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Increased Heart Rate Responsiveness after Heart Transplant is Associated with Increased Peak Oxygen Consumption and Treadmill Time in CPET
The 23rd Annual Scientific Meeting HFSA 261 Racial Disparities in Blood Pressure Treatment and Control in US Heart Failure Patients: National Health and Nutrition Examination Surveys 1999-2016 Leah Rethy, Thanh-Huyen T. Vu, Nilay S. Shah, Mercedes Carnethon, Clyde W. Yancy, Donald M. Lloyd-Jones, Sadiya S. Khan; Northwestern University, Chicago, IL Background: Treatment and control of blood pressure (BP) may improve outcomes in patients with heart failure (HF) with preserved and reduced ejection fraction. Updated AHA/ACC/HFSA guidelines from 2017 added a recommendation to target a systolic BP less than 130mm Hg for those with Stage C HF regardless of ejection fraction (Class of recommendation I, level of evidence C). Nationally representative data regarding rates of BP treatment and control in ambulatory HF patients are needed to identify gaps in achieving this goal and determine if racial disparities exist. Hypothesis: Treatment and control rates of BP are low in those with HF and vary by race. Methods: We evaluated BP treatment and control rates in adults age 20 years who identified as non-Hispanic (NH) black, NH white, or Hispanic with self-reported HF from the National Health and Nutrition Examination Surveys (NHANES) 19992016. We determined prevalence rates of BP treatment and control by race. Control BP (for those on BP treatment) or goal BP (for those not on BP treatment) was defined as <130/80 mm Hg. Odds ratios (OR) and 95% confidence intervals (CI) of control or goal BP of NH Black and Hispanic adults compared to NH whites were calculated with adjustment for age, sex, and proxies of SES (education level, health insurance, and income). All analyses accounted for the complex-weighted sampling design of NHANES. Results: Among 1240 adults with HF, mean age was 66§0.5 years and 48% were female, 14% NH black, 9% Hispanic, and 69% were on BP treatment. Rate of BP treatment was highest in NH blacks (82%) compared with NH whites (65%) or Hispanics (55%) (p <0.001). However, the proportion of BP control among those on BP treatment was lowest among NH blacks (39%) compared with NH whites (51%) or Hispanic adults (45%). Among those not on BP treatment, there were no significant differences in rates of goal BP by race (NH blacks [41%], NH whites [53%], and Hispanics [57%]). After adjustments for age, sex, and SES, the OR (95% CI) of BP control for NH blacks on treatment was 0.62 (0.43, 0.91) compared to NH whites (TABLE). Conclusions: Despite the fact that patients with HF constitute a high-risk population, we found low rates of BP treatment and control (defined by <130/80mm Hg). There was significant discordance between rates of treatment and control among NH blacks who had the highest rates of treatment but the lowest rates of BP control while on treatment. Focused efforts are needed to achieve the BP target set by the 2017 AHA/ACC/HFSA guidelines with attention towards eliminating disparities.
262 Impact of R-hf Risk Score on All-Cause Mortality in Acute Heart Failure Patients in the Middle East Rajesh Rajan1, Mohammed Al Jarallah1, Ibrahim Al Zakwani2, Raja Dashti1, Bassam Bulbanat1, Mustafa Ridha3, Kadhim F Sulaiman4, Prashanth Panduranga4, Wael Almahmeed5, Jassim Al-Suwaidi6, Alawi Alsheikh-Ali5, Khalid F AlHabib7, Nooshin Bazargani8, Nidal Asaad9, Ahmed Al-Motarreb10, Haitham Amin11, Hussam AlFaleh12, Abdelfatah Elasfar13; 1Sabah Al Ahmad Cardiac Center, Al-Amiri Hospital, Sharq, Kuwait; 2Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman, Muscat, Oman; 3 Adan Hospital, Kuwait, Kuwait; 4Royal Hospital, Muscat, Oman; 5Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; 6Department of Cardiology, Hamad General Hospital & Weill Cornell Medical College, Doha, Qatar, Doha, Qatar; 7Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia; 8Dubai hospital, Dubai, United Arab Emirates, Dubai, United Arab Emirates; 9Department of Cardiology, Hamad General Hospital & Weill Cornell Medical College, Doha, Qatar, Doha, Saudi Arabia; 10Internal Medicine Department, Faculty of Medicine, Sana’a University, Sana’a, Yemen; 11Mohammed Bin Khalifa Cardiac Center, Manama, Bahrain, Manama, Bahrain; 12Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 13 Department of Adult Cardiology, Prince Salman Heart Center, King Fahad Medical City, PO Box 59046, Riyadh 11525, Saudi Arabia, Riyadh, Saudi Arabia Objective: The purpose of this study was to evaluate the impact of R-heart failure (R-hf) risk score on all-cause mortality in acute heart failure (AHF) patients in the Middle East. Methods: Data was analyzed from 776 consecutive patients. R-hf risk score were derived by multiplying (eGFR (mL/min), left ventricular ejection fraction (%) and hemoglobin levels (g/dL)) and then by dividing by NT proBNP (pg/ml). R-hf
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scores of <5 indicated high risk, 5-<10 indicated moderate risk, 10-<50 indicated low risk while R-hf scores of 50 indicated minimal risk. Analyses were made using univariate and multivariate logistic regression techniques. Results: The overall mean age of the cohort was 62§14 years, 63% (n=484) were males. The proportion of patients that had high, moderate, low, and minimal risk was 42% (n=324), 16% (n=127), 31% (n=242), and 11% (n=83), respectively. Adjusting for demographic and clinical characteristics as well as medications use in the multivariate logistic regression models, AHF patients with high risk (R-hf score, <5) were associated with higher 12-month all-cause mortality when compared to those with low (adjusted odds ratio (aOR), 3.10; 95% confidence interval (CI): 1.56-6.20; p=0.001) and minimal (aOR, 3.84; 95% CI: 1.23-12.0; p=0.021) risk. Conclusions: Lower R-hf risk scores (www.hfriskcalc.in) were associated with higher risk of all-cause 12-month mortality in AHF patients in the Middle East. Table. Impact of Cardiorenal Anemia Syndrome (R-hf) Scores on Mortality (at InHospital, at 3-month, and at 12-month) of the Gulf CARE Cohort.
263 Increased Heart Rate Responsiveness after Heart Transplant is Associated with Increased Peak Oxygen Consumption and Treadmill Time in CPET Robert Zhang, Thomas C. Hanff, Yuhui Zhang, Maria Molina, Rhondalyn C. McLean, Jeremy A. Mazurek, Monique Tanna, J. Eduardo Ramo, Joyce Wald, Pavan Atluri, Michael Acker, Lee R. Goldberg, Edo Y. Birati; Hospital of the University of Pennsylvania, Philadelphia, PA Introduction: Chronotropic incompetence is very common after heart transplant. The extent to which it affects the functional capacity of heart transplant patients is unknown. We hypothesize that a higher heart rate responsiveness would be associated with improved peak oxygen uptake and may have long-term prognostic impact. Methods: We performed a retrospective analysis of all patients who underwent heart transplantation and cardiopulmonary exercise testing (CPET) in the first post-transplant year at a single large academic center between the year 2000 and 2011. Peak VO2 and total exercise time were assessed by CPET. Heart rate responsiveness was defined as the difference between peak and resting heart rate during CPET. The association of heart rate responsiveness with peak VO2 and total exercise time was analyzed using multivariable linear regression, and survival analysis was performed via a cox proportional hazard model. Results: CPET was performed at our institution in 271 patients during the first year post heart transplantation at a median of 2.3 months. Subjects were 82% male, age 55 (IQR 45-61) at time of CPET. After multivariate adjustment, each ten beat/min increase in heart rate responsiveness was associated with a 0.9 ml/kg/min increase in peak oxygen consumption (p<0.001) and 35 second increase in treadmill time (p<0.001). Mortality over a median follow-up of 8 years was not predicted by early heart rate responsiveness (HR 0.99, p=0.32). Conclusions: Chronotropic incompetence after heart transplant is associated with decreased functional capacity but is not a prognostic indicator of mortality after transplant.
262 Impact of R-hf Risk Score on All-Cause Mortality in Acute Heart Failure Patients in the Middle East Rajesh Rajan1, Mohammed Al Jarallah1, Ibrahim Al Zakwani2, Raja Dashti1, Bassam Bulbanat1, Mustafa Ridha3, Kadhim F Sulaiman4, Prashanth Panduranga4, Wael Almahmeed5, Jassim Al-Suwaidi6, Alawi Alsheikh-Ali5, Khalid F AlHabib7, Nooshin Bazargani8, Nidal Asaad9, Ahmed Al-Motarreb10, Haitham Amin11, Hussam AlFaleh12, Abdelfatah Elasfar13; 1Sabah Al Ahmad Cardiac Center, Al-Amiri Hospital, Sharq, Kuwait; 2Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman, Muscat, Oman; 3 Adan Hospital, Kuwait, Kuwait; 4Royal Hospital, Muscat, Oman; 5Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; 6Department of Cardiology, Hamad General Hospital & Weill Cornell Medical College, Doha, Qatar, Doha, Qatar; 7Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia; 8Dubai hospital, Dubai, United Arab Emirates, Dubai, United Arab Emirates; 9Department of Cardiology, Hamad General Hospital & Weill Cornell Medical College, Doha, Qatar, Doha, Saudi Arabia; 10Internal Medicine Department, Faculty of Medicine, Sana’a University, Sana’a, Yemen; 11Mohammed Bin Khalifa Cardiac Center, Manama, Bahrain, Manama, Bahrain; 12Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 13 Department of Adult Cardiology, Prince Salman Heart Center, King Fahad Medical City, PO Box 59046, Riyadh 11525, Saudi Arabia, Riyadh, Saudi Arabia Objective: The purpose of this study was to evaluate the impact of R-heart failure (R-hf) risk score on all-cause mortality in acute heart failure (AHF) patients in the Middle East. Methods: Data was analyzed from 776 consecutive patients. R-hf risk score were derived by multiplying (eGFR (mL/min), left ventricular ejection fraction (%) and hemoglobin levels (g/dL)) and then by dividing by NT proBNP (pg/ml). R-hf
S97
scores of <5 indicated high risk, 5-<10 indicated moderate risk, 10-<50 indicated low risk while R-hf scores of 50 indicated minimal risk. Analyses were made using univariate and multivariate logistic regression techniques. Results: The overall mean age of the cohort was 62§14 years, 63% (n=484) were males. The proportion of patients that had high, moderate, low, and minimal risk was 42% (n=324), 16% (n=127), 31% (n=242), and 11% (n=83), respectively. Adjusting for demographic and clinical characteristics as well as medications use in the multivariate logistic regression models, AHF patients with high risk (R-hf score, <5) were associated with higher 12-month all-cause mortality when compared to those with low (adjusted odds ratio (aOR), 3.10; 95% confidence interval (CI): 1.56-6.20; p=0.001) and minimal (aOR, 3.84; 95% CI: 1.23-12.0; p=0.021) risk. Conclusions: Lower R-hf risk scores (www.hfriskcalc.in) were associated with higher risk of all-cause 12-month mortality in AHF patients in the Middle East. Table. Impact of Cardiorenal Anemia Syndrome (R-hf) Scores on Mortality (at InHospital, at 3-month, and at 12-month) of the Gulf CARE Cohort.
263 Increased Heart Rate Responsiveness after Heart Transplant is Associated with Increased Peak Oxygen Consumption and Treadmill Time in CPET Robert Zhang, Thomas C. Hanff, Yuhui Zhang, Maria Molina, Rhondalyn C. McLean, Jeremy A. Mazurek, Monique Tanna, J. Eduardo Ramo, Joyce Wald, Pavan Atluri, Michael Acker, Lee R. Goldberg, Edo Y. Birati; Hospital of the University of Pennsylvania, Philadelphia, PA Introduction: Chronotropic incompetence is very common after heart transplant. The extent to which it affects the functional capacity of heart transplant patients is unknown. We hypothesize that a higher heart rate responsiveness would be associated with improved peak oxygen uptake and may have long-term prognostic impact. Methods: We performed a retrospective analysis of all patients who underwent heart transplantation and cardiopulmonary exercise testing (CPET) in the first post-transplant year at a single large academic center between the year 2000 and 2011. Peak VO2 and total exercise time were assessed by CPET. Heart rate responsiveness was defined as the difference between peak and resting heart rate during CPET. The association of heart rate responsiveness with peak VO2 and total exercise time was analyzed using multivariable linear regression, and survival analysis was performed via a cox proportional hazard model. Results: CPET was performed at our institution in 271 patients during the first year post heart transplantation at a median of 2.3 months. Subjects were 82% male, age 55 (IQR 45-61) at time of CPET. After multivariate adjustment, each ten beat/min increase in heart rate responsiveness was associated with a 0.9 ml/kg/min increase in peak oxygen consumption (p<0.001) and 35 second increase in treadmill time (p<0.001). Mortality over a median follow-up of 8 years was not predicted by early heart rate responsiveness (HR 0.99, p=0.32). Conclusions: Chronotropic incompetence after heart transplant is associated with decreased functional capacity but is not a prognostic indicator of mortality after transplant.