Noncardiac Versus Cardiac Mortality in Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction

Vergaro, Giuseppe; Ghionzoli, Nicolò; Innocenti, Lisa; Taddei, C; Giannoni, Alberto; Valleggi, Alessandro; Borrelli, Chiara; Senni, Michele; Passino, Claudio; Emdin, Michele

doi:10.1161/jaha.119.013441

Cited by 79 publications

(76 citation statements)

References 34 publications

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“…As has been noted in other studies, patients in the highest LVEF quartile experienced a greater likelihood of non‐CV death than patients in the other quartiles and there was a trend toward greater likelihood of non‐CV death with increasing LVEF (online supplementary Figure ). However, we were unable to provide further breakdown of cause of death as this information was not collected in RELAX‐AHF‐2.…”

Section: Discussionsupporting

confidence: 83%

Relationship between left ventricular ejection fraction and cardiovascular outcomes following hospitalization for heart failure: insights from the RELAX‐AHF‐2 trial

Janwanishstaporn

Feng

Teerlink

et al. 2020

European J of Heart Fail

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Aims Although left ventricular ejection fraction (LVEF) is routinely used to categorize patients with heart failure (HF), whether it predicts outcomes after hospitalization for acute heart failure (AHF) is uncertain. Consequently, we assessed the relationship between LVEF and cardiovascular (CV) outcomes in a large, well characterized cohort of patients hospitalized for AHF. Methods and results The 6128 patients from the RELAX‐AHF‐2 trial who had LVEF measured during AHF hospitalization were separated into LVEF quartiles and the relationship between LVEF and a composite of CV mortality and rehospitalization for HF or renal failure through 180 days was assessed. We found progressively lower risk for this composite outcome as LVEF increased (hazard ratio 0.95, 95% confidence interval 0.93–0.98 per 5% LVEF increase, P < 0.001) that was driven predominantly by decreased risk for rehospitalization. The smoothed spline curve depicting risk remained stable as LVEF decreased until reaching approximately 40%, at which point risk increased progressively with further reductions in LVEF. Significant differences between LVEF quartiles for post‐discharge CV risk were seen in patients with an ischaemic aetiology or with a history of HF preceding index hospitalization, but were less robust in patients with non‐ischaemic aetiology and absent in those with de novo HF. Conclusion In patients hospitalized with AHF, CV events over 180 days were more frequent in patients with lower LVEF. This was due predominantly to a significant increase in risk for HF/renal failure rehospitalization but not in either CV or all‐cause mortality. LVEF had greater prognostic value in patients with ischaemic aetiology or pre‐existing HF.

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Section: Discussionsupporting

confidence: 83%

Relationship between left ventricular ejection fraction and cardiovascular outcomes following hospitalization for heart failure: insights from the RELAX‐AHF‐2 trial

Janwanishstaporn

Feng

Teerlink

et al. 2020

European J of Heart Fail

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“… 15 One of the most recent studies on mortality in stable outpatient CHF patients with reduced EF demonstrated a 66% survival rate with a mean follow-up of 39 months and an average age of 69 years. 36 We feel that the overall survival of our patient population is consistent with that of a typical HFrEF cohort with an average life-expectancy comparable to the findings of prior studies.…”

Section: Discussionsupporting

confidence: 88%

First Demonstration of Cardiac Resynchronization Therapy Defibrillator Service Life Exceeding Patient Survival in a Heart Failure with Reduced Ejection Fraction Cohort

Williams

Harley

Williams

2020

J Innov Cardiac Rhythm Manage.

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The occurrence of patient longevity exceeding implantable cardioverterdefibrillator (ICD) service life has important implications for patient outcomes and the cost of care. Battery capacity as measured in ampere-hours (Ah) is a strong predictor of survival to an elective replacement indicator (ERI) point and 2.1 Ah is the largest-capacity ICD battery in use at our facility. This was a long-term study of ICDs out of service (OOS) in patients with heart failure with reduced ejection fraction who received a 2.1-Ah cardiac resynchronization therapy defibrillator (CRT-D). All 2.1-Ah CRT-D systems implanted (n = 418) from August 1, 2008 through August 31, 2016 were included in this retrospective chart review. The primary endpoint was device OOS due to the battery reaching an ERI point, patient death, infection/ erosion, advisory/recall, heart transplant, or unspecified. The maximum follow-up period was 10.3 years, with a mean follow-up length of 4.7 years. The most common reason for device OOS was patient death (65.6%), with only 5.7% of devices reaching the ERI point during the study. There was a period of OOS acceleration driven numerically by patient death in the sixth to ninth years of follow-up. Male sex, ischemic cardiomyopathy, elevated creatinine level, advanced age, and reduced ejection fraction were associated with OOS (p < 0.05). To our knowledge, this is the first study to report ICD battery life exceeding patient survival in a chronic heart failure cohort. During an accelerated time of CRT-D OOS (when it is expected that ~98% of 1.0-Ah and 1.4-Ah CRT-D systems reach an ERI point), patient death resulted in substantially more device OOS than battery replacement and avoided costs of complications and generator changes. These results help to explain the elevated risks of CRT-D generator changes in shorter-longevity devices.

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“…The mortality from sepsis in patients with HFrEF is greater than that for those with normal ventricular function and could be related to demand cardiac ischemia compromising already impaired ventricular function [ 7 ]. Sepsis causes a greater percentage of death in patients with mild to moderate HFrEF compared to severe CHF in which direct cardiac causes predominate [ 8 ]. Our results provide evidence that 26 mL/kg of fluid provides a more precise treatment goal in HFrEF.…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of the Use of Aggressive Fluid Resuscitation in the Early Treatment of Sepsis Patients

Payne¹,

Tager²,

Broce³

et al. 2021

Cureus

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Introduction Fluid resuscitation is a critical aspect of the sepsis protocol with the usual initial dose being 30 mL per kilogram. Although this dose is well accepted in patients with normal cardiac function, there is some significant variation in clinical practice concerning the optimal fluid resuscitation in septic patients with underlying congestive heart failure (CHF). Many different approaches have been tried to best treat these patients by using lesser volumes of fluid. The purpose of this retrospective study is to attempt to better define optimal fluid resuscitation in congestive heart failure patients and whether standard fluid resuscitation exacerbates CHF in these cases. Methods This was a retrospective study involving patients admitted to the Emergency Department (ED) during the time period of September of 2016 through March of 2019 with a primary diagnosis of sepsis and pre-existing CHF. Data collected from the data warehouse and patient charts included demographics, total amount of fluid received in the ED and outcome data. Evidence of fluid overload (chest X-ray [CXR] evidence, rising B-type natriuretic peptide [BNP], or use of diuretics), was evaluated with respect to in-hospital mortality, white blood cell (WBC) count and comorbidities (chronic obstructive pulmonary disease [COPD], hypertension and coronary artery disease). Results There were 422 patients included in the cohort. Of the 422, 113 (26.8%) patients showed evidence of fluid overload on CXR during hospital stay and received diuretics and therefore considered in the CHF exacerbation group. The patients that experienced CHF exacerbation were significantly older (mean ± SD, 70.9 ± 11.8 years versus 67.4 ± 15.1 years, p=0.014). Patients with exacerbation also received more fluid (median and interquartile range, 3.0, 2:5.5 L versus 2.0, 1:4.3 L, p=0.017). The receiver operating characteristic curve analysis for fluid to predict exacerbation resulted in an area under the curve of 0.59 with a 95% confidence interval (CI) of 0.52 to 0.65, p=0.012. The Youden Index was used to determine an optimal cutoff value of 2.6 L. The percentage of patients in the exacerbation group above the threshold was significantly higher (57.3%) than those without exacerbation (43.3%), p=0.019. Following multivariate analysis, age greater than 60 (odds ratio [OR]: 2.5; CI: 1.4-4.6, p=0.003) and fluid cutoff of 2.6 L (OR: 1.9; CI: 1.2-3.1, p=0.007) were both found to be independent predictors of CHF exacerbation. There was no significant difference in mortality based on the total fluid received in the ED. Conclusion The findings of this study showed that septic patients with pre-existing CHF who received more than 2.6 L of fluid in the ED were 90% more likely to develop symptoms of CHF exacerbation with no evidence of lowering mortality compared to the group that received less than 2.6 L. Our data supports the practice of limiting total fluid resuscitation in CHF to 2.6 L and reconfirms...

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Noncardiac Versus Cardiac Mortality in Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction

Cited by 79 publications

References 34 publications

Relationship between left ventricular ejection fraction and cardiovascular outcomes following hospitalization for heart failure: insights from the RELAX‐AHF‐2 trial

Relationship between left ventricular ejection fraction and cardiovascular outcomes following hospitalization for heart failure: insights from the RELAX‐AHF‐2 trial

First Demonstration of Cardiac Resynchronization Therapy Defibrillator Service Life Exceeding Patient Survival in a Heart Failure with Reduced Ejection Fraction Cohort

An Evaluation of the Use of Aggressive Fluid Resuscitation in the Early Treatment of Sepsis Patients

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