bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of late right heart failure after mechanical circulatory support
Authors: Felix S , Oerlemans M.I.F , Asselbergs F.W , Van Laake L.W , De Jonge N 
Published: November 2020

Abstract

Introduction
Right heart failure (RHF) is associated with a worse outcome in mechanical circulatory support (MCS). Several studies have identified risk factors for RHF shortly after MCS, though information about late RHF is limited.

Purpose
We aimed to identify risk factors for late RHF in patients with MCS, implanted as a bridge to heart transplantation.

Methods
Data of all patients, who were successfully discharged after MCS implantation in a University Medical Center between 2006–2019 were included and follow-up was completed until March 2019. Late RHF was defined as the occurrence of right ventricular dysfunction associated with symptoms, including jugular venous distension, hepatic congestion and peripheral edema during MCS support, if diagnosed after the index admission for MCS implantation. The primary end point was the diagnosis of late RHF in combination with the need for intensification of diuretics (either with or without hospitalization) and/or the need for inotropes and/or right ventricular assist device. Univariable and multivariable Cox regression analyses were performed to identify risk factors for late RHF.

Results
262 patients (66% male, mean age 51±13 years) had a mean follow-up of 901±643 days. 49 (18.7%) patients suffered from late RHF after a median of 363 (IQR 131–1001) days. Multivariable risk factors for late RHF were a higher body mass index (hazard ratio (HR) 1.05; CI 1.00–1.11), a history of atrial fibrillation (AF) prior to the operation (HR 2.11; CI 1.12–3.96), a lower (i.e. clinically worse) INTERMACS profile and a longer duration on the intensive care unit (HR 1.03; CI 1.00–1.06) during the index admission for MCS implantation (Table 1). The occurrence of early RHF was not associated with late RHF (p=0.211).

Conclusion
Late RHF is a clinically important adverse event in MCS, affecting approximately 20% of patients. Risk factors associated with late RHF most relate to the severity of the clinical situation at the time of implantation.

Funding Acknowledgement
Type of funding source: None
Device thrombosis in the Heartware LVAD treatment decision and role of log files
Authors: Demir E , Nalbantgil S.N , Ozturk P.O , Candemir A.C , Kahraman U.K , Engin C.E , Yagdi T.Y , Saeed O.S , Jorde U.J , Ozbaran M.O 
Published: November 2020

Abstract

Background
Device thrombosis is a significant problem during durable LVAD support, and device-specific diagnosis and treatment algorithms are necessary to optimize outcomes. The HVAD LVAD has a unique and well-developed logfile capability, yet clinical data on it's use are lacking.

Methods and results
We reviewed overall outcomes of 322 consecutive patients implanted at our University Medical Center with the HVAD LVAS with a particular emphasis on device thrombosis events. Thirty days, one year, and two years survival was 85.4%,65.0%, and 53.1%, respectively. One hundred eighty-one device thrombosis events occurred in 76 patients. Based on logfile patterns, events were categorized as gradual build-up or sudden build-up or acute occlusion/ingestion (Jorde U JACC-HF 2015). The first thrombosis event was a gradual build-up in 32, sudden build up in 5, and acute occlusion in 11 pts. An additional 46 gradual build-up, two sudden build-up, nine acute occlusion events occurred as recurrent events. 2-year survival without CVA was 72.8% in patients with gradual onset device thrombosis
72 pts received TPA. TPA was given, after discontinuing anticoagulation, and taking the INR level is under 2.0 and keeping invasively measured mean arterial blood pressure between 65–80 mmHg low dose tenecteplase (1000 units) was then given, and if clinical and logfile improvement did not occur repeated every six hours up to a total fo 4 doses (4000 units) over 24 hours. Successful therapy was defined as clinical resolution of pump thrombosis without recurrence in 30 days, LDH improvement and power consumption returned to normal, and occurred in 74.4% gradual onset, 71.4% sudden onset, and 56.3% acute occlusion. TPA was complicated by severe hemorrhage or death in 6.4% of patienst with a gradual build-up pattern, 14.3% with sudden build-up, and in 33.3% with acute occlusion.

Conclusion
Device thrombosis frequently occurs in HVAD patients, and response to therapy can be predicted by logfile analysis. TPA is an excellent option for gradual onset device thrombosis but should be avoided in the setting of acute occlusions, where early device exchange may be a better first-line strategy. Refinement of logfile analysis including earlier thrombus detection and incorporation of these techniques into clinical practice may significantly improve outcomes with the HVAD LVAD.

Funding Acknowledgement
Type of funding source: None
A nationwide analysis of 16 year trends in cardiac transplantation for acute myocarditis
Authors: Isath A , Perembeti S , Correa A , Haider S , Ho K , Rao S , Chahal A , Narasimhan B , Padmanabhan D , Garg V , Contreras J 
Published: November 2020

Abstract

Background
Orthotopic heart transplant (OHT) is indicated in 1–8% of patients with myocarditis. However, national trends in the utilization of transplantation and outcomes in myocarditis across the United States are not well established.

Purpose
Our objective was to study the trends and baseline characteristic of myocarditis patients undergoing heart transplant in the United States using Healthcare Cost and Utilization Project (HCUP) National (nationwide) Inpatient Sample (NIS) from 1999 to 2014.

Methods
Using NIS data, we identified patients older than 18 years with myocarditis using codes ICD9 codes of 422.0 and 422.9. Among these patients, we identified those who underwent cardiac transplantation using ICD9 procedure codes 37.5 and 33.6. We presented categorical data as percentages and continuous data as mean or median as appropriate.

Results
We identified a total of 62,264 hospitalizations for myocarditis from 1999–2014. 430 (0.69%) myocarditis patients underwent OHT which consisted of 0.82% of all 29990 cardiac transplants identified in the same period. The trends in OHT for myocarditis is as shown in Figure 1.
The mean age was 32.9±2.4 years and 51.1% (n=219) were females. 235 (54.6%) were Caucasians and 60 (13.9%) were Hispanic. Majority of the transplants were performed at medium (16%) and large sized hospitals (80.4%). Cardiac transplants were mainly done at teaching hospitals (98.9%). Further, with regards to the geographical distribution of transplant procedure, most were done in the West (37.2%) followed by South (25.3%), Northeast (21.4%) and Mid-west (16%) of the United States. Private insurance was the major payor source which covered 245 (58%) patients followed by Medicaid covering 112 (26%) patients.
A total of 26 (6%) myocarditis patients died during the same hospitalization for OHT. In terms of discharge following OHT in myocarditis 85.8% (n=369) were discharged home and 8.1% (n=35) to short term hospitalization. The average length of stay for OHT for myocarditis was 64.3±6.3 days. Also, the mean cost of hospitalization for heart transplant in myocarditis when adjusted for inflation was 789,566±93,108 dollars.
In-patient mortality following OHT was not significantly different in large sized hospital compared to small and medium sized hospitals (7.6% vs 5.7%, p=0.54). However, the cost of hospitalization was significantly lesser in small and medium sized hospitals (588,363±154,349 vs 826,864±106,110 dollars, p&lt;0.0001).

Conclusions
Only a small percentage of OHT is done for myocarditis with high proportion done in female when compared to OHT for other etiologies. Further studies need to be done to compare long term outcomes of heart transplant in myocarditis.

Funding Acknowledgement
Type of funding source: None
Quality of life response to BAROSTIM Therapy
Authors: Zannad F , Abraham W.T , Lindenfeld J , Weaver F , Galle E , Rogers T , Zile M 
Published: November 2020

Abstract

Background
Patients with heart failure with reduced ejection fraction (HFrEF) have poor quality of life as measured by both physical and emotional dimensions.

Purpose
Evaluate the quality of life in subjects with and without baroreflex activation therapy (BAT) at six months.

Methods
In a multicenter randomized trial conducted in subjects with NYHA class II (recently III) or III HFrEF, left ventricular ejection fraction ≤35%, stable optimal guideline directed medical HF therapy (GDMT), no Class 1 indication for cardiac resynchronization therapy (CRT), and NT-proBNP&lt;1600 pg/ml, a total of 264 subjects were randomized to BAROSTIM therapy plus GDMT (BAT group) or GDMT alone (Control group). Quality of life was measured at baseline and six months using the Minnesota Living with HF Questionnaire (MLWHF) and the EuroQol 5-Dimension Long (EQ-5D) tool. From the MLWHF questionnaire, both a physical and an emotional dimension was analyzed using subsets of the 21 questions. From the EQ-5D, the five individual dimensions and the overall health status (0–100, where 100 is best) was analyzed.

Results
Of the 264 randomized subjects, 120 BAT and 125 Control subjects had 6-month quality of life data. As shown in the table, treatment with BAT resulted in significant improvements in quality of life overall, as well as in the specific dimensions of the quality of life questionnaires, compared to the Control subjects.

Conclusion
Among subjects with symptomatic HFrEF, treatment with BAT resulted in significant improvement in quality of life at six months.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): CVRx, Inc.
How mortality risk estimated by MAGGIC-HF, SHFM and BCN-Bio HF scores is modified after 12-month management in a multidisciplinary HF Clinic
Authors: Codina P , De Antonio M , Santiago-Vacas E , Domingo M , Zamora E , Santesmases J , Subirana I , Buchaca D , Alonso N , Troya M.I , Velayos P , Pulido A , Nunez J , Lupon J , Bayes-Genis A 
Published: November 2020

Abstract

Background
Heart failure (HF) contemporary management has significantly improved over the past two decades leading to better survival. How application of the contemporary HF management guidelines affects the risk of death estimated by available web-based risk scores is not elucidated.

Objective
To assess changes in mortality risk prediction after a after a 12-month management period in a multidisciplinary HF Clinic.

Methods
Out of 1,689 consecutive patients with HF admitted at our ambulatory HF Clinic from May 2006 to November 2018, those who completed one year follow-up were considered for the study. Patients without NTproBNP measurement or with more than 3 missing variables for risk estimation were excluded. Three contemporary web-based HF risk scores were evaluated: MAGGIC-HF, Seattle HF Model (SHFM) and the Barcelona Bio-HF Calculator containing NTproBNP (BCN Bio-HF). Risk of all-cause death at one year and at 3 years were calculated at baseline and re-evaluated after 12-month management in a multidsisciplinary HF Clinic. Wilcoxon paired data test was used to compare changes in mortality risk estimation over time and test equality of matched pairs for comparing estimated change among tools. 442 patients used to derive the Barcelona Bio-HF Calculator were excluded for discrimination purposes.

Results
1,157 patients were included (age 65.7±12.7 years, 70.4% men). A significant reduction in mortality risk estimation was observed with the three HF risk scores evaluated at 12-months (Table). The BCN Bio-HF model showed significantly different changes in risk estimation, fact that indeed was partnered with numerically better discrimination. AUC at 1 and 3 years, respectively, were: BCN Bio-HF (0.773 and 0.775), MAGGIC HF (0.686 and 0.748) and SHFM (0.773 and 0.739).

Conclusions
The three web-based risk scores evaluated showed a significant reduction in mortality risk estimation after 12 month management in a multidisciplinary HF Clinic. The BCN Bio-HF score showed higher reduction in estimated risk, together with better discrimination, likely because it incorporates contemporary treatment and use of biomarkers.

Funding Acknowledgement
Type of funding source: None
Effects of a multidisciplinary heart failure program in short term readmissions of heart failure patients, preliminary results
Authors: Gorriz Magana J , Espinosa Pascual M.J , Abad Romero R , Olsen Rodriguez R , Nieto Ibanez D , Perela Alvarez C , Fraile Sanz A , Saavedra Falero J , Perea Egido J 
Published: November 2020

Abstract

Background
Unexpected readmissions are frequent among heart failure patients, due to their natural history that implies multiple readmissions, with high costs and clinical relevance.

Purpose
We aimed to assess the impact of a Multidisciplinary Heart Failure Program (MHFP) on the readmission-free period after an episode of acute decompensated heart failure (ADHF).

Methods
We carried out an analytical and observational study including all patients admitted to our Universitary Hospital, which covers 220,000 individuals, with an episode of heart failure when there was not a Multidisciplinary Heart Failure Program (January 2013 to December 2013). Once the MHFP was established, we compared non-MHFP patients with every patient admitted during February 2019 and February 2020 in terms of clinical data, imaging technique findings and short-term readmissions.

Results
The rate of readmission during this period was a 24.8% in non-MHFP and 17.2% in MHFP (p=0.15). However, we could find differences in median time to readmission due to ADHF, that was 1.74 months (CI 95%, 0.12–3.35) in non-MHFP, compared to 5.125 months (CI 95%, 4.15–6.09) in MHFP (p=0.002) (see Graph 1). There were also no significant differences in terms of basic characteristics between the MHFP and the non-MHFP patients (age, gender, left ventricular ejection fraction, left bundle branch block, hypertension). It is remarkable that establishing a MHFP has lengthened the readmission-free period. The rate of decompensation in the first and sixth month was respectively in the non–MHFP 9% and 21%; and in the MHFP 2% and 10%.

Conclusion
According to our results, the implantation of this Multidisciplinary Heart Failure Program has shown a reduction in the time to ADHF readmission compared with a cohort of similar pts some years before, which is clinically relevant.
Graph 1

Funding Acknowledgement
Type of funding source: None
Heart failure with improved ejection fraction in advanced heart failure clinic
Authors: Kittipibul V.K , Sinphurmsukskul S.S , Chattranukulchai P.C , Krailak L.K , Boonbumrung N.B , Nakviroj P.N , Ariyachaipanich A.A , Siwamogsatham S.S , Boonyaratavej S.B , Puwanant S 
Published: November 2020

Abstract

Objectives
The aims of the study were: (1) to determine the pattern of myocardial fibrosis assessed by delayed gadolinium enhancement cardiac MRI (DGE-CMRI) in patients with heart failure improved ejection fraction (HF-iEF) in an advanced heat failure clinic; and (2) to examine the dosage of beta-blocker and angiotensin converting enzyme inhibitor/ angiotensin receptor blockage/angiotensin neprilysin inhibitor (ACE-I/ARB/ARNI) in those patients.

Methods
HF-iEF was defined as patients with LVEF &gt;40% with previously documented LVEF &lt;35% at baseline.

Results
Among 312 consecutive patients with HF-rEF who were referred for an advanced HF clinic, 18% (56 patients) had HF-iEF within 12 months after referral. Of these, 84% (47 patients) had non-ischemic cardiomyopathy (CM); complete data on MRI for analysis were available for 25 of these patients (62%). Myocardial scar was found in 52% of patients with nonischemic CM (13 of 25). All patients with nonischemic CM had the myocardial scar of less than 10% of the total LV volume. Mid-wall DGE of the interventricular septum was the most common scar pattern. Among patients with HF-iEF, 36% (20 patients) were referred for heart transplant. Two patients with peripartum related and nonischemic etiologies were listed for heart transplant, and delisted 12 months after. No patient died during 1-year follow up. At 12 months, the mean LVEF change was +27±12%. Improvement of the LVEF to ≥50% occurred in 31 patients (55%). The percentage use of ACE-I/ARB/ARNI and beta-blocker was significantly increased, at 1-year-follow-up. Fourteen percent and 48% of patients achieved target dose of ACE-I/ARB/ARNI and beta-blocker, respectively. There was no significant association between myocardial scar pattern or extent and dosage of medical titration.

Conclusions
HF-iEF was present in 18% of patients with HF-rEF after 1-year follow-up in advanced heart failure clinic. Mid-wall DGE of the interventricular septum was the most common scar pattern in nonischemic HF-iEF. None of patients with nonischemic HF-iEF had myocardial scar &gt;10% of the total LV volume. Improvement of LVEF to ≥50% occurred in approximately half of the study patients, and led to delisting patients from heart transplant waiting list. The majority of patients had recovery of the LVEF when the target dose of beta-blocker or ACE-I/ARB/ARNI had not been achieved during medical up-titration.

Funding Acknowledgement
Type of funding source: None
Impella versus intra-aortic balloon pump in cardiogenic shock: a meta-analysis assessing 30-days mortality
Authors: Shariff M , Doshi R , Pedreira Vaz I , Adalja D , Krishnan A , Hegde S , Kumar A 
Published: November 2020

Abstract

Introduction
Cardiogenic shock is linked with eminent morbidity and mortality despite advances in treatment modality. Adjuvant treatment modalities to provide mechanical haemodynamic support in the form of intra-aortic balloon pump (IABP) or Impella are being used among patients with cardiogenic shock. The Impella prunes left ventricular preload, whereas, IABP persuades after load reduction and both contribute to improved cardiac output. A few underpowered randomised control trials (RCTs) and observational studies compared short term mortality benefit of Impella juxtaposed to IABP among patients with cardiogenic shock.

Purpose
A meta-analysis of RCTs and observational studies researching the short-term mortality in cardiogenic shock comparing Impella to IABP was executed.

Methods
The databases PubMed, EMBASE and Cochrane were searched systematically to identify relevant RCTs and observational studies contrasting Impella to IABP and reporting 30-days mortality as outcomes. The search terms used were “Impella”, “IAPB”, “intra-aortic balloon pump” and all word variations were utilised. The search was conducted from the debut of the databases up to January 2020. Two reviewers independently and in tandem performed data screening and extraction from identified articles. Inverse variance method with Paule-Mandel estimator for tau2 and Hartung-Knapp adjustment was used to calculate Risk Ratio with 95% confidence interval. Heterogeneity was assessed using I2 statistics. Furthermore, we calculated the 95% predictive interval for the pooled estimate. All statistical analysis for this meta-analysis was carried out using R statistical software version 3.6.2 using the package meta ( ). Additionally, Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess the certainty of evidence.

Results
Five studies constituting 728 patients were included in the final analysis. Two were RCTs (ISAR-SHOCK trial and IMPRESS in Severe Shock trial), one study was a propensity score matched observational study and two were unmatched observational studies. There was no difference in the risk of 30-days mortality in patients treated with Impella as compared to IABP [Risk Ratio: 0.97, 95% confidence interval: 0.66–1.41, I2: 32%]. To account for the heterogeneity, we calculated 95% predictive interval: 0.46–2.02. Thus, very low certainty of evidence concluded no difference in the risk of 30-days mortality among cardiogenic shock patients treated with Impella in opposition to IABP.

Conclusion
This meta-analysis comparing Impella juxtaposed with IABP demonstrated no difference in the risk of 30-days mortality among patients with cardiogenic shock.
30-days Mortality

Funding Acknowledgement
Type of funding source: None
Impact of influenza and pneumococcal vaccines upon in-hospital mortality in patients with heart failure: a retrospective cohort study in the United States
Authors: Gonuguntla K , Patil S.P , Rojulpote C 
Published: November 2020

Abstract

Introduction
Heart failure has been increasing in prevalence over the past decade. Respiratory infections have been associated with exacerbations of underlying heart failure. Hence, vaccinations against these infections may serve to be an effective intervention to improve overall outcomes.

Purpose
We sought to compare the in-hospital mortality in patients with heart failure who received influenza and pneumococcal vaccine.

Methods
We analysed the United States National Inpatient Sample Database from 2010–2014 to identify patients with primary discharge diagnosis of heart failure. We identified pneumococcal vaccine with ICD 9 code V03.82 and influenza vaccine with ICD-9 code V04. 81. We excluded patients who were transferred out to prevent duplication of data. Chi-Square test was used for statistical analysis.

Results
The sample consisted of 587,018 patients with heart failure from 2010 to 2014 (Mage= 70.53±14.6 years), the majority of whom were male (60.1%) and Caucasian (53.2%). Upon comparing the group that received the influenza vaccine to the group that did not receive the influenza vaccine, rates of in-hospital mortality in patients with heart failure were 1.3% vs 3.6%; p&lt;0.001. Furthermore, comparison of the group that received pneumococcal vaccine to the group that did not receive the pneumococcal vaccine, rates of in-hospital mortality were 1.2% vs 3.6%; p&lt;0.001.

Conclusions
Despite the growing awareness regarding vaccinations in patients with heart failure the rates of vaccination in heart failure patients remain low. Our study findings indicate that patients who received influenza and pneumococcal vaccine had lower in-hospital mortality. The results of our study indicate that these vaccines have a significant impact in improving outcomes in heart failure patients.

Funding Acknowledgement
Type of funding source: None