Misdiagnosis of Sepsis in Patients with Acutely Decompensated Heart Failure. Real World Outcomes

S150 Journal of Cardiac Failure Vol. 25 No. 8S August 2019 worsened PAH was identified in 83 (13.1%) cases. In the dasatinib PAH group (n=75, 90.4% of all PAH), mean age was 54.95 years and there were 45 (60%) women. In the nilotinib PAH group (n=3, 6% of all PAH), mean age was 69 years and there was 1 (33%) woman. In the imatinib PAH group (n=5, 3.6% of all PAH), mean age was 49.6 years and there were 3 (60%) women. Conclusions: Patients treated with TKIs, especially dasatinib, may develop PAH while the incidence of PAH with nilotinib and imatinib appears to be low. Further research is warranted to cover the gap of screening guidelines, which challenges the detection of CML patients treated with TKIs who develop PAH. As comparable outcomes are reported with first line therapy, in patients at risk for PAH, clinicians can opt for the therapy with decreased association with the syndrome.

415 Misdiagnosis of Sepsis in Patients with Acutely Decompensated Heart Failure. Real World Outcomes Jesus E. Pino, Fergie J. Ramos Tuarez, Jorge E. Saona, Kai Chen, Endri Ceka, Julio Grajeda Chavez, Andres Chacon Martinez, Charles Bornmann, Pedro Torres, Robert Chait; University of Miami/ JFK Medical Center, West Palm Beach, FL Introduction: Acutely decompensated heart failure (ADHF) is a complex clinical syndrome that has a heterogeneous presentation often mimicked by multiple conditions, including sepsis. There is limited data on the prevalence and factors associated with sepsis misdiagnoses in patients experiencing ADHF. Methods: This is a retrospective cohort study of patients admitted to tertiary cardiovascular center with a primary diagnosis of sepsis and heart failure (chronic or newly diagnosed) between January 2015 and December 2018. Primary outcomes include the prevalence of sepsis misdiagnosis in patients with ADHF. Secondary outcomes include analysis of factors associated with sepsis misdiagnoses in patients with ADHF. Results: A total of 974 patients with a diagnosis of sepsis and a history of heart failure (HF) or newly diagnosed HF admitted to our institution between January 2015, and December 2018 were included in the study. Out of the 974 patients, 536 were male with a mean age of 75§14. Sepsis was misdiagnosed in 246/974 patients with ADHF. Current clinical and laboratory criteria used to diagnose sepsis and classify its severity (i.e., tachycardia, tachypnea, leukocytosis, organ dysfunction [i.e., elevated BUN, creatinine, lactic acidosis]) were significantly abnormal in both groups (Sepsis and no-sepsis [ADHF] patients. See table for baseline characteristics. All patients (974) received early sepsis-goal directed therapy including intravenous fluid administration. Conclusions: This study suggests that standard clinical and laboratory criteria use to diagnose and classified sepsis are present in patients with ADHF. Sepsis can be misdiagnosed in up to 25% of the patients with ADHF, carrying a significant treatment consequence such as aggressive fluid administration. Further studies are recommended to test this hypothesis.

characteristics predict ARNI-mediated improvements in left ventricular function (EF). Methods: Our cohort included 131 patients prescribed ARNI who had serial assessments of EF derived from 2D echocardiography at a community-based practice, Franciscan Health Indianapolis, from July 2016 to April 2018. Baseline patient characteristics predicting improvements in EF were assessed using univariate analysis. For continuous variables, logistic regression was used to determine predictors of EF improvement. Results: Mean absolute EF improvement for the cohort was 6.7%. Presence of non-ischemic cardiomyopathy (NICM) vs ischemic cardiomyopathy (ICM) and absence of coronary artery disease (CAD) vs CAD were predictors of significant improvements in EF (3.5% vs 9.2%, p=0.003; and 4.6% vs 9.8%, p=0.009, respectively), while initiation of intermediate-dose vs low-dose ARNI and black vs caucasian trended toward significance (p=0.059 and 0.113, respectively) (see Table). No significant differences between NICM and ICM patients were observed with respect to baseline diastolic blood pressure (DBP), baseline EF, ARNI/beta-blocker dosing, duration of ARNI exposure, or presence of biventricular implantable defibrillator. Furthermore, higher baseline DBP (p=0.036) and lower baseline EF (p=0.0006) correlated with greater improvements in EF on ARNI. Conclusions: In this retrospective cohort of HFrEF patients treated with ARNI, we observed greater improvements in EF in patients with a non-ischemic etiology as well as lower baseline EF and higher DBP. Interestingly, despite very low numbers of black patients, the largest absolute mean EF increase occurred in this group. Future studies exploring the mechanistic underpinnings for these findings and validation in a larger cohort are warranted.

417 Pulmonary Hypertension is Associated with Higher In-Hospital Mortality in Patients with Hypertrophic Cardiomyopathy Nosheen Reza, Nadim Mahmud, Anjali T. Owens; University of Pennsylvania, Philadelphia, PA

416 Predictors of Left Ventricular Function Improvement in Patients Prescribed Sacubitril/Valsartan in a Tertiary-Care Community-Based Heart Failure Cohort Vijay U. Rao, Varun Dobariya, Keem Patel, Kathy Kioussopoulos, Susan Nicoson, Ashley Titus, Teresa Stickford, Atul R. Chugh; Franciscan Health, Indianapolis, Indianapolis, IN Introduction: Sacubitril/valsartan (ARNI) effects on outcome and quality of life in patients with HFrEF are well established. Limited data exist regarding which patient

Background: Little is known regarding the characteristics and outcomes of patients with hypertrophic cardiomyopathy (HCM) and concomitant pulmonary hypertension (PHTN). Existing data is limited to small retrospective cohort studies performed at single centers with considerable HCM experience. In this study, we characterize the incidence and impact of PHTN in HCM patients in the United States. Methods: We performed a retrospective cohort study using the Nationwide/National Inpatient Sample between 2005 and 2014. HCM and PHTN were identified using International Classification of Diseases (ICD)-9 codes. Patients under age 18 were excluded. Demographics, primary payer, hospital length of stay, hospital admission category, hospital region, bed size, location/ teaching status, charges, and in-hospital death were collected. We performed univariate and multivariable modeling to find factors associated with mortality in hospitalized HCM patients. Results: We identified 117,650 patients with hospital admissions for HCM from 2005 to 2014; 14,895 (12.7%) of these patients had concomitant PHTN. The median age of admitted patients with PHTN was higher than those without PHTN (73 years v. 68 years, p <0.001). More women with HCM and PHTN were admitted than with HCM alone (70.0% v. 56.5%, p <0.001). Median length of stay was longer for patients with PHTN (5 days [IQR 3-8] v. 4 days [IQR 2-7]). Patients without PHTN accounted for more elective admissions (18.9% v. 15.3%, p <0.001). There were no differences between the two cohorts with regard to hospital bed size or location/teaching status. In-hospital mortality (5.0% v. 2.8%, p <0.001) and median hospital charges ($34,012 [IQR 17,618 - 74,736] v. $29,235 [IQR 14,898 - 62,386]) were higher for patients with PHTN. In adjusted analysis, the odds (OR) of in-hospital death were significantly higher in patients with PHTN (OR 1.57, 95% CI [1.30 - 1.89]). Increasing age and longer length of stay were also associated with higher odds of in-hospital mortality. Conclusions: In the largest contemporary study of hospitalized patients with HCM and PHTN, we found that patients admitted to U.S. hospitals with HCM and PHTN have a 1.5-