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Hemodynamic Monitoring in Patients with Heart Failure Improves NYHA Class and 6-Minute Walk Test
The 20th Annual Scientific Meeting
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HFSA
S101
of Glasgow, Glasgow, United Kingdom; 6University of Alberta, Edmonton, Alberta, Canada; 7University of Gothenburg, Goteborg, Sweden Aims: Heart failure (HF) can be associated with a higher resting heart rate (HR) and an elevated HR is associated with adverse long-term events. However, the mechanistic and causal role of HR in HF is unclear. This study aimed to investigate changes in HR during hospitalization, and the association between discharge HR and clinical outcomes as well as an interaction with beta-blocker therapy in patients with acute decompensated HF (ADHF). Methods and Results: We studied 2906 patients with a left ventricular ejection fraction (LVEF) ≤ 35%, without atrial fibrillation, who were enrolled in the ASCEND-HF trial. A total of 2492 (85.8%) patients had a HR ≥70 bpm at baseline and 1580 (54.4%) patients were on beta-blocker treatment. Although HR was gradually reduced from baseline to discharge (85.4 ± 15.6 bpm at baseline, 81.5 ± 14.1 bpm at 24 hours from treatment initiation and 79.0 ± 12.1 bpm at discharge), 80.2% of the patients still had a HR ≥70 bpm at discharge. Patients with a HR ≥70 bpm at discharge had significantly lower survival rates than those with a HR <70 bpm (adjusted hazard ratio: 1.64, 95% confidential interval 1.08 to 2.59, P = .02). Moreover, HR at discharge had a curvilinear association with mortality, and had no significant interaction effect with beta-blocker therapy at discharge (P = .82). Conclusions: Despite current beta-blocker therapy, many patients with hospitalized ADHF with reduced LVEF have relatively higher discharge HR, and discharge HR was associated with higher mortality. Further studies are warranted to determine the optimal strategy for HR control to improve outcomes.
293 Hemodynamic Monitoring in Patients with Heart Failure Improves NYHA Class and 6-Minute Walk Test Haider Nazeer, Rita Jermyn; Northwell Health, Manhasset, New York Background: In clinical practice, the efficacy of treatments for advanced heart failure is often assessed by clinical status such as blood pressure, weight, and lab values. However, from the patient perspective quality-of-life-related parameters, such as functional capacity, may subjectively be more important to the patient. We hypothesized patients implanted with a pulmonary artery pressure monitor would report better quality of life scores as reported on the Minnesota Living with Heart Failure Questionnaire and objectively demonstrate improved 6 minute walk testing over three months. Methods: 61 patients with New York Heart Association (NYHA) class III heart failure were prospectively followed over a period of 90 days at a single center medical heart failure program. 32 of these patients underwent implantation of a wireless implantable hemodynamic monitoring system, the remainder of the patient population, sans device, represented our control group, monitored by symptoms/weight. Baseline NYHA class and 6 minute walk test distance were recorded. Clinicians reassessed patients at 30 days and 90 days respectively. The primary efficacy endpoints were change in NYHA class and 6-minute walk test measured in meters over the course of 90 days. Results: Among patients being hemodynamically monitored (n = 32) 61.8% showed at least 1 class NYHA improvement, compared to 12.5% of the unmonitored (n = 29) control group (P < .0001). 11.8 % of the patients in the hemodynamically monitored group achieved 2 class NYHA improvement, with 0% of the control group exhibiting such improvement (Fig. 1). The mean improvement in 6-minute walk distance (meters) at day 90 in the hemodynamically monitored group was 107.7 meters vs. 13.0 meters in the control group (P < .025) (Fig. 2). Conclusions: Our results support that pulmonary artery pressure monitoring over the use of traditional signs and symptoms of congestion improve both NYHA class and mean six-minute walk distance in a statistically significant manner. The addition of pulmonary artery pressure readings to a cardiologists clinical gestalt allows for improved heart failure symptom control.
294 Performance of MAGGIC Score in African Americans Compared to Whites Ryhm Radjef, Alexander Michaels, Ed Peterson, Ruicong She, Bin Liu, Keoki Williams, Hani Sabbah, David Lanfear; Henry Ford Hospital, Detroit, Michigan Background: Risk stratification is critical in Heart Failure (HF) care. The MAGGIC score is a validated tool derived from a large multi-study cohort of nearly 40,000 but very few of the patients self-identified as Black or of African Ancestry (less than 400). There is little data assessing MAGGIC score utility in African Americans (AA). Methods: This single center study analyzed a total of 4264 patients from 2 cohorts; one utilizing administrative data from hospital discharges for HF (January 1st, 2014 through July 30th, 2015, n = 2503) and a prospective registry of ambulatory HF patients (n = 1761), both based in southeast Michigan. Baseline characteristics were collected to tabulate MAGGIC score and test its risk stratification in selfidentified African Americans (AA) and whites. The primary endpoint was time to all-cause mortality. Death was detected using system records and the social security death master file. Cox models with MAGGIC score as the only variable stratified by race, and a combined model including MAGGIC, race, and MAGGIC*race were tested. P < .05 was considered significant. Results: Overall, 1748 patients (41%) were AA, and a total of 1151 (27%) patients died during follow up. MAGGIC score was strongly and similarly predictive of survival in both race groups. Among AA, each MAGGIC point carried HR of 1.12 (95%CI 1.10, 1.14; P < .001) while in whites the HR was 1.13 (95%CI 1.12, 1.14; P < .001). Formal test of interaction of MAGGIC by race was not significant (P = .153). However, there was a difference in survival by race, with African Americans showing a survival advantage (HR = 0.72, P = .001) which appears to be isolated to the highest risk subgroup (Figure). Conclusion: These data support the utility of the MAGGIC score for risk stratification in African Americans who suffer from HF. However, there may still be residual differences in outcomes between AA and whites despite overall risk adjustment, particularly in highest risk subgroup.
•
HFSA
S101
of Glasgow, Glasgow, United Kingdom; 6University of Alberta, Edmonton, Alberta, Canada; 7University of Gothenburg, Goteborg, Sweden Aims: Heart failure (HF) can be associated with a higher resting heart rate (HR) and an elevated HR is associated with adverse long-term events. However, the mechanistic and causal role of HR in HF is unclear. This study aimed to investigate changes in HR during hospitalization, and the association between discharge HR and clinical outcomes as well as an interaction with beta-blocker therapy in patients with acute decompensated HF (ADHF). Methods and Results: We studied 2906 patients with a left ventricular ejection fraction (LVEF) ≤ 35%, without atrial fibrillation, who were enrolled in the ASCEND-HF trial. A total of 2492 (85.8%) patients had a HR ≥70 bpm at baseline and 1580 (54.4%) patients were on beta-blocker treatment. Although HR was gradually reduced from baseline to discharge (85.4 ± 15.6 bpm at baseline, 81.5 ± 14.1 bpm at 24 hours from treatment initiation and 79.0 ± 12.1 bpm at discharge), 80.2% of the patients still had a HR ≥70 bpm at discharge. Patients with a HR ≥70 bpm at discharge had significantly lower survival rates than those with a HR <70 bpm (adjusted hazard ratio: 1.64, 95% confidential interval 1.08 to 2.59, P = .02). Moreover, HR at discharge had a curvilinear association with mortality, and had no significant interaction effect with beta-blocker therapy at discharge (P = .82). Conclusions: Despite current beta-blocker therapy, many patients with hospitalized ADHF with reduced LVEF have relatively higher discharge HR, and discharge HR was associated with higher mortality. Further studies are warranted to determine the optimal strategy for HR control to improve outcomes.
293 Hemodynamic Monitoring in Patients with Heart Failure Improves NYHA Class and 6-Minute Walk Test Haider Nazeer, Rita Jermyn; Northwell Health, Manhasset, New York Background: In clinical practice, the efficacy of treatments for advanced heart failure is often assessed by clinical status such as blood pressure, weight, and lab values. However, from the patient perspective quality-of-life-related parameters, such as functional capacity, may subjectively be more important to the patient. We hypothesized patients implanted with a pulmonary artery pressure monitor would report better quality of life scores as reported on the Minnesota Living with Heart Failure Questionnaire and objectively demonstrate improved 6 minute walk testing over three months. Methods: 61 patients with New York Heart Association (NYHA) class III heart failure were prospectively followed over a period of 90 days at a single center medical heart failure program. 32 of these patients underwent implantation of a wireless implantable hemodynamic monitoring system, the remainder of the patient population, sans device, represented our control group, monitored by symptoms/weight. Baseline NYHA class and 6 minute walk test distance were recorded. Clinicians reassessed patients at 30 days and 90 days respectively. The primary efficacy endpoints were change in NYHA class and 6-minute walk test measured in meters over the course of 90 days. Results: Among patients being hemodynamically monitored (n = 32) 61.8% showed at least 1 class NYHA improvement, compared to 12.5% of the unmonitored (n = 29) control group (P < .0001). 11.8 % of the patients in the hemodynamically monitored group achieved 2 class NYHA improvement, with 0% of the control group exhibiting such improvement (Fig. 1). The mean improvement in 6-minute walk distance (meters) at day 90 in the hemodynamically monitored group was 107.7 meters vs. 13.0 meters in the control group (P < .025) (Fig. 2). Conclusions: Our results support that pulmonary artery pressure monitoring over the use of traditional signs and symptoms of congestion improve both NYHA class and mean six-minute walk distance in a statistically significant manner. The addition of pulmonary artery pressure readings to a cardiologists clinical gestalt allows for improved heart failure symptom control.
294 Performance of MAGGIC Score in African Americans Compared to Whites Ryhm Radjef, Alexander Michaels, Ed Peterson, Ruicong She, Bin Liu, Keoki Williams, Hani Sabbah, David Lanfear; Henry Ford Hospital, Detroit, Michigan Background: Risk stratification is critical in Heart Failure (HF) care. The MAGGIC score is a validated tool derived from a large multi-study cohort of nearly 40,000 but very few of the patients self-identified as Black or of African Ancestry (less than 400). There is little data assessing MAGGIC score utility in African Americans (AA). Methods: This single center study analyzed a total of 4264 patients from 2 cohorts; one utilizing administrative data from hospital discharges for HF (January 1st, 2014 through July 30th, 2015, n = 2503) and a prospective registry of ambulatory HF patients (n = 1761), both based in southeast Michigan. Baseline characteristics were collected to tabulate MAGGIC score and test its risk stratification in selfidentified African Americans (AA) and whites. The primary endpoint was time to all-cause mortality. Death was detected using system records and the social security death master file. Cox models with MAGGIC score as the only variable stratified by race, and a combined model including MAGGIC, race, and MAGGIC*race were tested. P < .05 was considered significant. Results: Overall, 1748 patients (41%) were AA, and a total of 1151 (27%) patients died during follow up. MAGGIC score was strongly and similarly predictive of survival in both race groups. Among AA, each MAGGIC point carried HR of 1.12 (95%CI 1.10, 1.14; P < .001) while in whites the HR was 1.13 (95%CI 1.12, 1.14; P < .001). Formal test of interaction of MAGGIC by race was not significant (P = .153). However, there was a difference in survival by race, with African Americans showing a survival advantage (HR = 0.72, P = .001) which appears to be isolated to the highest risk subgroup (Figure). Conclusion: These data support the utility of the MAGGIC score for risk stratification in African Americans who suffer from HF. However, there may still be residual differences in outcomes between AA and whites despite overall risk adjustment, particularly in highest risk subgroup.