scholarly journals Anemia in chronic heart failure patients: comparison between invasive and non-invasive prognostic markers

2005 ◽  
Vol 64 (2) ◽  
Author(s):  
Monica Ceresa ◽  
Soccorso Capomolla ◽  
GianDomenico Pinna ◽  
Eleonora Aiolfi ◽  
Maria Teresa La Rovere ◽  
...  
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Functional Class ◽  
Prognostic Models ◽  
Class Iii ◽  
Cardiac Events ◽  
Non Invasive ◽  
Peak Vo2

Background: The prognosis of chronic heart failure (CHF) remains poor despite advances in medical management. Several different variables determine prognosis. Recently anemia has emerged as an independent prognostic variable in the evaluation of CHF. It is therefore important to analyze the role of anemia in patients with mild to severe CHF already well characterized by hemodynamic, echo- Doppler, and cardiopulmonary exercise testing. Objective: We performed this study to evaluate, in a large general cohort of CHF patients, the frequency of anemia and its correlation with their clinical profile. We assessed the prognostic value of anemia in relation to other known prognostic variables. Methods: Two-dimensional echocardiography, right heart catheterization, cardiopulmonary tests and laboratory examinations were performed in a population of 980 consecutive patients with CHF (53±9.4 years, 85% male, LVEF 25±8%; 45% with NYHA class III-IV). A hemoglobin (Hb) concentration less than 12 g/dl was used to define anemic patients. The primary end point was cardiac death or urgent heart transplantation. Results: Nineteen percent of patients were anemic. These patients had a lower body mass index (24±3 vs. 25±4 Kg/m2 p <0.0004), a worse functional class (64% were in NYHA class III-IV vs 41% in the non-anemic group, p <0.0001), poorer exercise capacity (12.4 vs. 14.8 ml/kg/min peak VO2, p <0.0001) and increased right (7±5 vs. 5±4 mmHg, p <.0004) and left (21±9 vs. 19±10 p <0.007) ventricular filling pressures. During a 3-year follow-up cardiac deaths occurred in 236 (24%) and 52 (5%) of patients received an urgent heart transplant. On univariate regression analysis anemia was significantly correlated with these “hard” cardiac events (39% of anemic patients vs 27% of non-anemic patients). By multivariate logistic regression analysis different prognostic models were identified using non-invasive, with or without peak VO2, or invasive parameters. The prognostic model including anemia (AUCROC: 0.720) showed similar accuracy in predicting cardiac events to other prognostic models with peak VO2 (AUCROC: 0.719) or invasive variables (AUCROC: 0.719). Conclusions: The present study demonstrates that anemia in CHF patients is associated with prognosis, worse NYHA functional class, exercise capacity and hemodynamic profiles. The relationship between anemia and mortality is independent of other simple non-invasive prognostic factors. Prognostic models with more complex or invasive independent predictors did not increase the accuracy to predict cardiac mortality or the need for urgent transplantation.

Association between self-care and prognosis in 1123 patients with chronic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Calero ◽  
E Hidalgo ◽  
R Marin ◽  
L Rosenfeld ◽  
I Fernandez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Acute Heart Failure ◽  
Nyha Class ◽  
Self Care ◽  
P Value ◽  
Funding Source ◽  
Class Iii ◽  
Cox Models ◽  
Lower Tertile

Abstract Background Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF. Aims and methods The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF. We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline. Results We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour. Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception. Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028] Conclusion Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure. These results highlight the importance of assessing self-care and provide measures to improve them. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge

scholarly journals Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management

2019 ◽  
Vol 28 (1) ◽  
pp. 3-13 ◽  
Author(s):  
J. F. Veenis ◽  
J. J. Brugts
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Remote Monitoring ◽  
Heart Association ◽  
The United States ◽  
Pharmacological Therapy ◽  
Functional Class ◽  
Class Iii ◽  
Additional Tool

AbstractExacerbations of chronic heart failure (HF) with the necessity for hospitalisation impact hospital resources significantly. Despite all of the achievements in medical management and non-pharmacological therapy that improve the outcome in HF, new strategies are needed to prevent HF-related hospitalisations by keeping stable HF patients out of the hospital and focusing resources on unstable HF patients. Remote monitoring of these patients could provide the physicians with an additional tool to intervene adequately and promptly. Results of telemonitoring to date are inconsistent, especially those of telemonitoring with traditional non-haemodynamic parameters. Recently, the CardioMEMS device (Abbott Inc., Atlanta, GA, USA), an implantable haemodynamic remote monitoring sensor, has shown promising results in preventing HF-related hospitalisations in chronic HF patients hospitalised in the previous year and in New York Heart Association functional class III in the United States. This review provides an overview of the available evidence on remote monitoring in chronic HF patients and future perspectives for the efficacy and cost-effectiveness of these strategies.

Abstract 3143: Reverse Hemodynamic Remodelling May Be Possible Over Time

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lynne W Stevenson ◽  
Yong K Cho ◽  
J. T Heywood ◽  
Robert C Bourge ◽  
William T Abraham ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Nyha Class ◽  
Systolic Pressure ◽  
Filling Pressure ◽  
Class Iii ◽  
One Year ◽  
Over Time

Introduction : Elevated filling pressures are a hallmark of chronic heart failure. They can be reduced acutely during HF hospitalization but the hemodynamic impact of ongoing therapy to maintain optivolemia has not been established. Methods and Results : After recent HF hospitalization, 274 NYHA Class III or IV HF patients were enrolled in the COMPASS-HF study at 28 experienced HF centers and received intense HF management (average 24.7 staff contacts/ 6 months) ± access to filling pressure information to adjust diuretics to maintain optivolemia, usually defined as estimated pulmonary artery diastolic (PAD) pressure of 12±4 mmHg. Filling pressure information was available for half the patients during the first 6 months (the Chronicle group, <Access), and for all patients during the next 6 months. Diuretics were adjusted 12.7 times per patient in the Chronicle group and 8.2 times per patient in the Control (-Access) group during the first 6 months (p = 0.0001). Compared to baseline, decreases in RV systolic pressure (RVSP) and ePAD were significant for the +Access patients by one year (p=0.0012 and p =.04, respectively). The Control patients exhibited a similar trend 6 months after crossing to +Access (figure ). Conclusions: Targeted therapeutic adjustments, based on continuous filling pressures along with intensification of HF management contacts, are associated with a reduction in chronic left-sided filling pressures and right ventricular load.

scholarly journals Prognostic Value of Combination of Cardiac Troponin T and B-Type Natriuretic Peptide after Initiation of Treatment in Patients with Chronic Heart Failure

2003 ◽  
Vol 49 (12) ◽  
pp. 2020-2026 ◽  
Author(s):  
Junnichi Ishii ◽  
Wei Cui ◽  
Fumihiko Kitagawa ◽  
Takahiro Kuno ◽  
Yuu Nakamura ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Myocardial Damage ◽  
Left Ventricular ◽  
Functional Class ◽  
Cardiac Troponin T ◽  
Cardiac Events ◽  
Nyha Functional Class

Abstract Background: Recent studies have suggested that cardiac troponin T (cTnT) and troponin I may detect ongoing myocardial damage involved in the progression of chronic heart failure (CHF). This study was prospectively designed to examine whether the combination of cTnT, a marker for ongoing myocardial damage, and B-type natriuretic peptide (BNP), a marker for left ventricular overload, would effectively stratify patients with CHF after initiation of treatment. Methods: We measured serum cTnT, plasma BNP, and left ventricular ejection fraction (LVEF) on admission for worsening CHF [New York Heart Association (NYHA) functional class III to IV] and 2 months after initiation of treatment to stabilize CHF (n = 100; mean age, 68 years). Results: Mean (SD) concentrations of cTnT [0.023 (0.066) vs 0.063 (0.20) μg/L] and BNP [249 (276) vs 753 (598) ng/L], percentage increased cTnT (&gt;0.01 μg/L; 35% vs 60%), NYHA functional class [2.5 (0.6) vs 3.5 (5)], and LVEF [43 (13)% vs 36 (12)%] were significantly (P &lt;0.01) improved 2 months after treatment compared with admission. During a mean follow-up of 391 days, there were 44 cardiac events, including 12 cardiac deaths and 32 readmissions for worsening CHF. On a stepwise Cox regression analysis, increased cTnT and BNP were independent predictors of cardiac events (P &lt;0.001). cTnT &gt;0.01 μg/L and/or BNP &gt;160 ng/L 2 months after initiation of treatment were associated with increased cardiac mortality and morbidity rates. Conclusion: The combination of cTnT and BNP measurements after initiation of treatment may be highly effective for risk stratification in patients with CHF.

scholarly journals Increased Interleukin-11 Levels Are Correlated with Cardiac Events in Patients with Chronic Heart Failure

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Jing Ye ◽  
Zhen Wang ◽  
Di Ye ◽  
Yuan Wang ◽  
Menglong Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Plasma Concentrations ◽  
Heart Association ◽  
Functional Class ◽  
Control Group ◽  
Class Iii ◽  
Cardiac Events ◽  
Nyha Functional Class ◽  
Interleukin 11

Background. Interleukin-11 (IL-11) is an important inflammatory cytokine and has been demonstrated to participate in cardiovascular diseases. However, there have been no studies about the role of IL-11 in heart failure (HF). The present study is aimed at investigating whether IL-11 levels are associated with the cardiac prognosis in patients with HF. Methods. The plasma concentrations of IL-11 were measured in 240 patients with chronic HF (CHF) and 80 control subjects without signs of significant heart disease. In addition, we prospectively followed these CHF patients to endpoints of cardiac events. Results. Compared with the control group, the plasma IL-11 concentrations were significantly increased in the CHF patients and gradually increased in the New York Heart Association (NYHA) functional class II group, the NYHA functional class III group, and the NYHA functional class IV group. The receiver operating characteristic (ROC) curve revealed that the predictive role of IL-11 in HF is not as good as N-terminal B-type natriuretic peptide (BNP), although IL-11 has a certain value in predicting cardiac events. In addition, the CHF patients were divided into 3 groups according to the plasma IL-11 concentration category (low, T1; middle, T2; and high, T3). The multivariate Cox hazard analysis showed that the high plasma IL-11 concentrations were independently associated with the presence of cardiac events after adjustment for confounding factors. Furthermore, the CHF patients were divided into two groups based on the median plasma IL-11 concentrations. The Kaplan-Meier analysis revealed that the patients with high IL-11 concentrations had a higher risk of cardiac events compared with those with low IL-11 concentrations. Conclusions. Higher plasma IL-11 levels significantly increase the presence of cardiac events and suggest a poor outcome; although the diagnostic value of IL-11 in CHF is not as good as BNP, there is a certain value in predicting cardiac events in CHF.

scholarly journals One-Year Survival and Renal Function Recovery of Acute Kidney Injury Patients with Chronic Heart Failure

2014 ◽  
Vol 5 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Wen Zhang ◽  
Dan Wen ◽  
Yan-Fang Zou ◽  
Ping-Yan Shen ◽  
Yao-Wen Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Clinical Characteristics ◽  
Nyha Class ◽  
Kidney Injury ◽  
Class Iii ◽  
Kidney Dysfunction ◽  
Nyha Classification

Objective: To describe and analyze the clinical characteristics of acute kidney injury (AKI) patients with preexisting chronic heart failure (CHF) and to identify the prognostic factors of the 1-year outcome. Methods: A total of 120 patients with preexisting CHF who developed AKI between January 2005 and December 2010 were enrolled. CHF was diagnosed according to the European Society of Cardiology guidelines, and AKI was diagnosed using the RIFLE criteria. Clinical characteristics were recorded, and nonrecovery from kidney dysfunction as well as mortality were analyzed. Results: The median age of the patients was 70 years, and 58.33% were male. 60% of the patients had an advanced AKI stage (‘failure') and 90% were classified as NYHA class III/IV. The 1-year mortality rate was 35%. 25.83% of the patients progressed to end-stage renal disease after 1 year. Hypertension, anemia, coronary atherosclerotic heart disease and chronic kidney disease were common comorbidities. Multiple organ dysfunction syndrome (MODS; OR, 35.950; 95% CI, 4.972-259.952), arrhythmia (OR, 13.461; 95% CI, 2.379-76.161), anemia (OR, 6.176; 95% CI, 1.172-32.544) and RIFLE category (OR, 5.353; 95% CI, 1.436-19.952) were identified as risk factors of 1-year mortality. For 1-year nonrecovery from kidney dysfunction, MODS (OR, 8.884; 95% CI, 2.535-31.135) and acute heart failure (OR, 3.281; 95% CI, 1.026-10.491) were independent risk factors. Conclusion: AKI patients with preexisting CHF were mainly elderly patients who had an advanced AKI stage and NYHA classification. Their 1-year mortality and nonrecovery from kidney dysfunction rates were high. Identifying risk factors may help to improve their outcome.

scholarly journals Current approaches to rehabilitation of patients with chronic heart failure

2010 ◽  
Vol 1 (1) ◽  
pp. 20-24 ◽  
Author(s):  
G. P Arutyunov ◽  
E. A Kolesnikova ◽  
A. K Rylova
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Treatment Adherence ◽  
Treatment Process ◽  
Functional Class ◽  
Respiratory Muscle Training ◽  
Class Iii ◽  
Muscle Training ◽  
Russian Study ◽  
Positive Results

The paper provides a critical review of the specific features of treatment in patients with Functional Class III-IV chronic heart failure (CHF). In addition, the authors give the positive results of their own studies dealing with respiratory muscle training in CHF. Greater treatment adherence by a patient is promoted by the attraction of his/her relatives to the treatment process. For wider involvement of physicians in the problem, the authors arranged a Russian study to increase the adherence of patients with CHF to treatment and rehabilitation, by attracting patients’ relatives to this process.

scholarly journals Utilization of Bio Impedance Spectroscopy in lieu of Invasive Monitoring for Monitoring Fluid Overload

2018 ◽  
Vol 3 (10) ◽  
Keyword(s):  
Heart Failure ◽  
Impedance Spectroscopy ◽  
Nyha Class ◽  
Extracellular Fluid ◽  
Volume Overload ◽  
Heart Association ◽  
Insurance Companies ◽  
Invasive Monitoring ◽  
Class Iii ◽  
Non Invasive

Congestive heart failure (CHF) has become one of the most common diagnoses and a leading cost concern for Medicare and insurance companies. The majority of costs associated with CHF surround hospitalization and re-admissions. As a result of these rising costs, there has been a push to identify early markers of impending congestion as a surveillance tool and possible measure of effectiveness of treatment. The measurement of diastolic pulmonary artery (PA) pressure from invasive devices has been shown to be useful in the management of New York Heart Association (NYHA) class III heart failure (HF) patients. It has been suggested that bio impedance spectroscopy (BIS) could be used as a surrogate for volume overload, offering a non-invasive option for patients. We present a case of a NYHA class III HF patient with end stage liver disease. The patient had previously been implanted with a Cardio MEMS device. Over several weeks, diastolic PA pressures and weight were compared to BIS measures from a SOZO, (noninvasive fluid monitoring system). The use of BIS to estimate extracellular fluid accumulation shows excellent correlation to both diastolic PA pressure and weight, suggesting a use for non-invasive monitoring

scholarly journals Chronic heart failure and chronic kidney disease

2016 ◽  
Vol 63 (1) ◽  
pp. 35-38
Author(s):  
Camelia C. Diaconu ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Chronic Heart Failure ◽  
Kidney Disease ◽  
Nyha Class ◽  
Significant Proportion ◽  
Class Iii ◽  
One Year ◽  
Internal Medicine Clinic ◽  
Stage 1

Introduction. Renal dysfunction is one of the most common comorbidity of heart failure and may complicate its evolution. Aim. To analyze the frequency of chronic kidney disease in patients with decompensated chronic heart failure hospitalized in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest over a period of one year. Material and method. We retrospectively analyzed the data registered in hospital’s database between June 1st, 2014 – June 1st, 2015. Between 01.06.2014-01.06.2015, 609 patients with the diagnosis of chronic heart failure were hospitalized. Of these, 109 (17.89%) were diagnosed with chronic kidney disease (CKD) and represented our group of study. Distribution of chronic kidney disease in patients with chronic heart failure, depending on the stage of chronic kidney disease, was: no patient with stage 1, 26.61% with stage 2, 33.94% with stage 3A, 28.44% in stage 3B, 8.26% with stage 4 and 2.75% with stage 5. Distribution of NYHA class in the study group was: 20.18% NYHA class II, 40.37% NYHA class III, 39, 45% NYHA IV. 37 of the 109 patients (33.94%) with chronic heart failure and CKD had type 2 diabetes. Other important comorbidities in the group of study have been hypertension and anemia. Conclusions. Most patients with chronic heart failure admitted to our clinic were men, had heart failure NYHA class III and presented CKD class 3. A significant proportion of patients had risk factors for both BRC and heart failure: essential hypertension, diabetes and anemia.

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