The history of peripheral nerve stimulation (PNS) is rich and quite extensive. The first recorded use of electrostimulation In This Issue

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Background: The H2FPEF score is a validated scoring system to determine whether dyspnea may be due to heart failure with preserved ejection fraction (HFpEF). Recent evidence has suggested that H2FPEF scoring system may correlate with outcomes in established HFpEF. Its utilization for estimating mortality in patients who die within one year of discharge is not known. Methods: We collected clinical demographics and echocardiographic parameters from reports to calculate H2FPEF scores for 301 patients admitted with decompensated HFpEF between August 2016 and 2017. Patients were included if an echocardiographic report was available within 3 months, confirming an ejection fraction > 50%. E/E’ and filling pressures were scored as 0 if not recorded in the echocardiographic report. Results: Median age was 81 years (IQR: 71-89), with 62.9% female. One-year follow-up was confirmed for 268 patients, with 56 deaths (20.9%). Receiver operating curve analysis suggest borderline significance of H2FPEF in predicting one-year mortality (area under curve, 0.576, 95% CI: 0.493-0.658, p=0.073). Optimal H2FPEF cutpoint score was 4.5 (73% sensitivity, 50% specificity). On univariate analysis, body mass index (BMI) > 30, hypertension, atrial fibrillation (p<0.001) and pulmonary artery systemic pressure > 35 mmHg (p=0.038) were associated with one-year mortality. On stepwise logistic regression, only BMI > 30 and atrial fibrillation remained associated with mortality in multivariate analysis. Conclusion: The utilization of H2FPEF in established HFpEF might confer some ability to predict one-year mortality, driven by obesity (2 points) and atrial fibrillation (3 points). Validation in larger cohorts with longer follow-up is necessary to establish its potential role in discharge planning and transitions of care of decompensated HFpEF.

Introduction: Heart Failure is one of the leading causes of readmission in the United States. Heart Failure with preserved Ejection Fraction (HFpEF) accounts for a growing proportion of heart failure hospitalizations and accounts for approximately half of hospitalizations today. Unlike Heart Failure with reduced Ejection Fraction (HFrEF), there are no consensus-driven guidelines for the management of HFpEF. Methods: We collected demographic data, co-morbidities, laboratory and echocardiographic data on patients hospitalized with HFpEF throughout our health care system between August 2016 to August 2017. We assessed length of stay (LOS), whether the patient was re-admitted for any cause within 30 days and whether the patient died within 1 year of index hospitalization. We performed a Wilcoxon rank-sum test comparing patients who were both readmitted within 30 days for any reason and died within 1 year, against patients who were readmitted but were verified alive at one-year follow-up. Results: There were 366 patients hospitalized for HFpEF during the study period. Overall 30-day readmission rate was 24.3%, with a one-year mortality of 19.9%. One-year outcomes was verifiable for 359 patients. There were 27 patients who were readmitted within 30 days and died within one year of follow-up. Median LOS was significantly greater in patients during index hospitalization who died within 1 year of follow-up (Median LOS: 8 days, IQR 5-10 days), compared to patients who were readmitted within 30 days, but were alive at 1-year follow-up (Median LOS: 5 days, IQR: 3-8 days; p-value = 0.001). Conclusions: Among patients who were re-hospitalized within 30 days of an index hospitalization for HFpEF, LOS was significantly greater than patients who died within one year, compared to patients who remained alive at one-year follow-up. This may help identify a high-risk subset on index hospitalization and assist care transition teams and primary care physicians at follow-up in regarding discussions on goals of care and life sustaining treatments.