Prognostic Importance of Elevated Jugular Venous Pressure and a Third Heart Sound in Patients with Heart Failure

Drazner, Mark H.; Rame, J. Eduardo; Stevenson, Lynne Warner; Dries, Daniel L.

doi:10.1056/nejmoa010641

Cited by 587 publications

(344 citation statements)

References 51 publications

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“…Elevated cardiac filling pressures are associated with higher rates of re‐hospitalization and mortality in patients with HF 23, 24. Independent of LVEF, rises in cardiac filling pressures can often be detected several weeks prior to patients experiencing symptoms of HF decompensation that require hospitalization 25, 26.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary artery pressure‐guided heart failure management: US cost‐effectiveness analyses using the results of the CHAMPION clinical trial

Martinson

Bharmi

Dalal

et al. 2016

European J of Heart Fail

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AimsHaemodynamic‐guided heart failure (HF) management effectively reduces decompensation events and need for hospitalizations. The economic benefit of clinical improvement requires further study.Methods and resultsAn estimate of the cost‐effectiveness of haemodynamic‐guided HF management was made based on observations published in the randomized, prospective single‐blinded CHAMPION trial. A comprehensive analysis was performed including healthcare utilization event rates, survival, and quality of life demonstrated in the randomized portion of the trial (18 months). Markov modelling with Monte Carlo simulation was used to approximate comprehensive costs and quality‐adjusted life years (QALYs) from a payer perspective. Unit costs were estimated using the Truven Health MarketScan database from April 2008 to March 2013. Over a 5‐year horizon, patients in the Treatment group had average QALYs of 2.56 with a total cost of US$56 974; patients in the Control group had QALYs of 2.16 with a total cost of US$52 149. The incremental cost‐effectiveness ratio (ICER) was US$12 262 per QALY. Using comprehensive cost modelling, including all anticipated costs of HF and non‐HF hospitalizations, physician visits, prescription drugs, long‐term care, and outpatient hospital visits over 5 years, the Treatment group had a total cost of US$212 004 and the Control group had a total cost of US$200 360. The ICER was US$29 593 per QALY.ConclusionsStandard economic modelling suggests that pulmonary artery pressure‐guided management of HF using the CardioMEMS™ HF System is cost‐effective from the US‐payer perspective. This analysis provides the background for further modelling in specific country healthcare systems and cost structures.

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Section: Introductionmentioning

confidence: 99%

Pulmonary artery pressure‐guided heart failure management: US cost‐effectiveness analyses using the results of the CHAMPION clinical trial

Martinson

Bharmi

Dalal

et al. 2016

European J of Heart Fail

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“…One problem with HF is its correct identification, usually empiric and based primarily on clinical manifestations that many times are nonspecific [1][2][3][4][5] . The complementary tests, usually of great help in identifying HF, are also of lower specificity, the result being that many patients are wrongly diagnosed.…”

Section: Discussionmentioning

confidence: 99%

“…Jugular ingurgitation and the third heart sound are more specific clinical signs that help us in the characterization of this syndrome, but they are not present in the early forms and they can be intermittent [1][2][3][4][5] . Of the complementary tests, not one allows us to systematically diagnose HF.…”

Section: Discussionmentioning

confidence: 99%

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ProBNP for stratifying patients with heart failure

Pereira-Barretto

Oliveira

Franco

et al. 2003

Arq. Bras. Cardiol.

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OBJECTIVE: To verify whether the serum levels of N-Terminal ProBNP fraction (ProBNP) allow us to identify with accuracy the clinical functional status of patients with heart failure (HF), because the clinical diagnosis of this syndrome is based basically on clinical data when the complementary tests have lower specificity. METHODS: Sixty-nine patients with a history of HF were studied. Their mean age of was 53.5 years and 78.3% were males. All underwent clinical and echocardiographic evaluations and a test to determine the serum dosage of ProBNP. According to clinical manifestation, patients were in the following functional classes (FC), 14% FC I, 40.6% FC II, 28.1% FC III, and 23.4% FC IV. The mean ejection fraction (EF) was 0.28. RESULTS: ProBNP did not differ according to age, sex, and cause of cardiopathy. No correlation existed between EF and the ProBNP serum level. ProBNP levels were significantly lower in patients in FC I than those in FC II (42 vs 326.7 pmol/L; P=0.0001), and in FC II than those in FC III (P=0.01). ProBNP levels did not differ statically between FC III and IV patients (888.1 vs 1082.8 pmol/L; P=0.25). ProBNP values greater than 100 pmol/L identify patients with decompensated HF with a sensitivity of 98%. CONCLUSION: ProBNP values over 100 pmol/L were indicative of HF, and patients with advanced HF had values over 270 pmol/L. A ProBNP dosage test was an excellent auxiliary in the clinical characterization of patients with HF

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“…Its presence is highly specific for the detection of ventricular dysfunction and elevated filling pressures, estimated at 93% 20 . Additionally, it is pointed out as an independent prognostic marker in patients with HF 11 . On the other hand, its sensitivity is low (between 13% and 52%) and it displays a lot of interobserver variability, depending on their experience 21 .…”

Section: Figure 1 -Potential Therapeutic Targets Related To the Incrementioning

confidence: 99%

Avaliação hemodinâmica na insuficiência cardíaca: papel do exame físico e dos métodos não invasivos

Júnior¹,

Xavier

Garcia

et al. 2012

Arq. Bras. Cardiol.

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Among the cardiovascular diseases, heart failure (HF) has a high rate of hospitalization, morbidity and mortality, consuming vast resources of the public health system in Brazil and other countries. The correct determination of the filling pressures of the left ventricle by noninvasive or invasive assessment is critical to the proper treatment of patients with decompensated chronic HF, considering that congestion is the main determinant of symptoms and hospitalization. Physical examination has shown to be inadequate to predict the hemodynamic pattern. Several studies have suggested that agreement on physical findings by different physicians is small and that, ultimately, adaptive physiological alterations in chronic HF mask important aspects of the physical examination. As the clinical assessment fails to predict hemodynamic aspects and because the use of Swan-Ganz catheter is not routinely recommended for this purpose in patients with HF, noninvasive hemodynamic assessment methods, such as BNP, echocardiography and cardiographic bioimpedance, are being increasingly used. The present study intends to carry out, for the clinician, a review of the role of each of these tools when defining the hemodynamic status of patients with decompensated heart failure, aiming at a more rational and individualized treatment.

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Prognostic Importance of Elevated Jugular Venous Pressure and a Third Heart Sound in Patients with Heart Failure

Abstract: In patients with heart failure, elevated jugular venous pressure and a third heart sound are each independently associated with adverse outcomes, including progression of heart failure. Clinical assessment for these findings is currently feasible and clinically meaningful.

Cited by 587 publications

References 51 publications

Pulmonary artery pressure‐guided heart failure management: US cost‐effectiveness analyses using the results of the CHAMPION clinical trial

Pulmonary artery pressure‐guided heart failure management: US cost‐effectiveness analyses using the results of the CHAMPION clinical trial

ProBNP for stratifying patients with heart failure

Avaliação hemodinâmica na insuficiência cardíaca: papel do exame físico e dos métodos não invasivos

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