bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discharge heart rate and beta-blockers treatments in hospitalized heart failure patients with coexisted atrial fibrillation
Authors: Xing F , Bai X , Li J 
Published: November 2020

Abstract

Background
Beta-blockers are widely used to improve clinical outcomes in heart failure (HF) patients. However, the effects of beta-blockers on clinical outcomes in those who have coexisted atrial fibrillation (AF) remains uncertain.

Purpose
We investigated the associations between beta-blockers and clinical outcomes according to discharge heart rate.

Methods
The study cohort included 1631 HF patients hospitalized primarily with AF, which was from the China PEACE Prospective Heart Failure Study. Clinical outcome was 1-year combined all-cause mortality and HF hospitalization after discharge. The associations between beta-blockers and clinical outcome were assessed using Cox proportional hazard and standardization mortality weighting regression models, with stratified discharge heart rate group predefined by restricted cubic spline.

Results
The median age was 68 (IQR: 60- 77) years, 41.9% were women, discharge heart rate was (median (IQR)) 75 (69- 84) beats per minute (bpm), and 60.2% received beta-blockers at discharge. According to the result of restricted cubic spline plot, these patients were divided into 3 groups: lowest &lt;65 bpm, middle 65–86 bpm and highest ≥87 bpm (Fig.1). In the Cox proportional hazard analysis, a significant interaction between discharge heart rate and beta-blocker use was observed (P&lt;0.001 for interaction). Stratified analysis showed beta-blocker prescription at discharge was associated with reduced risk for clinical outcomes in patients with high heart rates (hazard ratio 0.336, 95% CI: 0.144–0.786, p=0.012) but not in those with lowest and middle heart rates (hazard ratio: 1.32; 95% CI, 0.95–1.63; hazard ratio: 1.02; 95% CI, 0.68–1.55, respectively).

Conclusion
The associations between beta-blockers and clinical outcomes may be significantly influenced by baseline heart rate. Hospitalized HF patients with AF benefit the most from beta-blockers use if they had high heart rate (≥87 bpm) at discharge.
Figure 1

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This work was supported by the National Key Research and Development Program (2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-B&R-02); the 111 Project from the Ministry of Education of China (B16005).
Novel rehabilitation program after left ventricular assist device (LVAD) implantation improves functional tests and reduces levels of prognostic heart failure biomarkers
Authors: Chwyczko T , Zalucka L , Smolis-Bak E , Kowalik I , Noszczak E , Bogucki M , Piotrowicz E , Sobieszczanska-Malek M , Zielinski T , Szymanski J , Was J , Kusmierczyk M , Dabrowski R , Szwed H , Piotrowicz R 
Published: November 2020

Abstract

Background
Rehabilitation after LVAD implantation is increasingly used. We developed the novel method of comprehensive rehabilitation starting directly after LVAD implantation.

Study group
21 recent LVAD (15 Heart Mate III, 6 HeartWare) recipients (56.2±11.7 yrs, 100% men) were included to 5-week rehabilitation program, which included supervised endurance training on cycloergometer (5 times per week), resistance training, general fitness exercises with elements of equivalent and coordination exercises (every day). 6-minute walking test (6MWT), cardiopulmonary exercise test (CPET) and prognostic biomarkers: NT-proBNP, Galectin-3 and ST2 were investigated at the beginning and at the end of rehabilitation program.

Results
See Table 1.
At the end of rehabilitation program, significant increase in 6MWT distance, maximum workload, peak VO2 and upward shift of anaerobic threshold in CPET were observed in all patients. Significant reductions of NTproBNP, ST2 and galectin-3 levels were observed. There were no major adverse events during rehabilitaton.

Conclusions
Comprehensive novel rehabilitation in LVAD recipients is safe and results in significant improvement of 6-minutes walking test distance and cardiopulmonary exercise test results. Moreover, this novel rehabilitation program reduces levels of prognostic biomarkers of heart failure: NT-proBNP, Galectin-3 and ST2.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Center for Research and Development - STRATEGMED II project
Quantitative analysis of dyssynchrony assessed by multidetector computed tomography can predict clinical outcome after cardiac resynchronization therapy
Authors: Onishi T , Koyama Y , Inoue K , Okamura A , Iwamoto M , Tanaka K , Nagai H , Hirao Y , Oka T , Tanaka N , Watanabe S , Sumiyoshi A , Okada M , Iwakura K , Fujii K 
Published: November 2020

Abstract

Background
The degree of mechanical dyssynchrony has been suggested as a predictor for long-term survival after cardiac resynchronization therapy (CRT). There have been little reports of dyssynchrony assessment with the use of cardiac computed tomography (CCT).

Methods
We studied 35 heart failure (HF) patients (average age 67±10 years) referred for CRT with NYHA III-IV heart failure, left ventricular (LV) ejection fraction (EF) 20±10% (all ≤35%), and QRS duration 156±22 ms (all ≥120ms). Electrocardiogram-gated contrast-enhanced 256-slice multidetector CT was performed before CRT. Based on CCT, the LV endocardial boundaries from short-axis images reconstructed at 5% increments of cardiac cycle were automatically detected, and the time from R-wave to maximal wall motion was calculated for each of the 16 standardized segments for all slices using software “Myocardial Contraction Map”. The standard deviation modified by mean heart rate (%SD) was respectively calculated as the global parameter of dyssynchrony. LVEF was also measured using MDCT. The predefined primary end-point was the first HF hospitalization or death over 2 years.

Results
%SD was feasible in all patients, respectably. There were 16 events over 2 years; 11 HF hospitalizations and 5 deaths. Patients with %SD ≥22% (optimal cutoff for outcome by ROC curve analysis) had a better clinical outcome than patients with %SD &lt;22% (p=0.01, Figure).

Conclusion
Patients who had %SD ≥22% assessed by MDCT had a particularly favorable event-free survival following CRT, and this appears to be an important prognostic marker.

Funding Acknowledgement
Type of funding source: None
Higher pulsatile index in carotid arteries is associated with adverse outcomes in patients treated by left ventricular assist device
Authors: Tucanova Z , Wohlfahrt P , Ivak P , Netuka I , Pitha J 
Published: November 2020

Abstract

Introduction
Better understanding of vascular changes in patients after implantation of left ventricular assist devices (LVAD) is important to understand and prevent complications of this therapy. Currently, there is substantial lack of data regarding the impact of changes in carotid territory on clinical events in this population. Our aim was to analyze the association between carotid flow patterns and atherosclerotic changes with serious clinical events after LVAD implantation in a prospective single-center study.

Methods
Eighty five patients were included (Heart mate II, n=34; Heart mate 3, n=51; mean age 55±15 years; 13 women). Pulsatile and resistance indexes were calculated and atherosclerotic changes (Belcaro score) were assessed using triplex ultrasound at the 3rd and 6th month after LVAD implantation. Basic clinical and laboratory data were also included into the analyses. The median follow-up time was 982 days [IQR 472–1431].

Results
Pulsatile and resistance index significantly increased between 3rd and 6th month (p=0.036 and p=0.012, respectively). Belcaro score did not change significantly. During the follow-up, 17 patients died, 4 due to stroke. Another 4 patients suffered from non-fatal stroke. Pulsatile index measured at 3rd month was associated with an increased risk of composite outcome of stroke, GIT hemorrhage and all-cause mortality (HR 10.6, 95% CI 2.0–55.2, p=0.005) only in the group of HeartMate 3 patients, while not in patients with HeartMate II (HR 0.96, 95% CI 0.07–12.4, p=0.97), p for interaction between groups 0.04. Association between pulsatile index and the risk of adverse events in patients with HeartMate 3 remained significant after adjustments for age, cause of heart failure and INTERMACS score.

Conclusion
Among patients after LVAD implantation, assessment of carotid flow patterns, pulsatile index in particular, may identify individuals at increased risk of serious clinical complications. Future studies are needed to understand mechanisms leading to increase flow pulsatility in this population.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic
Heart rate response during cardiopulmonary exercise in heart transplant recipients
Authors: Nygaard S , Rolid K , Nytroen K , Fiane A , Wyller V.B.B , Gullestad L , Broch K 
Published: November 2020

Abstract

Background
Denervation at heart transplant (HTx) results in attenuated heart rate (HR) control and limited exercise tolerance.

Purpose
The aim of this study was to assess longitudinal changes in the HR response to exercise in HTx recipients. We compared the results with those of healthy controls.

Methods
Seventy-four HTx recipients were enrolled in a cardiopulmonary exercise trial. The HR response to maximal exercise was tested at 11 weeks and at 1- and 3-years follow-up post HTx, and compared with the HR response in 50 age and gender matched controls. The HR was measured at rest, at 25-, 50-, 75-, and 100% of VO2peak, and 30 sec, 1, 2, and 4 min after peak exercise on a treadmill or bicycle ergometer. We also assessed the HR reserve and the chronotropic response index (CRI).

Results
Elleven weeks after HTx, the HR response to exercise was blunted, but improved significantly during follow-up. The change in HR from rest to peak exercise increased by 53% (41 bpm vs 62 bpm; p&lt;0.001) from inclusion to 12 months follow-up, but levelled off between 12- and 36 months (62 bpm vs 65 bpm; p=0.59) (Figure 1). In comparison, the exercise-induced increase in HR in healthy controls was 117 bpm. In HTx recipients, approximately 40% of the total increase in HR occurred between rest and 25% of VO2peak at inclusion (Figure). In contrast, only 31% of the increase in HR in healthy controls occurred between rest and 25% of VO2peak (p&lt;0.001). The fall in HR during the first 4 minutes after exercise increased over the duration of the study (p&lt;0.001 for all comparisons between inclusion and 12 months, and 12- and 36 months at 30 sec, 1, 2, 3 and 4 min after exercise). During the first minute after the end of exercise, the HR rose 2 bpm at baseline, but fell 10 bpm at 12 months (p for difference &lt;0.001). However, even at 36 months, the decline in HR after exercise remained less rapid than in healthy controls (p&lt;0.001) (Figure). CRI increased between baseline and 12 months, but levelled off between the 12-month visit and 36 months (0.50±0.2 vs 0.79±0.3; p&lt;0.001 and 0.79±0.3 vs 0.81±0.3; p=0.51). The chronotropic response was normalized (&gt;0.85) in 44% of the HTx recipients at 1 year and in 51% at 3 year after HTx.

Conclusion
The increase and decrease in HR during exercise are considerably muted in de novo HTx recipients. The HR response improves during the first year after surgery, and thereafter levels off. In contrast the decline in HR after exercise seems to increase with time, which may be related to the effect of exercise. This suggests that partial re-innervation takes place. Whether this response continues to improve in the longer term remains to be determined.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority
Effectiveness of nurse-led hospital-based heart failure programmes in octagenarians and nonagenarians: is age important?
Authors: Guerrero G , Alcoberro L , Vime J , Calero E , Hidalgo E , Marin R , Enjuanes C , Garay A , Yun S , Jimenez S , Moliner P , Delso C , Fernandez I , Rosenfeld L , Comin J 
Published: November 2020

Abstract

Background
Efficacy of HF programmes in oldest old (octogenarians and nonagenarians) has not been fully explored.

Methods
We conducted a natural experiment evaluating all patients after hospitalization for heart failure as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1, before the implementation of the program with patients discharged during Period #2, after the implementation of the 7-step bundle of interventions. We explored the interaction between age group (&lt;80 vs. ≥80 years old) by the intervention modality (HF programme vs. usual care). Primary end-point was the combined end-point of all-cause death or all-cause hospitalization at 6 months after discharge from the index hospitalization.

Results
The study enroled 440 patients. Mean age of the whole cohort was 75±9 years. In the oldest old subgroup (n=160), mean age was 84±3. No differences were found in baseline characteristics of patients between usual care and HF program. 30-day all-cause readmission was significantly reduced in patients in the HF programme group compared to patients in the usual care group in both age strata. In unadjusted Cox regression analyses in the oldest old group, management of patients in the HF programme was significanty associated with a reduction in the risk of the primary end-point (HR: 0.50; 95% CI [0.29–0.85]; p=0.011).

Conclusions
Management of patients in a nurse-led integrated care-based heart failure programme results in reduction of all-cause death or all-cause hospitalizations in oldest old patients.
Event-free survival cumulative curves.

Funding Acknowledgement
Type of funding source: None
Increased incidence of heart failure in patients with severe obstructive sleep apnoea: a long-term prospective cohort study
Authors: Liang V , Holtstrand-Hjalm H , Peker Y , Thunstrom E 
Published: November 2020

Abstract

Background
Obstructive sleep apnoea (OSA) is highly prevalent among patients with heart failure. Accumulating research data suggest that this association is bidirectional. Less is known regarding the long-term impact of OSA and continuous positive airway pressure (CPAP) treatment on incident heart failure.

Purpose
We addressed the association of severe OSA with development of heart failure, and consequently addressed the impact of efficient CPAP treatment in a sleep clinic cohort.

Methods
The “Sleep Apnea Patients in Skaraborg (SAPIS)” project was a single center (two sites), open-label, prospective cohort study, conducted in Sweden between 2005 and 2018. All consecutive adults admitted to the Skaraborg Hospital between 2005 and 2011 were registered in a local database, and the follow-up ended in May 2018. Anthropomorphic and clinical characteristics as well as results of the diagnostic cardiorespiratory recordings were documented. Treatment of OSA was based on the clinical routines. OSA was defined as an apnoea-hypopnoea index (AHI) of at least 5 events/hr, and severe OSA consisted of patients with an AHI ≥30 events/hr. Median follow-up for the entire cohort was 8.8 years (interquartile range 7.5–10.1 years). Data regarding incident heart failure were obtained from the medical records and the Swedish Hospital Discharge Register. CPAP use (downloaded reports from the devices) of at least 4 hrs/night was defined as efficient treatment.

Results
Among 4239 patients with diagnostic sleep recordings, 3185 were free of a known cardiac disease at baseline. Severe OSA was observed among 953 (29.9%). Severe OSA significantly predicted incident heart failure (hazard ratio [HR] 2.42; 95% confidence interval [CI] 1.44–4.06) compared to adults with AHI &lt;30 events/hr, adjusted for age, gender, obesity, hypertension and diabetes mellitus. The adjusted HR for severe OSA was 2.82 (95% CI 1.33–5.99) among inefficiently treated/untreated patients whereas the risk was lower but still meaningful among the individuals who were adherent to CPAP (HR 2.25; 95% CI 0.99–5.15)

Conclusion
Our results suggest that severe OSA is associated with increased risk for development of heart failure. More than 4 hours of CPAP use per night may be necessary for OSA patients in the primary prevention models.
CHF-free survival

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): ALF
Axial muscle size quantification by cardiac mri as a strong predictor of major cv events in hf
Authors: Lopes Da Cunha G.J , Rocha B.M.L , Freitas P.N , Lopes P.M.D , Guerreiro S , Andrade M.J , Aguiar C.M.T , Abecasis J , Saraiva C , Mendes M , Ferreira A 
Published: November 2020

Abstract

Background
Clinical overt cardiac cachexia is a late and ominous sign in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). Low muscle mass could serve as a surrogate of subclinical cardiac cachexia and has already been shown to predict major adverse events in HF patients. The main goal of this study was to assess the feasibility and prognostic significance of a simplified muscle mass quantification by cardiac magnetic resonance (CMR) in HF with reduced LVEF.

Methods
HF patients with LVEF &lt;40% referred for a clinically indicated CMR (1.5T scanner) were retrospectively identified in a single center. The main exclusion criteria were known primary muscle disease, diagnosed or suspected infiltrative myocardial disease and implanted device. The area of both pectoralis major muscles was measured on standard axial images at the level of the carina using manual outlining. To account for the effect of age and gender, pectoralis major muscle area was expressed as the difference in standard deviations in relation to the mean pectoralis major muscle area of a healthy cohort of 32 females and 37 males aged between 50 and 80 years old. The primary endpoint was a composite of all-cause mortality or HF hospitalization. Survival analysis was performed with Cox-regression hazards model and Kaplan-Meier.

Results
A total of 184 HF patients were included (mean age 65±12 years; 78% male; LVEF 30±8%). Lower pectoralis major area was significantly correlated with older age (r=−0.36, p&lt;0.001), lower LVEF (r=0.14, p=0.050) and higher NT-proBNP (r=−0.44, p&lt;0.001). During a median follow-up of 22 months (IQR: 14–29) there were 44 (23.9%) patients who met the primary endpoint (a total of 15 patients died and 29 had at least one HF hospitalization). In multivariate analysis, LVEF (HR per 1%: 0.95; CI: 0.91–0.98; p=0.004), creatinine (HR per 1mg/dL: 2.12; CI: 1.09–4.11; p=0.026) and pectoralis major area (HR per 1 SD below the mean: 1.40; CI: 1.01–1-1.95; p=0.047) were independent primary endpoint predictors.

Conclusions
Pectoralis major size measured by CMR in HFrEF was independently associated with a higher risk of death or HF hospitalization. Further studies need to be undertaken to establish appropriate age and gender-adjusted cut-offs of muscle areas that identify high-risk subgroups.
Figure 1

Funding Acknowledgement
Type of funding source: None
Do Rockwood frailty score and Charlson comorbidity index help to risk stratify outpatient versus inpatient management of acute decompensated heart failure?
Authors: Neoh K.A.I , Sevdynidis L , Hatherley J , Tay J , Douglas H , Akpan A , Sankaranarayanan R 
Published: November 2020

Abstract

Introduction
Acute decompensated heart failure (ADHF) is associated with frailty and co-morbidities which influence prognosis. The Rockwood Frailty Score (RFS) and age-adjusted Charlson co-morbidity index (CCI) have been used to predict outcomes in hospitalised ADHF patients.

Purpose
To describe the relationship of CCI, RFS and clinical risk score -Get With The Guidelines Score (GWTG) with mortality in ADHF treated as outpatients (OP) versus hospitalised inpatients (IP).

Methods
This retrospective analysis compared 2 cohorts of consecutive ADHF patients - hospitalised in-patients (IP) versus outpatients (OP) who were treated with bolus intravenous diuretics in a specialist heart failure nurse delivered OP HF unit (Ambulatory HF Unit -AHFU) with input from various specialties (renal, palliative, ascitic, pleural teams) from Nov 16 to Dec 17. Mean follow-up duration was similar for both groups (IP=19.5±4.1 months; OP=19.3±3.9 months, p=0.6). Mortality was compared at 1, 3 and 12 months based on RFS (no frailty &lt;5, mild to moderate frailty 5/6, severe frailty - 7 to 9). Results were expressed as mean±SD and analysed using One-Way ANOVA and Chi-squared with Fisher's exact test test.

Results
410 consecutive patients (482 admissions) were hospitalised (inpatients -IP) and 231 OP (289 OP visits) were treated in the AHFU. IP group had significantly higher mean CCI (IP=6.55±2; OP=6.10±1.9; p=0.006) and mean RFS (IP 5.2±1.2; OP 4.9±1.1; p=0.002). Mean Clinical Risk Score GWTG was similar (IP=38.9±7.2; OP=38.4±6.6; p=0.44). Mean survival was significantly lower in IP (IP=378±270 days; OP=437±228; P=0.003). As shown in the table higher RFS predicts increased mortality risk (1 month, 3 month and 12 month).

Conclusions
Rockwood Frailty Score predicts mortality in ADHF and assessment of RFS can play an important role in risk stratifying and decision-making in addition to clinical risk-scores, with regards to suitability for outpatient treatment of ADHF.

Funding Acknowledgement
Type of funding source: None
The association between acute-to-chronic glycemic ratio and outcome in acute heart failure
Authors: Teraguchi I , Imanishi T , Komukai K , Tamaki T , Imamura S , Kataiwa H 
Published: November 2020

Abstract

Introduction
Elevated blood glucose level on admission worsen outcome in acute heart failure (AHF). The admission blood glucose (ABG)/ the estimated average glucose (eAG) ratio which combines both acute and chronic glucose levels is attracting attention as a newly introduced glycemic index. It may be accepted as indicating the true acute glycemic rise in critically in all patients.

Purpose
The aim of this study was to assess the association between acute-to-chronic glycemic ratio and outcome in AHF.

Methods
This study assessed consecutive patients with AHF. The ABG/ eAG ratio was determined as ABG divided by eAG. We examined the relationship between ABG/ eAG ratio and all-cause mortality and readmission for heart failure within 30 days.

Results
A total of 249 patients with AHF (mean age; 81 years, 50% male and 37% DM) were studied. 31 (12.4%) patients had events within 30 days [18 (7.2%) died and 13 (5.2%) readmitted for HF]. We divided into three tertiles [T1 (&lt;0.93), T2 (0.93–1.21) and T3 (&gt;1.21)] based on the ABG/ eAG ratio. There was a stepwise worsening of the 30 days outcome [1 patient (0.4%) vs 7 patients (2.8%) vs 23 patients (9.2%), p&lt;0.0001]. In multiple variable analysis, ABG/ eAG ratio was an independent predictor of the events (p=0.002). A cut-off value of the ABG/ eAG ratio &lt;1.11 had a sensitivity of 94% and specificity of 67% for the increase of events within 30 days. In full model, the ABG/ eAG ratio was independent predictor of 30 days outcome in AHF (odds ratio: 11.7; 95% confidence interval: 3.65–37.5; p&lt;0.0001).

Conclusion
ABG/ eAG ratio was one of the strong predictors 30 days outcome in AHF. Elevated blood glucose in the acute phase evaluated using the ABG/ eAG ratiocan enhance affect outcome and it could be a potential therapeutic target in patients of AHF.

Funding Acknowledgement
Type of funding source: None