Gender-Based Differences in Heart Transplantation Rates

Dewaswala, Nakeya; Bhopalwala, Huzefa; Shikari, Saima; Villegas-Galaviz, J.; Noor, A.Z.; Jones, Jarred; Rajagopalan, Navin; Kolodziej, Andrew; Malyala, Rajasekhar; Birks, Emma J.; Vaidya, Gaurang

doi:10.1016/j.healun.2022.01.1667

The Journal of Heart and Lung Transplantation

2022

DOI: 10.1016/j.healun.2022.01.1667

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Gender-Based Differences in Heart Transplantation Rates

Nakeya Dewaswala

Huzefa Bhopalwala

Saima Shikari

et al.

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confidence: 99%

“…In this review, we will cover the pathophysiology and the management of HF in the elderly, specifically discussing important geriatric domains such as frailty, cognitive impairment, delirium, polypharmacy, and multimorbidity. [2][3][4][5][6][7][8] Pathophysiology HF occurs when structural and functional defects in the myocardium decrease cardiac output or ventricular filling. The normal aging biology includes progressive disruption at cellular and genetic levels, and changes in molecular signaling and mechanical activities that contribute to myocardial abnormalities.…”

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Pathophysiology and Management of Heart Failure in the Elderly

et al. 2022

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The population of elderly adults is increasing globally. It has been projected that the population of adults aged 65 years will increase by approximately 80% by 2050 in the United States. Similarly, the elderly population is rising in other countries; a notable example being Japan where approximately 30% of the population are aged above 65 years. The pathophysiology and management of heart failure (HF) in this age group tend to have more intricacies than in younger age groups owing to the presence of multiple comorbidities. The normal aging biology includes progressive disruption at cellular and genetic levels and changes in molecular signaling and mechanical activities that contribute to myocardial abnormalities. Older adults with HF secondary to ischemic or valvular heart disease may benefit from surgical therapy, valve replacement or repair for valvular heart disease and coronary artery bypass grafting for coronary artery disease. While referring these patients for surgery, patient and family expectations and life expectations should be taken into account. In this review, we will cover the pathophysiology and the management of HF in the elderly, specifically discussing important geriatric domains such as frailty, cognitive impairment, delirium, polypharmacy, and multimorbidity.

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Pathophysiology and Management of Heart Failure in the Elderly

et al. 2022

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Postoperative, but Not Preoperative, MELD-3.0 Prognosticates 3-Month Procedural Success in Patients Undergoing Orthotopic Heart Transplantation

Ptak,

Sokolski,

Gontarczyk

et al. 2024

JCM

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Background/Objectives: Multi-organ failure (MOF) often complicates advanced heart failure (HF), contributing to a poor prognosis. The Model of End-Stage Liver Disease 3.0 (MELD-3.0) scale incorporates liver and kidney function parameters. This study aims to evaluate the prognostic significance of the MELD-3.0 score in patients with advanced HF who have undergone heart transplantation (HTx). Methods: The MELD-3.0 score was computed using the average values of the international normalized ratio and bilirubin, creatinine, sodium, and albumin levels during a hospital stay following HTx. The average MELD-3.0 scores from the period of 1 month preceding HTx and 1 week after HTx were analyzed. The primary endpoint of the study was the 6-month total mortality, and the secondary endpoint was ICU hospitalization time after HTx. Results: The analysis included 106 patients undergoing HTx, with a median age of 53 years (44–63), 81% of whom were male. Within 6 months post-HTx, 17 patients (16%) died; those patients had a higher 1-week post-HTx MELD-3.0 score of 18.3 (14.5–22.7) in comparison to survivors, whose average score was 13.9 (9.5–16.4), p < 0.01. There was no difference in MELD 3.0 score in the pre-HTx period: 16.6 (11.4–17.8) vs. 12.3 (8.6–17.1), p = 0.36. The post-HTx MELD-3.0 score independently predicted death: RR 1.17 (95% CI 1.05–1.30), p < 0.01. A Receiver Operating Characteristic (ROC) determined the cut-off value of the MELD-3.0 score as 17.3 (AUC = 0.83; sensitivity—67%; specificity—86%). Survivors with scores above this value had a longer ICU hospitalization time: 7 (5.0–11.0) vs. 12 (8–20) days (p = 0.01). Conclusions: The post-HTx MELD-3.0 score serves as an independent predictor of an unfavorable prognosis in patients with advanced HF undergoing HTx. The evaluation of MELD-3.0 scores provides additional prognostic information in this population.

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Gender-Based Differences in Heart Transplantation Rates

Cited by 2 publications

References 0 publications

Pathophysiology and Management of Heart Failure in the Elderly

Pathophysiology and Management of Heart Failure in the Elderly

Postoperative, but Not Preoperative, MELD-3.0 Prognosticates 3-Month Procedural Success in Patients Undergoing Orthotopic Heart Transplantation

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