- Email: [email protected]
O210 Risk factors for congestive heart failure in patients with chronic kidney disease: the CRIC study
ORAL ABSTRACTS
hospital, ischaemic heart disease, valvular heart disease and chronic kidney disease were all significant predictors of increased HF readmissions. Conclusion: Aboriginal HF patients despite being younger have higher readmission rates and a shorter interval to first HF readmission compared with non-Aboriginal patients. Possible contributory factors include remoteness, a higher patient comorbidity burden, inferior multidisciplinary and coordinated before care after hospital discharge and suboptimal secondary prevention. Disclosure of Interest: None Declared O208 Comparison of NZ European and NZ Maori of Patients Hospitalised for Heart Failure: New Zealand Heart Failure Registry Karthigesh (Kat) Sree Raman*1, Richard Troughton2, Mayanna Lund3, Rob Doughty4, Gerard Devlin1, New Zealand Heart Failure Registry (NZHFR) 1 Cardiology, Waikato Hospital, Hamilton, 2Cardiology, Christchurch Hospital, Christchurch, 3 Cardiology, Middlemore Hospital, 4Cardiology, Auckland Hospital, Auckland, New Zealand Introduction: Prior reviews of the New Zealand Heart Failure Registry (NZHFR) showed that NZ-Maori present at a younger age with heart failure and have higher prevalence of LV systolic dysfunction. Objectives: We aim to revisit and compare outcomes for NZ-Maori (NZM) and NZEuropeans (NZE), based on updated NZHFR data. Methods: NZHFR is a national, prospective, observational, web-based registry. All hospitals in New Zealand admitting patients with acute heart failure have been invited to participate. Results: A total of 1904 patients are enrolled from July 2006 to September 2013, and 90day follow up data is available in 90% (1705/1890). There are 446 NZM (mean-age 62 years, 69.5% males) and 1094 NZE (mean-age 79.1 years, 61% males). Hypertension and atrial fibrillation are the major aetiological factors for heart failure in both groups. Higher prevalence of severe valvular disease (24.4% vs. 19.6%, p<0.0383) and diabetes (44% vs. 29.5%, p<0.0001) in NZM group with ischemic heart disease more prevalent in NZE (22.5% vs. 12.3%, p<0.0001). Predisposing factors for hospital admission for NZM are uncontrolled hypertension (11.4% vs. 4.8%, p<0.0001) and non-compliance with medication (16.1% vs. 3.2%, p<0.0001). NZM have high prevalence of impaired left ventricular systolic function (LVEF<50%, 83.5% vs. 66.7%, P<0.0001). A higher proportion of NZM have been referred to heart failure nurse on discharge (59.4% vs. 44.8%, p<0.0001). Discharge medications and 90 days follow up as shown in table: Discharge medications
NZ European
NZ Maori
Diuretics
96.4% (1001/1037)
98.2% (426/434)
p value 0.12
Beta-blockers
76.9% (797/1037)
80.2% (348/434)
0.16
ACE-i/ARBs
78.4% (813/1037)
88.0% (382/434)
<0.0001*
Aldosterone antagonist
28.5% (296/1037)
41.0% (178/434)
<0.0001*
p value
Outcomes
NZ European
NZ Maori
Median length of stay
6 days
7 days
In-hospital mortality
5.2% (57/1094)
2.7% (12/446)
0.0298*
Mortality at 90-day follow up
13.1% (128/975)
8.1% (33/407)
0.0076*
Hospital readmission at 90-days
16.9% (165/975)
15.0% (61/407)
0.425
Compliance with treatment
87.4% (852/975)
82.6% (336/407)
0.0217*
O209 Asian Patients With Heart Failure and Ejection Fraction ‡40%: Predictors of TwoYear Mortality 2
2
2
2
Andy Neo* , Jonathan Yap , Shaw Yang Chia , Ling Ling Sim , David Sim , Chi Keong Ching Yong Loo Lin School of Medicine, National University of Singapore, 2National Heart Centre, Singapore General Hospital, Singapore, Singapore
Risk factors for congestive heart failure in patients with chronic kidney disease: the CRIC study Jiang He*1, Wei Yang2, Amanda Anderson2, Harold Feldman2, John Kusek3, Akinlolu Ojo4, Dominic Raj5, Mahboob Rahman6, Michael Shlipak7, Lee Hamm8, CRIC Investigators 1 Department of Epidemiology, Tulane University, New Orleans, 2Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, 3Kidney & Urology Branch, NIDDK, Bethesda, 4Internal Medicine, University of Michigan, Ann Arbor, 5Medicine, George Washington University, Washington DC, 6Medicine, Case Western Reserve University, Cleveland, 7Medicine, University of California, San Francisco , San Francisco, 8Internal Medicine, Tulane University, New Orleans, United States Introduction: Congestive heart failure (CHF) is common in patients with chronic kidney disease (CKD). Objectives: We studied the prospective relationship of novel cardiovascular risk factors with the event rate of CHF among 3,939 CKD patients from the Chronic Renal Insufficiency Cohort (CRIC) Study. Methods: Kidney function was assessed by estimated glomerular filtration rate (eGFR) using the CKD-EPI equation, serum cystatin C, and 24-hour urinary excretion of albumin. During an average of 3.6 years of follow up, 390 individuals were hospitalized for CHF. Results: After adjustment for age, gender, race, self-reported history of CHF and clinical site, the hazard ratio (HR, 95% CI) for CHF associated with 1 standard deviation (SD) lower eGFR (13.5 mL/min/1.73 m2) was 1.53 (1.35,1.73), 1 SD higher cystatin C (0.55 mg/L) was 1.61 (1.47,1.75), and 1 SD higher log[urine albumin (0.52 mg/24 h)] was 1.62 (1.48, 1.76), all p<0.001. When all 3 kidney function measures were simultaneously included in the model, only cystatin C (HR, 1.53, 95% CI 1.34, 1.74) and log(urine albumin) (HR 1.47, 95% CI 1.35, 1.61) were significantly associated with increased risk of CHF. These associations remained statistically significant after further adjustment for other known risk factors including education, physical activity, cigarette smoking, alcohol consumption, history of myocardial infarction and diabetes, body mass index, systolic blood pressure, HDL and LDL cholesterol. After adjustment for all above mentioned risk factors, the relationships of novel risk factors (1 SD higher) with CHF are given in the table below: p-value
Blood hemoglobin, 1.78 g/dL
0.82 (0.72, 0.94)
0.004
Hemoglobin A1c, 1.56%
1.28 (1.14, 1.43)
<0.001 0.025
Uric acid, 1.92 mg/dL
1.14 (1.02, 1.28)
Log(C-reactive protein, 0.87 mg/L)
1.12 (1.01, 1.25)
0.038
Log(Interleukin-6, 17.1 pg/mL)
1.16 (1.07, 1.26)
<0.001
Conclusion: Our study indicated that cystatin C and urine albumin are better predictors for risk of CHF compared to eGFR. Furthermore, anemia, inflammation, higher uric acid, and poor glycemic control are independent risk factors for the development of CHF among patients with CKD. Disclosure of Interest: None Declared O211
2
1
Introduction: Despite advances in care, there is a high mortality seen in patients with heart failure and left ventricular ejection fraction (LVEF) 40%. Of note, data from Asia is scarce. Objectives: Our objective is to analyse the predictors of two-year mortality in these patients. Methods: Consecutive patients admitted to 2 Asian institutions for heart failure with LVEF 40% on transthoracic echocardiogram from 1 January 2008 to 31 December 2009 were included. Clinical demographics, risk factors, laboratory and imaging results and medication history were obtained. All patients were followed-up for 2 years. Overall mortality was obtained from the national registry of deaths in our country. Results: A total of 1055 patients were included. Mean age was 72.4 (standard deviation 10.9) years old and there were 407 (39%) males. 771 (73.1%) patients were Chinese, 143 (13.6%) Malay, 123 Indian (11.7%) and 18 (1.7%) were of other ethnicities. There were 819 (77.6%) patients with LVEF 50% and 236 (22.4%) with LVEF 40-49%. Mortality at
e58
O210
HR (95% CI)
Conclusion: NZ-Maori present at a much younger age with heart failure and have increased prevalence of systolic dysfunction. They are more likely to receive evidence based care with ACEi/ARBs and aldosterone antagonists but higher compliance is noted in the NZE group. There is no difference in at 90-day readmission but NZE have higher in-hospital and 90-day mortality. Disclosure of Interest: None Declared
1
one and two years were 19.1% (n¼201) and 28.4% (n¼300) respectively. On multivariate Cox regression analysis, significant predictors of two-year mortality were prior myocardial infarction (HR 1.849; 95% CI 1.411-2.422; p<0.001), previous stroke (HR 1.377; 95% CI 1.042-1.819; p¼0.024), increased age (HR 1.017; 95% CI 1.004-1.029; p¼0.009) and increased serum creatinine (HR 1.002; 95% CI 1.001-1.003; p<0.001). Higher systolic blood pressure (HR 0.993; 95% CI 0.988-0.998; p¼0.011), higher hemoglobin levels (HR 0.899; 95% CI 0.844-0.958; p¼0.001) and use of aspirin (HR 0.763; 95% CI 0.592-0.984; p¼0.037) and warfarin (HR 0.576; 95% CI 0.382-0.868; p¼0.008) and lipid-lowering drugs (HR 0.655; 95% CI 0.511-0.839; p¼0.001) resulted in significantly less mortality. Amongst others, sex, ethnicity, use of beta-blockers and angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers had no significant effect on mortality. Conclusion: In our Asian population presenting with heart failure and LVEF 40%, twoyear mortality was 28%. Prior myocardial infarction, previous stroke, increased age and increased serum creatinine resulted in significantly higher mortality. Higher systolic blood pressure and hemoglobin levels, use of aspirin and lipid-lowering drugs resulted in significantly lower mortality. Disclosure of Interest: None Declared
Urinary Sodium and Potassium Excretion and Cardiovascular Diseases in Patients with Chronic Kidney Disease: the Chronic Renal Insufficiency Cohort study Katherine T. Mills*1, Lawrence J. Appel2, Jing Chen1,3, Patrice Delafontaine3, John Kusek4, Akinlolu Ojo5, Mahboob Rahman6, Raymond R. Townsend7, Peter Yang8, Jiang He1,3, the Chronic Renal Insufficiency Cohort (CRIC) Investigators 1 Department of Epidemiology, Tulane University, New Orleans, 2Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, 3 Department of Medicine, Tulane University, New Orleans, 4Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, NIH , Bethesda, 5Department of Internal Medicine, University of Michigan, Ann Arbor, 6Department of Medicine, Case Western Reserve University, Cleveland, 7Department of Medicine, 8Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, United States Introduction: Chronic kidney disease (CKD) patients are at an increased risk of cardiovascular disease (CVD) compared to the general population. Prior work has produced
GHEART Vol 9/1S/2014
j
March, 2014
j
ORAL/2014 WCC Orals
hospital, ischaemic heart disease, valvular heart disease and chronic kidney disease were all significant predictors of increased HF readmissions. Conclusion: Aboriginal HF patients despite being younger have higher readmission rates and a shorter interval to first HF readmission compared with non-Aboriginal patients. Possible contributory factors include remoteness, a higher patient comorbidity burden, inferior multidisciplinary and coordinated before care after hospital discharge and suboptimal secondary prevention. Disclosure of Interest: None Declared O208 Comparison of NZ European and NZ Maori of Patients Hospitalised for Heart Failure: New Zealand Heart Failure Registry Karthigesh (Kat) Sree Raman*1, Richard Troughton2, Mayanna Lund3, Rob Doughty4, Gerard Devlin1, New Zealand Heart Failure Registry (NZHFR) 1 Cardiology, Waikato Hospital, Hamilton, 2Cardiology, Christchurch Hospital, Christchurch, 3 Cardiology, Middlemore Hospital, 4Cardiology, Auckland Hospital, Auckland, New Zealand Introduction: Prior reviews of the New Zealand Heart Failure Registry (NZHFR) showed that NZ-Maori present at a younger age with heart failure and have higher prevalence of LV systolic dysfunction. Objectives: We aim to revisit and compare outcomes for NZ-Maori (NZM) and NZEuropeans (NZE), based on updated NZHFR data. Methods: NZHFR is a national, prospective, observational, web-based registry. All hospitals in New Zealand admitting patients with acute heart failure have been invited to participate. Results: A total of 1904 patients are enrolled from July 2006 to September 2013, and 90day follow up data is available in 90% (1705/1890). There are 446 NZM (mean-age 62 years, 69.5% males) and 1094 NZE (mean-age 79.1 years, 61% males). Hypertension and atrial fibrillation are the major aetiological factors for heart failure in both groups. Higher prevalence of severe valvular disease (24.4% vs. 19.6%, p<0.0383) and diabetes (44% vs. 29.5%, p<0.0001) in NZM group with ischemic heart disease more prevalent in NZE (22.5% vs. 12.3%, p<0.0001). Predisposing factors for hospital admission for NZM are uncontrolled hypertension (11.4% vs. 4.8%, p<0.0001) and non-compliance with medication (16.1% vs. 3.2%, p<0.0001). NZM have high prevalence of impaired left ventricular systolic function (LVEF<50%, 83.5% vs. 66.7%, P<0.0001). A higher proportion of NZM have been referred to heart failure nurse on discharge (59.4% vs. 44.8%, p<0.0001). Discharge medications and 90 days follow up as shown in table: Discharge medications
NZ European
NZ Maori
Diuretics
96.4% (1001/1037)
98.2% (426/434)
p value 0.12
Beta-blockers
76.9% (797/1037)
80.2% (348/434)
0.16
ACE-i/ARBs
78.4% (813/1037)
88.0% (382/434)
<0.0001*
Aldosterone antagonist
28.5% (296/1037)
41.0% (178/434)
<0.0001*
p value
Outcomes
NZ European
NZ Maori
Median length of stay
6 days
7 days
In-hospital mortality
5.2% (57/1094)
2.7% (12/446)
0.0298*
Mortality at 90-day follow up
13.1% (128/975)
8.1% (33/407)
0.0076*
Hospital readmission at 90-days
16.9% (165/975)
15.0% (61/407)
0.425
Compliance with treatment
87.4% (852/975)
82.6% (336/407)
0.0217*
O209 Asian Patients With Heart Failure and Ejection Fraction ‡40%: Predictors of TwoYear Mortality 2
2
2
2
Andy Neo* , Jonathan Yap , Shaw Yang Chia , Ling Ling Sim , David Sim , Chi Keong Ching Yong Loo Lin School of Medicine, National University of Singapore, 2National Heart Centre, Singapore General Hospital, Singapore, Singapore
Risk factors for congestive heart failure in patients with chronic kidney disease: the CRIC study Jiang He*1, Wei Yang2, Amanda Anderson2, Harold Feldman2, John Kusek3, Akinlolu Ojo4, Dominic Raj5, Mahboob Rahman6, Michael Shlipak7, Lee Hamm8, CRIC Investigators 1 Department of Epidemiology, Tulane University, New Orleans, 2Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, 3Kidney & Urology Branch, NIDDK, Bethesda, 4Internal Medicine, University of Michigan, Ann Arbor, 5Medicine, George Washington University, Washington DC, 6Medicine, Case Western Reserve University, Cleveland, 7Medicine, University of California, San Francisco , San Francisco, 8Internal Medicine, Tulane University, New Orleans, United States Introduction: Congestive heart failure (CHF) is common in patients with chronic kidney disease (CKD). Objectives: We studied the prospective relationship of novel cardiovascular risk factors with the event rate of CHF among 3,939 CKD patients from the Chronic Renal Insufficiency Cohort (CRIC) Study. Methods: Kidney function was assessed by estimated glomerular filtration rate (eGFR) using the CKD-EPI equation, serum cystatin C, and 24-hour urinary excretion of albumin. During an average of 3.6 years of follow up, 390 individuals were hospitalized for CHF. Results: After adjustment for age, gender, race, self-reported history of CHF and clinical site, the hazard ratio (HR, 95% CI) for CHF associated with 1 standard deviation (SD) lower eGFR (13.5 mL/min/1.73 m2) was 1.53 (1.35,1.73), 1 SD higher cystatin C (0.55 mg/L) was 1.61 (1.47,1.75), and 1 SD higher log[urine albumin (0.52 mg/24 h)] was 1.62 (1.48, 1.76), all p<0.001. When all 3 kidney function measures were simultaneously included in the model, only cystatin C (HR, 1.53, 95% CI 1.34, 1.74) and log(urine albumin) (HR 1.47, 95% CI 1.35, 1.61) were significantly associated with increased risk of CHF. These associations remained statistically significant after further adjustment for other known risk factors including education, physical activity, cigarette smoking, alcohol consumption, history of myocardial infarction and diabetes, body mass index, systolic blood pressure, HDL and LDL cholesterol. After adjustment for all above mentioned risk factors, the relationships of novel risk factors (1 SD higher) with CHF are given in the table below: p-value
Blood hemoglobin, 1.78 g/dL
0.82 (0.72, 0.94)
0.004
Hemoglobin A1c, 1.56%
1.28 (1.14, 1.43)
<0.001 0.025
Uric acid, 1.92 mg/dL
1.14 (1.02, 1.28)
Log(C-reactive protein, 0.87 mg/L)
1.12 (1.01, 1.25)
0.038
Log(Interleukin-6, 17.1 pg/mL)
1.16 (1.07, 1.26)
<0.001
Conclusion: Our study indicated that cystatin C and urine albumin are better predictors for risk of CHF compared to eGFR. Furthermore, anemia, inflammation, higher uric acid, and poor glycemic control are independent risk factors for the development of CHF among patients with CKD. Disclosure of Interest: None Declared O211
2
1
Introduction: Despite advances in care, there is a high mortality seen in patients with heart failure and left ventricular ejection fraction (LVEF) 40%. Of note, data from Asia is scarce. Objectives: Our objective is to analyse the predictors of two-year mortality in these patients. Methods: Consecutive patients admitted to 2 Asian institutions for heart failure with LVEF 40% on transthoracic echocardiogram from 1 January 2008 to 31 December 2009 were included. Clinical demographics, risk factors, laboratory and imaging results and medication history were obtained. All patients were followed-up for 2 years. Overall mortality was obtained from the national registry of deaths in our country. Results: A total of 1055 patients were included. Mean age was 72.4 (standard deviation 10.9) years old and there were 407 (39%) males. 771 (73.1%) patients were Chinese, 143 (13.6%) Malay, 123 Indian (11.7%) and 18 (1.7%) were of other ethnicities. There were 819 (77.6%) patients with LVEF 50% and 236 (22.4%) with LVEF 40-49%. Mortality at
e58
O210
HR (95% CI)
Conclusion: NZ-Maori present at a much younger age with heart failure and have increased prevalence of systolic dysfunction. They are more likely to receive evidence based care with ACEi/ARBs and aldosterone antagonists but higher compliance is noted in the NZE group. There is no difference in at 90-day readmission but NZE have higher in-hospital and 90-day mortality. Disclosure of Interest: None Declared
1
one and two years were 19.1% (n¼201) and 28.4% (n¼300) respectively. On multivariate Cox regression analysis, significant predictors of two-year mortality were prior myocardial infarction (HR 1.849; 95% CI 1.411-2.422; p<0.001), previous stroke (HR 1.377; 95% CI 1.042-1.819; p¼0.024), increased age (HR 1.017; 95% CI 1.004-1.029; p¼0.009) and increased serum creatinine (HR 1.002; 95% CI 1.001-1.003; p<0.001). Higher systolic blood pressure (HR 0.993; 95% CI 0.988-0.998; p¼0.011), higher hemoglobin levels (HR 0.899; 95% CI 0.844-0.958; p¼0.001) and use of aspirin (HR 0.763; 95% CI 0.592-0.984; p¼0.037) and warfarin (HR 0.576; 95% CI 0.382-0.868; p¼0.008) and lipid-lowering drugs (HR 0.655; 95% CI 0.511-0.839; p¼0.001) resulted in significantly less mortality. Amongst others, sex, ethnicity, use of beta-blockers and angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers had no significant effect on mortality. Conclusion: In our Asian population presenting with heart failure and LVEF 40%, twoyear mortality was 28%. Prior myocardial infarction, previous stroke, increased age and increased serum creatinine resulted in significantly higher mortality. Higher systolic blood pressure and hemoglobin levels, use of aspirin and lipid-lowering drugs resulted in significantly lower mortality. Disclosure of Interest: None Declared
Urinary Sodium and Potassium Excretion and Cardiovascular Diseases in Patients with Chronic Kidney Disease: the Chronic Renal Insufficiency Cohort study Katherine T. Mills*1, Lawrence J. Appel2, Jing Chen1,3, Patrice Delafontaine3, John Kusek4, Akinlolu Ojo5, Mahboob Rahman6, Raymond R. Townsend7, Peter Yang8, Jiang He1,3, the Chronic Renal Insufficiency Cohort (CRIC) Investigators 1 Department of Epidemiology, Tulane University, New Orleans, 2Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, 3 Department of Medicine, Tulane University, New Orleans, 4Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, NIH , Bethesda, 5Department of Internal Medicine, University of Michigan, Ann Arbor, 6Department of Medicine, Case Western Reserve University, Cleveland, 7Department of Medicine, 8Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, United States Introduction: Chronic kidney disease (CKD) patients are at an increased risk of cardiovascular disease (CVD) compared to the general population. Prior work has produced
GHEART Vol 9/1S/2014
j
March, 2014
j
ORAL/2014 WCC Orals