Association of Beta Blocker Exposure with Outcomes in Heart Failure Differs Between Afric…

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Is Worsening Renal Function an Ominous Prognostic Sign in Patients with Acute Heart Failu…

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Increased 90-day mortality in patients with acute heart failure with elevated copeptin: s…

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Prognostic Importance of Early Worsening Renal Function Following Initiation of Angiotensin Converting Enzyme Inhibitor Therapy in Patients with Cardiac Dysfunction.
Circ Heart Fail. 2011 Sep 8;
Authors: Testani JM, Kimmel SE,…

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Thromboembolism and antithrombotic therapy in patients with heart failure in sinus rhythm: current status and future directions.
Circ Heart Fail. 2011 May 1;4(3):361-8
Authors: Bettari L, Fiuzat M, Becker R, Felker GM, Metra M…

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Characteristics and Outcomes of Very Elderly Patients Following First Hospitalization for Heart Failure.
Circ Heart Fail. 2011 Apr 5;
Authors: Shah RU, Tsai V, Klein L, Heidenreich PA
BACKGROUND: -The very elderly (age…

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Discharge to a Skilled Nursing Facility and Subsequent Clinical Outcomes Among Older Patients Hospitalized for Heart Failure.
Circ Heart Fail. 2011 Mar 29;
Authors: Allen LA, Hernandez AF, Peterson ED, Curtis LH, Dai D, Masoud…

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Factors associated with outcome in heart failure with preserved ejection fraction: findings from the Irbesartan in Heart Failure with Preserved Ejection Fraction Study (I-PRESERVE).

Circ Heart Fail. 2011 Jan 1;4(1):27-35

Authors: Komajda M, Carson PE, Hetzel S, McKelvie R, McMurray J, Ptaszynska A, Zile MR, Demets D, Massie BM

The determinants of prognosis in patients with heart failure and preserved ejection fraction (HF-PEF) are poorly documented.

PMID: 21068341 [PubMed - indexed for MEDLINE]

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Race, Gender, and Age Differences in Heart Failure-Related Hospitalizations in a Southern State: Implications for Prevention.

Circ Heart Fail. 2010 Dec 22;

Authors: Husaini BA, Mensah GA, Sawyer D, Cain VA, Samad Z, Hull PC, Levine RS, Sampson UK

BACKGROUND: -Since heart failure (HF) is the final common pathway for most heart diseases, we examined its 10-year prevalence trend by race, gender, and age in Tennessee. METHODS AND RESULTS: -HF hospitalization data from the Tennessee Hospital Discharge Data System were analyzed by race, gender and age. Rates were directly age-adjusted using the Year 2000 standard population. Adult (age 20+) in-patient hospitalization for primary diagnosis of HF (HFPD) increased from 4.2% in 1997 to 4.5% in 2006. Age-adjusted hospitalization for HF (per 10,000 population) rose by 11.3% (from 29.3 in 1997 to 32.6 in 2006). Parallel changes in secondary HF admissions were also noted. Age-adjusted rates were higher among blacks than whites and higher among men than women. The ratios of black to white by gender admitted with HFPD in 2006 were highest (9:1) among the youngest age categories (20-34 and 35-44 years). Furthermore, for each age category of black men below 65 years, there were higher HF admission rates than for white men in the immediate older age category. In 2006, the adjusted rate ratios for HFPD in black to white men aged 20-34 and 35-44 years were OR=4.75, CI (3.29-6.86) and OR 5.10, CI (4.15-6.25) respectively. Hypertension was the independent predictor of HF admissions in black men age 20-34 years. CONCLUSIONS: -The higher occurrence of HF among young adults in general, particularly among young black men, highlights the need for prevention by identifying modifiable biological and social determinants in order to reduce cardiovascular health disparities in this vulnerable group.

PMID: 21178017 [PubMed - as supplied by publisher]

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BNP Testing and the Accuracy of Heart Failure Diagnosis in the Emergency Department.

Circ Heart Fail. 2009 Nov 20;

Authors: Lokuge A, Lam LL, Cameron P, Krum H, Smit DV, Bystrzycki A, Naughton MT, Eccleston D, Flannery G, Federman J, Schneider HG

BACKGROUND: -It is often difficult to diagnose heart failure (HF) accurately in patients presenting with dyspnoea to the emergency department (ED). This study assessed whether B-type Natriuretic Peptide (BNP) testing in these patients improved the accuracy of HF diagnosis. METHODS AND RESULTS: -Patients presenting to The Alfred and The Northern Hospital EDs with a chief complaint of dyspnoea were enrolled prospectively from August 2005 to April 2007. Patients were randomly allocated to have BNP levels tested or not. The diagnostic “gold” standard for HF was determined by one cardiologist and one emergency or respiratory physician who, blinded to the BNP result, independently reviewed all available information. The ED diagnosis of HF in the non BNP group, showed a sensitivity, specificity and accuracy of 65%, 92% and 81% respectively. The BNP group had a similar sensitivity, specificity and accuracy of 66%, 90% and 78% respectively for the diagnosis of HF in the ED. There was no significant difference between the BNP and non BNP groups in any of the measures of diagnostic accuracy for HF. CONCLUSIONS: -In the clinical setting of emergency departments, availability of BNP levels did not significantly improve the accuracy of a diagnosis of HF.

PMID: 19933409 [PubMed - as supplied by publisher]

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Association of Blood Pressure at Hospital Discharge With Mortality in Patients Diagnosed With Heart Failure.

Circ Heart Fail. 2009 Nov 1;2(6):616-623

Authors: Lee DS, Ghosh N, Floras JS, Newton GE, Austin PC, Wang X, Liu PP, Stukel TA, Tu JV

BACKGROUND: Higher blood pressure in acute heart failure has been associated with improved survival; however, the relationship between blood pressure and survival in stabilized patients at hospital discharge has not been established. METHODS AND RESULTS: In 7448 patients with heart failure (75.2+/-11.5 years; 49.9% men) discharged from the hospital in Ontario, Canada, we examined the association of systolic blood pressure (SBP) and diastolic blood pressure with long-term survival. Parametric survival analysis was performed, and survival time ratios were determined according to discharge blood pressure group. A total of 25 427 person-years of follow-up were examined. In those with left ventricular ejection fraction </=40%, median survival was decreased by 17% (survival time ratio, 0.83; 95% CI, 0.71 to 0.98; P=0.029) when discharge SBP was 100 to 119 mm Hg and decreased by 23% (survival time ratio, 0.77; 95% CI, 0.62 to 0.97; P=0.024) when discharge SBP was <100 mm Hg, compared with those in the reference range of 120 to 139 mm Hg. Survival time ratios were 0.75 (95% CI, 0.60 to 0.92; P=0.007) and 0.75 (95% CI, 0.53 to 1.07; P=0.12) when discharge SBPs were 140 to 159 and >/=160 mm Hg, respectively. In those with left ventricular ejection fraction >40%, survival time ratios were 0.69 (95% CI, 0.51 to 0.93), 0.83 (95% CI, 0.71 to 0.99), 0.95 (95% CI, 0.80 to 1.14), and 0.76 (95% CI, 0.61 to 0.95) for discharge SBPs <100, 100 to 119, 140 to 159, and >/=160 mm Hg, respectively. CONCLUSIONS: In this long-term population-based study of patients with heart failure, the association of discharge SBP with mortality followed a U-shaped distribution. Survival was shortened in those with reduced or increased values of discharge SBP.

PMID: 19919987 [PubMed - as supplied by publisher]

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Prognosis in Heart Failure and the Value of {beta}-Blockers Are Altered by the Use of Antidepressants and Depend on the Type of Antidepressants Used.

Circ Heart Fail. 2009 Nov 1;2(6):582-590

Authors: Fosbøl EL, Gislason GH, Poulsen HE, Hansen ML, Folke F, Schramm TK, Olesen JB, Bretler DM, Abildstrøm SZ, Sørensen R, Hvelplund A, Køber L, Torp-Pedersen C

BACKGROUND: Depression worsens the prognosis in patients with cardiac disease, and treatment with antidepressants may improve survival. Guidelines recommend use of selective serotonin reuptake inhibitors (SSRIs), but knowledge of the prognostic effect of different classes of antidepressants is sparse. METHODS AND RESULTS: We studied 99 335 patients surviving first hospitalization for heart failure (HF) from 1997 to 2005. Use of HF medication and antidepressants (divided into tricyclic antidepressants [TCA] and SSRI) was determined by prescription claims. Risk of overall and cardiovascular death associated with antidepressants, HF medication, and coadministration of these 2 drug classes was estimated by Cox proportional hazard analyses. Propensity adjusted models were performed as sensitivity analysis. During the study period, there were 53 988 deaths, of which 83.0% were due to cardiovascular causes (median follow-up, 1.9 years; 5, 95% fractiles, 0.04 to 7.06 years). Use of beta-blockers was associated with decreased risk of cardiovascular death (hazard ratio [HR], 0.77; 95% CI, 0.75 to 0.79). Antidepressants were prescribed to 19 411 patients, and both TCA and SSRI were associated with increased risk of overall and cardiovascular death (TCA: HR, 1.33; CI, 1.26 to 1.40; and HR, 1.25; CI, 1.17 to 1.32; SSRI: HR, 1.37; CI, 1.34 to 1.40; and HR, 1.34; CI, 1.30 to 1.38, respectively). Coadministration of SSRI and beta-blockers was associated with a higher risk of overall and cardiovascular death compared with coadministration of beta-blockers and TCA (P for interaction <0.01). CONCLUSIONS: Use of antidepressants in patients with HF was associated with worse prognosis. Coadministration of SSRIs and beta-blockers was associated with increased risk of overall death and cardiovascular death compared with coadministration of TCAs and beta-blockers. To further clarify this, clinical trials testing the optimal antidepressant strategy in patients with HF are warranted.

PMID: 19919983 [PubMed - as supplied by publisher]

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Recent National Trends in Readmission Rates after Heart Failure Hospitalization.

Circ Heart Fail. 2009 Nov 10;

Authors: Ross JS, Chen J, Lin ZQ, Bueno H, Curtis JP, Keenan PS, Normand SL, Schreiner G, Spertus JA, Vidán MT, Wang Y, Wang Y, Krumholz HM

BACKGROUND: -In July 2009, Medicare will begin publicly reporting hospitals’ risk-standardized, all-cause 30-day readmission rates (RSRRs) among fee-for-service beneficiaries discharged after heart failure hospitalization from all U.S. acute care non-federal hospitals. No recent national trends in RSRRs have been reported and it is not known if hospital-specific performance is improving or if variation in performance is decreasing. METHODS AND RESULTS: -We used 2004-2006 Medicare administrative data to identify all fee-for-service beneficiaries admitted to a U.S. acute care hospital for heart failure and discharged alive. We estimated mean annual RSRRs, a National Quality Forum-endorsed metric for quality, using two-level hierarchical models that accounted for age, sex, and multiple co-morbidities; variation in quality was estimated by the standard deviation of the RSRRs. There were 570,996 distinct hospitalizations for heart failure in which the patient was discharged alive in 4728 hospitals in 2004; 544,550 in 4694 hospitals in 2005; and 501,234 in 4674 hospitals in 2006. Unadjusted 30-day all-cause readmission rates were virtually identical over this period: 23.0% in 2004, 23.3% in 2005, and 22.9% in 2006. The mean and standard deviation (SD) of RSRRs were also similar: mean [SD] of 23.7% [1.3] in 2004, 23.9% [1.4] in 2005, and 23.8% [1.4] in 2006, suggesting similar hospital variation throughout the study period. CONCLUSIONS: -National mean and RSRR distributions among Medicare beneficiaries discharged after heart failure hospitalization have not changed in recent years, indicating that there was neither improvement in hospital readmission rates nor in hospital variations in rates over this time period.

PMID: 19903931 [PubMed - as supplied by publisher]

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