scholarly journals The Added Value of In-Hospital Tracking of the Efficacy of Decongestion Therapy and Prognostic Value of a Wearable Thoracic Impedance Sensor in Acutely Decompensated Heart Failure With Volume Overload: Prospective Cohort Study

JMIR Cardio ◽  
10.2196/12141 ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. e12141 ◽  
Author(s):  
Christophe J P Smeets ◽  
Seulki Lee ◽  
Willemijn Groenendaal ◽  
Gabriel Squillace ◽  
Julie Vranken ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Fluid Balance ◽  
Volume Overload ◽  
Decompensated Heart Failure ◽  
Added Value ◽  
Thoracic Impedance ◽  
Fluid Status ◽  
All Cause Mortality

Background Incomplete relief of congestion in acute decompensated heart failure (HF) is related to poor outcomes. However, congestion can be difficult to evaluate, stressing the urgent need for new objective approaches. Due to its inverse correlation with tissue hydration, continuous bioimpedance monitoring might be an effective method for serial fluid status assessments. Objective This study aimed to determine whether in-hospital bioimpedance monitoring can be used to track fluid changes (ie, the efficacy of decongestion therapy) and the relationships between bioimpedance changes and HF hospitalization and all-cause mortality. Methods A wearable bioimpedance monitoring device was used for thoracic impedance measurements. Thirty-six patients with signs of acute decompensated HF and volume overload were included. Changes in the resistance at 80 kHz (R80kHz) were analyzed, with fluid balance (fluid in/out) used as a reference. Patients were divided into two groups depending on the change in R80kHz during hospitalization: increase in R80kHz or decrease in R80kHz. Clinical outcomes in terms of HF rehospitalization and all-cause mortality were studied at 30 days and 1 year of follow-up. Results During hospitalization, R80kHz increased for 24 patients, and decreased for 12 patients. For the total study sample, a moderate negative correlation was found between changes in fluid balance (in/out) and relative changes in R80kHz during hospitalization (rs=-0.51, P<.001). Clinical outcomes at both 30 days and 1 year of follow-up were significantly better for patients with an increase in R80kHz. At 1 year of follow-up, 88% (21/24) of patients with an increase in R80kHz were free from all-cause mortality, compared with 50% (6/12) of patients with a decrease in R80kHz (P=.01); 75% (18/24) and 25% (3/12) were free from all-cause mortality and HF hospitalization, respectively (P=.01). A decrease in R80kHz resulted in a significant hazard ratio of 4.96 (95% CI 1.82-14.37, P=.003) on the composite endpoint. Conclusions The wearable bioimpedance device was able to track changes in fluid status during hospitalization and is a convenient method to assess the efficacy of decongestion therapy during hospitalization. Patients who do not show an improvement in thoracic impedance tend to have worse clinical outcomes, indicating the potential use of thoracic impedance as a prognostic parameter.

scholarly journals The Added Value of In-Hospital Tracking of the Efficacy of Decongestion Therapy and Prognostic Value of a Wearable Thoracic Impedance Sensor in Acutely Decompensated Heart Failure With Volume Overload: Prospective Cohort Study (Preprint)

2018 ◽  
Author(s):  
Christophe J P Smeets ◽  
Seulki Lee ◽  
Willemijn Groenendaal ◽  
Gabriel Squillace ◽  
Julie Vranken ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Fluid Balance ◽  
Volume Overload ◽  
Decompensated Heart Failure ◽  
Added Value ◽  
Thoracic Impedance ◽  
Fluid Status ◽  
All Cause Mortality

BACKGROUND Incomplete relief of congestion in acute decompensated heart failure (HF) is related to poor outcomes. However, congestion can be difficult to evaluate, stressing the urgent need for new objective approaches. Due to its inverse correlation with tissue hydration, continuous bioimpedance monitoring might be an effective method for serial fluid status assessments. OBJECTIVE This study aimed to determine whether in-hospital bioimpedance monitoring can be used to track fluid changes (ie, the efficacy of decongestion therapy) and the relationships between bioimpedance changes and HF hospitalization and all-cause mortality. METHODS A wearable bioimpedance monitoring device was used for thoracic impedance measurements. Thirty-six patients with signs of acute decompensated HF and volume overload were included. Changes in the resistance at 80 kHz (R<sub>80kHz</sub>) were analyzed, with fluid balance (fluid in/out) used as a reference. Patients were divided into two groups depending on the change in R<sub>80kHz</sub> during hospitalization: increase in R<sub>80kHz</sub> or decrease in R<sub>80kHz</sub>. Clinical outcomes in terms of HF rehospitalization and all-cause mortality were studied at 30 days and 1 year of follow-up. RESULTS During hospitalization, R<sub>80kHz</sub> increased for 24 patients, and decreased for 12 patients. For the total study sample, a moderate negative correlation was found between changes in fluid balance (in/out) and relative changes in R<sub>80kHz</sub> during hospitalization (rs=-0.51, <i>P</i>&lt;.001). Clinical outcomes at both 30 days and 1 year of follow-up were significantly better for patients with an increase in R<sub>80kHz</sub>. At 1 year of follow-up, 88% (21/24) of patients with an increase in R<sub>80kHz</sub> were free from all-cause mortality, compared with 50% (6/12) of patients with a decrease in R<sub>80kHz</sub> (<i>P</i>=.01); 75% (18/24) and 25% (3/12) were free from all-cause mortality and HF hospitalization, respectively (<i>P</i>=.01). A decrease in R<sub>80kHz</sub> resulted in a significant hazard ratio of 4.96 (95% CI 1.82-14.37, <i>P</i>=.003) on the composite endpoint. CONCLUSIONS The wearable bioimpedance device was able to track changes in fluid status during hospitalization and is a convenient method to assess the efficacy of decongestion therapy during hospitalization. Patients who do not show an improvement in thoracic impedance tend to have worse clinical outcomes, indicating the potential use of thoracic impedance as a prognostic parameter.

scholarly journals Lack of Diuretic Efficiency (but Not Low Diuresis) Early in An Acutely Decompensated Heart Failure Episode Is Associated with Increased 180-Day Mortality

2017 ◽  
Vol 7 (2) ◽  
pp. 137-149 ◽  
Author(s):  
João Pedro Ferreira ◽  
Nicolas Girerd ◽  
Pedro Bettencourt Medeiros ◽  
Miguel Bento Ricardo ◽  
Tiago Almeida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Room ◽  
Decompensated Heart Failure ◽  
University Hospital ◽  
Acutely Decompensated Heart Failure ◽  
All Cause Mortality ◽  
Diuretic Efficiency ◽  
Relevant Variables ◽  
Emergency Room Admission

Introduction: The assessment of the amount of urine produced by the dose of administered diuretic has been proposed as the main signal of interest in diuretic responsiveness - diuretic efficiency (DE). The main aim of our study is to determine if a low DE is associated with 180-day all-cause mortality (ACM). Methods: During a 3-year period, we retrospectively studied patients with acutely decompensated heart failure (ADHF) and respiratory insufficiency admitted to the emergency room of a tertiary university hospital in Porto, Portugal. A total of 170 patients (age 76.2 ± 10.3 years) were included. The outcome of ACM occurred in 43 (25.3%) patients during the 180-day follow-up period. DE was evaluated for a maximum of 3 h after emergency room admission. The lowest DE was defined as ≤140 mL of diuresis per 40 mg of furosemide equivalents. Results: No significant differences in age, comorbidities, baseline HF symptoms, or disease-modifying medication were found between the lowest and highest DE groups. The lowest DE group had higher blood urea and lower estimated glomerular filtration rate (eGFR) levels (41.3 ± 24.5 vs. 56.7 ± 23.2 mL/min/1.73 m2, p < 0.001). The patients with the lowest DE had significantly higher rates of ACM during the 180-day follow-up, even after adjustment for other clinically relevant variables: hazard ratio (HR) [95% CI] = 2.31 [1.16-4.58], p = 0.016. The lowest diuresis (≤300 mL) and the highest intravenous furosemide dose (>80 mg) alone were not significantly associated with the outcome. After adjustment for N-terminal prohormone of brain natriuretic peptide, the association between the lowest DE and the outcome lost strength (HR [95% CI] = 1.53 [0.75-3.13], p = 0.240). Conclusion: A low DE (≤140 mL/40 mg of furosemide) in the first 3 h after an ADHF episode was associated with increased mid-term mortality rates.

scholarly journals Renal Function during Hospitalization and Outcome in Chinese Patients with Acute Decompensated Heart Failure

2021 ◽  
Author(s):  
Hao-Wei Lee ◽  
Chin-Chou Huang ◽  
Chih-Yu Yang ◽  
Hsin-Bang Leu ◽  
Po-Hsun Huang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Clinical Outcomes ◽  
Acute Decompensated Heart Failure ◽  
Significant Risk ◽  
Decompensated Heart Failure ◽  
Chinese Patients ◽  
Cox Regression Analysis ◽  
The Impact

Abstract It is well known that the heart and kidney have a bi-directional correlation, in which organ dysfunction results in maladaptive changes in the other. We aimed to investigate the impact of renal function and its decline during hospitalization on clinical outcomes in patients with acute decompensated heart failure (ADHF). A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four-variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF), defined as eGFR decline between admission (eGFRadmission) and pre-discharge (eGFRpredischarge), occurred in 41 patients. Clinical outcomes during the follow-up period were defined as 4P-major adverse cardiovascular events (4P-MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization. During an average follow-up period of 2.6±3.2 years, 66 patients experienced 4P-MACE. Cox regression analysis revealed that impaired eGFRpredischarge, but not eGFRadmission or WRF, was significantly correlated with the development of 4P-MACE (HR, 2.003; 95% CI, 1.072–3.744; P=0.029). In conclusion, impaired renal function before discharge, but not WRF, is a significant risk factor for poor outcomes in patients with ADHF.

Abstract 13918: Prognostic Value of Plasma Ngal in the 12-month All-cause Mortality of Acute Heart Failure or Acute Decompensated Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hao T Phan
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Prognostic Value ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Plasma Ngal ◽  
Kaplan Meier ◽  
All Cause Mortality

Introduction: The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Renal dysfunction is common in patients with AHF or ADHF and is associated with significant early and late morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is an early predictor of acute kidney injury and adverse events in various diseases; however, in AHF or ADHF patients, its significance remains poorly understood. This study was aimed to evaluate the 12 month prognostic value of plasma NGAL in AHF or ADHF patients Hypothesis: plasma NGAL has value in prognosis of 12-month all-cause mortality of Acute Heart Failure or Acute Decompensated Heart Failure Methods: This was a prospective cohort study Results: there were 46 all-cause mortality cases (rate 33.1%) 12 months follow up after discharge. There were 11 cases (rate 7.9%) lost to follow-up; mean age 66.12 ± 15.77, men accounted for 50.4%. The optimal cut-off of NGAL for 12-month all-cause mortality prognosis was > 383.74 ng/ml, AUC 0.632 (95% CI 0.53-0.74, p = 0.011), sensitivity 58.7 %, specificity 68.29 %, positive predictive value 50.9%, negative predictive value 74.7%. Kaplan-Meier analysis revealed that the high plasma NGAL (≥ 400 ng/ml) group exhibited a worse prognosis than the low plasma NGAL (< 400 ng/ml) group in 12-month all-cause death (Hazard Ratio 2.56; 95%CI 1.35-4.84, P=0.0039. Independent predictors of 12-month all-cause-mortality were identified using multivarable Cox proportional-hazards regression models with backward-stepwise selection method consisted of two variables: level of NGAL, mechanical ventialtion at admission. Conclusions: Plasma NGAL and mechanical ventilation at admission were independent predictors of 12-month all-cause mortality in patients with AHF or ADHF. The survival probability 12-month follow-up of high level NGAL (≥ 400 ng/ml) groups were lower than that of low level NGAL (<400 ng/ml,), difference was statistically significant χ2 = 8.31; p = 0.0047 by Kaplan-Meier curves.

scholarly journals Socioeconomic deprivation and 1 year clinical outcomes after cryablation for atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
Y Lau ◽  
O Cimpeanu ◽  
GE Marshall ◽  
GJ Padfield ◽  
GA Wright ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Alcohol Misuse ◽  
Socioeconomic Deprivation ◽  
Socioeconomic Group ◽  
Bleeding Diathesis ◽  
Lower Socioeconomic ◽  
All Cause Mortality ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Socioeconomic deprivation has previously been demonstrated to result in worse heart failure and myocardial infarction outcomes. Published studies shown lower socioeconomic group to associate with higher prevalence of atrial fibrillation (AF), increased mortality and morbidity. However, the impact of socioeconomic deprivation on clinical outcomes post AF cryoablation has yet to be investigated. AIM To assess the impact of socioeconomic deprivation (as categorised by Scottish Index of Multiple Deprivation, SIMD) on the medical management and clinical outcomes of patients with AF treated by cryoablation.  METHODS A retrospective study of paroxysmal or persistent AF patients after cryoablation. The parameters included basic demographics, weight, past medical history (inclusive of hypertension, heart failure, diabetes, stroke or transient ischaemic attacks, prior myocardial infarction, obstructive sleep apnoea) and alcohol misuse. Medical treatment post AF ablation (Beta blocker, non-dihydropyridine calcium channel blocker, flecainide, amiodarone, dronaderone, sotolol, anticoagulant use) were also recorded. Individual’s socioeconomic deprivation index, as described SIMD was also recorded (1 – most deprived and 10 – least deprived), and accordingly placed into quintile (SIMD 1-2,3-4,5-6,7-8, 9-10). Follow-up for 12 months. Clinical outcome assessed was rate of readmission for symptomatic documented AF, rate of heart failure admission, stroke, bleeding diathesis and all-cause mortality. RESULTS 312 patients were identified: 65 from the lowest quintile (SIMD 1-2), 57 from SIMD 3-4, 54 from SIMD 5-6, 52 from SIMD 7-8, and 84 from the highest quintile (SIMD 9-10).  No statistical difference exists between age, gender or weight. Lowest socioeconomic quintile has higher incidence of heart failure (p =0.018) but other past medical history was no different. No difference in incidence of alcohol misuse. Prescription rate/rhythm control agents and anticoagulant use post ablation was not statistically different between all groups. 12 months follow-up demonstrated readmission for symptomatic documented AF was statistically higher among patients of lowest socioeconomic quintile (Keplan Meier plot, p = 0.001). Stepwise multiple regression analysis also confirmed multiple socioeconomic deprivation as an independent predictor for more adverse clinical outcome (p = 0.02). Risk of readmission for AF in patients from the wealthiest socioeconomic group is almost a quarter as compared to those of most deprived social group (Odd-ratio 0.273 (95% CI 0.122 – 0.607)). Other clinical outcomes including risk of admissions for heart failure, stroke, bleeding diathesis and all-cause mortality was not statistically different across all groups. Summary After cryoablation for AF, patients from the lower socioeconomic group are still more likely to experience readmission for symptomatic AF at 12-month, despite similar post-procedure pharmaceutical agents utilised.

P1638Predictors of in-hospital and late mortality in acutely decompensated chronic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Fernandez-Berges ◽  
F J Felix Redondo ◽  
M R Gonzalez ◽  
L Consuegra-Sanchez ◽  
F Buitrago ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nursing Home ◽  
Hospital Mortality ◽  
Hospital Readmissions ◽  
Decompensated Heart Failure ◽  
Primary Objective ◽  
Late Mortality ◽  
Global Pandemic ◽  
All Cause Mortality

Abstract Background Heart failure (HF) is a global pandemic, and the cause of the greater health expenditure on hospitalization. Purpose To determine, in patients admitted due to decompensated heart failure (dHF), the predictors of in-hospital and late all-cause mortality. Methods Retrospective and longitudinal observational study of consecutive patients admitted with a diagnosis of dHF in a General Hospital between 2000–2015. Primary objective was in-hospital and late mortality. Results A total of 3705 patients were included (76.9 + 10.1 years, 54.1% women). Diabetes was present in 1611 (43.5%) patients, hypertension in 3210 (86.6%), active smoking in 221 (6%), COPD in 989 (26.7%), neoplasms in 415 (11.2%), chronic renal failure (CRF) in 628 (17%), previous myocardial infarction (pMI) in 449 (12.1%), stroke in 416 (11.2%), previous heart failure (pHF) in 1015 (27.4%), atrial fibrillation in 1672 (45.1%). A total of 239 (6.5%) lived in a nursing home (NH). The rate of 6-months readmission due to heart failure was 473 (12.8%). The in-hospital all-cause mortality rate was 9.3% (345). During a median follow-up of 930 days (RI 230–2611), 2165 (58.4%) patients died. The following variables were independent predictors of in-hospital mortality (Odds ratio, 95% CI): age 1.03 (1.02–1.05), basal creatinine 1.18 (1.01–1.39) and urea 1.014 (1.011–1.018) (model AUC 0.78 (0.75–0.81)). We identified the following predictors of late mortality (Hazard ratio, 95% CI): age 1,029 (1,022–1,035), diabetes mellitus 1,13 (1,02–1,25), COPD 1,15 (1,03–1,28), neoplasms 1,17 (1,008–1,361), pMI 1.19 (1.02–1.38), pHF 1.25 (1.12–1.39), NH 1.24 (1.03–1.49), readmission 1.73 (1.51–1.97), urea 1.003 (1.001–1.005) (model AUC 0.73 (0.71–0.75)). Conclusions In-hospital mortality was significantly associated with age and markers of renal function, while for late mortality the predictors were comorbidities, hospital readmissions and living in a nursing home.

Impact of Platelet-to-Lymphocyte Ratio on Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction

Angiology ◽  
2016 ◽  
Vol 68 (4) ◽  
pp. 346-353 ◽  
Author(s):  
Xi-Peng Sun ◽  
Jing Li ◽  
Wei-Wei Zhu ◽  
Dong-Bao Li ◽  
Hui Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
St Segment Elevation ◽  
Recurrent Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Infarction Heart

We investigated the association between platelet-to-lymphocyte ratio (PLR) and clinical outcomes (including all-cause mortality, recurrent myocardial infarction, heart failure, serious cardiac arrhythmias and ischemic stroke) in patients with ST-segment elevation myocardial infarction (STEMI). Based on PLR quartiles, 5886 patients with STEMI were categorized into 4 groups: <98.8 (n = 1470), 98.8 to 125.9 (n = 1474), 126.0 to 163.3 (n = 1478), >163.3 (n = 1464), respectively. We used Cox proportional hazards models to examine the relation between PLR and clinical outcomes. Mean duration of follow-up was 81.6 months, and 948 patients (16.1%) died during follow-up. The lowest mortality occurred in the lowest PLR quartile group ( P = 0.006), with an adjusted hazard ratio of 1.18 (95% confidence interval [CI], 1.04-1.55), 1.31 (95% CI, 1.18-1.64), and 1.59 (95% CI, 1.33-1.94) in patients with PLR of 98.8 to 125.9, 126.0 to 163.3, >163.3, respectively. Higher levels of PLR were also associated with recurrent myocardial infarction ( Ptrend = .023), heart failure ( Ptrend = .018), and ischemic stroke ( Ptrend = .043). In conclusion, a higher PLR was associated with recurrent myocardial infarction, heart failure, ischemic stroke, and all-cause mortality in patients with STEMI.

Abstract 5946: Ntprobnp Guided Treatment for Chronic Heart Failure: Results from the Battlescarred Trial

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
A Mark Richards ◽  
John G Lainchbury ◽  
Richard W Troughton ◽  
Kim Strangman ◽  
Christopher M Frampton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Usual Care ◽  
Treatment Algorithm ◽  
Treatment Strategies ◽  
Decompensated Heart Failure ◽  
Significant Treatment ◽  
Serial Measurement ◽  
All Cause Mortality ◽  
One Year

Three hundred and sixty four (364) patients satisfying Framingham and ESC criteria for symptomatic heart failure were randomized 1:1:1 (with prospective sub-stratification according to age ≤ or > 75 years) to Usual Care (UC), Intensive Clinical Management (CC) or Hormone Guided Care (HGC) incorporating serial measurement of NTproBNP levels into the treatment algorithm. The 3 treatment strategies were applied for 2 years. Minimum follow-up was 12 months with median follow-up 2.8 years. The primary end-points were all-cause mortality and death+/− admission with decompensated Heart Failure (HF). Groups were matched for age (median 76–77years); LVEF (37%) and baseline NTproBNP (medians 235–239 pmol/L ie 1997–2021 pg/ml). All-cause mortality at 12 months was halved by both intensive strategies (18.9, 9.1 and 9.1% respectively for UC, CC and HGC respectively; (P=0.028 overall and P=0.029 for pairwise (UC vs CC and UC vs HGC) intergroup comparisons). At 2 and 3 years follow-up mortality rates did not differ overall but significant treatment effects were observed in those aged ≤75years (P<0.025 for interaction between age and management strategy at all time points). At 1, 2 and 3 years, in those ≤ 75 years, cumulative all-cause mortality was 1.7, 7.3 and 15.5% in HGC; 7.3, 20.0, and 30.9% in CC and 20.3, 23.4 and 31.3% in UC. HGC significantly reduced cumulative mortality below that in UC throughout follow-up (P=0.001 and P=0.021 at 1 and 3 years respectively) and also below that in CC by 3 years follow-up (P=0.048) whereas CC conferred no advantage over UC after one year of follow-up (P=0.04 and ns at 1 and 3 years respectively). The composite end-point of death+/− admission with HF was reduced only in younger patients receiving HGC (P<0.05 at 1, 2 and 3 years follow-up compared with UC). Total days “alive and not in hospital with HF” over 3 years of follow-up, averaged 206 days more in this subgroup than in their peers within the UC group (P<0.05). No benefits were observed in those aged > 75 years. Intensive management of chronic HF reduces one-year mortality compared to usual care. Over long-term follow-up hormone guided therapy may offer an additional mortality advantage over otherwise similarly intensive specialist clinic-based care particularly in those aged ≤ 75 years.

scholarly journals Impact of Increased Body Mass Index on Accuracy of B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP for Diagnosis of Decompensated Heart Failure and Prediction of All-Cause Mortality

2010 ◽  
Vol 56 (4) ◽  
pp. 633-641 ◽  
Author(s):  
Robert H Christenson ◽  
Hassan ME Azzazy ◽  
Show-Hong Duh ◽  
Susan Maynard ◽  
Stephen L Seliger ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Body Mass ◽  
Decompensated Heart Failure ◽  
Normal Weight ◽  
Multivariate Logistic Regression Model ◽  
Obese Patients ◽  
All Cause Mortality ◽  
Study Population

Abstract Background: BNP and N-terminal proBNP (NT-proBNP) concentrations may be depressed in patients with increased body mass index (BMI). Whether increased BMI affects accuracy of these biomarkers for diagnosing decompensated heart failure (HF) and predicting outcomes is unknown. Methods: We measured BNP and NT-proBNP in 685 patients with possible decompensated HF in a free-living community population subdivided by BMI as obese, overweight, and normal weight. HF diagnosis was adjudicated by a cardiologist blinded to BNP and NT-proBNP results. We tabulated all-cause mortality over a median follow-up of 401 days and assessed marker accuracy for HF diagnosis and mortality by ROC analysis. Results: Of the 685 patients, 40.9% were obese (n = 280), 28.2% were overweight (n = 193), and 30.9% had normal BMI (n = 212). Obese patients had lower BNP and NT-proBNP compared with overweight or normal-weight individuals (P &lt; 0.001) and decreased mortality compared with normal-weight individuals (P &lt; 0.001). Both biomarkers added significantly to a multivariate logistic regression model for diagnosis of decompensated HF across BMI categories. NT-proBNP outperformed BNP for predicting all-cause mortality in normal-weight individuals (χ2 for BNP = 6.4, P = 0.09; χ2 for NT-proBNP = 16.5, P &lt; 0.001). Multivariate regression showed that both biomarkers remained significant predictors of decompensated HF diagnosis in each BMI subgroup. Conclusions: In this study population, obese patients had significantly lower BNP and NT-proBNP that reflected lower mortality. BNP and NT-proBNP can be used in all BMI groups for decompensated HF diagnosis, although BMI-specific cutpoints may be necessary to optimize sensitivity.

Adequate contacts after remote monitoring alerts were associated with improved outcomes in chronic heart failure: results from the OptiLink HF study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Wintrich ◽  
V.P Pavlicek ◽  
J.B Brachmann ◽  
R.B Bosch ◽  
C.B Butter ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Fluid Overload ◽  
Medical Intervention ◽  
Lower Number ◽  
Telephone Contact ◽  
Cardioverter Defibrillator ◽  
Fluid Status ◽  
Improved Outcomes

Abstract Aims To investigate the effects of adequate reactions to telemedicine alerts triggered by fluid index threshold crossings (FTC) on clinical outcomes in the OptiLink HF trial. Methods We separated adequate from inadequate reactions to FTC transmissions in patients with remote impedance-based monitoring (RM) of fluid status in the OptiLink HF trial. Adequate contacts had to meet the following criteria: i) initial telephone contact within 2 working days after FTC transmission, ii) follow-up contacts according to study protocol, and iii) medical intervention initiated after FTC due to true fluid overload. We compared time to cardiovascular (CV) death or heart failure (HF) hospitalization and all CV- and HF-hospitalizations at follow-up between RM patients contacted adequately or inadequately and patients with usual care (UC). Results In the RM group, transmission of at least one FTC alert occurred in 356 patients (70.5%; n=505). While 113 patients (31.7%; n=356) have been contacted adequately after every FTC, in 243 patients (68.3%; n=356) at least one FTC was not responded by an adequate contact. Adequate responses to RM significantly reduced risk of the primary endpoint (hazard ratio (HR), 0.68; 95% confidence interval (CI) 0.48–0.95; p=0.025, figure 1), and led to a significantly lower number of CV (52.1±7.5 vs. 99.9±19.8; p=0.007) and HF hospitalizations per 100 patient years when compared with UC (26.1±4.4 vs. 67±15.2; p=0.007). Conclusion RM with adequate reactions to FTC alerts significantly reduced total number of both CV and HF hospitalizations and improved clinical outcomes in patients with advanced HF and implantable cardioverter defibrillator (ICD). Funding Acknowledgement Type of funding source: None

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