In-hospital heart rate reduction and its relation to outcomes of heart failure patients with sinus rhythm: Results from the Polish part of the European Society of Cardiology Heart Failure Pilot and Long-Term Registries

Balsam, Paweł; Peller, Michał; Borodzicz, Sonia; Kapłon‐Cieślicka, Agnieszka; Ozierański, Krzysztof; Tymińska, Agata; Marchel, Michał; Crespo-Leiro, María G.; Maggioni, Aldo P.; Dróżdż, Jarosław; Grabowski, Marcin; Filipiak‬, Krzysztof J.; Opolski, Grzegorz

doi:10.5603/cj.a2018.0094

Cited by 4 publications

(4 citation statements)

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“…They concluded that there was a need to wait for hemodynamic stability and a 36-h wash-out period in the sacubitril/ /valsartan group, with 6 h of obligatory observation, may require prolonged hospital stays. However, the median duration of the index hospitalization (5.2 days) was shorter than was shown in a previous analysis from the registry of European Society of Cardiology (median hospital stay was 7 days) [28]. Additionally, there was high discontinuation rate of study drug in both arms and 15% had missing data for the primary endpoint [16].…”

Section: Tion (The Comparison Of Pre-and Post-discharge Initiation Of Lcz696 Therapy In Hfref Patientsmentioning

confidence: 57%

Feasibility of sacubitril/valsartan initiation early after acute decompensated heart failure

Tymińska¹,

Ozierański²,

Grabowski³

et al. 2020

Cardiol J.

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Despite significant diagnostic and therapeutic advances, heart failure (HF) is linked with high mortality and morbidity. Hospitalization for decompensated HF is still the most common cause of hospitalization in adults. What is more, a particularly high risk of hospitalization (even up to 50% of patients) is observed within a few months after a previous HF hospitalization. Sacubitril/valsartan, a first-in-class drug, contains a neprilysin inhibitor (sacubitril) and an angiotensin II receptor blocker (valsartan). In PARADIGM-HF trial investigators showed, that sacubitril/valsartan significantly reduced primary endpoint combined with cardiovascular death or HF hospitalization in patients with chronic, symptomatic HF (New York Heart Association class II-IV) with reduced ejection fraction (left ventricular ejection fraction . Recently, results of the PIONEER-HF trial, which included HF patients with LVEF ≤ 40% who were hospitalized for acute decompensated HF were also published. The study proved that early, in-hospital, implementation of sacubitril/valsartan in these patients resulted in a substantially greater reduction of N-terminal prohormone B-type natriuretic peptide concentration and a lower rate of HF rehospitalizations with similar safety profile for enalapril.

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Section: Tion (The Comparison Of Pre-and Post-discharge Initiation Of Lcz696 Therapy In Hfref Patientsmentioning

confidence: 57%

Feasibility of sacubitril/valsartan initiation early after acute decompensated heart failure

Tymińska¹,

Ozierański²,

Grabowski³

et al. 2020

Cardiol J.

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“…That is, patients presenting with tachycardia and discharged with a controlled HR had better outcomes. In contrast, another study revealed that HR reduction during hospitalization for HF was not associated with better prognosis in patients with sinus rhythm 6 . However, these studies evaluated the HR change at admission and discharge, and no conclusion has been reached as yet.…”

Section: Introductionmentioning

confidence: 93%

“…In contrast, another study revealed that HR reduction during hospitalization for HF was not associated with better prognosis in patients with sinus rhythm. 6 However, these studies evaluated the HR change at admission and discharge, and no conclusion has been reached as yet. Several guidelines emphasize the importance of earlier stabilization for haemodynamic abnormalities, 7 and HR often changes dramatically after initial treatment for AHF in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Clinical impact of heart rate change in patients with acute heart failure in the early phase

et al. 2021

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Aims Patients with acute heart failure (AHF) often present with an increased heart rate (HR), and the HR changes dramatically after initial treatment for AHF. However, the HR change after admission and the relationship between HR change in the early phase and prognosis have not been fully elucidated. Methods and results From a multicentre AHF registry, we retrospectively evaluated 1527 consecutive patients admitted with AHF. HR change (%) was calculated by [HR (at admission) À HR (24 h after admission)] × 100∕HR (at admission). The median HR change was 15.1% (range, 2.0-28.4%). The HR decreased most in the first 24 h and then gradually thereafter [admission: 98 (81-117) b.p.m., 24 h: 80 (70-92) b.p.m., 48 h: 78 (68-90) b.p.m., and 72 h: 77 (67-88) b.p.m.]. In Kaplan-Meier analysis, the cumulative event-free rates in the composite endpoint of death and rehospitalization due to AHF showed better according to larger HR change (P = 0.012, log rank). Cox proportional hazards analysis showed that HR change was a prognostic factor for composite endpoint adjusted by age and sex [hazard ratio, 0.995; 95% confidence interval (CI), 0.991-0.998; P = 0.006]. HR change was associated with outcome adjusted by age and sex in patients with sinus rhythm (hazard ratio, 0.993; 95% CI, 0.988-0.999; P = 0.015), but not in patients with atrial fibrillation (hazard ratio, 0.996; 95% CI, 0.990-1.002; P = 0.15). Conclusions A decrease in HR in the first 24 h after admission indicates better prognosis in patients with AHF, although the prognostic influence may differ between patients with sinus rhythm and those with atrial fibrillation.

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“…In previous publications, we have demonstrated that our e-consultation model was associated with improved accessibility to care 11 and reduced cardiovascular mortality and hospital admissions. 3 These facts are particularly relevant in patients with suspected or confirmed AF, since a delayed diagnosis may lead to a poor outcome related to delayed rhythm and rate control 12,13 and, most importantly, a delayed optimisation of OAC. 7 The increased rate of OAC use and the reduction in the elapsed time for clinical assessment of patients with AF after the implementation of our e-consultation program may have influenced our findings.…”

Section: Temporal Trend In Oral Anticoagulation Rate and Elapsed Time...mentioning

confidence: 99%

The impact of inter‐clinician electronic consultation in patients diagnosed with atrial fibrillation in primary care

Mazón‐Ramos

Cinza‐Sanjurjo

Garcia‐Vega

et al. 2022

Eur J Clin Investigation

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Background An early diagnosis and early initiation of oral anticoagulants (OAC) are main determinants for outcomes in patients with atrial fibrillation (AF). Inter‐clinician electronic consultations (e‐consultations) program for the general practitioner referrals to cardiologist may improve health care access by reducing the elapsed time for cardiology care. Objective To evaluate the effect of a reduced elapsed time to care after a inter‐clinician e‐consultations program implementation (2013–2019) in comparison with previous in‐person consultation (2010–2012) in the outpatient health care management in a Cardiology Department. Methodology We included 10,488 patients with AF from 1 January 2010, to 31 December 2019. Until 2012, all patients attended an in‐person consultation (2010–2012). In 2013, we instituted an e‐consult program (2013–2019) for all primary care referrals to cardiologists that preceded patient's in‐person consultation when considered. The shared electronic patient dossier (EPD) was available between GP and cardiologist, and any change in therapy advice from cardiologist was directly implemented in this EPD. Results During the e‐consultation period (2013–2019) were referred 6627 patients by GPs to cardiology versus 3861 during the in‐person consultation (2010–2012). The e‐consultation implementation was associated with a reduction in the elapsed time to anticoagulation prescription (177.6 ± 8.9 vs. 22.5 ± 8.1 days, p < .001), and an increase of OAC use (61% [95% IC: 19.6%–102.4%], p < .001). The e‐consult program implementation was associated with a reduction in the 1‐year CV mortality (.48 [95% CI: .30–.75]) and all‐cause mortality (.42 [95% CI: .29–.62]). The OAC reduces the stroke mortality (.15 [95% CI: .06–.39]) and CV mortality (.43 [95% CI: .29–.62]) and all‐cause mortality (.23 [95% CI: .17–.31]). Conclusion A shared EPD‐based inter‐clinician e‐consultation program significantly reduced the elapsed time for cardiology consultation and initiation of OAC. The implementation of this program was associated with a lower risk of stroke and cardiovascular/all‐cause mortality.

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In-hospital heart rate reduction and its relation to outcomes of heart failure patients with sinus rhythm: Results from the Polish part of the European Society of Cardiology Heart Failure Pilot and Long-Term Registries

Abstract: In-hospital HR reduction did not influence on the outcomes of HF patients in sinus rhythm.

Cited by 4 publications

References 26 publications

Feasibility of sacubitril/valsartan initiation early after acute decompensated heart failure

Feasibility of sacubitril/valsartan initiation early after acute decompensated heart failure

Clinical impact of heart rate change in patients with acute heart failure in the early phase

The impact of inter‐clinician electronic consultation in patients diagnosed with atrial fibrillation in primary care

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