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Blood Urea Nitrogen Is a Predictor of Adverse Outcomes in Overweight or Obese Patients with Acute Decompensated Heart Failure
S44 Journal of Cardiac Failure Vol. 23 No. 10S October 2017 O25-1 Hospitalization Period in AHF Patients Affects Prognosis after Discharge? Motoko Kametani, Kentaro Jujo, Yuichiro Minami, Keiko Mizobuchi, Issei Ishida, Hiromu Kadowaki, Madoka Akashi, Shintaro Haruki, Nobuhisa Hagiwara; Departement of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
lower BP and HR. Conclusion: Low HR, in addition to low SBP predict high cardiovascular mortality in AHF.
Background: Hospitalization of patients with acute heart failure (AHF) in Japan is extremely longer than that in Western countries. Longer stay is often due to social background rather than patient systemic status. Additionally, Japanese cardiologists tend to try to achieve complete restoration of decompensated HF to avoid rehospitalization and improve mortality after discharge. We aimed to evaluate the impact of hospital duration on clinical prognosis after discharge in patients with AHF. Methods and Results: This study included 1,070 consecutive patients who were urgently hospitalized due to AHF and discharged alive between 2013 and 2017. They were divided into 2 groups depending on a median hospital stay of enrolled patients (18.5 days); the Longer stay (n = 533) and Shorter stay group (n = 539). The primary endpoint was a combination of death from any cause and readmission due to worsening of HF. The Longer group had significantly higher BNP, lower cardiac function and poorer renal function, and were treated with higher dose of daily furosemide than Shorter group at baseline. After propensity score matching, during 275 days of median follow-up period, KaplanMeier analysis did not show a significant difference in the incidence of primary endpoint between the Shorter and Longer stay groups (n = 239 e.a., Log-rank: P = .97). Conclusions: Longer hospital stay did not achieve better clinical outcomes in patients with AHF after discharge alive.
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O25-2
Blood Urea Nitrogen Is a Predictor of Adverse Outcomes in Overweight or Obese Patients with Acute Decompensated Heart Failure Yoichi Iwasaki, Yoshifumi Takata, Yuki Itou, Tasuku Yamaguchi, Masataka Watanabe, Taishirou Chikamori; The Department of Cardiology, Tokyo Medical University, Tokyo, Japan
The Impact of Early Readmission on Subsequent Long-term Clinical Outcomes in Patients Hospitalized for Acute Heart Failure Hiroki Kitakata1, Takashi Kohno1, Shun Kohsaka1, Yasuyuki Shiraishi1, Ryoma Fukuoka1, Yuji Nagatomo2, Ayumi Goda3, Atsushi Mizuno4, Tsutomu Yoshikawa2, Keiichi Fukuda1,5; 1Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; 2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; 3 Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan; 4 Department of Cardiology, St. Lukes International Hospital, Tokyo, Japan; 5Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan Background: Heart failure is characterized by high mortality and frequent rehospitalization, and is one of the leading cause for early-discharge readmission. Here, we investigated the impact of short-term HF readmission on subsequent long-term outcomes in patients hospitalized for acute decompensated heart failure (ADHF). Methods and Results: We analyzed the data from 2330 consecutive ADHF patients, who were registered in the West Tokyo Heart Failure (WET-HF) registry and could be followed 90 days after discharge from index hospitalization (38.1% female; median 75 yeast old). During the 0–90 days after discharge, 237 patients [10.2%] had HF readmission, which was defined as early readmission. During 91–730 days of follow-up after discharge, patients with early readmission had higher subsequent all cause death than those without after adjustment for known predictors (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.44 to 2.34). Among the patients with early readmission, older age (HR 1.05, 95% CI 1.02 to 1.07) and lower ejection fraction (HR 0.98, 95% CI 0.96 to 0.99) was associated with subsequent all-cause death. Conclusions: Early readmission after discharge was associated with increased risk of subsequent all-cause mortality in ADHF patients. Among the early readmission patients, age and LV function are independent determinants of worse clinical outcomes. These findings suggest that these vulnerable subgroups should be managed cautiously after discharge.
O25-3 Low Heart Rate in Combination with Low Blood Pressure at Initial Presentation Predicts High Mortality in Acute Heart Failure Patients Masaru Hiki1, Hiroshi Iwata1, Shoichiro Yatsu1, Azusa Murata1, Hiroki Matsumoto1,2, Takao Kato1, Shoko Suda1,2, Kiyoshi Takasu1, Takatoshi Kasai1,2, Hiroyuki Daida1; 1 Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan; 2Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan Introduction: Despite its high prevalence and clinical significance, characterization of acute heart failure (AHF) has not been fully addressed. Thus this study aimed to evaluate prognostic impact of physiological parameters, systolic blood pressure (SBP) and heart rate (HR), in AHF patients. Methods and Results: Consecutive 535 patients diagnosed as AHF were studied. Kaplan-Meier analysis when participants were divided into four subgroups by with or without elevated SBP (>or ≤140 mmHg) and HR (>94 or ≤94 bpm) showed highest incidence of cardiovascular death in patients with low systolic BP and low HR. Categorical hazard ratios by multivariate Cox hazard analysis showed significantly high risk for cardiovascular death in the subgroup having
Background: Elevated blood urea nitrogen (BUN) has been shown to be closely related not only to renal dysfunction but also neurohumoral activation in heart failure (HF), and also reported to predict poor in-hospital and longterm outcomes in HF patients. In obese HF patients who have relatively lower BNP levels and higher neurohumoral activation, BUN may be greater significance. Methods and Results: We enrolled 53 overweight or obese patients with acute decompensated HF. (body mass index >25 kg/ dL/m2 at discharge). They were divided into 2 groups according to BUN at discharge (groupL; BUN < 25 mg/dL n = 37, groupH; BUN >25 mg/dL n = 16). The composite endpoints were all cause death and re-hospitalization for HF were compared between the groups. GroupH had significantly higher older age, lower hemoglobin levels at discharge. During a median follow-up period of 438 ± 408 days after discharge, the KaplanMeier curve showed groupH had worse prognosis compared with groupL (Log-lank test P < .001) Multivariate analysis showed that BUN at discharge was a predictor of the composite endpoints. (hazard ratio, 1.25; 95% confidence interval, 1.03 to 1.52; P < .03) independent of other parameter of renal function. Conclusion: In overweight or obese patients with acute decompensated HF, BUN at discharge may be a useful predictor for adverse outcomes.
O26-1 Initial Hemoconcentration during Hospitalization Is a Prognostic Factor in Patients with Cardiac Type Acute Heart Failure Soichiro Aoki1, Takahiro Okumura2, Akinori Sawamura2, Ryota Morimoto2, Masaki Sakakibara3, Toyoaki Murohara2; 1Department of Cardiology, Aoki Naika Clinic, Kuwana, Japan; 2Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; 3Department of Cardiology, Handa City Hospital, Handa, Japan Introduction: Hemoconcentration (HC) is an important index for decongestion and has been proposed as a prognostic factor in heart failure (HF) patients. We investigated the importance of initial HC during hospitalization focused on the difference between cardiac type HF and vascular type HF. Methods: We enrolled 209 consecutive acute decompensated HF inpatients classified as Nohria/Stevenson wet&warm (78 years, 118 females). HC was defined as the elevation of hemoglobin after initial 3 days therapy. Vascular type of HF was simply defined as systolic blood pressure ≥140 mmHg at initial visit and Cardiac type as 90–140 mmHg. All patients were divided into 4 groups: Vascular type with HC (n = 62), Vascular type without HC (n = 63), Cardiac type with HC (n = 40) and Cardiac type without HC (n = 44). All patients were followed up to 180 days. Cardiac-event was defined as cardiac death and re-hospitalization for worsening heart failure. Results: The mean of ejection fraction was 43% and plasma brain natriuretic peptide level was 1,132 pg/mL. In Kaplan-Meier survival analysis, the cardiacevent rate in Cardiac type without HC was significantly higher than that in any other groups (Log-rank P = .001). Adjusted multivariate analysis identified Cardiac type without HC as an independent predictor of cardiac-events (HR: 2.43; 95%CI: 1.36–4.38; P = .003). Conclusion: Initial HC during hospitalization is a prognostic factor in cardiac type acute HF patients.
lower BP and HR. Conclusion: Low HR, in addition to low SBP predict high cardiovascular mortality in AHF.
Background: Hospitalization of patients with acute heart failure (AHF) in Japan is extremely longer than that in Western countries. Longer stay is often due to social background rather than patient systemic status. Additionally, Japanese cardiologists tend to try to achieve complete restoration of decompensated HF to avoid rehospitalization and improve mortality after discharge. We aimed to evaluate the impact of hospital duration on clinical prognosis after discharge in patients with AHF. Methods and Results: This study included 1,070 consecutive patients who were urgently hospitalized due to AHF and discharged alive between 2013 and 2017. They were divided into 2 groups depending on a median hospital stay of enrolled patients (18.5 days); the Longer stay (n = 533) and Shorter stay group (n = 539). The primary endpoint was a combination of death from any cause and readmission due to worsening of HF. The Longer group had significantly higher BNP, lower cardiac function and poorer renal function, and were treated with higher dose of daily furosemide than Shorter group at baseline. After propensity score matching, during 275 days of median follow-up period, KaplanMeier analysis did not show a significant difference in the incidence of primary endpoint between the Shorter and Longer stay groups (n = 239 e.a., Log-rank: P = .97). Conclusions: Longer hospital stay did not achieve better clinical outcomes in patients with AHF after discharge alive.
O25-4
O25-2
Blood Urea Nitrogen Is a Predictor of Adverse Outcomes in Overweight or Obese Patients with Acute Decompensated Heart Failure Yoichi Iwasaki, Yoshifumi Takata, Yuki Itou, Tasuku Yamaguchi, Masataka Watanabe, Taishirou Chikamori; The Department of Cardiology, Tokyo Medical University, Tokyo, Japan
The Impact of Early Readmission on Subsequent Long-term Clinical Outcomes in Patients Hospitalized for Acute Heart Failure Hiroki Kitakata1, Takashi Kohno1, Shun Kohsaka1, Yasuyuki Shiraishi1, Ryoma Fukuoka1, Yuji Nagatomo2, Ayumi Goda3, Atsushi Mizuno4, Tsutomu Yoshikawa2, Keiichi Fukuda1,5; 1Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; 2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; 3 Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan; 4 Department of Cardiology, St. Lukes International Hospital, Tokyo, Japan; 5Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan Background: Heart failure is characterized by high mortality and frequent rehospitalization, and is one of the leading cause for early-discharge readmission. Here, we investigated the impact of short-term HF readmission on subsequent long-term outcomes in patients hospitalized for acute decompensated heart failure (ADHF). Methods and Results: We analyzed the data from 2330 consecutive ADHF patients, who were registered in the West Tokyo Heart Failure (WET-HF) registry and could be followed 90 days after discharge from index hospitalization (38.1% female; median 75 yeast old). During the 0–90 days after discharge, 237 patients [10.2%] had HF readmission, which was defined as early readmission. During 91–730 days of follow-up after discharge, patients with early readmission had higher subsequent all cause death than those without after adjustment for known predictors (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.44 to 2.34). Among the patients with early readmission, older age (HR 1.05, 95% CI 1.02 to 1.07) and lower ejection fraction (HR 0.98, 95% CI 0.96 to 0.99) was associated with subsequent all-cause death. Conclusions: Early readmission after discharge was associated with increased risk of subsequent all-cause mortality in ADHF patients. Among the early readmission patients, age and LV function are independent determinants of worse clinical outcomes. These findings suggest that these vulnerable subgroups should be managed cautiously after discharge.
O25-3 Low Heart Rate in Combination with Low Blood Pressure at Initial Presentation Predicts High Mortality in Acute Heart Failure Patients Masaru Hiki1, Hiroshi Iwata1, Shoichiro Yatsu1, Azusa Murata1, Hiroki Matsumoto1,2, Takao Kato1, Shoko Suda1,2, Kiyoshi Takasu1, Takatoshi Kasai1,2, Hiroyuki Daida1; 1 Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan; 2Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan Introduction: Despite its high prevalence and clinical significance, characterization of acute heart failure (AHF) has not been fully addressed. Thus this study aimed to evaluate prognostic impact of physiological parameters, systolic blood pressure (SBP) and heart rate (HR), in AHF patients. Methods and Results: Consecutive 535 patients diagnosed as AHF were studied. Kaplan-Meier analysis when participants were divided into four subgroups by with or without elevated SBP (>or ≤140 mmHg) and HR (>94 or ≤94 bpm) showed highest incidence of cardiovascular death in patients with low systolic BP and low HR. Categorical hazard ratios by multivariate Cox hazard analysis showed significantly high risk for cardiovascular death in the subgroup having
Background: Elevated blood urea nitrogen (BUN) has been shown to be closely related not only to renal dysfunction but also neurohumoral activation in heart failure (HF), and also reported to predict poor in-hospital and longterm outcomes in HF patients. In obese HF patients who have relatively lower BNP levels and higher neurohumoral activation, BUN may be greater significance. Methods and Results: We enrolled 53 overweight or obese patients with acute decompensated HF. (body mass index >25 kg/ dL/m2 at discharge). They were divided into 2 groups according to BUN at discharge (groupL; BUN < 25 mg/dL n = 37, groupH; BUN >25 mg/dL n = 16). The composite endpoints were all cause death and re-hospitalization for HF were compared between the groups. GroupH had significantly higher older age, lower hemoglobin levels at discharge. During a median follow-up period of 438 ± 408 days after discharge, the KaplanMeier curve showed groupH had worse prognosis compared with groupL (Log-lank test P < .001) Multivariate analysis showed that BUN at discharge was a predictor of the composite endpoints. (hazard ratio, 1.25; 95% confidence interval, 1.03 to 1.52; P < .03) independent of other parameter of renal function. Conclusion: In overweight or obese patients with acute decompensated HF, BUN at discharge may be a useful predictor for adverse outcomes.
O26-1 Initial Hemoconcentration during Hospitalization Is a Prognostic Factor in Patients with Cardiac Type Acute Heart Failure Soichiro Aoki1, Takahiro Okumura2, Akinori Sawamura2, Ryota Morimoto2, Masaki Sakakibara3, Toyoaki Murohara2; 1Department of Cardiology, Aoki Naika Clinic, Kuwana, Japan; 2Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; 3Department of Cardiology, Handa City Hospital, Handa, Japan Introduction: Hemoconcentration (HC) is an important index for decongestion and has been proposed as a prognostic factor in heart failure (HF) patients. We investigated the importance of initial HC during hospitalization focused on the difference between cardiac type HF and vascular type HF. Methods: We enrolled 209 consecutive acute decompensated HF inpatients classified as Nohria/Stevenson wet&warm (78 years, 118 females). HC was defined as the elevation of hemoglobin after initial 3 days therapy. Vascular type of HF was simply defined as systolic blood pressure ≥140 mmHg at initial visit and Cardiac type as 90–140 mmHg. All patients were divided into 4 groups: Vascular type with HC (n = 62), Vascular type without HC (n = 63), Cardiac type with HC (n = 40) and Cardiac type without HC (n = 44). All patients were followed up to 180 days. Cardiac-event was defined as cardiac death and re-hospitalization for worsening heart failure. Results: The mean of ejection fraction was 43% and plasma brain natriuretic peptide level was 1,132 pg/mL. In Kaplan-Meier survival analysis, the cardiacevent rate in Cardiac type without HC was significantly higher than that in any other groups (Log-rank P = .001). Adjusted multivariate analysis identified Cardiac type without HC as an independent predictor of cardiac-events (HR: 2.43; 95%CI: 1.36–4.38; P = .003). Conclusion: Initial HC during hospitalization is a prognostic factor in cardiac type acute HF patients.