Clinical Scenario 1 Is Associated With Winter Onset of Acute Heart Failure

Hirai, Masayuki; Kato, Masahiko; Kinugasa, Yoshiharu; Sugihara, Shinobu; Yanagihara, Kiyotaka; Yamada, Kensaku; Watanabe, Tomomi; Yamamoto, Kazuhide

doi:10.1253/circj.cj-14-0710

Cited by 10 publications

(3 citation statements)

References 30 publications

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“…Other Japanese registry studies have reported that the prognosis of patients with dyspnea and/ or congestion with systolic blood pressure >140 mmHg (clinical scenario [CS] 1) is better than that of other CS groups, with higher rates of comorbid hypertension and dyslipidemia in CS1 cases. 20,21 We believe that our study shows similar results. Interestingly, even after adjusting for factors that may reflect the severity and pathophysiology of 84.9%), followed by tolvaptan (3,309/9,653; 34.3%).…”

Section: Discussionsupporting

confidence: 83%

Real-World Intravenous Diuretic Use to Treat Congestion in Patients With Heart Failure　― An Observational Study Using a Research Database ―

2023

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Background: Intravenous (IV) diuretics are key in the treatment of acute heart failure, but the time of administration can affect outcomes. Using a medical database, we assessed the real-world usage and clinical impact of IV diuretics after admission. Methods and Results:This observational study included hospitalized patients with heart failure who received IV diuretics. Relationships between IV diuretic use and clinical outcomes (duration of hospitalization, in-hospital mortality, readmission) were evaluated using analysis of variance or logistic regression. Overall, 9,653 patients (51.1% male) were assessed (mean age 80.9 years). Most (89.1%) patients had IV loop diuretic treatment initiated on Day 1 of hospitalization and 68.0% achieved the maximum dose on that day. The median duration of hospitalization was 17.0 days. In-hospital mortality was 9.2%; 13.7% of patients were readmitted within 3 months after discharge. There were prognostic relationships between IV diuretic usage and both duration of hospitalization and in-hospital mortality. On multivariable analysis, the time of maximum dose had the biggest impact on outcomes. Duration of hospitalization was prolonged and in-hospital mortality rates increased when the time of maximum dose was delayed. There was little correlation between IV diuretic use and readmission following discharge.Conclusions: Short-term outcomes (duration of hospitalization, in-hospital mortality) correlated with the time of maximum IV diuretic dose; thus, early initiation and subsequent modification of appropriate congestion treatment is critical for prognostic improvement.

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Section: Discussionsupporting

confidence: 83%

Real-World Intravenous Diuretic Use to Treat Congestion in Patients With Heart Failure　― An Observational Study Using a Research Database ―

2023

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“…Hirai et al recently reported a significant increase in acute heart failure during the winter in patients with systolic blood pressure >140 mmHg, but not in those with systolic blood pressure ≤140 mmHg [27]. Another report showed little body-weight change during pulmonary edema in some patients, suggesting that pulmonary edema may occur as a result of fluid redistribution, with no outstanding systemic volume overload [28, 29].…”

Section: Discussionmentioning

confidence: 99%

Seasonal variation in hemodialysis initiation: A single-center retrospective analysis

et al. 2017

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The number of new dialysis patients has been increasing worldwide, particularly among elderly individuals. However, information on seasonal variation in hemodialysis initiation in recent decades is lacking, and the seasonal distribution of patients' conditions immediately prior to starting dialysis remains unclear. Having this information could help in developing a modifiable approach to improving pre-dialysis care. We retrospectively investigated the records of 297 patients who initiated hemodialysis at Hiroshima Prefectural Hospital from January 1st, 2009 to December 31st, 2013. Seasonal differences were assessed by χ 2 orKruskal-Wallis tests. Multiple comparison analysis was performed with the Steel test. The overall number of patients starting dialysis was greatest in winter (n = 85, 28.6%), followed by spring (n = 74, 24.9%), summer (n = 70, 23.6%), and autumn (n = 68, 22.9%), though the differences were not significant. However, there was a significant winter peak in dialysis initiation among patients aged !65 years, but not in those aged <65 years. Fluid overload assessed by clinicians was the most common uremic symptom among all patients, but a winter peak was only detected in patients aged !65 years. The body weight gain ratio showed a similar trend to fluid overload assessed by clinicians. Pulmonary edema was most pronounced in winter among patients aged !65 years compared with other seasons. The incidences of infection were modestly increased in summer and winter, but not statistically significant. Cardiac complications were similar in all seasons. This study demonstrated the existence of seasonal variation in dialysis initiation, with a winter peak among patients aged !65 years. The winter increment in dialysis initiation was mainly attributable to increased fluid overload. These findings suggest that elderly individuals should be monitored particularly closely during the winter.

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“…ADHF was defined as new-onset decompensated heart failure or decompensation of chronic heart failure as previously described. 15 Acute coronary syndrome was excluded. Heart failure (HF) was defined according to Framingham criteria, together with pulmonary congestion on X-rays or pulmonary hypertension as evaluated by Doppler echocardiography.…”

Section: Subjectsmentioning

confidence: 99%

Ultrasound Assessment of Kidney Volume in Patients with Acute Decompensated Heart Failure: A Predictor of Diuretic Resistance

et al. 2017

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Background Diuretics are essential for treating acute decompensated heart failure (ADHF), but the response is inconsistent. This study aimed to clarify whether kidney volume as assessed by ultrasound (US) predicts diuretic resistance in patients with ADHF. Methods We enrolled 29 patients with ADHF and 32 controls. Height-adjusted kidney volume was assessed by US. We divided patients into two groups based on the median value of total daily use of furosemide (intravenous dose plus 0.5 × oral dose of furosemide equivalents) during 3 days from admission. Results Patients with ADHF had a significantly smaller left kidney volume than did control subjects (27.7 ± 10.0 vs. 32.8 ± 8.8 mL/m, P < 0.05). Patients in the highdose furosemide group (≥ 51.7 mg/d) had a significantly lower estimated glomerular filtration rate (eGFR) and a significantly smaller kidney volume than did those in the low-dose furosemide group (eGFR: 43.9 ± 20.4 vs. 60.8 ± 21.6 mL/min/1.73 m 2 , left kidney volume: 23.2 ± 5.2 vs. 32.6 ± 11.0 mL/m, right kidney volume: 26.5 ± 7.5 vs. 32.6 ± 7.9 mL/m, all P < 0.05). Multivariate logistic analysis showed that left kidney volume, but not eGFR, was independently associated with the requirement of high-dose furosemide (odds ratio: 0.856, 95% confidence interval: 0.735-0.997, P < 0.05). Conclusion Kidney volume as assessed by US is a useful predictor of diuretic resistance in patients with ADHF.

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Clinical Scenario 1 Is Associated With Winter Onset of Acute Heart Failure

Cited by 10 publications

References 30 publications

Real-World Intravenous Diuretic Use to Treat Congestion in Patients With Heart Failure　― An Observational Study Using a Research Database ―

Real-World Intravenous Diuretic Use to Treat Congestion in Patients With Heart Failure　― An Observational Study Using a Research Database ―

Seasonal variation in hemodialysis initiation: A single-center retrospective analysis

Ultrasound Assessment of Kidney Volume in Patients with Acute Decompensated Heart Failure: A Predictor of Diuretic Resistance

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Clinical Scenario 1 Is Associated With Winter Onset of Acute Heart Failure

Cited by 10 publications

References 30 publications

Real-World Intravenous Diuretic Use to Treat Congestion in Patients With Heart Failure ― An Observational Study Using a Research Database ―

Real-World Intravenous Diuretic Use to Treat Congestion in Patients With Heart Failure ― An Observational Study Using a Research Database ―

Seasonal variation in hemodialysis initiation: A single-center retrospective analysis

Ultrasound Assessment of Kidney Volume in Patients with Acute Decompensated Heart Failure: A Predictor of Diuretic Resistance

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Real-World Intravenous Diuretic Use to Treat Congestion in Patients With Heart Failure　― An Observational Study Using a Research Database ―

Real-World Intravenous Diuretic Use to Treat Congestion in Patients With Heart Failure　― An Observational Study Using a Research Database ―