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One-Year Mortality among the Spectrum of Myopericardial Diseases
The 21st Annual Scientific Meeting
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HFSA
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heart failure patients. Using these tools together may be helpful in guiding patient management and appropriate transitions of care.
289 One-Year Mortality among the Spectrum of Myopericardial Diseases Saqer Alkharabsheh, Khalid Agha, Neha Gupta, Allan Klein; Cleveland Clinic, Cleveland, Ohio Background: Myopericardial diseases involve a wide spectrum of conditions ranging from “pure” pericarditis to a “pure” myocarditis. It can also be “mixed” to varying degrees with both myocardial and pericardial involvement and presents as myopericarditis (MP) or perimyocarditis (PM). Outcomes between the different groups are poorly defined in the literature; we sought to identify the one-year mortality of them. Methods: This is a retrospective single-center study. With the use of the ICD-9 code and the Cleveland Clinic pericardial disease database, we identified 71 patients with a diagnosis of PM or MP between 2003 and 2015. MP was defined as patients with a diagnosis of acute pericarditis and elevation of cardiac markers without a new onset of depressed left ventricular (LV) function by echocardiography or CMR. PM was defined as patients with a diagnosis of acute pericarditis and elevation of cardiac markers and with a new onset of depressed LV function by echocardiography or CMR. Outcomes were compared to 84 consecutive patients with a diagnosis of myocarditis and 220 consecutive patients with a diagnosis of acute pericarditis between 2011 and 2012. Results: Among the PM/MP group (n = 71, of whom 38 MP and 33 PM; mean age of 35 years; 70% male), the one-year mortality was 6% (n = 4). In the myocarditis group (n = 84; mean age of 49; 60% male), the one-year mortality was 7% (n = 6). Within the acute pericarditis group (n = 220; mean age of 55; 64% male), one-year mortality was 2% (n = 4). Using Fisher’s exact test, no significant difference was noted between the PM/ MP group and the acute pericarditis group P = .1. However, there was a significant difference between the myocarditis and the acute pericarditis groups P = .03.In the multivariate analysis, we did not identify any variable that significantly correlated with the mortality. Conclusion: Mortality outcomes of acute pericarditis remain good regardless of the myocardial involvement. Myocarditis carries a higher risk of mortality compared to acute pericarditis, hence a closer follow-up for this group may be warranted.
290 Impact of Coronary Artery Disease on Clinical Outcomes among Patients with Newly-Diagnosed Hearth Failure with Systolic Dysfunction: Is It Changing Over Time? Qi Zhao1, Li Wang2, Paul A. Kurlansky3, Jeff Schein1, Onur Baser3, Jeffrey S. Berger4; 1 Janssen Scientific Affairs LLC, Titusville, New Jersey; 2STATinMED Research, Plano, Texas; 3Columbia University, New York, New York; 4New York University, New York, New York Introduction: Coronary Artery Disease (CAD) accelerates the progression of heart failure (HF) with systolic dysfunction (SD), leading to poor prognosis and a substantial increase in morbidity and mortality. Hypothesis: New-onset HF patients with CAD had a substantial burden of all-cause mortality, myocardial infarction (MI), and ischemic stroke (IS), all of which declined over time. Methods: Medicare patients with newly diagnosed HF (≥1 inpatient or ≥2 outpatient claims ≥30 days apart) between 01JAN200731DEC2013 were included. Outcomes were assessed until death, end of follow-up, or end of data availability, whichever occurred first. HF patients (excluding atrial fibrillation) with SD, defined as ICD-9 diagnosis codes with indication of “systolic heart failure,” were stratified into two cohorts based on the presence or absence of CAD. CAD is defined as a history of documented previous CAD, coronary artery bypass grafting, or percutaneous coronary intervention. Propensity score matching (PSM) was used to achieve baseline balance for patients’ characteristics. Incidence of mortality, MI, and IS were presented by days or months (during the first year) and each year throughout the follow-up period. Results: 28,983 HF patients had SD, of whom 19,672 were in the CAD cohort, and 9,311 were in the non-CAD cohort. The CAD cohort was slightly younger (79.4 [8.2] vs. 80.2 [8.5] years) with a higher proportion of males (51.0% vs. 36.6%), whites (86.4% vs. 82.2%), prior hypertension (79.6% vs. 72.3%), hyperlipidemia (68.8% vs. 48.1%), diabetes (45.6% vs. 35.0%) and peripheral arterial disease (22.5% vs. 12.5%) when compared to the non-CAD cohort (all characteristics: P < .0001). After PSM, each cohort included 8,069 patients. During 28 months’ mean follow up, 49.5% of patients in the CAD cohort had a MI, 13.5% during the first week and 33.3% during the first year; 25.9% patients had IS, 1.6% during the first week and 12.0% during the first year [Figure]. Incidence rates of MI and IS declined over time in both cohorts. The all-cause mortality was not significantly different between the two cohorts at 1 year. Conclusion: HF patients with SD and CAD had higher incidence of MI during the 1st year. Secondary prevention for this elderly population could further reduce HF associated burden.
291 Aquapheresis for Heart Failure Treatment in a Community Hospital: Is It Effective? Sindhu Avula, Bhavna Toprani, Anupam Suneja, Marlo Leonen, Gaurav Vashishta; Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan Introduction Congestive Heart Failure(CHF) affects nearly 5 million Americans with 250,000 deaths annually. A recent RCT showed that ultrafiltration (aquapheresis) lead to fewer 90-day heart failure and cardiovascular events compared to adjustable intravenous diuretics, while causing more study product-related serious adverse events. Our study examined the introduction of aquapheresis to a community hospital. Method: This descriptive QI study compared hospitalized CHF patients who underwent aquapheresis to a group provided usual care. Patients with CHF readmission in past 90 days with estimated weight gain of 15 pounds or more, use of 2 or more diuretics, or failure of inpatient diuretics were offered aquapheresis. Average lengths of stay, total cost of treatment and readmission rates were collected. Results: Of the 35 patients, 14 underwent aquapheresis and 21 usual care. Intervention compared to routine care group had higher average length of stay of (13.9 vs 7.2 days), higher hospital cost ($11,962 vs $ 9,055), and similar readmission rate (21.42% vs 19.04%). Complications encountered in the intervention group were filter clotting requiring multiple filters and bleeding secondary to heparin used in the filter. Discussion: Aquapheresis was expensive due to requirement of multiple filters, need for involvement of sub-specialists, and longer average length of stay. Limitations of the study were limited sample size, lack of randomization, aquapheresis group being more diuretic-resistant than usual care group, and early termination of the study. Overall, in our community hospital, aquapheresis was clinically inferior to usual CHF care.
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HFSA
S105
heart failure patients. Using these tools together may be helpful in guiding patient management and appropriate transitions of care.
289 One-Year Mortality among the Spectrum of Myopericardial Diseases Saqer Alkharabsheh, Khalid Agha, Neha Gupta, Allan Klein; Cleveland Clinic, Cleveland, Ohio Background: Myopericardial diseases involve a wide spectrum of conditions ranging from “pure” pericarditis to a “pure” myocarditis. It can also be “mixed” to varying degrees with both myocardial and pericardial involvement and presents as myopericarditis (MP) or perimyocarditis (PM). Outcomes between the different groups are poorly defined in the literature; we sought to identify the one-year mortality of them. Methods: This is a retrospective single-center study. With the use of the ICD-9 code and the Cleveland Clinic pericardial disease database, we identified 71 patients with a diagnosis of PM or MP between 2003 and 2015. MP was defined as patients with a diagnosis of acute pericarditis and elevation of cardiac markers without a new onset of depressed left ventricular (LV) function by echocardiography or CMR. PM was defined as patients with a diagnosis of acute pericarditis and elevation of cardiac markers and with a new onset of depressed LV function by echocardiography or CMR. Outcomes were compared to 84 consecutive patients with a diagnosis of myocarditis and 220 consecutive patients with a diagnosis of acute pericarditis between 2011 and 2012. Results: Among the PM/MP group (n = 71, of whom 38 MP and 33 PM; mean age of 35 years; 70% male), the one-year mortality was 6% (n = 4). In the myocarditis group (n = 84; mean age of 49; 60% male), the one-year mortality was 7% (n = 6). Within the acute pericarditis group (n = 220; mean age of 55; 64% male), one-year mortality was 2% (n = 4). Using Fisher’s exact test, no significant difference was noted between the PM/ MP group and the acute pericarditis group P = .1. However, there was a significant difference between the myocarditis and the acute pericarditis groups P = .03.In the multivariate analysis, we did not identify any variable that significantly correlated with the mortality. Conclusion: Mortality outcomes of acute pericarditis remain good regardless of the myocardial involvement. Myocarditis carries a higher risk of mortality compared to acute pericarditis, hence a closer follow-up for this group may be warranted.
290 Impact of Coronary Artery Disease on Clinical Outcomes among Patients with Newly-Diagnosed Hearth Failure with Systolic Dysfunction: Is It Changing Over Time? Qi Zhao1, Li Wang2, Paul A. Kurlansky3, Jeff Schein1, Onur Baser3, Jeffrey S. Berger4; 1 Janssen Scientific Affairs LLC, Titusville, New Jersey; 2STATinMED Research, Plano, Texas; 3Columbia University, New York, New York; 4New York University, New York, New York Introduction: Coronary Artery Disease (CAD) accelerates the progression of heart failure (HF) with systolic dysfunction (SD), leading to poor prognosis and a substantial increase in morbidity and mortality. Hypothesis: New-onset HF patients with CAD had a substantial burden of all-cause mortality, myocardial infarction (MI), and ischemic stroke (IS), all of which declined over time. Methods: Medicare patients with newly diagnosed HF (≥1 inpatient or ≥2 outpatient claims ≥30 days apart) between 01JAN200731DEC2013 were included. Outcomes were assessed until death, end of follow-up, or end of data availability, whichever occurred first. HF patients (excluding atrial fibrillation) with SD, defined as ICD-9 diagnosis codes with indication of “systolic heart failure,” were stratified into two cohorts based on the presence or absence of CAD. CAD is defined as a history of documented previous CAD, coronary artery bypass grafting, or percutaneous coronary intervention. Propensity score matching (PSM) was used to achieve baseline balance for patients’ characteristics. Incidence of mortality, MI, and IS were presented by days or months (during the first year) and each year throughout the follow-up period. Results: 28,983 HF patients had SD, of whom 19,672 were in the CAD cohort, and 9,311 were in the non-CAD cohort. The CAD cohort was slightly younger (79.4 [8.2] vs. 80.2 [8.5] years) with a higher proportion of males (51.0% vs. 36.6%), whites (86.4% vs. 82.2%), prior hypertension (79.6% vs. 72.3%), hyperlipidemia (68.8% vs. 48.1%), diabetes (45.6% vs. 35.0%) and peripheral arterial disease (22.5% vs. 12.5%) when compared to the non-CAD cohort (all characteristics: P < .0001). After PSM, each cohort included 8,069 patients. During 28 months’ mean follow up, 49.5% of patients in the CAD cohort had a MI, 13.5% during the first week and 33.3% during the first year; 25.9% patients had IS, 1.6% during the first week and 12.0% during the first year [Figure]. Incidence rates of MI and IS declined over time in both cohorts. The all-cause mortality was not significantly different between the two cohorts at 1 year. Conclusion: HF patients with SD and CAD had higher incidence of MI during the 1st year. Secondary prevention for this elderly population could further reduce HF associated burden.
291 Aquapheresis for Heart Failure Treatment in a Community Hospital: Is It Effective? Sindhu Avula, Bhavna Toprani, Anupam Suneja, Marlo Leonen, Gaurav Vashishta; Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan Introduction Congestive Heart Failure(CHF) affects nearly 5 million Americans with 250,000 deaths annually. A recent RCT showed that ultrafiltration (aquapheresis) lead to fewer 90-day heart failure and cardiovascular events compared to adjustable intravenous diuretics, while causing more study product-related serious adverse events. Our study examined the introduction of aquapheresis to a community hospital. Method: This descriptive QI study compared hospitalized CHF patients who underwent aquapheresis to a group provided usual care. Patients with CHF readmission in past 90 days with estimated weight gain of 15 pounds or more, use of 2 or more diuretics, or failure of inpatient diuretics were offered aquapheresis. Average lengths of stay, total cost of treatment and readmission rates were collected. Results: Of the 35 patients, 14 underwent aquapheresis and 21 usual care. Intervention compared to routine care group had higher average length of stay of (13.9 vs 7.2 days), higher hospital cost ($11,962 vs $ 9,055), and similar readmission rate (21.42% vs 19.04%). Complications encountered in the intervention group were filter clotting requiring multiple filters and bleeding secondary to heparin used in the filter. Discussion: Aquapheresis was expensive due to requirement of multiple filters, need for involvement of sub-specialists, and longer average length of stay. Limitations of the study were limited sample size, lack of randomization, aquapheresis group being more diuretic-resistant than usual care group, and early termination of the study. Overall, in our community hospital, aquapheresis was clinically inferior to usual CHF care.