated PNEUMOINDEX consists of data obtained at admission, namely NYHA III and IV heart failure, COPD, generalized atherosclerosis, NIHHS score on admission, and CRP/Hgb ratio, and shows high prediction accuracy in predicting hospital-acquired pneumonia in ischemic stroke patients.
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Affiliation(s)
- Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-204 Szczecin, Poland
| | - Marta Bott-Olejnik
- Department of Neurology, Regional Specialist Hospital in Gryfice, 72-300 Gryfice, Poland
| | - Paweł Wańkowicz
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-204 Szczecin, Poland
| | - Dariusz Karoń
- Department of Anesthesiology and Intensive Therapy, Regional Specialist Hospital in Gryfice, 72-300 Gryfice, Poland
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-204 Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 71-204 Szczecin, Poland
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16
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Zhang B, Guo S, Fu Z, Wu N, Liu Z. Association between fluid balance and mortality for heart failure and sepsis: a propensity score-matching analysis. BMC Anesthesiol 2022; 22:324. [PMID: 36273128 PMCID: PMC9587660 DOI: 10.1186/s12871-022-01865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fluid resuscitation is necessary to correct the sepsis-induced hypoperfusion, which is contradictory to the treatment of heart failure. This study explored the association between fluid balance (FB) of the first 24 h after ICU admission and mortality in critically ill patients with heart failure and sepsis. METHODS Data were extracted from the Medical Information Mart for Intensive Care database. The locally weighted scatterplot smoothing (Lowess) method was used to demonstrate the relationship between FB and in-hospital mortality. Groups were divided into high FB (≥ 55.85 ml/kg) and low FB (< 55.85 ml/kg) according to the cut-off value of FB using Receiver operating characteristic analysis and Youden index method. The primary outcome was in-hospital mortality. Subgroup analyses, multivariable logistic regression analyses, and Kaplan-Meier curves were used to detect the association and survival difference between groups. Inverse probability treatment weighting (IPTW) and propensity score matching (PSM) were performed to minimize the bias of confounding factors and facilitate the comparability between groups. RESULTS A total of 936 patients were included. The Lowess curve showed an approximate positive linear relationship for FB and in-hospital mortality. In the multivariable logistic regression adjusted model, high FB showed strong associations with in-hospital mortality (OR 2.53, 95% CI 1.60-3.99, p < 0.001) as compared to the low FB group. In IPTW and PSM models, high FB consistently showed higher in-hospital mortality (IPTW model: OR 1.94, 95% CI 1.52-2.49, p < 0.001; PSM model: OR 2.93, 95% CI 1.75-4.90, p < 0.001) and 30-day mortality (IPTW model: OR 1.65, 95% CI 1.29-2.10, p < 0.001; PSM model: OR 2.50, 95% CI 1.51-4.15, p < 0.001), compared with the low FB group. CONCLUSION For critically ill patients with heart failure and sepsis, high FB within the first 24 h after ICU admission could serve as an independent risk factor for in-hospital mortality and 30-day mortality. The avoidance of fluid overload exerts important effects on reducing mortality in such patients.
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Affiliation(s)
- Bufan Zhang
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
- Department of Cardiovascular Surgery & Intensive Care Unit, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, People's Republic of China
| | - Shaohua Guo
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Zean Fu
- Department of Cardiovascular Surgery & Intensive Care Unit, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, People's Republic of China
| | - Naishi Wu
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
| | - Zhigang Liu
- Department of Cardiovascular Surgery & Intensive Care Unit, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, People's Republic of China.
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17
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Mefford MT, Liu R, Bruxvoort K, Qian L, Doris JM, Koyama SY, Tseng HF, Reynolds K. Influenza vaccination and mortality among adults with heart failure in an integrated healthcare delivery system, 2009-2018. J Gen Intern Med 2022; 37:2405-2412. [PMID: 34379280 PMCID: PMC9360203 DOI: 10.1007/s11606-021-07068-x] [Citation(s) in RCA: 2] [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: 03/27/2021] [Accepted: 07/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Influenza infection can result in decompensation or exacerbation of heart failure (HF) symptoms, hospitalization, and death. OBJECTIVE To examine the association of influenza vaccination with mortality and hospitalization during influenza and non-influenza seasons between 2009 and 2018. DESIGN, SETTING, AND PARTICIPANTS In this prospective, observational cohort study, we included Kaiser Permanente Southern California members with a HF diagnosis prior to September 1 each year from 2009 to 2017. EXPOSURE The first influenza vaccination in each season (September 1 to May 31) was recorded. Vaccinated/unvaccinated patients were matched 1:1 on age, sex, and ejection fraction at the vaccination date (n-total = 74,870). MAIN OUTCOMES Patients were followed through the end of each influenza season for all-cause mortality. Secondary outcomes included cardiovascular mortality and all-cause hospitalization. In a sensitivity analysis, we examined mortality in the non-influenza season. RESULTS Influenza vaccinated vs unvaccinated patients had more comorbidities and higher healthcare utilization. After multivariable adjustment for utilization, sociodemographics, comorbidities, and medications, influenza vaccinated vs unvaccinated patients had a lower risk of all-cause mortality and cardiovascular mortality during the influenza season (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.63, 0.70 and HR 0.68, 95% CI 0.63, 0.74, respectively) but a higher risk of all-cause hospitalization (HR 1.27, 95% CI 1.21, 1.31). There was no association between influenza vaccination and all-cause or cardiovascular mortality during the non-influenza season (HR 0.99, 95% CI 0.89, 1.09 and HR 1.00, 95% CI 0.84, 1.21, respectively). CONCLUSIONS Influenza vaccination in HF patients was associated with a lower risk of mortality during the influenza season. Our findings provide support for recommendations of universal influenza vaccination in patients with HF.
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Affiliation(s)
- Matthew T Mefford
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
| | - Ran Liu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Katia Bruxvoort
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Lei Qian
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jonathan M Doris
- Department of Cardiac Electrophysiology, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Sandra Y Koyama
- Internal Medicine, Kaiser Permanente Southern California, Baldwin Park, CA, USA
| | - Hung Fu Tseng
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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18
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Fukuta H, Hagiwara H, Kamiya T. Influenza vaccination in patients with heart failure: A protocol for meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e28844. [PMID: 35147132 PMCID: PMC8830872 DOI: 10.1097/md.0000000000028844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Heart failure is a major public health problem. Although there have been significant advances in the management of heart failure, the mortality and morbidity in heart failure patients remain high. Heart failure patients are susceptible to influenza-related complications including acute heart failure exacerbations and secondary infections such as pneumonia, both of which lead to significant morbidity and mortality. An earlier meta-analysis of observational cohort studies reported that influenza vaccination was associated with reduced risk of mortality in heart failure patients. Although there are no published randomized controlled trials (RCTs) on the effect of influenza vaccination on clinical outcomes in heart failure patients, there are several on-going RCTs examining the effect in these patients. We aim to conduct a meta-analysis of RCTs to assess the efficacy and safety of influenza vaccination in heart failure patients. METHODS This meta-analysis will include RCTs examining the effect of influenza vaccination in heart failure patients. Information of studies will be collected from electronic databases. The primary outcome of interest will be cardiovascular death. The secondary outcomes of interest will be all-cause death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, and hospitalization for any cause. DISCUSSION This meta-analysis will evaluate the efficacy and safety of influenza vaccination in heart failure patients, providing evidence to the use of influenza vaccine in these patients. SYSTEMATIC REVIEW REGISTRATION INPLASY202210115.
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Affiliation(s)
- Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromi Hagiwara
- Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takeshi Kamiya
- Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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19
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Ng TMH, Oh EE, Bae-Shaaw YH, Minejima E, Joyce G. Acute Bacterial Infections and Longitudinal Risk of Readmissions and Mortality in Patients Hospitalized with Heart Failure. J Clin Med 2022; 11:jcm11030740. [PMID: 35160192 PMCID: PMC8836984 DOI: 10.3390/jcm11030740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/16/2022] [Accepted: 01/27/2022] [Indexed: 12/04/2022] Open
Abstract
Aims: Infections are associated with worse short-term outcomes in patients with heart failure (HF). However, acute infections may have lasting pathophysiologic effects that adversely influence HF outcomes after discharge. Our objective was to describe the impact of acute bacterial infections on longitudinal outcomes of patients hospitalized with a primary diagnosis of HF. Methods and Results: This paper is based on a retrospective cohort study of patients hospitalized with a primary diagnosis of HF with or without a secondary diagnosis of acute bacterial infection in Optum Clinformatics DataMart from 2010–2015. Primary outcomes were 30 and 180-day hospital readmissions and mortality, intensive care unit admission, length of hospital stay, and total hospital charge, compared between those with or without an acute infection. Cohorts were compared after inverse probability of treatment weighting. Multivariable logistic regression was used to examine relationship to outcomes. Of 121,783 patients hospitalized with a primary diagnosis of HF, 27,947 (23%) had a diagnosis of acute infection. After weighting, 30-day hospital readmissions [17.1% vs. 15.7%, OR 1.11 (1.07–1.15), p < 0.001] and 180-day hospital readmissions [39.6% vs. 38.7%, OR 1.04 (1.01–1.07), p = 0.006] were modestly greater in those with an acute infection versus those without. Thirty-day [5.5% vs. 4.3%, OR 1.29 (1.21–1.38), p < 0.001] and 180-day mortality [10.7% vs. 9.4%, OR 1.16 (1.11–1.22), p < 0.001], length of stay (7.1 ± 7.0 days vs. 5.7 ± 5.8 days, p < 0.001), and total hospital charges (USD 62,200 ± 770 vs. USD 51,100 ± 436, p < 0.001) were higher in patients with an infection. Conclusions: The development of an acute bacterial infection in patients hospitalized for HF was associated with an increase in morbidity and mortality after discharge.
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Affiliation(s)
- Tien M. H. Ng
- Department of Clinical Pharmacy and Medicine, University of Southern California, Los Angeles, CA 90089-9121, USA
- Correspondence:
| | - Esther E. Oh
- Department of Clinical Pharmacy, University of Southern California, Los Angeles, CA 90089-9121, USA; (E.E.O.); (E.M.)
| | - Yuna H. Bae-Shaaw
- Department of Pharmaceutical and Health Economics, University of Southern California, Los Angeles, CA 90089-9121, USA; (Y.H.B.-S.); (G.J.)
| | - Emi Minejima
- Department of Clinical Pharmacy, University of Southern California, Los Angeles, CA 90089-9121, USA; (E.E.O.); (E.M.)
| | - Geoffrey Joyce
- Department of Pharmaceutical and Health Economics, University of Southern California, Los Angeles, CA 90089-9121, USA; (Y.H.B.-S.); (G.J.)
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20
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Clinical Characteristics and Predictors of In-Hospital Mortality among Older Patients with Acute Heart Failure. J Clin Med 2022; 11:jcm11020439. [PMID: 35054133 PMCID: PMC8781633 DOI: 10.3390/jcm11020439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/17/2022] Open
Abstract
Acute Heart Failure (AHF)-related hospitalizations and mortality are still high in western countries, especially among older patients. This study aimed to describe the clinical characteristics and predictors of in-hospital mortality of older patients hospitalized with AHF. We conducted a retrospective study including all consecutive patients ≥65 years who were admitted for AHF at a single academic medical center between 1 January 2008 and 31 December 2018. The primary outcome was all-cause, in-hospital mortality. We also analyzed deaths due to cardiovascular (CV) and non-CV causes and compared early in-hospital events. The study included 6930 patients, mean age 81 years, 51% females. The overall mortality rate was 13%. Patients ≥85 years had higher mortality and early death rate than younger patients. Infections were the most common condition precipitating AHF in our cohort, and pneumonia was the most frequent of these. About half of all hospital deaths were due to non-CV causes. After adjusting for confounding factors other than NYHA class at admission, infections were associated with an almost two-fold increased risk of mortality, HR 1.74, 95% CI 1.10-2.71 in patients 65-74 years (p = 0.014); HR 1.83, 95% CI 1.34-2.49 in patients 75-84 years (p = 0.001); HR 1.74, 95% CI 1.24-2.19 in patients ≥85 years (p = 0.001). In conclusion, among older patients with AHF, in-hospital mortality rates increased with increasing age, and infections were associated with an increased risk of in-hospital mortality. In contemporary patients with AHF, along with the treatment of the CV conditions, management should be focused on timely diagnosis and appropriate treatment of non-CV factors, especially pulmonary infections.
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21
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Salzer U, Müller A, Zhou Q, Nieters A, Grundmann S, Wehr C. Susceptibility to infections and adaptive immunity in adults with heart failure. ESC Heart Fail 2022; 9:1195-1205. [PMID: 35032103 PMCID: PMC8934962 DOI: 10.1002/ehf2.13793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 12/11/2022] Open
Abstract
Aims Heart failure (HF) is a systemic inflammatory disorder with infections being an important cause of morbidity and mortality. We asked if HF patients have a higher susceptibility to infections compared with the general population and if a subtle secondary immunodeficiency facilitates infectious complications. Methods and results In a cohort of 92 patients with HF with reduced ejection fraction, we analysed recirculating lymphocyte subpopulations, serum immunoglobulin levels, and specific antibody titres against pneumococcal antigens. We quantified susceptibility to infections of the respiratory tract with a validated questionnaire and compared it to the general population. Susceptibility to infections of the respiratory tract was comparable in HF patients and the general population. Hypogammaglobulinaemia was present in 16% of HF patients, but anti‐pneumococcal titres showed no evidence of specific secondary antibody deficiency. Relative lymphopaenia in our HF cohort was due to B lymphocytopenia with a relative reduction in naive B‐cells and expansion of memory B‐cells while CD4+ and CD8+ T‐lymphocytes as well as NK‐cell counts were comparable between HF and healthy donors. The intake of the angiotensin receptor neprilysin (CD10) inhibitor (ARNI) sacubitril/valsartan was associated with increased B‐lymphocyte counts, possibly by an increased output of CD10+ transitional B lymphocytes from the bone marrow. Conclusion Despite a reduction of B lymphocytes in HF and mild hypogammaglobulinaemia, patients showed no evidence of secondary immunodeficiency or increased susceptibility to infections. The relevance of B‐cell lymphopenia in HF patients and modulation of B‐cell counts under ARNI treatment remains to be investigated.
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Affiliation(s)
- Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alisa Müller
- Department of General Paediatrics, Children's Hospital, University of Bonn, Bonn, Germany.,Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Qian Zhou
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine, Division of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Alexandra Nieters
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Grundmann
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claudia Wehr
- Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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22
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Kim HJ, Park MS, Shin JI, Park J, Kim DH, Jeon J, Kim J, Song TJ. Associations of heart failure with susceptibility and severe complications of COVID-19: A nationwide cohort study. J Med Virol 2021; 94:1138-1145. [PMID: 34738248 PMCID: PMC8661586 DOI: 10.1002/jmv.27435] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 12/23/2022]
Abstract
Infection is associated with occurrence and worsening of heart failure (HF). However, studies on the association of susceptibility and severe complications of coronavirus disease 2019 (COVID-19) with HF history are limited. From the Korean nationwide COVID-19 data set, 212,678 participants with at least one severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction (RT-PCR) test were included between January 1 and June 4, 2020. To investigate the association of HF with susceptibility and severe complications of COVID-19, 1:4 ratio propensity score matching (PSM) and logistic regression analysis were performed. The primary outcome was a composite outcome of mechanical ventilation, intensive care unit (ICU) admission, and death. After PSM, COVID-19 PCR positivity did not show a significant difference according to HF history in multivariable analysis (odds ratio [OR]: 0.91, 95% confidence interval (CI) (0.79-1.04), p = 0.146). Of 7630 individuals with confirmed COVID-19 infection, 310 (4.1%) had HF history. The overall primary outcome occurred in 426 (5.6%) individuals, including 159 (2.1%) cases of mechanical ventilation, 254 (3.3%) cases of ICU admission, and 215 (2.8%) cases of death. In multivariate logistic analysis, presence of HF history was associated independently with primary outcome (OR: 1.99, 95% CI: 1.42-2.79, p < 0.001), particularly mortality (OR: 2.02, 95% CI: 1.36-3.00, p < 0.001). Our study demonstrated that HF history is associated poor prognosis, particularly mortality, in COVID-19. Patients with HF can have severe complication if infected with COVID-19; therefore, careful management are necessary.
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Affiliation(s)
- Hyung Jun Kim
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Moo-Suk Park
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Park
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Dong-Hyeok Kim
- Department of Cardiology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jimin Jeon
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Jinkwon Kim
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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23
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Khan S, Rasool ST, Ahmed SI. Role of Cardiac Biomarkers in COVID-19: What Recent Investigations Tell Us? Curr Probl Cardiol 2021; 46:100842. [PMID: 33994028 PMCID: PMC7977033 DOI: 10.1016/j.cpcardiol.2021.100842] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Although the respiratory system is the main target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is evident from recent data that other systems, especially cardiovascular and hematological, are also significantly affected. In fact, in severe form, COVID-19 causes a systemic illness with widespread inflammation and cytokine flood, resulting in severe cardiovascular injury. Therefore, we reviewed cardiac injury biomarkers' role in various cardiovascular complications of COVID 19 in recent studies. RECENT FINDINGS Cardiac injury biomarkers were elevated in most of the complicated cases of COVID-19, and their elevation is directly proportional to the worst outcome. Evaluation of cardiac biomarkers with markers of other organ damage gives a more reliable tool for case fatalities and future outcome. SUMMARY Significant association of cardiac biomarkers in COVID-19 cases helps disease management and prognosis, especially in severely ill patients.
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Key Words
- ace, angiotensin-converting enzyme
- ami, acute myocardial infarction
- acs, acute coronary syndrome
- acovcs, acute covid–19 cardiovascular syndrome
- alt, alanine aminotransferase
- ast, aspartate aminotransferase
- bnp, brain-type natriuretic peptide
- cap, community-acquired pneumonia
- chf, congestive heart failure
- covid-19, 2019 novel coronavirus disease
- crp, c-reactive protein
- copd, chronic obstructive pulmonary disease
- ctn, cardiac troponin
- ctni, cardiac troponin i
- ctnt, cardiac troponin t
- ck, creatine kinase
- ck-mb, creatine kinase-mb
- cvd, cardiovascular diseases
- dcm, diabetic cardiomyopathy
- ihd, ischemic heart diseases
- sars, severe acute respiratory syndrome
- ldh, lactate dehydrogenase
- nt-probnp, n-terminal pro b-type natriuretic peptide
- mr-pro anp, mid regional proatrial natriuretic peptide
- raas, renin-angiotensin-aldosterone system
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- sst2, soluble source of tumorigenicity 2
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Affiliation(s)
- Shahzad Khan
- Department of Pathophysiology, Wuhan University School of Medicine, Hubei, Wuhan, China.
| | | | - Syed Imran Ahmed
- College of Science, School of Pharmacy, University of Lincoln, Lincoln, United Kingdom.
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24
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Girerd N, Chapet N, Roubille C, Roncalli J, Salvat M, Mouquet F, Lamblin N, Gueffet JP, Damy T, Galinier M, Tartiere JM, Janssen C, Berthelot E, Aguilhon S, Escamilla R, Roubille F. Vaccination for Respiratory Infections in Patients with Heart Failure. J Clin Med 2021; 10:jcm10194311. [PMID: 34640328 PMCID: PMC8509310 DOI: 10.3390/jcm10194311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/23/2022] Open
Abstract
Bronchopulmonary infections are a major trigger of cardiac decompensation and are frequently associated with hospitalizations in patients with heart failure (HF). Adverse cardiac effects associated with respiratory infections, more specifically Streptococcus pneumoniae and influenza infections, are the consequence of inflammatory processes and thrombotic events. For both influenza and pneumococcal vaccinations, large multicenter randomized clinical trials are needed to evaluate their efficacy in preventing cardiovascular events, especially in HF patients. No study to date has evaluated the protective effect of the COVID-19 vaccine in patients with HF. Different guidelines recommend annual influenza vaccination for patients with established cardiovascular disease and also recommend pneumococcal vaccination in patients with HF. The Heart Failure group of the French Society of Cardiology recently strongly recommended vaccination against COVID-19 in HF patients. Nevertheless, the implementation of vaccination recommendations against respiratory infections in HF patients remains suboptimal. This suggests that a national health policy is needed to improve vaccination coverage, involving not only the general practitioner, but also other health providers, such as cardiologists, nurses, and pharmacists. This review first summarizes the pathophysiology of the interrelationships between inflammation, infection, and HF. Then, we describe the current clinical knowledge concerning the protective effect of vaccines against respiratory diseases (influenza, pneumococcal infection, and COVID-19) in patients with HF and finally we propose how vaccination coverage could be improved in these patients.
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Affiliation(s)
- Nicolas Girerd
- Centre d’Investigations Cliniques—INSERM CHRU de Nancy, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France;
| | - Nicolas Chapet
- Department of Clinical Pharmacy, CHU de Montpellier, 34295 Montpellier, France;
| | - Camille Roubille
- Department of Internal Medicine, CHU Montpellier, Montpellier University, PhyMedExp, 34295 Montpellier, France;
| | - Jérôme Roncalli
- Service de Cardiologie, CHU de Toulouse-Rangueil, Université Paul Sabatier–Toulouse III, 31400 Toulouse, France;
| | | | - Frédéric Mouquet
- Department of Cardiology, Hôpital Privé Le Bois, 59000 Lille, France;
| | - Nicolas Lamblin
- Institut Pasteur, Université Lille, Inserm, CHU Lille, U1167 Lille, France;
| | | | - Thibaud Damy
- Referral Center for Cardiac Amyloidoisis, Department of Cardiology, GHU Henri Mondor-APHP, IMRB 955, 94000 Créteil, France;
| | - Michel Galinier
- Fédération des Services de Cardiologie, CHU Toulouse-Rangueil, Faculté de Médecine, Toulouse, Université Paul Sabatier-Toulouse III, 31400 Toulouse, France;
| | | | - Cécile Janssen
- Centre Hospitalier Annecy Genevois, Infectious Diseases Unit, 74370 Annecy, France;
| | - Emmanuelle Berthelot
- Service de Cardiologie, Hôpital Bicêtre, AP-HP, University of Paris Sud, 94270 Le Kremlin-Bicêtre, France;
| | - Sylvain Aguilhon
- Cardiology Department, CHU de Montpellier, 34295 Montpellier, France;
| | - Roger Escamilla
- Service de Pneumologie, Hôpital Larrey, 31400 Toulouse, France;
| | - François Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France
- Correspondence:
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25
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Fung E, Cheng HY, Choi KC, Hui DSC, Yang C, Chair SY. Differential risks for heart failure hospitalization following severe respiratory infection by common pathogens. Eur J Prev Cardiol 2021; 29:e163-e166. [PMID: 34283202 DOI: 10.1093/eurjpc/zwab123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/20/2021] [Accepted: 07/06/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Erik Fung
- Laboratory for Heart Failure + Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.,Division of Cardiology and Gerald Choa Cardiac Research Centre, Department of Medicine & Therapeutics, Faculty of Medicine, Shatin, Hong Kong SAR, China.,CUHK Medical Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,CARE Programme, Lui Che Woo Institute of Innovative Medicine, CUHK Hong Kong Hub of Paediatric Excellence, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong SAR, China.,Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, UK
| | - Ho Yu Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - David S C Hui
- Stanley Ho Centre for Emerging Infectious Diseases and Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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26
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Suciadi LP, Wibawa K, Jessica G, Henrina J, Cahyadi I, Santi BT, Hariadi TK, Tedjasukmana F, Kristanti NM, Pakpahan EF, Manullang RA, Sutandar A. Tachycardia and Pre-existing Chronic Kidney Disease Are Predictors of the Worse Clinical Outcomes in Patients Recently Hospitalized With Acute Heart Failure. Cureus 2021; 13:e15802. [PMID: 34306870 PMCID: PMC8294205 DOI: 10.7759/cureus.15802] [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] [Accepted: 06/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background: This study aimed to assess the factors contributing to the outcomes of recently hospitalized patients with heart failure (HF). Methods: A prospective data of 76 adults who were admitted due to acute HF between October 1, 2019 and June 30, 2020 at our center were analyzed. Endpoints included survival and rehospitalization within six months after discharge. Results: The mean age was 64.9 ± 13.8 years, with a male preponderance (68.4%). Approximately 60.5% of patients had the left ventricular ejection fraction (LVEF) <40%, whereas 26.3% of patients had LVEF ≥50%. Coronary artery disease (75%), arterial hypertension (72.4%), chronic kidney disease (46.1%), and diabetes mellitus (46.1%) were the most frequent comorbidities. Poor compliance (40.8%) and non-cardiac infection (21.1%) were the common precipitating factors for hospitalization. The majority of subjects had severe symptoms, indicated by the frequent need of intensive care unit (43%), high N-terminal prohormone brain natriuretic peptide levels [NT-proBNP; median, 4765 (1539.7-11782.2) pg/mL], and presence of either atrial fibrillation, severe mitral regurgitation, or significant pulmonary hypertension in approximately one-third of cases. Even though in-hospital mortality was relatively low (2.6%), the all-cause mortality and rehospitalization rates in the next six months after discharge were still high, reaching 22.54% and 19.72%, respectively. Further survival analysis showed that tachycardia on admission and pre-existing chronic kidney disease (CKD) resulted in low six-month survival rates among these patients. Conclusion: After hospital discharge, patients with HF were still exposed to higher risks of death and readmission albeit with the medication addressed. Tachycardia on admission and pre-existing CKD might predict worse outcomes.
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Affiliation(s)
- Leonardo P Suciadi
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
| | | | | | | | | | - Bryany T Santi
- Epidemiology, School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia, Jakarta, IDN
| | - Titus K Hariadi
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
| | - Firman Tedjasukmana
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
| | | | - Elisa F Pakpahan
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
| | - Reynold A Manullang
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
| | - Antono Sutandar
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
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Cheng CW, Liu MH, Wang CH. Predictors of infection-related rehospitalization in heart failure patients and its impact on long-term survival. J Cardiovasc Med (Hagerstown) 2021; 21:889-896. [PMID: 32576750 PMCID: PMC7752229 DOI: 10.2459/jcm.0000000000001025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infection is the most common non-cardiovascular cause of re-hospitalizations for heart failure patients. We therefore investigated the predictors of infection-related re-hospitalization (IRRH) in heart failure patients and its impact on long-term survival. METHODS AND RESULTS We prospectively recruited 622 patients after the index hospitalization for decompensated heart fail with primary endpoints of IRRH and all-cause mortality. During follow-up of 3.9 ± 2.7 years, IRRHs occurred in 104 (16.7%) patients. Of the 104 patients who experienced IRRHs, the time from the index hospitalization to IRRH was 1.0 (interquartile range: 0.4-2.6) years. Independent predictors of IRRH were age (hazard ratio: 1.02, 95% confidence interval: 1.01-1.04), diabetes mellitus (2.12, 1.42-3.17), not taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (1.67, 1.01-2.78), needing maintenance therapy with a loop diuretic (2.10, 1.36-3.26), hemoglobin levels (0.87, 0.79-0.96), and estimated glomerular filtration rates (eGFRs) (0.99, 0.98-0.99). IRRH independently predicted all-cause mortality (1.99, 1.32-2.98) after adjusting for age, body mass index, New York Heart Association functional class, chronic obstructive pulmonary disease, brain natriuretic peptide, hemoglobin, and eGFR. The increased risk of death associated with IRRHs was predominantly for lower respiratory tract infections (3.71, 2.28-6.04), urogenital tract infections (2.83, 1.32-6.10), and sepsis (3.26, 1.20-8.85). CONCLUSION IRRHs in patients discharged for acute decompensated heart fail independently predicted worse long-term survival. We further identified independent predictors of IRRHs. These findings warrant future studies for tackling IRRH.
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Affiliation(s)
- Chi-Wen Cheng
- Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung City.,Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C
| | - Min-Hui Liu
- Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung City
| | - Chao-Hung Wang
- Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung City.,Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C
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Impact of Pneumonia in Heart Failure Patients. J Am Coll Cardiol 2021; 77:1974-1976. [PMID: 33888246 DOI: 10.1016/j.jacc.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/23/2022]
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García-Guimaraes M, Mojón D, Calvo A, Izquierdo A, Belarte-Tornero L, Salvatella N, Llagostera M, Negrete A, Mas-Stachurska A, Ruiz S, Valdivielso S, Ribas N, Marrugat J, Farré N, Vaquerizo B. Influence of cardiovascular disease and cardiovascular risk factors in COVID-19 patients. Data from a large prospective Spanish cohort. REC: CARDIOCLINICS 2021. [PMCID: PMC7670893 DOI: 10.1016/j.rccl.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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Shen L, Jhund PS, Anand IS, Bhatt AS, Desai AS, Maggioni AP, Martinez FA, Pfeffer MA, Rizkala AR, Rouleau JL, Swedberg K, Vaduganathan M, Vardeny O, van Veldhuisen DJ, Zannad F, Zile MR, Packer M, Solomon SD, McMurray JJV. Incidence and Outcomes of Pneumonia in Patients With Heart Failure. J Am Coll Cardiol 2021; 77:1961-1973. [PMID: 33888245 DOI: 10.1016/j.jacc.2021.03.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The incidence of pneumonia and subsequent outcomes has not been compared in patients with heart failure and reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). OBJECTIVES This study aimed to examine the rate and impact of pneumonia in the PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) and PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in Heart Failure with Preserved Ejection Fraction) trials. METHODS The authors analyzed the incidence of investigator-reported pneumonia and the rates of HF hospitalization, cardiovascular death, and all-cause death before and after the occurrence of pneumonia, and estimated risk after the first occurrence of pneumonia in unadjusted and adjusted analyses (the latter including N-terminal pro-B-type natriuretic peptide). RESULTS In PARADIGM-HF, 528 patients (6.3%) developed pneumonia after randomization, giving an incidence rate of 29 (95% CI: 27 to 32) per 1,000 patient-years. In PARAGON-HF, 510 patients (10.6%) developed pneumonia, giving an incidence rate of 39 (95% CI: 36 to 42) per 1,000 patient-years. The subsequent risk of all trial outcomes was elevated after the occurrence of pneumonia. In PARADIGM-HF, the adjusted hazard ratio (HR) for the risk of death from any cause was 4.34 (95% CI: 3.73 to 5.05). The corresponding adjusted HR in PARAGON-HF was 3.76 (95% CI: 3.09 to 4.58). CONCLUSIONS The incidence of pneumonia was high in patients with HF, especially HFpEF, at around 3 times the expected rate. A first episode of pneumonia was associated with 4-fold higher mortality. (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF], NCT01035255; Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] With ARB [Angiotensin Receptor Blocker] Global Outcomes in Heart Failure With Preserved Ejection Fraction [PARAGON-HF], NCT01920711).
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Affiliation(s)
- Li Shen
- School of Medicine, Hangzhou Normal University, Hangzhou, China; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Inder S Anand
- Department of Medicine, University of Minnesota Medical School and VA Medical Center, Minneapolis, Minnesota, USA
| | - Ankeet S Bhatt
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Akshay S Desai
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aldo P Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | | | - Marc A Pfeffer
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Adel R Rizkala
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Jean L Rouleau
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Muthiah Vaduganathan
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Administration Health Care System and University of Minnesota, Minneapolis, Minnesota, USA
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Faiez Zannad
- Centre d'Investigations Cliniques-Plurithématique 1433 and Institut National de la Santé et de la Recherche Médicale U1116, Centre Hospitalier Regional Universitaire, French Clinical Research Infrastructure Network, Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Nancy, France
| | - Michael R Zile
- Ralph H. Johnson Department of Veterans Affairs Medical Center, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Scott D Solomon
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
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Aghili SR, Abastabar M, Soleimani A, Haghani I, Azizi S. High prevalence of asymptomatic nosocomial candiduria due to Candida glabrata among hospitalized patients with heart failure: a matter of some concern? Curr Med Mycol 2021; 6:1-8. [PMID: 34195453 PMCID: PMC8226045 DOI: 10.18502/cmm.6.4.5327] [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] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose: Heart failure is a leading cause of hospitalization, and asymptomatic candiduria is common in hospitalized patients with low morbidity.
However, in most patients, it is resolved spontaneously on the removal of the catheter. Despite the publication of guidelines,
there are still controversies over the diagnosis and management of candiduria.
However, in hospitalized patients with heart failure, the decision to treat candiduria is especially important since
the nosocomial infections are associated with an increase in morbidity, mortality, length of hospital stay, and healthcare costs.
Some species of Candida, such as Candida glabrata, are increasingly resistant to the first-line and second-line antifungal medications.
The present study aimed to investigate the incidence of asymptomatic Candida urinary tract infection due to C.
glabrata and antifungal susceptibility of Candida isolates in hospitalized patients with heart failure. Materials and Methods: In total, 305 hospitalized patients with heart failure were studied to identify asymptomatic nosocomial candiduria during 2016-17
in one private hospital in the north of Iran.
The Sabouraud’s dextrose agar culture plates with a colony count of >104 colony-forming
unit/ml of urine sample were considered as Candida urinary tract infection.
Candida species were identified based on the morphology of CHROMagar Candida (manufactured by CHROMagar, France) and
PCR-RFLP method with MspI restriction enzyme.
Antifungal susceptibility testing of the isolates was performed using five mediations, including itraconazole, voriconazole,
fluconazole, amphotericin B, and caspofungin by broth
microdilution method according to CLSI M27-S4. Results: In this study, the rate of asymptomatic Candida urinary tract infection was 18.8%, which was more common in people above 51
years old and females (70%).
In addition to the urinary and intravascular catheter, the occurrence of candiduria in hospitalized patients had significant relationships
with a history of
surgical intervention, diastolic heart failure, and use of systemic antibiotics (P>0.05). Among Candida spp., non-albicans Candida
species was the most common
infectious agent (59.7%). Moreover, C. glabrata (n=27, 40.3%) (alone or with other species) and Candida albicans (n=27, 40.3%) were the most
common agents isolated in
Candida urinary tract infection. Based on the results of the in vitro susceptibility test, the C. glabrata isolates were 15%, 59%, 70%, 74%,
and 85% susceptible to
caspofungin, amphotericin B, itraconazole, voriconazole, and fluconazole, respectively. Conclusion: According to the findings, there was a high prevalence of asymptomatic Candida urinary tract infection in hospitalized patients with heart failure.
Besides, it was suggested that there was a shift towards non-albicans Candida, especially C. glabrata, in these patients.
Therefore, asymptomatic candiduria in hospitalized patients with heart failure should be considered significant.
Furthermore, the identification of Candida species along with antifungal susceptibility is essential and helps the clinicians to
select the appropriate antifungal agent for better management of such cases.
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Affiliation(s)
- Seyed Reza Aghili
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ameneh Soleimani
- Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Soheil Azizi
- Department of Laboratory Medicine, Faculty of Allied Medical Sciences, Mazandaran University of Medical Science, Sari, Iran
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Belarte-Tornero LC, Valdivielso-Moré S, Vicente Elcano M, Solé-González E, Ruíz-Bustillo S, Calvo-Fernández A, Subinara I, Cabero P, Soler C, Cubero-Gallego H, Vaquerizo B, Farré N. Prognostic Implications of Chronic Heart Failure and Utility of NT-proBNP Levels in Heart Failure Patients with SARS-CoV-2 Infection. J Clin Med 2021; 10:jcm10020323. [PMID: 33477268 PMCID: PMC7829899 DOI: 10.3390/jcm10020323] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 02/07/2023] Open
Abstract
Background: The prevalence and prognostic value of chronic heart failure (CHF) in the setting of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has seldom been studied. The aim of this study was to analyze the prevalence and prognosis of CHF in this setting. Methods: This single-center study included 829 consecutive patients with SARS-CoV-2 infection from February to April 2020. Patients with a previous history of CHF were matched 1:2 for age and sex. We analyze the prognostic value of pre-existing CHF. Prognostic implications of N terminal pro brain natriuretic peptide (NT-proBNP) levels on admission in the CHF cohort were explored. Results: A total of 129 patients (43 CHF and 86 non-CHF) where finally included. All-cause mortality was higher in CHF patients compared to non-CHF patients (51.2% vs. 29.1%, p = 0.014). CHF was independently associated with 30-day mortality (hazard ratio (HR) 2.3, confidence interval (CI) 95%: 1.26–2.4). Patients with CHF and high-sensitivity troponin T < 14 ng/L showed excellent prognosis. An NT-proBNP level > 2598 pg/mL on admission was associated with higher 30-day mortality in patients with CHF. Conclusions: All-cause mortality in CHF patients hospitalized due to SARS-CoV-2 infection was 51.2%. CHF was independently associated with all-cause mortality (HR 2.3, CI 95% 1.26–4.2). NT-proBNP levels could be used for stratification risk purposes to guide medical decisions if larger studies confirm this finding.
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Affiliation(s)
- Laia C. Belarte-Tornero
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
- Correspondence: (L.C.B.-T.); (N.F.)
| | - Sandra Valdivielso-Moré
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
| | | | - Eduard Solé-González
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
| | - Sonia Ruíz-Bustillo
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
- Department of Medicine, School of Medicine, Universidad Autonoma de Barcelona, 08003 Barcelona, Spain
| | - Alicia Calvo-Fernández
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
| | - Isaac Subinara
- CIBER Epidemiology and Public Health, IMIM-Parc de Salut Mar, 08003 Barcelona, Spain;
| | - Paula Cabero
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain;
| | - Cristina Soler
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
| | - Héctor Cubero-Gallego
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain;
| | - Beatriz Vaquerizo
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain;
- Department of Medicine, School of Medicine, Universidad Autonoma de Barcelona, 08003 Barcelona, Spain
| | - Núria Farré
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
- Department of Medicine, School of Medicine, Universidad Autonoma de Barcelona, 08003 Barcelona, Spain
- Correspondence: (L.C.B.-T.); (N.F.)
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Wu CI, Wu CL, Su FC, Lin SW, Huang WY. Association between Pre-Existing Coronary Artery Disease and 5-Year Mortality in Stroke Patients with High-Grade Carotid Artery Stenosis. Eur Neurol 2020; 84:31-37. [PMID: 33361700 DOI: 10.1159/000512407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The coincidence of coronary artery disease (CAD) and carotid artery stenosis (CAS) was observed. However, the association between pre-existing CAD and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between pre-existing CAD and outcomes of acute IS patients with high-grade CAS. METHODS From January 1, 2007, to April 30, 2012, we enrolled 372 acute IS patients with high-grade CAS and prospectively observed them for 5 years. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between patients with and without pre-existing CAD. RESULTS Among 372 individuals, 75 (20.2%) patients had pre-existing CAD and 297 (79.8%) patients did not have pre-existing CAD. The prevalence rates of hypertension, congestive heart failure, chronic kidney disease, and gout in patients with pre-existing CAD were significantly higher than in those without pre-existing CAD (p = 0.017, p < 0.001, p = 0.002, and p < 0.001, respectively). The multivariate Cox proportional hazards model revealed that pre-existing CAD was a significant risk factor for a 5-year all-cause mortality in acute IS patients with high-grade CAS (hazard ratio = 2.26; 95% confidence interval = 1.35-3.79; p = 0.002). CONCLUSION Pre-existing CAD was associated with an increased risk of 5-year mortality in acute IS patients with high-grade CAS. Intensive treatment for the pre-existing CAD may reduce long-term mortality in acute IS patients with high-grade CAS.
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Affiliation(s)
- Ching-I Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Feng-Chieh Su
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Shun-Wen Lin
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan, .,Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan,
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34
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Tersalvi G, Winterton D, Cioffi GM, Ghidini S, Roberto M, Biasco L, Pedrazzini G, Dauw J, Ameri P, Vicenzi M. Telemedicine in Heart Failure During COVID-19: A Step Into the Future. Front Cardiovasc Med 2020; 7:612818. [PMID: 33363223 PMCID: PMC7755592 DOI: 10.3389/fcvm.2020.612818] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023] Open
Abstract
During the Coronavirus Disease 2019 worldwide pandemic, patients with heart failure are a high-risk group with potential higher mortality if infected. Although lockdown represents a solution to prevent viral spreading, it endangers regular follow-up visits and precludes direct medical assessment in order to detect heart failure progression and optimize treatment. Furthermore, lifestyle changes during quarantine may trigger heart failure decompensations. During the pandemic, a paradoxical reduction of heart failure hospitalization rates was observed, supposedly caused by patient reluctance to visit emergency departments and hospitals. This may result in an increased patient mortality and/or in more complicated heart failure admissions in the future. In this scenario, different telemedicine strategies can be implemented to ensure continuity of care to patients with heart failure. Patients at home can be monitored through dedicated apps, telephone calls, or devices. Virtual visits and forward triage screen the patients with signs or symptoms of decompensated heart failure. In-hospital care may benefit from remote communication platforms. After discharge, patients may undergo remote follow-up or telerehabilitation to prevent early readmissions. This review provides a comprehensive appraisal of the many possible applications of telemedicine for patients with heart failure during Coronavirus disease 2019 and elucidates practical limitations and challenges regarding specific telemedicine modalities.
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Affiliation(s)
- Gregorio Tersalvi
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Dario Winterton
- Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - Giacomo Maria Cioffi
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Department of Cardiology, Kantonsspital Luzern, Lucerne, Switzerland
| | - Simone Ghidini
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Roberto
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Luigi Biasco
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, Ciriè, Italy
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Giovanni Pedrazzini
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Pietro Ameri
- Cardiovascular Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Marco Vicenzi
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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35
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Böhm M, Frey N, Giannitsis E, Sliwa K, Zeiher AM. Coronavirus Disease 2019 (COVID-19) and its implications for cardiovascular care: expert document from the German Cardiac Society and the World Heart Federation. Clin Res Cardiol 2020; 109:1446-1459. [PMID: 32462267 PMCID: PMC7252421 DOI: 10.1007/s00392-020-01656-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus diseases 2019 (COVID-19) has become a worldwide pandemic affecting people at high risk and particularly at advanced age, cardiovascular and pulmonary disease. As cardiovascular patients are at high risk but also have dyspnea and fatigue as leading symptoms, prevention, diagnostics and treatment in these patients are important to provide adequate care for those with or without COVID-19 but most importantly when comorbid cardiovascular conditions are present. Severe COVID-19 with acute respiratory distress (ARDS) is challenging as patients with elevated myocardial markers such as troponin are at enhanced high risk for fatal outcomes. As angiotensin-converting enzyme 2 (ACE2) is regarded as the viral receptor for cell entry and as the Coronavirus is downregulating this enzyme, which provides cardiovascular and pulmonary protection, there is ongoing discussions on whether treatment with cardiovascular drugs, which upregulate the viral receptor ACE2 should be modified. As most of the COVID-19 patients have cardiovascular comorbidities like hypertension, diabetes, coronary artery disease and heart failure, which imposes a high risk on these patients, cardiovascular therapy should not be modified or even withdrawn. As cardiac injury is a common feature of COVID-19 associated ARDS and is linked with poor outcomes, swift diagnostic management and specialist care of cardiovascular patients in the area of COVID-19 is of particular importance and deserves special attention.
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Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, 66421, Homburg, Saar, Germany.
| | - Norbert Frey
- Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Evangelos Giannitsis
- Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Karen Sliwa
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Andreas M Zeiher
- Department of Medicine-Cardiology,, J.W. Goethe University, Frankfurt, Germany
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36
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Haberkorn S, Uwarow A, Haurand J, Jung C, Kelm M, Westenfeld R, Horn P. Percutaneous left ventricular assist support is associated with less pulmonary congestion and lower rate of pneumonia in patients with cardiogenic shock. Open Heart 2020; 7:openhrt-2020-001385. [PMID: 33132209 PMCID: PMC7607612 DOI: 10.1136/openhrt-2020-001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives The aim of this study was to investigate the impact of acute left ventricular unloading by percutaneous left ventricular assist device on pulmonary congestion and pneumonia in patients with cardiogenic shock (CS). Methods In this retrospective study, we analysed patients with CS who received the Impella percutaneous left ventricular assist device (n=50) compared with those who received intra-aortic balloon pump (IABP) support (n=50). Pulmonary congestion was longitudinally assessed while on support by calculating characteristic findings on the chest X-ray using the Halperin score. The rate of pneumonia and early mortality were assessed as a secondary endpoint. Results The groups (Impella vs IABP) did not differ in terms of age, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology, Chronic Health Evaluation (APACHE) II score or serum lactate levels. Pulmonary congestion decreased in patient treated with Impella at each time point postimplantation. No change in congestion status was observed in patients supported with IABP. Multivariate analysis indicated Impella support as an independent predictor for pulmonary decongestion (OR 4.06, 95% CI 1.15 to 14.35, p=0.030). The rate of early pneumonia was lower in the Impella group compared with the IABP group (54% vs 74%, p=0.037). Failure of pulmonary decongestion during mechanical circulatory support independently predicted early pneumonia (OR 0.28, 95% CI 0.12 to 0.70, p=0.006). Conclusion Pulmonary decongestion may facilitate treatment of pneumonia in patients with CS. Left ventricular unloading by Impella device might support pulmonary decongestion, although a larger prospective trial in this patient population is required.
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Affiliation(s)
- Sandra Haberkorn
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Angelika Uwarow
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Jean Haurand
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Cardiovascular Research Institute, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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Giakoumis M, Sargsyan D, Kostis JB, Cabrera J, Dalwadi S, Kostis WJ. Readmission and mortality among heart failure patients with history of hypertension in a statewide database. J Clin Hypertens (Greenwich) 2020; 22:1263-1274. [PMID: 33051955 DOI: 10.1111/jch.13918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 12/21/2022]
Abstract
Objective was to examine the temporal trends in readmission and mortality of heart failure (HF) patients with history of hypertension. This study includes 51 141 patients with history of hypertension who were discharged with a first diagnosis of HF between January 1, 2000, and December 31, 2014. Data were obtained from the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database of all hospitalizations for cardiovascular (CV) disease in New Jersey. The temporal trends of mortality, rates of HF-specific readmission, and all-cause readmissions up to 1 year after discharge were examined using multivariable logistic regression. The difference in all-cause mortality at 3 years between patients who were readmitted compared to those who were not readmitted at 1 year was examined. The number of patients with history of hypertension and HF remained unchanged during the study period. Male gender, black race, comorbidities, and admission to non-teaching hospitals were predictors of HF readmission and CV mortality (P < .05 for all). Readmission rate for any cause increased during the study period (P < .001) while rates of HF readmissions and mortality remained relatively unchanged. Patients that had been readmitted within a year exhibited a significantly higher 3-year mortality (P < .001). CV mortality among HF patients with history of hypertension did not change significantly between 2000 and 2014, while the rates of all-cause readmission increased. Patients who were readmitted had higher 3-year mortality (P < .001) than those who were not.
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Affiliation(s)
- Michail Giakoumis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Davit Sargsyan
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Javier Cabrera
- Department of Statistics, Rutgers University, Piscataway, New Jersey, USA
| | - Sanketkumar Dalwadi
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - William J Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Yoshida H, Inaguma D, Koshi-Ito E, Ogata S, Kitagawa A, Takahashi K, Koide S, Hayashi H, Hasegawa M, Yuzawa Y, Tsuboi N. Extreme hyperuricemia is a risk factor for infection-related deaths in incident dialysis patients: a multicenter prospective cohort study. Ren Fail 2020; 42:646-655. [PMID: 32662307 PMCID: PMC7470168 DOI: 10.1080/0886022x.2020.1788582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction There are few studies on the association between serum uric acid (UA) level and mortality in incident dialysis patients. We aimed to clarify whether the serum UA level at dialysis initiation is associated with mortality during maintenance dialysis. Methods We enrolled 1486 incident dialysis patients who participated in a previous multicenter prospective cohort study in Japan. We classified the patients into the following five groups according to their serum UA levels at dialysis initiation: G1 with a serum UA level <6 mg/dL; G2, 6.0–8.0 mg/dL; G3, 8.0–10.0 mg/dL; G4, 10.0–12.0 mg/dL; and G5, ≥12.0 mg/dL. We created three models (Model 1: adjusted for age and sex, Model 2: adjusted for Model 1 + 12 variables, and Model 3: stepwise regression adjusted for Model 2 + 13 variables) and performed a multivariate Cox proportional hazard regression analysis to examine the association between the serum UA level and outcomes, including infection-related mortality. Results Hazard ratios (HRs) were calculated relative to the G2, because the all-cause mortality rate was the lowest in G2. For Models 1 and 2, the all-cause mortality rate was significantly higher in G5 than in G2 (HR: 1.63, 95% confidence interval [CI]: 1.14–2.33 and HR: 1.78, 95% CI: 1.19–2.68, respectively). For Models 1, 2, and 3, the infection-related mortality rate was significantly higher in G5 than in G2 (HR: 2.75, 95% CI: 1.37–5.54, HR: 3.09, 95% CI: 1.45–6.59, HR: 3.37, and 95% CI: 1.24–9.15, respectively). Conclusions Extreme hyperuricemia (serum UA level ≥12.0 mg/dL) at dialysis initiation is a risk factor for infection-related deaths.
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Affiliation(s)
- Hiroyuki Yoshida
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Daijo Inaguma
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Eri Koshi-Ito
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Soshiro Ogata
- Faculty of Nursing, School of Health Sciences, Fujita Health University, Toyoake, Japan.,Department of Preventive Medicine & Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akimitsu Kitagawa
- Department of Nephrology, Fujita Health University, Bantane Hospital, Nagoya, Japan
| | - Kazuo Takahashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
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Ranard LS, Fried JA, Abdalla M, Anstey DE, Givens RC, Kumaraiah D, Kodali SK, Takeda K, Karmpaliotis D, Rabbani LE, Sayer G, Kirtane AJ, Leon MB, Schwartz A, Uriel N, Masoumi A. Approach to Acute Cardiovascular Complications in COVID-19 Infection. Circ Heart Fail 2020; 13:e007220. [PMID: 32500721 PMCID: PMC8126417 DOI: 10.1161/circheartfailure.120.007220] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The novel coronavirus disease 2019, otherwise known as COVID-19, is a global pandemic with primary respiratory manifestations in those who are symptomatic. It has spread to >187 countries with a rapidly growing number of affected patients. Underlying cardiovascular disease is associated with more severe manifestations of COVID-19 and higher rates of mortality. COVID-19 can have both primary (arrhythmias, myocardial infarction, and myocarditis) and secondary (myocardial injury/biomarker elevation and heart failure) cardiac involvement. In severe cases, profound circulatory failure can result. This review discusses the presentation and management of patients with severe cardiac complications of COVID-19 disease, with an emphasis on a Heart-Lung team approach in patient management. Furthermore, it focuses on the use of and indications for acute mechanical circulatory support in cardiogenic and/or mixed shock.
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Affiliation(s)
- Lauren S Ranard
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Justin A Fried
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Marwah Abdalla
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - D Edmund Anstey
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Raymond C Givens
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Deepa Kumaraiah
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Susheel K Kodali
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (S.K.K., D. Karmpaliotis, A.J.K., M.B.L.)
| | - Koji Takeda
- Department of Surgery (K.T.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Dimitrios Karmpaliotis
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (S.K.K., D. Karmpaliotis, A.J.K., M.B.L.)
| | - LeRoy E Rabbani
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Ajay J Kirtane
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (S.K.K., D. Karmpaliotis, A.J.K., M.B.L.)
| | - Martin B Leon
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (S.K.K., D. Karmpaliotis, A.J.K., M.B.L.)
| | - Allan Schwartz
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Nir Uriel
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Amirali Masoumi
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
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Jones TW, Smith SE, Van Tuyl JS, Newsome AS. Sepsis With Preexisting Heart Failure: Management of Confounding Clinical Features. J Intensive Care Med 2020; 36:989-1012. [PMID: 32495686 DOI: 10.1177/0885066620928299] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Preexisting heart failure (HF) in patients with sepsis is associated with worse clinical outcomes. Core sepsis management includes aggressive volume resuscitation followed by vasopressors (and potentially inotropes) if fluid is inadequate to restore perfusion; however, large fluid boluses and vasoactive agents are concerning amid the cardiac dysfunction of HF. This review summarizes evidence regarding the influence of HF on sepsis clinical outcomes, pathophysiologic concerns, resuscitation targets, hemodynamic interventions, and adjunct management (ie, antiarrhythmics, positive pressure ventilatory support, and renal replacement therapy) in patients with sepsis and preexisting HF. Patients with sepsis and preexisting HF receive less fluid during resuscitation; however, evidence suggests traditional fluid resuscitation targets do not increase the risk of adverse events in HF patients with sepsis and likely improve outcomes. Norepinephrine remains the most well-supported vasopressor for patients with sepsis with preexisting HF, while dopamine may induce more cardiac adverse events. Dobutamine should be used cautiously given its generally detrimental effects but may have an application when combined with norepinephrine in patients with low cardiac output. Management of chronic HF medications warrants careful consideration for continuation or discontinuation upon development of sepsis, and β-blockers may be appropriate to continue in the absence of acute hemodynamic decompensation. Optimal management of atrial fibrillation may include β-blockers after acute hemodynamic stabilization as they have also shown independent benefits in sepsis. Positive pressure ventilatory support and renal replacement must be carefully monitored for effects on cardiac function when HF is present.
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Affiliation(s)
- Timothy W Jones
- Department of Clinical and Administrative Pharmacy, 15506University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, 15506University of Georgia College of Pharmacy, Athens, GA, USA
| | - Joseph S Van Tuyl
- Department of Pharmacy Practice, 14408St Louis College of Pharmacy, St Louis, MO, USA
| | - Andrea Sikora Newsome
- Department of Clinical and Administrative Pharmacy, 15506University of Georgia College of Pharmacy, Augusta, GA, USA.,Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
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Kopp A, Mangin O, Gantzer L, Lekens B, Simoneau G, Ravelomanantsoa M, Evans J, Bergmann JF, Sellier P. Pneumococcal vaccination coverage in France by general practitioners in adults with a high risk of pneumococcal disease. Hum Vaccin Immunother 2020; 17:162-169. [PMID: 32429734 DOI: 10.1080/21645515.2020.1756669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Streptococcus pneumoniae, the main cause of community-acquired pneumonia (CAP), also leads to exacerbations, hospitalizations, and mortality in chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). The risk of CAP is increased in patients with diabetes mellitus (DM), and the risk of invasive pneumococcal disease is increased in HIV-infected patients. Pneumococcal vaccination is recommended for these patients in France. The objective was a large survey of pneumococcal vaccination coverage (PVC) by general practitioners (GPs) in these patients in France. Diagnosis and treatment forms were extracted from the database of 2000 GPs. The GPs and population panels were representative of the metropolitan populations. The primary endpoint was the comparison of PVC in the adult patients diagnosed with COPD, CHF, DM, or HIV infection during the study (April 2013-April 2017) and the control (March 2012-March 2013) periods. Of the 17,865 and 4,690 patients identified, 756 (4%) and 267 (6%) were vaccinated, respectively. During the study period, the PVC was significantly higher (35/282, 12%) in HIV-infected patients and lower in patients with DM (95/5994, 2%) than in other patients. Even though French pneumococcal vaccine recommendations in adults were updated in 2013, the PVC did not increase according to the years of the study period and slightly increased according to time after diagnosis. S. pneumoniae is responsible only for some CAP and meningitis, and incomplete protection by vaccine, hesitancy from practitioners and patients, and the moving schedule of vaccination could explain the results. New tools and/or strategies must be implemented to increase PVC in France. Abbreviations: CAP: community-acquired pneumonia; COPD: chronic obstructive pulmonary diseases; CHF: congestive heart failure; DM: diabetes mellitus; IPD: invasive pneumococcal disease; HIV: human immunodeficiency virus; PVC: pneumococcal vaccination coverage; PCV7: 7-valent pneumococcal conjugate vaccine; PCV13: 13-valent pneumococcal conjugate vaccine; PPSV23: 23-valent pneumococcal polysaccharide vaccine; GPs: general practitioners; CLM: Cegedim Logiciels Médicaux; MLM: monLogicielMedical; ICD-10: International Classification of Diseases; CNIL: Commission nationale de l'informatique et des libertés; HPV: human papillomavirus; HBV: hepatitis B virus.
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Affiliation(s)
- Aude Kopp
- Département de Médecine Interne, GH Saint-Louis-Lariboisière-Fernand Widal, AP-HP , Paris, France
| | - Olivier Mangin
- Département de Médecine Interne, GH Saint-Louis-Lariboisière-Fernand Widal, AP-HP , Paris, France
| | - Laurène Gantzer
- Cegedim Logiciels Médicaux (CLM®), GERSDATA, GERS SAS , Boulogne-Billancourt, France
| | - Béranger Lekens
- Cegedim Logiciels Médicaux (CLM®), GERSDATA, GERS SAS , Boulogne-Billancourt, France
| | - Guy Simoneau
- Département de Médecine Interne, GH Saint-Louis-Lariboisière-Fernand Widal, AP-HP , Paris, France
| | | | - John Evans
- Département de Médecine Interne, GH Saint-Louis-Lariboisière-Fernand Widal, AP-HP , Paris, France
| | - Jean-François Bergmann
- Département de Médecine Interne, GH Saint-Louis-Lariboisière-Fernand Widal, AP-HP , Paris, France
| | - Pierre Sellier
- Département de Médecine Interne, GH Saint-Louis-Lariboisière-Fernand Widal, AP-HP , Paris, France
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Drozd M, Garland E, Walker AMN, Slater TA, Koshy A, Straw S, Gierula J, Paton M, Lowry J, Sapsford R, Witte KK, Kearney MT, Cubbon RM. Infection-Related Hospitalization in Heart Failure With Reduced Ejection Fraction: A Prospective Observational Cohort Study. Circ Heart Fail 2020; 13:e006746. [PMID: 32354281 DOI: 10.1161/circheartfailure.119.006746] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hospitalization is a common adverse event in people with heart failure and reduced ejection fraction, yet is often not primarily due to decompensated heart failure (HF). We investigated the long-term prognosis following infection-related hospitalization. METHODS We conducted a prospective observational cohort study of 711 people with heart failure and reduced ejection fraction recruited from 4 specialist HF clinics in the United Kingdom. All hospitalization episodes (n=1568) were recorded and categorized as primarily due to decompensated HF, other cardiovascular disease, infection-related, or other noncardiovascular disease. Survival was determined after the first hospitalization. RESULTS During 2900 patient-years of follow-up, there were a total of 14 686 hospital days. At least one hospitalization occurred in 467 people (66%); 25% of first hospitalizations were primarily due to infection and these were not associated with typical signs including tachycardia and pyrexia. Compared with other categories of hospitalization, infection-related was associated with older age, lower serum albumin, higher blood neutrophil counts, and greater prevalence of chronic obstructive pulmonary disease at recruitment. Median survival after first infection-related hospitalization was 18.6 months, comparable to that after first decompensated HF hospitalization, even after age-sex adjustment. The burden of all-cause rehospitalization was comparable irrespective of the category of first hospitalization, but infection more commonly caused re-hospitalization after index infection hospitalization. CONCLUSIONS Infection is a common driver of hospitalization in heart failure and reduced ejection fraction and often presents without classical signs. It is associated with high mortality rates, comparable to decompensated HF, and a major burden of rehospitalization caused by recurrent episodes of infection.
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Affiliation(s)
- Michael Drozd
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
| | - Ellis Garland
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
| | - Andrew M N Walker
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
| | - Thomas A Slater
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
| | - Aaron Koshy
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
| | - Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
| | - Maria Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
| | - Judith Lowry
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
| | - Robert Sapsford
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, United Kingdom (R.S.)
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
| | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
| | - Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, United Kingdom (M.D., E.G., A.M.N.W., T.A.S., A.K., S.S., J.G., M.P., J.L., K.K.W., M.T.K., R.M.C.)
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Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data. Eur J Clin Pharmacol 2020; 76:979-989. [PMID: 32270213 PMCID: PMC7306029 DOI: 10.1007/s00228-020-02835-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/20/2020] [Indexed: 01/06/2023]
Abstract
Purpose Heart failure is among the leading causes for hospitalization in Europe. In this study, we evaluate potential precipitating factors for hospitalization for heart failure and shock. Methods Using Swiss claims data (2014–2015), we evaluated the association between hospitalization for heart failure and shock, and prescription of oral potassium supplements, non-steroidal anti-inflammatory drugs (NSAIDs), and amoxicillin/clavulanic acid. We conducted case-crossover analyses, where exposure was compared for the hazard period and the primary control period (e.g., 1–30 days before hospitalization vs. 31–60 days, respectively). Conditional logistic regression was applied and subsequently adjusted for addressing potential confounding by disease progression. Sensitivity analyses were conducted and stratification for co-medication was performed. Results We identified 2185 patients hospitalized with heart failure or shock. Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid was significantly associated with an increased risk for hospitalization for heart failure and shock with crude odds ratios (OR) of 2.04 for potassium (95% CI 1.24–3.36, p = 0.005, 30 days), OR 1.8 for NSAIDs (95% CI 1.39–2.33, p < 0.0001, 30 days), and OR 3.25 for amoxicillin/clavulanic acid (95% CI 2.06–5.14, p < 0.0001, 15 days), respectively. Adjustment attenuated odds ratios, while the significant positive association remained (potassium OR 1.70 (95% CI 1.01–2.86, p = 0.046), NSAIDs OR 1.50 (95% CI 1.14–1.97, p = 0.003), and amoxicillin/clavulanic acid OR 2.26 (95% CI 1.41–3.62, p = 0.001). Conclusion Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid is associated with increased risk for hospitalization. Underlying conditions such as pain, electrolyte imbalances, and infections are likely contributing risk factors. Physicians may use this knowledge to better identify patients at risk and adapt patient management. Electronic supplementary material The online version of this article (10.1007/s00228-020-02835-x) contains supplementary material, which is available to authorized users.
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Salam AM, Sulaiman K, Alsheikh-Ali AA, Singh R, AlHabib KF, Al-Zakwani I, Asaad N, Al-Qahtani A, Al-Jarallah M, AlMahmeed W, Bulbanat B, Ridha M, Bazargani N, Amin H, Al-Motarreb A, Panduranga P, AlFaleh H, Shehab A, Al Suwaidi J. Precipitating Factors for Hospitalization with Heart Failure: Prevalence and Clinical Impact Observations from the Gulf CARE (Gulf aCute heArt failuRe rEgistry). Med Princ Pract 2020; 29:270-278. [PMID: 31522185 PMCID: PMC7315136 DOI: 10.1159/000503334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/15/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Despite the expanding burden of heart failure (HF) worldwide, data on HF precipitating factors (PFs) in developing countries, particularly the Middle East, are very limited. We examined PFs in patients hospitalized with acute HF in a prospective multicenter HF registry from 7 countries in the Middle East. METHOD Data were derived from the Gulf CARE (Gulf aCute heArt failuRe rEgistry) for a prospective, multinational, multicenter study of consecutive patients hospitalized with HF in 47 hospitals in 7 Middle Eastern countries between February 2012 and November 2012. PFs were determined by the treating physician from a predefined list at the time of hospitalization. RESULTS The study included 5,005 patients hospitalized with acute HF, 2,276 of whom (45.5%) were hospitalized with acute new-onset HF (NOHF) and 2,729 of whom (54.5%) had acute decompensated chronic HF (DCHF). PFs were identified in 4,319 patients (86.3%). The most common PF in the NOHF group was acute coronary syndromes (ACS) (39.2%). In the DCHF group, it was noncompliance with medications (27.8%). Overall, noncompliance with medications was associated with a lower inhospital mortality (OR 0.47; 95% CI 0.28-0.80; p = 0.005) but a higher 1-year mortality (OR 1.43; 95% CI 1.1-1.85; p = 0.007). ACS was associated with higher inhospital mortality (OR 1.84; 95% CI 1.26-2.68; p = 0.002) and higher 1-year mortality (OR 1.62; 95% CI 1.27-2.06; p = 0.001). CONCLUSION Preventive and therapeutic interventions specifically directed at noncompliance with medications and ACS are warranted in our region.
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Affiliation(s)
- Amar M Salam
- College of Medicine, Qatar University, Doha, Qatar,
- Adult Cardiology, Hamad Medical Corporation, Doha, Qatar,
| | | | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Rajvir Singh
- Biostatistics Section, Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, and Gulf Health Research, Seeb, Oman
| | - Nidal Asaad
- College of Medicine, Qatar University, Doha, Qatar
| | | | | | | | - Bassam Bulbanat
- Department of Cardiology, Sabah Al-Ahmed Cardiac Center, Kuwait, Kuwait
| | - Mustafa Ridha
- Department of Cardiology, Adan Hospital, Kuwait, Kuwait
| | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed Al-Motarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | | | - Husam AlFaleh
- Department of Cardiology and Cardiovascular Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
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Affiliation(s)
- Adam D DeVore
- Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.D.D.)
| | - Ankeet S Bhatt
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.S.B.)
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Wang KN, Bell JS, Tan ECK, Gilmartin-Thomas JFM, Dooley MJ, Ilomäki J. Proton Pump Inhibitors and Infection-Related Hospitalizations Among Residents of Long-Term Care Facilities: A Case-Control Study. Drugs Aging 2019; 36:1027-1034. [PMID: 31485926 DOI: 10.1007/s40266-019-00704-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our objective was to investigate associations between proton pump inhibitor (PPIs) use and infection-related hospitalizations among residents of long-term care facilities (LTCFs). METHODS This was a case-control study of residents aged ≥ 65 years admitted to hospital between July 2013 and June 2015. Residents admitted for infections (cases) and falls or fall-related injuries (controls) were matched for age (± 2 years), sex, and index date of admission (± 6 months). Conditional logistic regression was used to estimate crude and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between PPI use and infection-related hospitalizations. Analyses were adjusted for age, sex, polypharmacy, diabetes, heart failure, chronic obstructive pulmonary disease, myocardial infarction, cerebrovascular accident, and concomitant use of cancer and immunosuppressant medications. Subgroup analyses were performed for high- and low/moderate-intensity PPIs and for respiratory and non-respiratory infections. Logistic regression was used to compare the odds of infection-related hospitalizations among users of high- and low/moderate-intensity PPIs. RESULTS Overall, 181 cases were matched to 354 controls. Preadmission PPI use was associated with infection-related hospitalizations (aOR 1.66; 95% CI 1.11-2.48). In subgroup analyses, the association was apparent only for respiratory infections (aOR 2.26; 95% CI 1.37-3.73) and high-intensity PPIs (aOR 1.93; 95% CI 1.23-3.04). However, the risk of infection-related hospitalization was not significantly higher among users of high- versus low/moderate-intensity PPIs (aOR 1.25; 95% CI 0.74-2.13). CONCLUSION Residents who use PPIs may be at increased risk of infection-related hospitalizations, particularly respiratory infections. Study findings provide further support for initiatives to minimize unnecessary PPI use in the LTCF setting.
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Affiliation(s)
- Kate N Wang
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 407 Royal Parade, Parkville, VIC, 3052, Australia. .,Pharmacy Department, Alfred Health, Melbourne, VIC, Australia.
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 407 Royal Parade, Parkville, VIC, 3052, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Edwin C K Tan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 407 Royal Parade, Parkville, VIC, 3052, Australia.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Julia F M Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Dooley
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 407 Royal Parade, Parkville, VIC, 3052, Australia.,Pharmacy Department, Alfred Health, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 407 Royal Parade, Parkville, VIC, 3052, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Markwart R, Willrich N, Haller S, Noll I, Koppe U, Werner G, Eckmanns T, Reuss A. The rise in vancomycin-resistant Enterococcus faecium in Germany: data from the German Antimicrobial Resistance Surveillance (ARS). Antimicrob Resist Infect Control 2019; 8:147. [PMID: 31485325 PMCID: PMC6712849 DOI: 10.1186/s13756-019-0594-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Due to limited therapeutic options, vancomycin-resistant Enterococcus faecium (VREF) is of great clinical significance. Recently, rising proportions of vancomycin resistance in enterococcal infections have been reported worldwide. This study aims to describe current epidemiological trends of VREF in German hospitals and to identify factors that are associated with an increased likelihood of vancomycin resistance in clinical E. faecium isolates. Methods 2012 to 2017 data from routine vancomycin susceptibility testing of 35,906 clinical E. faecium isolates from 148 hospitals were analysed using data from the German Antimicrobial Resistance Surveillance System. Descriptive statistical analyses and uni- and multivariable regression analyses were performed to investigate the impact of variables, such as year of sampling, age and region, on vancomycin resistance in clinical E. faecium isolates. Results From 2014 onwards the proportions of clinical E. faecium isolates exhibiting resistance to vancomycin increased from 11.2% (95% confidence interval [CI] 9.4-13.3%) to 26.1% (95% CI 23.1-29.4%) in 2017. The rise of VREF proportions is primarily observed in the southern regions of Germany, whereas northern regions do not show a major increase. In the Southwest and Southeast, VREF proportions increased from 10.8% (95% CI 6.9-16.5%) and 3.8% (95% CI 3.0-11.5%) in 2014 to 36.7% (95% CI 32.9-40.8%) and 36.8% (95% CI 29.2-44.7%) in 2017, respectively. VREF proportions were considerably higher in isolates from patients aged 40-59 years compared to younger patients. Further regression analyses show that in relation to secondary care hospitals, E. faecium samples collected in specialist care hospitals and prevention and rehabilitation care centres are more likely to be vancomycin-resistant (odds ratios: 2.4 [95% CI 1.2-4.6] and 2.4 [95% CI 1.9-3.0], respectively). No differences in VREF proportions were found between female and male patients as well as between different clinical specimens. Conclusion The proportion of VREF is increasing in German hospitals, particularly in southern regions in Germany. Increased efforts in infection control and antibiotic stewardship activities accounting for local resistance patterns are necessary to combat the spread of VREF in Germany.
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Affiliation(s)
- Robby Markwart
- 1Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Niklas Willrich
- 1Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Sebastian Haller
- 1Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Ines Noll
- 1Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Uwe Koppe
- 2Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Unit 34: HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Guido Werner
- 3Robert Koch Institute, Department 1: Infectious Diseases, Unit 13: Nosocomial Pathogens and Antibiotic Resistances, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Tim Eckmanns
- 1Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Annicka Reuss
- 1Robert Koch Institute, Department 3: Infectious Disease Epidemiology, Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
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Järvinen H, Taipale H, Koponen M, Tanskanen A, Tiihonen J, Tolppanen AM, Hartikainen S. Hospitalization after Oral Antibiotic Initiation in Finnish Community Dwellers with and without Alzheimer's Disease: Retrospective Register-Based Cohort Study. J Alzheimers Dis 2019; 64:437-445. [PMID: 29914029 DOI: 10.3233/jad-180125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Persons with Alzheimer's disease (AD) are frequently hospitalized from infection-related causes. There are no previous studies investigating hospitalization associated with antibiotic initiation in persons with AD. OBJECTIVE To investigate the frequency and risk of hospitalization associated with oral antibiotic initiation among community dwellers with and without AD. METHODS We performed a retrospective register-based study utilizing register-based Medication Use and Alzheimer's disease (MEDALZ) cohort. It includes all community dwellers diagnosed with AD during 2005-2011 in Finland and their matched comparison persons without AD. Antibiotic use was initiated by 34,785 persons with and 36,428 without AD. Drug use data were collected from Prescription Register and comorbidities from Special Reimbursement and Hospital Care Registers. Infection diagnoses were collected from the Hospital Care Register. Factors associated with hospitalization were estimated utilizing logistic regression models. RESULTS Risk of hospitalization following antibiotic initiation was higher among antibiotic initiators with AD than without AD (adjusted odds ratio, aOR, 1.37, 95% Cl 1.28-1.46).Strongest association with hospitalization was found for oral glucocorticoid use, aOR 1.41 (1.25-1.59); epilepsy, aOR 1.33 (1.10-1.63); and active cancer, aOR 1.30 (1.14-1.49). Among initiators of cephalexin, pivmecillinam, amoxicillin/amoxicillin, and enzyme inhibitor and doxycycline, persons with AD were more frequently hospitalized than persons without AD. A quarter of hospitalized antibiotic initiators had infection diagnosis in their hospital care records. CONCLUSIONS Persons with AD initiating an antibiotic had a higher risk for hospitalization than antibiotic initiators without AD. Further research is needed to determine whether infection-related hospitalization could be reduced.
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Affiliation(s)
- Heli Järvinen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Marjaana Koponen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | | | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
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49
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Vardeny O, Solomon SD. Influenza and Heart Failure. JACC-HEART FAILURE 2019; 7:118-120. [DOI: 10.1016/j.jchf.2018.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 11/24/2022]
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Panhwar MS, Kalra A, Gupta T, Kolte D, Khera S, Bhatt DL, Ginwalla M. Effect of Influenza on Outcomes in Patients With Heart Failure. JACC-HEART FAILURE 2019; 7:112-117. [DOI: 10.1016/j.jchf.2018.10.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 12/29/2022]
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