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Concomitant Atrial Fibrillation in Elderly Patients with Decompensated Heart Failure on Admission Does Not Influence Clinical Courses
S66 Journal of Cardiac Failure Vol. 23 No. 10S October 2017 derwent 6-minutes walk test and echocardiography before and after inhalation of iloprost. SpO2 at rest and minimum SpO2 during 6-minutes walk were not different before and after inhalation of iloprost. TrPG estimated by echocardiography before 6 min-walk test was 37.0 ± 2.9 mmHg, and were improved with inhaled iloprost (14.2 ± 4.6%, P < .05). TrPG immediately after 6 min-walk test were 59.4 ± 4.8 mmHg, and were improved with inhaled iloprost (16.2 ± 7.1%, P < .05). With inhaled iloprost, 6-minutes walk distance were improved in 5 of 8 patients, not changed in 2 patients, and deteriorated in 1 patient. 5 of 8 patients were continued to treat with inhaled iloprost, and 2 patients were underwent follow-up right heart catheterization and improved pulmonary hypertension. Inhaled Iloprost improved pulmonary hypertension in PAH patients with lung disease without worsening hypoxia.
mission or not. We compared clinical courses between the two groups. Results: The heart rate on admission and the ratio of non-ischemic etiology were significantly higher in the AF group. However, other parameters did not vary between the two groups. There was no significant difference in mortality and acute hospitalization by decompensated HF between the two groups. Conclusions: Concomitant AF in elderly patients with HF on admission did not influence clinical courses.
O58-1 Cognitive Function in Patients with Heart Failure is Related to Distribution of Body Water and Cardiac Diastolic Function Shutaro Futami, Joji Ishikawa, Chihiro Jubishi, Yoshiko Nemoto, Jun Tanaka, Yusuke Tsuboko, Kazuhiro Takeda, Hajime Fujimoto, Kazumasa Harada; Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan Backgrounds: Elderly patients who admitted to a hospital due to heart failure (HF) often have cognitive impairment; however, mechanisms causing cognitive impairment are unclear. Methods: We enrolled 43 patients who admitted to our hospital because of HF. We excluded patients unable to test Mini Mental State Examination (MMSE) nor walk. We evaluated echocardiography, blood test, MMSE and body composition using bioelectrical impedance analysis (Inbody S10) just before discharge. Results: Mean age was 85.1 ± 8.0 years (male 44.2%). The ejection fraction was 46.9 ± 16.2% and stroke volume was 36.5 ± 12.4 ml. The median B-type natriuretic peptide was 269.1 pg/dl. The MMSE score was 20.5 ± 5.4. MMSE score was significantly related to Age (r = −0.344, P = .032), Regular alcohol drinking habit (r = 0.437, P = .007), uric acid (r = 0.413, P = .010), and extracellular water per total body water (ECW/TBW) ratio (r = −0.437, P = .007). In stepwise regression analysis that included these covariates, MMSE score was significantly associated to ECW/TBW ratio (beta = 0.443, P = .009). However, when echocardiographic parameters of end-diastolic left ventricular volume (r = 0.327, P = .048), left atrial volume index (LAVI) (r = −0.411, P = .012), and A wave of transmitral flow (r = −0.625, P = .001)) were included to the model, MMSE score was independently related to A wave of transmitral flow (P = .001) and LAVI (P = .015). Conclusion: Cognitive function in elderly patients with HF might be affected by distribution of body water and cardiac diastolic function.
O58-2 Increased Risk of Cancer Death in Patients with Heart Failure -A Report from the CHART-2 StudyTakuya Oikawa1, Yasuhiko Sakata1, Kotaro Nochioka1, Ruri Abe1, Shintaro Kasahara1, Masayuki Sato 1 , Takashi Shiroto 1 , Jun Takahashi 1 , Satoshi Miyata 2 , Hiroaki Shimokawa 1,2 ; 1 Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; 2 Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan Background: Recent studies have reported that heart failure (HF) patients are at increased risk of developing cancer. However, these studies were all conducted with retrospective fashions or small sample sizes. Furthermore, no studies have examined the relationship between HF and cancer mortality. Methods and Results: Among 10,219 patients in our Chronic Heart Failure Registry and Analysis in the Tohoku district-2 (CHART-2) Study, we prospectively enrolled 8,843 eligible patients with HF (Stages A-D), after excluding 1,366 patients with past history of cancer and 10 without sufficient data. Mean age was 67.5 years and male accounted for 69.1%. We divided them into 2 groups; patients without HF (Stage A/B, n = 4,622), and those with current or past symptomatic HF (Stage C/D, n = 4,221). During the median follow-up of 6.5 years (52,675 person-years), the incidence of cancer death was significantly higher in patients with HF compared with those without HF (3.65 vs, 2.77%, hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.12–1.79, P = .004), which was confirmed in multiple sets of multivariable Cox proportional hazard analysis (adjusted for age and sex, HR 1.40, 95%CI 1.10–1.77, P = .005; adjusted for age, sex, body mass index, medical history, and treatment, HR 1.33, 95%CI 1.01–175, P = .04). Conclusions: These results provide the first evidence that HF patients are at increased risk of cancer death, demonstrating a new aspect of cardio-oncology.
O58-3 Concomitant Atrial Fibrillation in Elderly Patients with Decompensated Heart Failure on Admission Does Not Influence Clinical Courses Noboru Oda, Akane Tsuchiya, Arinori Takeuchi, Tasuku Higashihara, Michiaki Nagai, Eisuke Kagawa, Eiji Kunita, Shota Sasaki, Masaya Kato, Keigo Dote; Department of Cardiovascular Medicine, Hiroshima City Asa Hospital, Hiroshima, Japan Background: Atrial fibrillation (AF) is one of the risk factors of decompensated heart failure (HF). Methods: We investigated 212 patients more than 75 years old admitted to our hospital for the treatment of HF from June 2015 to July 2016. We divided the patients into two groups based on whether they presented with complicated AF on ad-
O58-4 Effects of Angiotensin-converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Prognosis of Elderly Patients with Systolic Heart Failure Yodo Tamaki, Takeshi Harita, Suguru Nishiuchi, Jiro Sakamoto, Soichiro Enomoto, Makoto Miyake, Toshihiro Tamura, Hirokazu Kondo, Chisato Izumi, Yoshihisa Nakagawa; Department of Cardiology, Tenri Hospital, Nara, Japan Background: The current guidelines recommend administration of angiotensinconverting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) in patients with systolic heart failure. However, there are limited data about the effectiveness of ACE-I and ARB in elderly patients. Methods: Among 186 patients admitted with acute decompensated heart failure between February 2015 and March 2016, 65 patients who showed left ventricular ejection fraction (LVEF) less than 40% and survived to hospital discharge were analyzed retrospectively. Results: Of 65 patients, 18 patients were 80 years old or older (Group A) and 47 patients were younger than 80 years of age (Group B). Less patients in Group A took ACE-I or ARB at discharge than patients in group B (55.6% vs. 78.7%, P = .07). In group A, patients taking ACE-I or ARB showed no difference from patients not taking ACE-I or ARB in baseline characteristics such as age, sex and LVEF. In group B, patients taking ACE-I or ARB showed better survival free from cardiac death or heart failure hospitalization 180 days after discharge (86.2% vs. 50.0%, P = .004). However, in group A, patients taking ACE-I or ARB showed comparable survival free from cardiac death or heart failure hospitalization (50.0% vs. 50.0%, P = .99). Conclusion: ACE-I or ARB might not improve the prognosis of patients with systolic heart failure who are 80 years old or older.
O59-1 Incidence of Adverse Drug Events in Hospitalized Patients with Acute Decompensated HF-insights from the KCHF Registry Neiko Ozasa1, Takao Kato1, Hidenori Yaku1, Yasutaka Inuzuka2, Yodo Tamaki3, Yukihito Sato4, Koichiro Kuwahara5, Takeshi Kitai6, Yuichi Kawase7, Takeshi Kimura1; 1 Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; 2Department of Cardiovascular Medicine, Shiga Medical Center for Adult, Shiga, Japan; 3Division of Cardiology, Tenri Hospital, Nara, Japan; 4 Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan; 5Department of Cardiovascular Medicine, Shinsyu University Graduate School of Medicine, Nagano, Japan; 6Department of Cardiology, Kobe City Medical Center General Hospital, Hyogo, Japan; 7Kurashiki Central Hospital, Okayama, Japan Background: Evaluating the prevalence and severity of adverse drug events (ADEs) in heart failure (HF) patients is highly important to provide optimal medication. However, little evidence is available to guide the inevitable polypharmacotherapy in patients with HF and multiple comorbidities. Methods: The Kyoto Congestive Heart Failure study is a physician-initiated, prospective, observational, multicenter cohort study enrolling consecutive patients who had hospital admission due to acute decompensated HF between November 2014 and March 2016 in the 19 participating hospitals in Japan. Patient demographics, past medical history, socio-economic status, laboratory, echocardiography, electrocardiogram data, data regarding drugs used for the acute management of HF as well as the medications taken at admission and discharge were collected. In addition, severe ADEs which required additional treatment during hospitalization were prospectively evaluated. Results: A total of 4,065 patients were enrolled. The median age was 80 (interquartile range [IQR], 72–86) years, 45% were women, 43% had preserved ejection fraction, 33% had coronary artery disease (CAD), 72% had history of
mission or not. We compared clinical courses between the two groups. Results: The heart rate on admission and the ratio of non-ischemic etiology were significantly higher in the AF group. However, other parameters did not vary between the two groups. There was no significant difference in mortality and acute hospitalization by decompensated HF between the two groups. Conclusions: Concomitant AF in elderly patients with HF on admission did not influence clinical courses.
O58-1 Cognitive Function in Patients with Heart Failure is Related to Distribution of Body Water and Cardiac Diastolic Function Shutaro Futami, Joji Ishikawa, Chihiro Jubishi, Yoshiko Nemoto, Jun Tanaka, Yusuke Tsuboko, Kazuhiro Takeda, Hajime Fujimoto, Kazumasa Harada; Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan Backgrounds: Elderly patients who admitted to a hospital due to heart failure (HF) often have cognitive impairment; however, mechanisms causing cognitive impairment are unclear. Methods: We enrolled 43 patients who admitted to our hospital because of HF. We excluded patients unable to test Mini Mental State Examination (MMSE) nor walk. We evaluated echocardiography, blood test, MMSE and body composition using bioelectrical impedance analysis (Inbody S10) just before discharge. Results: Mean age was 85.1 ± 8.0 years (male 44.2%). The ejection fraction was 46.9 ± 16.2% and stroke volume was 36.5 ± 12.4 ml. The median B-type natriuretic peptide was 269.1 pg/dl. The MMSE score was 20.5 ± 5.4. MMSE score was significantly related to Age (r = −0.344, P = .032), Regular alcohol drinking habit (r = 0.437, P = .007), uric acid (r = 0.413, P = .010), and extracellular water per total body water (ECW/TBW) ratio (r = −0.437, P = .007). In stepwise regression analysis that included these covariates, MMSE score was significantly associated to ECW/TBW ratio (beta = 0.443, P = .009). However, when echocardiographic parameters of end-diastolic left ventricular volume (r = 0.327, P = .048), left atrial volume index (LAVI) (r = −0.411, P = .012), and A wave of transmitral flow (r = −0.625, P = .001)) were included to the model, MMSE score was independently related to A wave of transmitral flow (P = .001) and LAVI (P = .015). Conclusion: Cognitive function in elderly patients with HF might be affected by distribution of body water and cardiac diastolic function.
O58-2 Increased Risk of Cancer Death in Patients with Heart Failure -A Report from the CHART-2 StudyTakuya Oikawa1, Yasuhiko Sakata1, Kotaro Nochioka1, Ruri Abe1, Shintaro Kasahara1, Masayuki Sato 1 , Takashi Shiroto 1 , Jun Takahashi 1 , Satoshi Miyata 2 , Hiroaki Shimokawa 1,2 ; 1 Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; 2 Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan Background: Recent studies have reported that heart failure (HF) patients are at increased risk of developing cancer. However, these studies were all conducted with retrospective fashions or small sample sizes. Furthermore, no studies have examined the relationship between HF and cancer mortality. Methods and Results: Among 10,219 patients in our Chronic Heart Failure Registry and Analysis in the Tohoku district-2 (CHART-2) Study, we prospectively enrolled 8,843 eligible patients with HF (Stages A-D), after excluding 1,366 patients with past history of cancer and 10 without sufficient data. Mean age was 67.5 years and male accounted for 69.1%. We divided them into 2 groups; patients without HF (Stage A/B, n = 4,622), and those with current or past symptomatic HF (Stage C/D, n = 4,221). During the median follow-up of 6.5 years (52,675 person-years), the incidence of cancer death was significantly higher in patients with HF compared with those without HF (3.65 vs, 2.77%, hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.12–1.79, P = .004), which was confirmed in multiple sets of multivariable Cox proportional hazard analysis (adjusted for age and sex, HR 1.40, 95%CI 1.10–1.77, P = .005; adjusted for age, sex, body mass index, medical history, and treatment, HR 1.33, 95%CI 1.01–175, P = .04). Conclusions: These results provide the first evidence that HF patients are at increased risk of cancer death, demonstrating a new aspect of cardio-oncology.
O58-3 Concomitant Atrial Fibrillation in Elderly Patients with Decompensated Heart Failure on Admission Does Not Influence Clinical Courses Noboru Oda, Akane Tsuchiya, Arinori Takeuchi, Tasuku Higashihara, Michiaki Nagai, Eisuke Kagawa, Eiji Kunita, Shota Sasaki, Masaya Kato, Keigo Dote; Department of Cardiovascular Medicine, Hiroshima City Asa Hospital, Hiroshima, Japan Background: Atrial fibrillation (AF) is one of the risk factors of decompensated heart failure (HF). Methods: We investigated 212 patients more than 75 years old admitted to our hospital for the treatment of HF from June 2015 to July 2016. We divided the patients into two groups based on whether they presented with complicated AF on ad-
O58-4 Effects of Angiotensin-converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Prognosis of Elderly Patients with Systolic Heart Failure Yodo Tamaki, Takeshi Harita, Suguru Nishiuchi, Jiro Sakamoto, Soichiro Enomoto, Makoto Miyake, Toshihiro Tamura, Hirokazu Kondo, Chisato Izumi, Yoshihisa Nakagawa; Department of Cardiology, Tenri Hospital, Nara, Japan Background: The current guidelines recommend administration of angiotensinconverting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) in patients with systolic heart failure. However, there are limited data about the effectiveness of ACE-I and ARB in elderly patients. Methods: Among 186 patients admitted with acute decompensated heart failure between February 2015 and March 2016, 65 patients who showed left ventricular ejection fraction (LVEF) less than 40% and survived to hospital discharge were analyzed retrospectively. Results: Of 65 patients, 18 patients were 80 years old or older (Group A) and 47 patients were younger than 80 years of age (Group B). Less patients in Group A took ACE-I or ARB at discharge than patients in group B (55.6% vs. 78.7%, P = .07). In group A, patients taking ACE-I or ARB showed no difference from patients not taking ACE-I or ARB in baseline characteristics such as age, sex and LVEF. In group B, patients taking ACE-I or ARB showed better survival free from cardiac death or heart failure hospitalization 180 days after discharge (86.2% vs. 50.0%, P = .004). However, in group A, patients taking ACE-I or ARB showed comparable survival free from cardiac death or heart failure hospitalization (50.0% vs. 50.0%, P = .99). Conclusion: ACE-I or ARB might not improve the prognosis of patients with systolic heart failure who are 80 years old or older.
O59-1 Incidence of Adverse Drug Events in Hospitalized Patients with Acute Decompensated HF-insights from the KCHF Registry Neiko Ozasa1, Takao Kato1, Hidenori Yaku1, Yasutaka Inuzuka2, Yodo Tamaki3, Yukihito Sato4, Koichiro Kuwahara5, Takeshi Kitai6, Yuichi Kawase7, Takeshi Kimura1; 1 Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; 2Department of Cardiovascular Medicine, Shiga Medical Center for Adult, Shiga, Japan; 3Division of Cardiology, Tenri Hospital, Nara, Japan; 4 Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan; 5Department of Cardiovascular Medicine, Shinsyu University Graduate School of Medicine, Nagano, Japan; 6Department of Cardiology, Kobe City Medical Center General Hospital, Hyogo, Japan; 7Kurashiki Central Hospital, Okayama, Japan Background: Evaluating the prevalence and severity of adverse drug events (ADEs) in heart failure (HF) patients is highly important to provide optimal medication. However, little evidence is available to guide the inevitable polypharmacotherapy in patients with HF and multiple comorbidities. Methods: The Kyoto Congestive Heart Failure study is a physician-initiated, prospective, observational, multicenter cohort study enrolling consecutive patients who had hospital admission due to acute decompensated HF between November 2014 and March 2016 in the 19 participating hospitals in Japan. Patient demographics, past medical history, socio-economic status, laboratory, echocardiography, electrocardiogram data, data regarding drugs used for the acute management of HF as well as the medications taken at admission and discharge were collected. In addition, severe ADEs which required additional treatment during hospitalization were prospectively evaluated. Results: A total of 4,065 patients were enrolled. The median age was 80 (interquartile range [IQR], 72–86) years, 45% were women, 43% had preserved ejection fraction, 33% had coronary artery disease (CAD), 72% had history of