|
1
|
Zheng B, Liang T, Mei J, Shi X, Liu X, Li S, Wan Y, Zheng Y, Yang X, Huang Y. Prediction of 90 day readmission in heart failure with preserved ejection fraction by interpretable machine learning. ESC Heart Fail 2024; 11:4267-4276. [PMID: 39168476 PMCID: PMC11631356 DOI: 10.1002/ehf2.15033] [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: 03/08/2024] [Revised: 07/11/2024] [Accepted: 08/07/2024] [Indexed: 08/23/2024] Open
Abstract
AIMS Certain critical risk factors of heart failure with preserved ejection fraction (HFpEF) patients were significantly different from those of heart failure with reduced ejection fraction (HFrEF) patients, resulting in the limitations of existing predictive models in real-world situations. This study aimed to develop a machine learning model for predicting 90 day readmission for HFpEF patients. METHODS AND RESULTS Data were extracted from electronic health records from 1 August 2020 to 1 August 2021 and follow-up records of patients with HFpEF within 3 months after discharge. Feature extraction was performed by univariate analysis combined with the least absolute shrinkage and selection operator (LASSO) algorithms. Machine learning models like eXtreme Gradient Boosting (XGBoost), random forest, neural network and logistic regression were adopted to construct models. The discrimination and calibration of each model were compared, and the Shapley Additive exPlanations (SHAP) method was used to explore the interpretability of the model. The cohort included 746 patients, of whom 103 (13.8%) were readmitted within 90 days. XGBoost owned the best performance [area under the curve (AUC) = 0.896, precision-recall area under the curve (PR-AUC) = 0.868, sensitivity = 0.817, specificity = 0.837, balanced accuracy = 0.827]. The Kolmogorov-Smirnov (KS) statistic was 0.694 at 0.468 in the XGBoost model. SHAP identified the top 12 risk features, including activities of daily living (ADL), left atrial dimension (LAD), left ventricular end-diastolic diameter (LVDD), shortness, nitrates, length of stay, nutritional risk, fall risk, accompanied by other symptoms, educational level, anticoagulants and edema. CONCLUSIONS Our model could help medical agencies achieve the early identification of 90 day readmission risk in HFpEF patients and reveal risk factors that provide valuable insights for treatments.
Collapse
Affiliation(s)
- Baojia Zheng
- The Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Tao Liang
- The Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Jianping Mei
- The Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Xiuru Shi
- The Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Xiaohui Liu
- The Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Sikai Li
- The Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Yuting Wan
- The Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Yifeng Zheng
- The Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Xiaoyue Yang
- The Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Yanxia Huang
- The Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| |
Collapse
|
|
2
|
Gallo-Fernández I, López-Aguilera J, González-Manzanares R, Pericet-Rodriguez C, Carmona-Rico MJ, Perea-Armijo J, Castillo-Domínguez JC, Anguita-Sánchez M. [Clinical differences between transthyretin cardiac amyloidosis and hypertensive heart disease]. Med Clin (Barc) 2024; 162:205-212. [PMID: 38044190 DOI: 10.1016/j.medcli.2023.10.006] [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: 05/15/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION A significant percentage of patients eventually diagnosed with cardiac transthyretin amyloidosis (TTRA) was previously diagnosed with hypertensive heart disease (HHD), since both conditions usually present with heart failure (HF) with preserved ejection fraction (HFpEF) and ventricular hypertrophy. Our objectives were to evaluate the clinical, electrocardiographic and echocardiographic differences, and to analyse whether there exists a differential prognosis between these two nosological entities. MATERIALS AND METHODS We retrospectively included all patients with HHD for whom a cardiac scintigraphy with 99mTc-diphosphonate (GDPD) and a free light chains test in blood and urine were ordered for ATTR screening in our centre, in the period between 2016 and 2021. Those diagnosed with other types of amyloidosis were excluded from the analysis. RESULTS A total of 72 patients were analyzed: 33 were finally diagnosed with TTRA and 39 with CHTA. Patients with TTRA had higher levels of ultrasensitive troponin I (TnI-US) and N-terminal brain natriuretic propeptide (NT-ProBNP); in electrocardiography (ECG) they presented a pseudo-infarction pattern more frequently as well as conduction disturbances; in echocardiography (TTE) they presented a higher degree of ventricular hypertrophy, left ventricular dysfunction and worse diastolic function parameters, with elevated filling pressures. In the 4-year follow-up, the ATTR group showed greater need for pacemaker (PCM), with no evidence regarding mortality, development of atrial fibrillation (AF), or more admissions for heart failure (HF). CONCLUSIONS In our series, patients with TTRA showed clinical, electrocardiographic and echocardiographic differences compared to patients with HHD, with increased risk of need for PCM.
Collapse
Affiliation(s)
- Ignacio Gallo-Fernández
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España
| | - José López-Aguilera
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España.
| | - Rafael González-Manzanares
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España
| | - Cristina Pericet-Rodriguez
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España
| | | | - Jorge Perea-Armijo
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España; Universidad de Córdoba, Córdoba, España
| | - Juan Carlos Castillo-Domínguez
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España
| | - Manuel Anguita-Sánchez
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España
| |
Collapse
|
|
3
|
Ferreira JP, Taveira‐Gomes T, Canelas‐Pais M, Phan P, Bernardo F, Andersson Sundell K, Almeida M, Martinho H, Gavina C. Missed opportunities in the diagnosis of heart failure: a real-world assessment. ESC Heart Fail 2023; 10:3438-3445. [PMID: 37702348 PMCID: PMC10682848 DOI: 10.1002/ehf2.14531] [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: 07/19/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
AIMS Heart failure (HF) is a leading cause of hospitalization worldwide. An early HF diagnosis is key to reducing hospitalizations. We used electronic health records (EHRs) to characterize HF pathways at the primary care physician (PCP) level prior to a first HF hospitalization (hHF). This study aimed to identify missed opportunities for HF diagnosis and management at the PCP level before a first hHF. METHODS AND RESULTS This cohort study used EHRs of a large health care organization in Portugal. Patients with incident hHF between 2017 and 2020 were identified. Missed opportunities were defined by the absence of any of the following work-up in the 6 months after signs or symptoms had been recorded: lab results and electrocardiogram, natriuretic peptides, echocardiogram, referral to HF specialist, or HF medication initiation. A total of 2436 patients with a first hHF were identified. The median (interquartile range) age at the time of hospitalization was 81 (14) years, and 1361 (56%) were women. Most patients were treated with cardiovascular drugs prior or at index event. A total of 720 (30%) patients had records of HF signs or symptoms, 94% (n = 674) within 6 months prior to hHF. Among patients with recorded HF signs or symptoms, 410 (57%) had clinical management considered adequate before signs and symptoms were recorded. Of the 310 remaining patients, 155 (50%) had a follow-up that was considered inadequate. CONCLUSIONS Relatively few patients with a first hHF had primary care records of signs or symptoms prior to admission. Of these, nearly half had inadequate management considering diagnosis and treatment. These data suggest the need to improve PCP HF awareness.
Collapse
Affiliation(s)
- João Pedro Ferreira
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Centre ‐ UnIC@RISEFaculty of Medicine of the University of PortoPortoPortugal
- Department of Internal Medicine, Heart Failure ClinicCentro Hospitalar de Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
- Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique 1433, U1116, CHRU de Nancy, F‐CRIN INI‐CRCTNancyFrance
| | - Tiago Taveira‐Gomes
- Department of Community Medicine, Information and Decision in HealthFaculty of Medicine of the University of PortoPortoPortugal
- MTG Research and Development LabPortoPortugal
- Faculty of Health SciencesUniversity Fernando PessoaPortoPortugal
| | - Mariana Canelas‐Pais
- Department of Community Medicine, Information and Decision in HealthFaculty of Medicine of the University of PortoPortoPortugal
- MTG Research and Development LabPortoPortugal
| | | | | | | | | | | | - Cristina Gavina
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Centre ‐ UnIC@RISEFaculty of Medicine of the University of PortoPortoPortugal
- Department of Internal Medicine, Heart Failure ClinicCentro Hospitalar de Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
- Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique 1433, U1116, CHRU de Nancy, F‐CRIN INI‐CRCTNancyFrance
- Department of CardiologyPedro Hispano HospitalMatosinhosPortugal
| |
Collapse
|
|
4
|
Wang Z, Fang J, Hong H. Evaluation the value of H 2FPEF score and HFA-PEFF step E score in the diagnosis of heart failure with preserved ejection fraction. Acta Cardiol 2023; 78:790-795. [PMID: 37318053 DOI: 10.1080/00015385.2023.2221149] [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: 03/22/2022] [Revised: 12/10/2022] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Clinical diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. The aim of the study is to evaluate the value of the H2FPEF score and HFA-PEFF step E score in the diagnosis of HFpEF. METHODS 319 hospitalised patients with 'shortness of breath' or 'dyspnoea' were retrospectively collected and scored with the above two scores, respectively. They were divided into HFpEF group and non-HFpEF group in the study. RESULTS Both the negative and positive predictive value of H2FPEF score and HFA-PEFF Step E score were 95.52%, 96.83% and 98.28%, 93.63%, respectively. However, there were 189 (59.25%) and 104 (32.60%) cases could not be diagnosed or excluded in the H2FPEF score and the HFA-PEFF step E score, respectively. CONCLUSIONS Both scores of the H2FPEF and the HFA-PEFF step E may be used to effectively rule out or confirm HFpEF according to the score point. However, there are three fifths and one third patients in the H2FPEF score and the HFA-PEFF step E score, respectively, in the intermediate scores who are needed further invasive catheterisation or exercise stress tests.
Collapse
Affiliation(s)
- Zhuolin Wang
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Fujian Institute of Geriatrics, Fuzhou, Fujian, China
- Department of Cardiology, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jun Fang
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Fujian Institute of Geriatrics, Fuzhou, Fujian, China
- Department of Cardiology, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Huashan Hong
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Fujian Institute of Geriatrics, Fuzhou, Fujian, China
- Department of Cardiology, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| |
Collapse
|
|
5
|
Tri Saputra PB, Kurniawan RB, Trilistyoati D, Al Farabi MJ, Susilo H, Alsagaff MY, Oktaviono YH, Sutanto H, Gusnanto A, Dyah Kencono Wungu C. Myocarditis and coronavirus disease 2019 vaccination: A systematic review and meta-summary of cases. BIOMOLECULES & BIOMEDICINE 2023; 23:546-567. [PMID: 36803547 PMCID: PMC10351100 DOI: 10.17305/bb.2022.8779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
Vaccination is significant to control, mitigate, and recover from the destructive effects of coronavirus disease 2019 (COVID-19). The incidence of myocarditis following COVID-19 vaccination has been increasing and growing public concern; however, little is known about it. This study aimed to systematically review myocarditis following COVID-19 vaccination. We included studies containing individual patient data of myocarditis following COVID-19 vaccination published between January 1, 2020 and September 7, 2022 and excluded review articles. Joanna Briggs Institute critical appraisals were used for risk of bias assessment. Descriptive and analytic statistics were performed. A total of 121 reports and 43 case series from five databases were included. We identified 396 published cases of myocarditis and observed that the majority of cases was male patients, happened following the second dose of mRNA vaccine administration, and experienced chest pain as a symptom. Previous COVID-19 infection was significantly associated (p < 0.01; OR, 5.74; 95% CI, 2.42-13.64) with the risk of myocarditis following the administration of the first dose, indicating that its primary mechanism is immune-mediated. Moreover, 63 histopathology examinations were dominated by non-infective subtypes. Electrocardiography and cardiac marker combination is a sensitive screening modality. However, cardiac magnetic resonance is a significant noninvasive examination to confirm myocarditis. Endomyocardial biopsy may be considered in confusing and severe cases. Myocarditis following COVID-19 vaccination is relatively benign, with a median length of hospitalization of 5 days, intensive care unit admission of <12%, and mortality of <2%. The majority was treated with nonsteroidal anti-inflammatory drugs, colchicine, and steroids. Surprisingly, deceased cases had characteristics of being female, older age, non-chest pain symptoms, first-dose vaccination, left ventricular ejection fraction of <30%, fulminant myocarditis, and eosinophil infiltrate histopathology.
Collapse
Affiliation(s)
- Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | | | - Makhyan Jibril Al Farabi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Henry Sutanto
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | | | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
|
6
|
Chaumont C, Omouri L, Savouré A, Al Hamoud R, Fauvel C, Godin B, Eltchaninoff H, Anselme F. Is excessive ventricular irregularity predictive of rehospitalization in patients with permanent AF and HFpEF? ESC Heart Fail 2023; 10:2120-2126. [PMID: 36940720 DOI: 10.1002/ehf2.14349] [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: 11/24/2022] [Revised: 02/06/2023] [Accepted: 02/27/2023] [Indexed: 03/23/2023] Open
Abstract
AIMS There are currently limited therapeutic approaches for patients with heart failure with preserved ejection fraction (HFpEF) who have developed permanent atrial fibrillation (AF). We aimed to analyse the impact of ventricular irregularity on heart failure rehospitalization in patients with permanent AF and HFpEF. METHODS AND RESULTS All 24 h ambulatory Holter monitoring performed in our centre within a month after a first heart failure hospitalization were screened. Patients with HFpEF and permanent AF were included in the retrospective analysis. The following parameters of ventricular irregularity were calculated over the 24 h recording period: standard deviation of all RR intervals (SDNN), coefficient of variation of SDNN (CV-SDNN = SDNN/mean RR), root of the mean squared differences of successive RR intervals (RMSSD), and percentage of consecutive RR intervals with difference over 50 ms (pNN50). The primary endpoint was rehospitalization for acute heart failure (HFrH). From 2010 to 2021, 51/216 screened patients were included. During a median follow-up of 3.13 years, 29/51 patients reached the primary endpoint. HFrH patients had higher SDNN (205 ± 65 vs. 154 ± 46 ms; P < 0.01), CV-SDNN (26 ± 8% vs. 19 ± 5%, P < 0.01), RMSSD (182 ± 47 vs. 138 ± 65 ms, P = 0.013), and pNN50 (76 ± 9 vs. 58 ± 26, P < 0.001) when compared with patients with no HFrH. In multivariate analysis, all those parameters remained significantly associated with HFrH. CONCLUSIONS In this pilot study, we found some evidences for a deleterious impact of excessive ventricular irregularity on HFrH in AF patients with HFpEF. Those new findings could pave the way for new prognosis and therapeutic approaches in this patients' population.
Collapse
Affiliation(s)
- Corentin Chaumont
- Department of Cardiology, CHU Rouen, F-76000, Rouen, France
- Department of Cardiology, Univ Rouen Normandie, Inserm EnVI UMR 1096, CHU Rouen, F-76000, Rouen, France
| | - Lisa Omouri
- Department of Cardiology, CHU Rouen, F-76000, Rouen, France
| | - Arnaud Savouré
- Department of Cardiology, CHU Rouen, F-76000, Rouen, France
| | | | - Charles Fauvel
- Department of Cardiology, CHU Rouen, F-76000, Rouen, France
- Department of Cardiology, Univ Rouen Normandie, Inserm EnVI UMR 1096, CHU Rouen, F-76000, Rouen, France
| | | | - Hélène Eltchaninoff
- Department of Cardiology, CHU Rouen, F-76000, Rouen, France
- Department of Cardiology, Univ Rouen Normandie, Inserm EnVI UMR 1096, CHU Rouen, F-76000, Rouen, France
| | - Frédéric Anselme
- Department of Cardiology, CHU Rouen, F-76000, Rouen, France
- Department of Cardiology, Univ Rouen Normandie, Inserm EnVI UMR 1096, CHU Rouen, F-76000, Rouen, France
| |
Collapse
|
|
7
|
Chatur S, Claggett BL, Vardeny O, Jering K, Desai AS, Pfeffer MA, Lefkowitz M, McMurray JJV, Solomon SD, Vaduganathan M. Sacubitril/valsartan and loop diuretic requirement in heart failure with preserved ejection fraction in the PARAGON-HF trial. Eur J Heart Fail 2023; 25:87-94. [PMID: 36181769 PMCID: PMC10092840 DOI: 10.1002/ejhf.2703] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 02/01/2023] Open
Abstract
AIMS As sacubitril/valsartan may potentiate early natriuresis, expert consensus documents recommend diuretic dose reduction on first initiation. However, there are limited data on the effects of sacubitril/valsartan on the background of varying diuretic regimens or on diuretic requirements over time in heart failure (HF) with preserved ejection fraction (HFpEF). METHODS AND RESULTS In this post hoc analysis of PARAGON-HF, of the 4796 patients, background diuretic therapy was distributed as follows: 341 (7%) on no diuretic, 698 (15%) on non-loop diuretic, and 3757 (78%) were on loop diuretics (1255, 1589, and 913 were on <40, 40 and >40 mg furosemide equivalent doses, respectively). The primary composite outcome of total HF hospitalizations and cardiovascular death was analysed using semiparametric proportional rates methods. The cumulative incidence of the primary composite outcome (first events) was lowest in patients on no diuretic and highest in those on >40 mg of loop diuretic (p < 0.001). The effects of sacubitril/valsartan (vs. valsartan) on the primary composite outcome (recurrent events) did not significantly vary by baseline diuretic use (pinteraction = 0.65). Treatment effects on safety outcomes were similar across diuretic categories. Sacubitril/valsartan reduced new loop diuretic initiations over the course of the trial (hazard ratio 0.83; 95% confidence interval 0.68-1.00, p = 0.055), with similar mean loop diuretic dose and rates of diuretic discontinuation between treatment groups in follow-up. Patients randomized to sacubitril/valsartan experienced a slight early reduction in diuretic initiation or dose escalation at 30 days after initiation (net reduction 1.7%, p = 0.02), but these differences were not sustained beyond this timepoint. CONCLUSIONS Patients with HFpEF on higher baseline diuretic doses were at heightened risk of HF events, but similarly benefited from sacubitril/valsartan with a consistent safety profile across a range of diuretic doses. Initiation of sacubitril/valsartan was associated with modestly lower new loop diuretic requirement in follow-up.
Collapse
Affiliation(s)
- Safia Chatur
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, MN, USA
| | - Karola Jering
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
|
8
|
Jha AK, Ojha CP, Krishnan AM, Paul TK. Thirty-day readmission in patients with heart failure with preserved ejection fraction: Insights from the nationwide readmission database. World J Cardiol 2022; 14:473-482. [PMID: 36187428 PMCID: PMC9523271 DOI: 10.4330/wjc.v14.i9.473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/16/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There are rising numbers of patients who have heart failure with preserved ejection fraction (HFpEF). Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies, the management of HFpEF is challenging.
AIM To determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.
METHODS We performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project, Nationwide Readmissions Database for the year 2017. We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF. The primary outcome was the rate of all-cause readmission within 30 d of discharge. Secondary outcomes were cause of readmission, mortality rate in readmitted and index patients, length of stay, total hospitalization costs and charges. Independent risk factors for readmission were identified using Cox regression analysis.
RESULTS The thirty day readmission rate was 21%. Approximately 9.17% of readmissions were in the setting of acute on chronic diastolic heart failure. Hypertensive chronic kidney disease with heart failure (1245; 9.7%) was the most common readmission diagnosis. Readmitted patients had higher in-hospital mortality (7.9% vs 2.9%, P = 0.000). Our study showed that Medicaid insurance, higher Charlson co-morbidity score, patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates. Lower readmission rate was found in residents of small metropolitan or micropolitan areas, older age, female gender, and private insurance or no insurance were associated with lower risk of readmission.
CONCLUSION We found that patients hospitalized for acute or acute on chronic HFpEF, the thirty day readmission rate was 21%. Readmission cases had a higher mortality rate and increased healthcare resource utilization. The most common cause of readmission was cardio-renal syndrome.
Collapse
Affiliation(s)
- Anil Kumar Jha
- Internal Medicine, Lowell General Hospital, Lowell, MA 01852, United States
| | - Chandra P Ojha
- Department of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
| | - Anand M Krishnan
- Department of Cardiovascular Disease, Larner College of Medicine at the University of Vermont, Burlington, VT 05405, United States
| | - Timir K Paul
- Department of Clinical Education, University of Tennessee Health Sciences Center at Nashville, Nashville, TN 37025, United States
| |
Collapse
|
|
9
|
Narayan P, Trikantzopoulos E, Mezzaroma E, Mauro AG, Vohra H, Abbate A, Toldo S. The interleukin-1 receptor type I promotes the development of aging-associated cardiomyopathy in mice. Cytokine 2022; 151:155811. [DOI: 10.1016/j.cyto.2022.155811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
|
|
10
|
Tay WT, Teng THK, Simon O, Ouwerkerk W, Tromp J, Doughty RN, Richards AM, Hung CL, Qin Y, Aung T, Anand I, Lam CSP. Readmissions, Death and Its Associated Predictors in Heart Failure With Preserved Versus Reduced Ejection Fraction. J Am Heart Assoc 2021; 10:e021414. [PMID: 34666509 PMCID: PMC8751971 DOI: 10.1161/jaha.121.021414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Data on rehospitalizations for heart failure (HF) in Asia are scarce. We sought to determine the burden and predictors of HF (first and recurrent) rehospitalizations and all‐cause mortality in patients with HF and preserved versus reduced ejection fraction (preserved EF, ≥50%; reduced EF, <40%), in the multinational ASIAN‐HF (Asian Sudden Cardiac Death in Heart Failure) registry. Methods and Results Patients with symptomatic (stage C) chronic HF were followed up for death and recurrent HF hospitalizations for 1 year. Predictors of HF hospitalizations or all‐cause mortality were examined with Cox regression for time to first event and other methods for recurrent events analyses. Among 1666 patients with HF with preserved EF (mean age, 68±12 years; 50% women), and 4479 with HF with reduced EF (mean age, 61±13 years; 22% women), there were 642 and 2302 readmissions, with 28% and 45% attributed to HF, respectively. The 1‐year composite event rate for first HF hospitalization or all‐cause death was 11% and 21%, and for total HF hospitalization and all‐cause death was 17.7 and 38.7 per 100 patient‐years in HF with preserved EF and HF with reduced EF, respectively. In HF with preserved EF, consistent independent predictors of these clinical end points included enrollment as an inpatient, Southeast Asian location, and comorbid chronic kidney disease or atrial fibrillation. The same variables were predictive of outcomes in HF with reduced EF except atrial fibrillation, and also included Northeast Asian location, older age, elevated heart rate, decreased systolic blood pressure, diabetes, smoking, and non‐usage of beta blockers. Conclusions One‐year HF rehospitalization and mortality rates were high among Asian patients with HF. Predictors of outcomes identified in this study could aid in risk stratification and timely interventions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01633398.
Collapse
Affiliation(s)
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore Singapore.,Duke-National University of Singapore Medical School Singapore.,School of Population & Global Health University of Western Australia Perth Australia
| | | | - Wouter Ouwerkerk
- National Heart Centre Singapore Singapore.,Department of Dermatology University of Amsterdam Medical Centre Amsterdam the Netherlands
| | - Jasper Tromp
- National Heart Centre Singapore Singapore.,Duke-National University of Singapore Medical School Singapore.,University Medical Centre Groningen, University of Groningen Department of Cardiology Groningen the Netherlands
| | - Robert N Doughty
- Faculty of Medicine and Health Sciences University of Auckland Auckland New Zealand.,Auckland City Hospital Auckland New Zealand
| | - A Mark Richards
- National University Heart Centre Singapore.,University of Otago Dunedin New Zealand
| | | | - Yan Qin
- Department of Internal Medicine Singapore General Hospital Singapore
| | - Than Aung
- Department of Internal Medicine Singapore General Hospital Singapore
| | - Inder Anand
- Veterans Affairs Medical Center University of Minnesota Minneapolis MN
| | - Carolyn S P Lam
- National Heart Centre Singapore Singapore.,Duke-National University of Singapore Medical School Singapore.,University Medical Centre Groningen, University of Groningen Department of Cardiology Groningen the Netherlands
| | | |
Collapse
|
|
11
|
Iyngkaran P, Thomas M, Horowitz JD, Komesaroff P, Jelinek M, Hare DL. Common Comorbidities that Alter Heart Failure Prognosis - Shaping New Thinking for Practice. Curr Cardiol Rev 2021; 17:e160721187934. [PMID: 33185169 PMCID: PMC8950452 DOI: 10.2174/1573403x16666201113093548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/22/2022] Open
Abstract
At least half of all heart failure (CHF) patients will have a comorbidity that could be undertreated, requires additional speciality input and/or polypharmacy. These patients are then at risk of iatrogenic and disease-related complications and readmissions if not closely supervised. Common comorbidities of relevance are cardiorenal and cardiometabolic syndromes (DM, obesity, OSA), chronic airways disease, elderly age, and accompanying pharmacotherapies. The structure of community practice often leaves primary, speciality, and allied health care in silos. For example, cardiology speciality training in Australia creates excellent sub-specialists to deliver diagnostic and therapeutic advances. A casualty of this process has been the gradual alienation of general cardiology toward general internal medical specialists and primary care practitioners. The consequences are largely noticed in community practice. The issue is compounded by suboptimal communication of information. This review explores these issues from a cardiology sub-speciality lens; firstly cross speciality areas that are important for cardiologists to maintain their skill, and finally, to obtain a brief overview of disease management and identify game-changing common denominators such as endothelial dysfunction and self-management.
Collapse
Affiliation(s)
- Pupalan Iyngkaran
- Address correspondence to this author at the Department of Cardiology, Heart West Institute, Werribee Mercy Sub School, School of Medicine, Notre Dame University, Notre Dame, IN 46556, United States; E-mail:
| | | | | | | | | | | |
Collapse
|
|
12
|
Regmi MR, Bhattarai M, Parajuli P, Lara Garcia OE, Tandan N, Ferry N, Cheema A, Chami Y, Robinson R. Heart Failure with Preserved Ejection Fraction and 30-Day Readmission. Clin Med Res 2020; 18:126-132. [PMID: 32340982 PMCID: PMC7735447 DOI: 10.3121/cmr.2020.1521] [Citation(s) in RCA: 5] [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: 08/05/2019] [Revised: 02/19/2020] [Accepted: 03/13/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Several studies identify heart failure (HF) as a potential risk for hospital readmission; however, studies on predictability of heart failure readmission is limited. The objective of this work was to investigate whether a specific type of heart failure (HFpEF or HFrEF) has a higher association to the rate of 30-day hospital readmission and compare their predictability with the two risk scores: HOSPITAL score and LACE index. DESIGN Retrospective study from single academic center. METHODS Sample size included adult patients from an academic hospital in a two-year period (2015 - 2017). Exclusion criteria included death, transfer to another hospital, and unadvised leave from hospital. Baseline characteristics, diagnosis-related group, and ICD diagnosis codes were obtained. Variables affecting HOSPITAL score and LACE index and types of heart failure present were also extracted. Qualitative variables were compared using Pearson chi2 or Fisher's exact test (reported as frequency) and quantitative variables using non-parametric Mann-Whitney U test (reported as mean ± standard deviation). Variables from univariate analysis with P values of 0.05 or less were further analyzed using multivariate logistic regression. Odds ratio was used to measure potential risk. RESULTS The sample size of adult patients in the study period was 1,916. All eligible cohort of patients who were readmitted were analyzed. Cumulative score indicators of HOSPITAL Score, LACE index (including the Charlson Comorbidity Index) predicted 30-day readmissions with P values of <0.001. The P value of HFpEF was found to be significant in the readmitted group (P < 0.001) compared to HFrEF (P = 0.141). Multivariate logistic regression further demonstrated the association of HFpEF with higher risk of readmission with odds ratio of 1.77 (95% CI: 1.25 - 2.50) and P value of 0.001. CONCLUSIONS Our data from an academic tertiary care center supports HFpEF as an independent risk factor for readmission. Multidisciplinary management of HFpEF may be an important target for interventions to reduce hospital readmissions.
Collapse
Affiliation(s)
- Manjari Rani Regmi
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Mukul Bhattarai
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Priyanka Parajuli
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | | | - Nitin Tandan
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Nicolas Ferry
- San Antonio Memorial Medical Center, San Antonio, Texas, USA
| | - Asad Cheema
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Youssef Chami
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Robert Robinson
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| |
Collapse
|
|
13
|
Bianchi VE. Caloric restriction in heart failure: A systematic review. Clin Nutr ESPEN 2020; 38:50-60. [PMID: 32690177 DOI: 10.1016/j.clnesp.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Nutrition exerts a determinant role in maintaining cardiac function, regulating insulin and mitochondrial efficiency, that are essential to support energy production for contractility. In patients with heart failure (HF), myocardial tissue efficiency is reduced because of decreased mitochondrial oxidative capacity. In HF conditions, cardiomyocytes shift toward glucose and a reduction in fatty acid utilization. Calorie restriction induces weight loss in obese patients and can be beneficial in some HF patients, although this has generated some controversy. This study aims to evaluate the impact of the CR diet on myocardial efficiency in HF patients. METHODS On Pubmed and Embase, articles related to the keywords: "chronic heart failure" with "diet," "nutrition," "insulin resistance," and "caloric restriction" have been searched, Studies, including exercise or food supplementation, were excluded. RESULTS The retrieved articles showed that weight loss, through the activation of insulin and various kinase pathways, regulates the efficiency of myocardial tissue. In contrast, insulin resistance represents a strong cardiovascular risk factor that reduces myocardial function. CONCLUSION CR diet represents the first therapy in overweight HF patients, both with preserved ejection fraction (HFpEF) and with reduced ejection fraction (HFrHF) because reducing body fat, the myocardial function increased. Insulin activity is the critical hormone that regulates mitochondrial function and cardiac efficiency. However, a severely restricted diet may represent a severe risk factor correlated with all-cause mortality, particularly in underweight HF patients. Long-term studies conducted on large populations are necessary to evaluate the effects of CR on myocardial function in HF patients.
Collapse
|
|
14
|
Iyngkaran P, Thomas MC, Neil C, Jelinek M, Cooper M, Horowitz JD, Hare DL, Kaye DM. The Heart Failure with Preserved Ejection Fraction Conundrum-Redefining the Problem and Finding Common Ground? Curr Heart Fail Rep 2020; 17:34-42. [PMID: 32112345 DOI: 10.1007/s11897-020-00454-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Heart failure with preserved ejection fraction (HFpEF) or diastolic heart failure (DHF) makes up more than half of all congestive heart failure presentations (CHF). With an ageing population, the case load and the financial burden is projected to increase, even to epidemic proportions. CHF hospitalizations add too much of the financial and infrastructure strain. Unlike systolic heart failure (SHF), much is still either uncertain or unknown. Specifically, in epidemiology, the disease burden is established; however, risk factors and pathophysiological associations are less clear; diagnostic tools are based on rigid parameters without the ability to accurately monitor treatments effects and disease progression; finally, therapeutics are similar to SHF but without prognostic data for efficacy. RECENT FINDINGS The last several years have seen guidelines changing to account for greater epidemiological observations. Most of these remain general observation of shortness of breath symptom matched to static echocardiographic parameters. The introduction of exercise diastolic stress test has been welcome and warrants greater focus. HFpEF is likely to see new thinking in the coming decades. This review provides some of perspective on this topic.
Collapse
Affiliation(s)
- P Iyngkaran
- Werribee Mercy Sub School, School of Medicine, Sydney, Australia
| | - M C Thomas
- Biochemistry of Diabetes Complications, Melbourne, Australia
| | - C Neil
- Department of Medicine-Western Precinct, University of Melbourne, Melbourne, Victoria, 3011, Australia
| | - M Jelinek
- Department of Cardiology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Cooper
- Department of Diabetes, The Alfred and Monash University, Melbourne, Australia
| | - J D Horowitz
- Cardiology University of Adelaide, Adelaide, 5011, Australia
| | - D L Hare
- Cardiovascular Research, Heart Failure Services, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - D M Kaye
- Cardiology and Head Heart Failure Research, Alfred Hospital, Melbourne, Australia.
| |
Collapse
|
|
15
|
Henning RJ. Diagnosis and treatment of heart failure with preserved left ventricular ejection fraction. World J Cardiol 2020; 12:7-25. [PMID: 31984124 PMCID: PMC6952725 DOI: 10.4330/wjc.v12.i1.7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/17/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023] Open
Abstract
Nearly six million people in United States have heart failure. Fifty percent of these people have normal left ventricular (LV) systolic heart function but abnormal diastolic function due to increased LV myocardial stiffness. Most commonly, these patients are elderly women with hypertension, ischemic heart disease, atrial fibrillation, obesity, diabetes mellitus, renal disease, or obstructive lung disease. The annual mortality rate of these patients is 8%-12% per year. The diagnosis is based on the history, physical examination, laboratory data, echocardiography, and, when necessary, by cardiac catheterization. Patients with obesity, hypertension, atrial fibrillation, and volume overload require weight reduction, an exercise program, aggressive control of blood pressure and heart rate, and diuretics. Miniature devices inserted into patients for pulmonary artery pressure monitoring provide early warning of increased pulmonary pressure and congestion. If significant coronary heart disease is present, coronary revascularization should be considered.
Collapse
Affiliation(s)
- Robert J Henning
- College of Public Health, University of South Florida, Tampa, FL33612, United States
| |
Collapse
|
|
16
|
Schmidt C, Santos M, Bohn L, Delgado BM, Moreira-Gonçalves D, Leite-Moreira A, Oliveira J. Comparison of questionnaire and accelerometer-based assessments of physical activity in patients with heart failure with preserved ejection fraction: clinical and prognostic implications. SCAND CARDIOVASC J 2020; 54:77-83. [DOI: 10.1080/14017431.2019.1707863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Cristine Schmidt
- UniC, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- CIAFEL, Faculdade de Desporto da, Universidade do Porto, Porto, Portugal
| | - Mário Santos
- UniC, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Departamento de Cardiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Lucimere Bohn
- CIAFEL, Faculdade de Desporto da, Universidade do Porto, Porto, Portugal
| | | | | | | | - José Oliveira
- CIAFEL, Faculdade de Desporto da, Universidade do Porto, Porto, Portugal
| |
Collapse
|
|
17
|
Evans M, Morgan AR, Yousef Z. What Next After Metformin? Thinking Beyond Glycaemia: Are SGLT2 Inhibitors the Answer? Diabetes Ther 2019; 10:1719-1731. [PMID: 31410711 PMCID: PMC6778564 DOI: 10.1007/s13300-019-00678-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Indexed: 02/07/2023] Open
Abstract
The prevalence of type 2 diabetes continues to increase, along with a proliferation of glucose-lowering treatment options. There is universal agreement in the clinical community for the use of metformin as the first-line glucose-lowering therapy for the majority of patients. However, controversy exists regarding the choice of second-line therapy once metformin is no longer effective. The most recent treatment consensus focuses on the presence of cardiovascular disease, heart failure or kidney disease as a determinant of therapy choice. The majority of patients in routine practice, however, do not fall into such categories. Heart failure and kidney disease represent significant clinical and cost considerations in patients with type 2 diabetes and have a close pathophysiological association. Recent data has illustrated that sodium-glucose transporter 2 (SGLT2) inhibitor therapy can reduce the burden of heart failure and the progression of renal disease across a wide range of patients including those with and without established disease, supported by an increased understanding of the mechanistic effects of these agents. Furthermore, there is growing evidence to illustrate the overall safety profile of this class of agents and support the benefit-risk profile of SGLT2 inhibitors as a preferred option following metformin monotherapy failure, with respect to both kidney disease progression and heart failure outcomes.
Collapse
Affiliation(s)
- Marc Evans
- Diabetes Resource Centre, University Hospital Llandough, Cardiff, UK.
| | | | - Zaheer Yousef
- Wales Heart Research Institute, Cardiff University, Cardiff, UK
| |
Collapse
|