Abstract 19477: Transthoracic Bioimpedance Monitoring Predicts Readmission After Hospitalization for Heart Failure: Preliminary Results From the SENTINEL-HF Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chad E Darling ◽  
Silviu Dovancescu ◽  
Jarno Riistama ◽  
Jane Saczynski ◽  
Nisha Kini ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Detection Algorithm ◽  
Fluid Accumulation ◽  
Predictive Values ◽  
Preliminary Results ◽  
Patients At Risk

Introduction: Patients and health systems are focused on reducing readmissions for patients with acute decompensated heart failure (ADHF). Readmission after hospitalization is often secondary to HF decompensation, but it remains challenging to identify patients at-risk. Bioimpedance is a validated marker of thoracic fluid accumulation. We examined whether changes in bioimpedance, measured using a Fluid Accumulation Vest (FAV), predicted subsequent HF decompensation in patients discharged after ADHF. Methods: Participants included 83 patients hospitalized for ADHF. Subjects were trained on the use of a FAV-smartphone dyad to obtain and transmit a 5-minute bioimpedance measurement once daily for 45-days after discharge.(see Figure) The outcome of interest, HF-related readmission was assessed using participant report and medical records. Sensitivity, specificity, negative and positive predictive values were calculated to describe the efficacy of the bioimpedance alert algorithm as a predictor of HF readmission. Results: Subject characteristics: mean age 68 ± 11 years, 36% female, 92% white, mean ejection fraction of 44 ± 19%. 49 participants completed the 45-day follow-up and had sufficient, daily FAV data for analysis. Our main outcome of HF-related rehospitalization occurred in 8% of patients during follow-up. The decompensation detection algorithm demonstrated a sensitivity of 75%, specificity of 47%, positive/negative predictive values of 11% and 96%, respectively. Conclusions: The preliminary results of this ongoing study suggest that HF readmissions may be predicted with modest sensitivity by our current decompensation detection algorithm. Further refinement of our transthoracic bioimpedance system may offer possibilities for reducing HF readmissions by enabling identification and treatment of outpatients at risk for readmission.

Abstract 319: Transthoracic Bioimpedance Monitoring Predicts Heart Failure Decompensation and Early Readmission after Heart Failure Hospitalization: Preliminary Data from SENTINEL-HF

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
David D McManus ◽  
Jarno Riistema ◽  
Jane S Saczynski ◽  
Fatima Sert Kuniyoshi ◽  
Joseph Rock ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Roc Curves ◽  
Decompensated Heart Failure ◽  
Clinical Event ◽  
Fluid Accumulation ◽  
Patients At Risk ◽  
Early Readmission ◽  
Heart Failure Decompensation ◽  
Study Participants

Background: Patients, providers, and health systems are focused on reducing readmissions for patients with acute decompensated heart failure (ADHF). Readmission after hospitalization is common and often secondary to HF decompensation, but it remains challenging to identify patients at-risk. Bioimpedance is a validated marker of thoracic fluid accumulation. We examined whether transthoracic bioimpedance, measured using a Fluid Accumulation Vest (FAV), predicted HF decompensation in advance of a clinical event in patients discharged after ADHF. Methods: Participants included 42 patients hospitalized for ADHF. Participants were trained on the use of a FAV-smartphone dyad to obtain and transmit a 5-minute bioimpedance measurement once daily for 45-days after discharge. Readmission and diuretic dosing adjustments were identified using participant report and causes adjudicated using medical records. Daily bioimpedance was analyzed using the HF detection strategy shown in Figure. Receiver operating characteristic (ROC) curves and C-statistics were calculated to describe the characteristics of a bioimpedance based algorithm as a predictor of HF decompensation 3 or 7-days in advance of the clinical event. Results: Participants (mean age 69 ± 12 years, 43% female, 88% white, 11% cognitively impaired, 12% depressed) had a mean ejection fraction of 50 ± 18%. HF-related rehospitalization occurred in 10% (n=4) and 10% (n=4) reported diuretic up-titration during the 45-day follow-up. An algorithm analyzing bioimpedance up to 3 or 7 days prior to an event was related to HF readmission (C statistics for 3 and 7 days = 0.83, 0.94, respectively) and the combined outcome of HF hospitalization or diuretic up-titration (C statistics for 3 and 7 days = 0.76, 0.80, respectively). Conclusions: Early readmission after hospitalization for ADHF was common and predicted up to 7 days in advance by an algorithm analyzing transthoracic bioimpedance. Despite their advanced age and high burden of comorbid diseases, study participants with ADHF were able to make daily bioimpedance measurements using a FAV and transmit them using a smartphone. Transthoracic bioimpedance monitoring may offer possibilities for reducing HF readmissions by enabling identification and treatment of outpatients with early HF decompensation.

P773Initiation of sacubitril/valsartan and optimisation of evidence-based heart failure therapies after hospitalisation for acute decompensated heart failure: An analysis of the TRANSITION study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Wachter ◽  
D Pascual-Figal ◽  
J Belohlavek ◽  
E Straburzynska-Migaj ◽  
K K Witte ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Target Dose ◽  
Open Label ◽  
Post Discharge ◽  
Reduced Ejection Fraction ◽  
Disease Modifying ◽  
Transition Study

Abstract Background Optimisation of chronic heart failure (HF) therapy remains the key strategy to improve outcomes after hospitalisation for acute decompensated HF (ADHF) with reduced ejection fraction (HFrEF). Initiation and uptitration of disease-modifying therapies is challenging in this vulnerable patient population. We aimed to describe the patterns of treatment optimisation including sacubitril/valsartan (S/V) in the TRANSITION study. Methods TRANSITION (NCT02661217) was a randomised, open-label study comparing S/V initiation pre- vs. post-discharge (1–14 days) in patients admitted for ADHF after haemodynamic stabilisation. The primary endpoint was the proportion of patients achieving 97/103 mg S/V twice daily (bid) at 10 weeks post-randomisation. Up-titration of S/V was as per label. Information on dose of S/V and on the use of concomitant HF medication was collected at each study visit up to week 26. Results A total of 493 patients received at least one dose of S/V in the pre-discharge arm and 489 patients in the post-discharge arm. One month after randomisation, 45% of patients in the pre-d/c arm vs. 44% in the post-discharge arm used 24/26 mg bid starting dose and 42% vs. 40% were on 49/51 mg S/V bid, respectively. At week 10, 47% of patients had achieved the target dose in the pre-discharge arm vs. 51% in the post-discharge arm. At the end of the follow-up at 26 weeks, the proportion of patients on S/V target dose further increased to 53% in the pre-discharge and 61% in the post-discharge arm (Figure 1). At week 10, the mean dose of S/V was 132 mg in the pre-discharge arm and 136 mg in the post-discharge arm, and at week 26, it was 140 mg and 147 mg, respectively. Before hospital admission, 52% and 54% of the patients received a beta-blocker (BB) in the pre-discharge and post-discharge group, respectively, and 42% in both arms received a mineralcorticoid receptor antagonist (MRA). At time of discharge, 68% and 71%% of the patients received a BB and 68% and 65% an MRA, in the pre-discharge and post-discharge groups, respectively. These proportions remained stable to week 10 and week 26. Uptitration of sacubitril/valsartan Conclusions In the vulnerable post-ADHF population, initiation of S/V and up-titration to target dose was feasible within 10 weeks in half of the patients alongside with a 20% increase in the use of other disease-modifying medications that remained stable through the end of the 6-month follow-up. Acknowledgement/Funding The TRANSITION study was funded by Novartis

P4553Clinical and prognostic value of right ventricular dysfunction in patients with chagas heart disease during acute decompensated heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S R R Siqueira ◽  
S M Ayub-Ferreira ◽  
P R Chizzola ◽  
V M C Salemi ◽  
S H G Lage ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Prognostic Value ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Jugular Venous Distension

Abstract Introduction The occurrence of right ventricular disfunction (RVD) is common in heart failure (HF) patients due to Chagas' disease (ChD). However, its clinical and prognostic value has not been studied during episodes of acute decompensated heart failure (ADHF). Purpose Evaluate the prognostic value of RVD in ADHF patients with ChD during hospitalization and after 180 days of discharge compared to other etiologies. Methods We analysed a prospective cohort of consecutive 768 patients admitted for ADHF between March 2013 and October 2018; 490 (63.7%) patients were male and the median age was 58 (48.3–66.8) years and left ventricular ejection fraction was 26% (median) (IQR 22–35%). We compared the clinical characteristics and the prognosis of ChD patients according to the presence of RVD in the echocardiogram to other etiologies. Results RVD was presented in 289 (37.6%) patients. Among patients with non-chagasic etiologies, those with RVD were younger [53 (41–62) vs 61 (52–70) years, p<0.0001], had high levels of BNP in the moment of hospitalization [1195 (606–2209) vs 886 (366– 555) pg/mL], p<0,0001], received more inotropes (79.2% vs 57.9%, p<0,0001), had longer hospitalization [35 (17–51) vs 21 (10–37) days, p<0.001] and more clinical signs of congestion as hepatomegaly (49% vs 28.6%, p<0.0001); jugular venous distension (68.3% vs 41.2%, p<0.0001) and leg edema (65.4% vs 49.2%, p=0.001). Among patients with ChD, those with RVD were older [61 (48- 66) vs 58 (48 - 67) years, p=0.017], and had more frequently signs of hypoperfusion (56.8% vs 36.5%, p=0.029), jugular venous distension (72.8% vs 52.8%, p=0.01) and hepatomegaly (56.8% vs 31.1%, p=0.011), higher BNP levels [1288 (567–2180) vs 1066 (472–2007) pg/mL, p=0.006] and more frequent use of intravenous inotropes (88.9% vs 67.1%, p=0.003); additionally ChD patients with RVD had a higher rate of death and transplant during hospitalization (51.2% vs 38.3%, p=0.001). When all groups were compared together, ChD patients with RVD had the highest rate of death, transplant and readmissions at 180-days of follow-up (Figure). Figure 1 Conclusion Patients with RVD demonstrated a distinct clinical presentation, biomarkers and worse prognosis in all etiologies. ChD patients with RVD in ADHF had the worst prognosis with the highest rate of death, heart transplant e rehospitalization in follow-up.

scholarly journals Biomarkers In Acute Heart Failure — Cardiac And Kidney

2015 ◽  
Vol 1 (2) ◽  
pp. 107 ◽  
Author(s):  
A Mark Richards ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Test Performance ◽  
Acute Decompensated Heart Failure ◽  
Unmet Need ◽  
Kidney Injury ◽  
High Sensitivity ◽  
Decompensated Heart Failure ◽  
Predictive Values

Natriuretic peptides (NP) are well-validated aids in the diagnosis of acute decompensated heart failure (ADHF). In acute presentations, both brain natriuretic peptide (BNP) and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) offer high sensitivity (>90 %) and negative predictive values (>95 %) for ruling out ADHF at thresholds of 100 and 300 pg/ml, respectively. Plasma NP rise with age. For added rule-in performance age-adjusted thresholds (450 pg/ml for under 50 years, 900 pg/ml for 50—75 years and 1,800 pg/ml for those >75 years) can be applied to NT-proBNP results. Test performance (specificity and accuracy but not sensitivity) is clearly reduced by renal dysfunction and atrial fibrillation. Obesity offsets the threshold downwards (to ~50 pg/ml for BNP), but overall discrimination is preserved. Reliable markers for impending acute kidney injury in ADHF constitute an unmet need, with candidates, such as kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin, failing to perform sufficiently well, and new possibilities, including the cell cycle markers insulin growth factor binding protein 7 and tissue inhibitor of metalloproteinases type 2, remain the subject of research.

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.

scholarly journals Study of association and prognostic correlation of cardiac troponin I estimation in acute decompensated heart failure patients

2020 ◽  
Vol 8 (1) ◽  
pp. 26
Author(s):  
Sunil Kumar Tripathi ◽  
Vikas A. Mishra ◽  
Amit B. Kinare ◽  
Vishwa Deepak Tripathi ◽  
Ravi Shankar Sharma
Keyword(s):  
Heart Failure ◽  
Troponin I ◽  
Acute Decompensated Heart Failure ◽  
Public Health Problem ◽  
Decompensated Heart Failure ◽  
Major Public Health Problem ◽  
Positive Group ◽  
Medical College ◽  
Follow Up Study

Background: Heart failure is a major public health problem since last few decades affecting significant number of people worldwide. Acute decompensated heart failure is a major cause of hospitalization in elderly people with a high mortality rate. Heterogeneity and non-specificity of symptoms makes diagnosis of heart failure by clinical presentation alone more challenging. Aim of current study was to investigate troponin biomarkers in diagnosis, prognosis and management of acute decompensated heart failure.  Methods: Present study was a prospective observational study conducted on 100 patients at Department of Cardiology, Superspeciality hospital, NSCB medical college Jabalpur and Department of cardiology Superspeciality hospital, SS medical college Rewa from October 2019 to August 2020. Patients were investigated for clinical, echocardiographic parameters and NYHA classification. Cardiac functions were analyzed by color doppler echocardiography. Results: According to study findings, 65.2% of TnI positive patients were males whereas 34.8% were females. Mean age of TnI positive group was observed to be higher. Majority of troponin positive patients were in NYHA class IV. Recurrent hospitalization was observed more in TnI positive group. Logistic regression analysis depicted systolic blood pressure reduced significantly (p<0.001) on follow up study in TnI positive patients, FBS was significantly more in TnI positive patients (131.4+42.9 mg/dl) (p=0.049). LVID was significantly more in TnI positive patients (p=0.022). Reduction in EF was statistically significant (p=0.03) at the three months follow up study.  Conclusions: A positive prognostic correlation was established between ADHF and troponin positivity, large prospective randomized trials are necessary to recommend quantitative troponin I determination in all patients of acute decompensated heart failure for prognosis and guiding therapy.

Loeys-Dietz Cardiomyopathy? Long-Term Follow-Up After Onset of Acute Decompensated Heart Failure

2021 ◽  
Author(s):  
Takashi Yokota ◽  
Hiroaki Koiwa ◽  
Shouji Matsushima ◽  
Shingo Tsujinaga ◽  
Masanao Naya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Long Term Follow Up

Abstract 11877: Novel Method to Quantify the Degree of Fluid Accumulation and Its Prognostic Implication in Patients With Acute Decompensated Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Taiki Sakaguchi ◽  
Kaori Yasumura ◽  
Hiroki Nishida ◽  
Hiroyuki Inoue ◽  
Tetsuo Furukawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Death ◽  
Acute Decompensated Heart Failure ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Decompensated Heart Failure ◽  
Regression Equations ◽  
Fluid Accumulation ◽  
Clinical Method ◽  
Control Subjects

Introduction: Fluid accumulation is an important therapeutic target in acute decompensated heart failure (ADHF). Our objective was to develop a non-invasive and repeatable clinical method to quantify the degree of fluid accumulation in ADHF patients, and investigate its prognostic implications. Methods: We measured extracellular water (ECW) volume using bioelectrical impedance analysis (BIA) in 60 control subjects without heart failure (aged 75±7 years). The reliability of the measured values was assessed through comparisons with ECW estimates from Moore’s regression equations based on multiple isotope dilution. We then developed original regression equations to predict ECW values from multivariate analyses that incorporate patient height, body weight, age and sex. ECW values on admission and at discharge in 120 ADHF patients (aged 73±11 years) were measured, and the ratios of measured to predicted ECW values (M/P ratios) were calculated. The primary endpoint was the occurrence of cardiac death or readmission for ADHF. Results: In the control subjects, BIA-measured ECW values correlated with those estimated by Moore’s equations (r 2 =0.72, p<0.001), and showed even stronger correlations with estimates from our equations (r 2 =0.86, p<0.001). In ADHF patients, measured ECW was significantly reduced during hospitalization (15.4±6.2L to 12.1±4.7L, p<0.001), and M/P ratios were approximately 100% at discharge (126±26% to 104±19%, p<0.001). Patients whose M/P ratios remained higher than 100% at discharge showed higher 3-month cardiac death or readmission rates than patients with lower M/P ratios (50% vs 17%, hazard ratio 3.69; 95% confidence interval 1.935-7.048, p<0.001). Conclusions: We successfully quantified the degree of fluid accumulation using BIA, and the predicted ECW estimates from our regression equations can be a treatment goal in ADHF patients. This BIA-guided therapy may provide better clinical outcomes in the management of ADHF.

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