Worsening Renal Function during Index Hospitalization Does Not Predict Prognosis in Heart Failure with Preserved Ejection Fraction Patients

Cardiology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Ravi Rasalingam ◽  
Rachel Parker ◽  
Katherine E. Kurgansky ◽  
Luc Djousse ◽  
David Gagnon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Incidence Density ◽  
Preserved Ejection Fraction ◽  
Index Hospitalization ◽  
Risk Of Death ◽  
Worsening Renal Function ◽  
Group 1

<b><i>Introduction:</i></b> Worsening renal function (WRF) predicts poor prognosis in patients with left ventricular systolic dysfunction. The effect of WRF in heart failure with preserved ejection fraction (HFpEF) is unclear. <b><i>Objective:</i></b> The objective of this study was to determine whether WRF during index hospitalization for HFpEF is associated with increased death or readmission for heart failure. <b><i>Methods:</i></b> National Veterans Affairs electronic medical data recorded between January 1, 2002, and December 31, 2014, were screened to identify index hospitalizations for HFpEF using an iterative algorithm. Patients were divided into 3 groups based on changes in serum Cr (sCr) during this admission. WRF was defined as a rise in sCr ≥0.3 mg/dL. Group 1 had no evidence of WRF, group 2 had transient WRF, and group 3 had persistent WRF at the time of discharge. <b><i>Results:</i></b> A total of 10,902 patients with index hospitalizations for HFpEF were identified (mean age 72, 97% male). Twenty-nine percent had WRF during this hospital admission, with 48% showing recovery of sCr and 52% with no recovery at discharge. The mortality rate over a mean follow-up duration of 3.26 years was 72%. Compared to group 1, groups 2 and 3 showed no significant difference in risk of death from any cause (hazard ratio [HR] = 0.95 [95% confidence interval [CI]: 0.87, 1.03] and 1.02 [95% CI: 0.93, 1.11], respectively), days hospitalized for any cause (incidence density ratio [IDR] = 1.01 [95% CI: 0.92, 1.11] and 1.01 [95% CI: 0.93, 1.11], respectively), or days hospitalized for heart failure (IDR = 0.94 [95% CI: 0.80, 1.10] and 0.94 [95% CI: 0.81, 1.09], respectively) in analyses adjusted for covariates affecting renal function and outcomes. <b><i>Conclusions:</i></b> While there is a high incidence of WRF during index hospitalizations for HFpEF, WRF is not associated with an increased risk of death or hospitalization. This suggests that WRF alone should not influence decisions regarding heart failure management.

WORSENING RENAL FUNCTION DOES NOT PREDICT PROGNOSIS IN HEART FAILURE WITH PRESERVED EJECTION FRACTION PATIENTS

2019 ◽  
Vol 73 (9) ◽  
pp. 908
Author(s):  
Ravi Rasalingam ◽  
Rachel Parker ◽  
Katherine Kurgansky ◽  
Luc Djousse ◽  
David Gagnon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction ◽  
Worsening Renal Function

Right-Sided Cardiac Dysfunction in Heart Failure With Preserved Ejection Fraction and Worsening Renal Function

2017 ◽  
Vol 120 (2) ◽  
pp. 274-278 ◽  
Author(s):  
Monica Mukherjee ◽  
Kavita Sharma ◽  
Jose A. Madrazo ◽  
Ryan J. Tedford ◽  
Stuart D. Russell ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Cardiac Dysfunction ◽  
Preserved Ejection Fraction ◽  
Worsening Renal Function

Comparison of risk factors for acute worsening renal function in heart failure patients with and without preserved ejection fraction

2015 ◽  
Vol 26 (8) ◽  
pp. 599-602 ◽  
Author(s):  
Tamiharu Yamagishi ◽  
Kenichi Matsushita ◽  
Toshinori Minamishima ◽  
Ayumi Goda ◽  
Konomi Sakata ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction ◽  
Heart Failure Patients ◽  
Worsening Renal Function

scholarly journals Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Kavita Sharma ◽  
Yejin Mok ◽  
Lucia Kwak ◽  
Sunil K. Agarwal ◽  
Patricia P. Chang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Renal Function ◽  
Ejection Fraction ◽  
Surveillance Study ◽  
Preserved Ejection Fraction ◽  
Predictors Of Mortality ◽  
Worsening Renal Function ◽  
Increased Risk

Background Heart failure with preserved ejection fraction (HFpEF) accounts for half of heart failure hospitalizations, with limited data on predictors of mortality by sex and race. We evaluated for differences in predictors of all‐cause mortality by sex and race among hospitalized patients with HFpEF in the ARIC (Atherosclerosis Risk in Communities) Community Surveillance Study. Methods and Results Adjudicated HFpEF hospitalization events from 2005 to 2013 were analyzed from the ARIC Community Surveillance Study, comprising 4 US communities. Comparisons between clinical characteristics and mortality at 1 year were made by sex and race. Of 4335 adjudicated acute decompensated heart failure cases, 1892 cases (weighted n=8987) were categorized as HFpEF. Men had an increased risk of 1‐year mortality compared with women in adjusted analysis (hazard ratio [HR], 1.27; 95% CI, 1.06–1.52 [ P =0.01]). Black participants had lower mortality compared with White participants in unadjusted and adjusted analyses (HR, 0.79; 95% CI, 0.64–0.97 [ P =0.02]). Age, heart rate, worsening renal function, and low hemoglobin were associated with increased mortality in all subgroups. Higher body mass index was associated with improved survival in men, with borderline interaction by sex. Higher blood pressure was associated with improved survival among all groups, with significant interaction by race. Conclusions In a diverse HFpEF population, men had worse survival compared with women, and Black participants had improved survival compared with White participants. Age, heart rate, and worsening renal function were associated with increased mortality across all subgroups; high blood pressure was associated with decreased mortality with interaction by race. These insights into sex‐ and race‐based differences in predictors of mortality may help strategize targeted management of HFpEF.

Outcomes and Worsening Renal Function in Patients Hospitalized With Heart Failure With Preserved Ejection Fraction

2015 ◽  
Vol 116 (10) ◽  
pp. 1534-1540 ◽  
Author(s):  
Kavita Sharma ◽  
Terence Hill ◽  
Morgan Grams ◽  
Natalie R. Daya ◽  
Allison G. Hays ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction ◽  
Worsening Renal Function

scholarly journals MO446THE ASSOCIATION BETWEEN RENAL FUNCTION AND LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND HEART FAILURE WITH PRESERVED EJECTION FRACTION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Robin Vernooij ◽  
Anne-Mar Van Ommen ◽  
Frans Rutten ◽  
Marianne Verhaar ◽  
Michiel Bots ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Renal Function ◽  
Ejection Fraction ◽  
Renal Dysfunction ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Lifestyle Risk Factors ◽  
Lifestyle Risk

Abstract Background and Aims Impaired kidney function increase the risk of cardiovascular disease. However, it remains unclear whether this crosstalk between organs already exists at early stages in the disease trajectory and whether this risk varies with age and other factors. We aim to investigate the association between renal dysfunction and early structural and functional cardiac abnormalities in a cohort of participants referred to a cardiology outpatient department. Method We included participants from HELPFul (i.e. HEart failure with Preserved ejection Fraction in patients at risk for cardiovascular disease), a case-cohort study at Dutch cardiology outpatient clinics, who were aged 45 years and older without history of cardiovascular disease. A random sample of participants enriched with cases (defined as an early filling (E) to early diastolic mitral annular velocity (e’) (E/e’) ratio of ≥8 measured with echocardiography) was included in our study. Routine care measurements, including echocardiography and laboratory testing at the outpatient clinic were collected for all participants. An expert panel decided on presence or absence of heart failure with preserved ejection fraction (HFpEF), and left ventricular diastolic dysfunction (LVDD), guided by available international guidelines. The association between renal function, in terms of estimated glomerular filtration rate (eGFR) categories, and diagnosis of HFpEF and LVDD was assessed with multivariable logistic regression analyses, adjusted for cardiovascular and lifestyle risk factors. The association between renal function, in terms of creatinine and cystatin C levels, and echocardiographic parameters, including E/e’ ratio, LAVI (Left atrial volume index), LVMI (left ventricular mass index), and E/A (early (E) to late (A) ventricular filling ratio, was assessed with multivariable linear regression analyses, adjusted for age, sex, cardiovascular and lifestyle risk factors. Adjusted odds ratios (OR) were reported and the corresponding 95% confidence interval (95%CI). Results 777 participants were included, mean age 62.9 (SD: 9.3) years, 67.3% were female. Hundred and fifty-six (20.1%) participants had mild renal dysfunction (eGFR: 60-89 ml/min/1.73 m2), and 24 (3.1%) moderate renal dysfunction (eGFR: 30-59 ml/min/1.73 m2). HFpEF and LVDD was more common in participants with moderate renal dysfunction (13% and 33%, respectively) than in those with normal renal function (6% and 16%, respectively). In the multivariable regression model. participants with both mild and moderate renal dysfunction had a higher likelihood of being diagnosed with HFpEF (OR: 2.82, 95%CI: 1.32 to 5.91; and OR: 5.37, 95%CI: 1.11 to 19.88, respectively), LVDD (OR: 2.08, 95%CI: 1.28 to 3.36; and OR: 2.92, 95%CI: 1.04 to 7.55, respectively), compared with participants with a normal renal function. However, no significant association between creatinine or cystatin C with E/e’, LAVI, LVMI, and E/A ratio was found after adjustment for age, sex, and cardiovascular risk and lifestyle factors. Conclusion Mild renal dysfunction is related to both LVDD and HFpEF, however, this might be partly explained by a higher age in patients with renal dysfunction. Further studies are warranted to determine if preventive cardiac treatment in patients with early renal dysfunction will benefit clinical outcomes.

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