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Prevalence of Iron Deficiency in Heart Failure Patients
Abstracts
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227 Presentation, Precipitants and Outcomes of Heart Failure and Preserved Ejection Fraction Wang 1,2,∗ ,
N. G. Tofler 1,2
S.
Hales 3 ,
E.
Barin 2 ,
1 University
of Sydney, Sydney, Australia North Shore Hospital, Sydney, Australia 3 Ryde Hospital, Sydney, Australia 2 Royal
Background: Although heart failure with preserved ejection fraction (HFpEF) is increasingly important, it has not been as well characterised as has heart failure with reduced ejection fraction (HFrEF). The aim of this study was to compare the precipitants, presenting symptoms, and outcomes of HFpEF versus HFrEF. We also investigated the long-term outcomes in response to medical therapy. Methods: We classified 5236 patients enrolled in the Management of Cardiac Failure (MACARF) program in Northern Sydney, into HFpEF (n = 1956, 37.3%) and HFrEF (n = 3280, 62.6%) patients using a cut-off left ventricular ejection fraction of 50%. Cox proportional hazards models were used for analysis of discharge medications. Results: Compared to HFrEF, the precipitant of hospitalisation for patients with HFpEF was more commonly infection (31.3% vs. 26.3%), and less likely to be ischaemia (18.7% vs. 23.3%). Although the predominant presenting symptom for all patients was dyspnoea, HFpEF patients were more likely to present with peripheral oedema (52.6% vs. 43.4%), whilst HFrEF patients were more likely to present with paroxysmal nocturnal dyspnoea, fatigue, weight gain, nausea and angina. Mortality rates at 30-days and 1-year were similar however HFpEF patients had higher 1-year readmission rates (45.4% vs. 40.7%) due to increased non-HF readmissions (34.7% vs. 29.8%). Adjusted hazard ratios showed improved survival for HFpEF patients discharged with beta blockers (HR 0.74; 95% CI: 0.60-0.88) and statins (HR 0.68; 95% CI: 0.53-0.88). Conclusion: Our study provides insight into differences between heart failure patients with preserved and reduced ejection fraction, and provides clues for prevention of hospitalisation and improved outcome. http://dx.doi.org/10.1016/j.hlc.2017.06.228
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228 Prevalence of Iron Deficiency in Heart Failure Patients P. Roy 1,3 , A. Dashwood 1,∗ , D. Platts 1,2 , G. Javorsky 1 , W. Chan 1,2 , W. Wong 1,2 , S. McKenzie 1,2 1 The Prince Charles Hospital, Brisbane, Australia 2 School of Medicine University of Queensland, Brisbane, Australia 3 Greenslopes Private Hospital, Brisbane, Australia
Background: Iron deficiency is an independent prognostic marker in heart failure. Treating iron deficiency in heart failure patients improves functional status. The 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure defined iron deficiency in heart failure as being demonstrated if either ferritin <100 ng/ml or ferritin <300 ng/ml and transferrin saturation <20%. The prevalence of iron deficiency in an Australian heart failure population is not established. Methods: Retrospective analysis of 100 consecutive patients who presented to our Advanced Heart Failure Clinic, and had iron studies within 2 months of clinic review. Variables assessed: gender, age, ejection fraction (EF), NYHA class, ferritin, transferrin saturation, haemoglobin, estimated glomerular filtration rate (eGFR) (by modification of diet in renal disease formula). Results: Overall prevalence of iron deficiency = 53%. Population: males = 67%, females = 33%. Mean age: 59 years. Mean ferritin in females: 161.27, mean ferritin in males: 176.5. Ferritin < 100 ng/ml in 36%. Ferritin <300 ng/ml and transferrin saturation <20% in 44%. Prevalence of iron deficiency if eGFR < 60 ml/min = 33.9% (18). Rate of iron deficiency by EF: EF 41-49% = 20.75% (11) EF ≤ 40% = 41.5% (22). Mean Hb Of overall cohort = 136.04 g/L, for iron deficient = 131.47 g/L, for iron replete = 141.19 (p = 0.007). Mean NYHA in iron deficient = 2.09, in iron replete = 1.680 (p = 0.0185). Conclusion: Iron deficiency is common in patients managed within an advanced heart failure service. Evaluation and management of patients with heart failure should include routine practices to engage in systematic screening for iron deficiency. http://dx.doi.org/10.1016/j.hlc.2017.06.229 229 Prognostic Value of an Abnormal Left Ventricular Contractile Reserve; A Systematic Review S. Mirzaee ∗ , A. Nasis, J. Cameron Monash Heart, Monash Health, Melbourne, Australia Background: An abnormal left ventricular contractile reserve (LVCR) is not always related to angiographically obstructive coronary artery disease. The prognostic value of
S144
227 Presentation, Precipitants and Outcomes of Heart Failure and Preserved Ejection Fraction Wang 1,2,∗ ,
N. G. Tofler 1,2
S.
Hales 3 ,
E.
Barin 2 ,
1 University
of Sydney, Sydney, Australia North Shore Hospital, Sydney, Australia 3 Ryde Hospital, Sydney, Australia 2 Royal
Background: Although heart failure with preserved ejection fraction (HFpEF) is increasingly important, it has not been as well characterised as has heart failure with reduced ejection fraction (HFrEF). The aim of this study was to compare the precipitants, presenting symptoms, and outcomes of HFpEF versus HFrEF. We also investigated the long-term outcomes in response to medical therapy. Methods: We classified 5236 patients enrolled in the Management of Cardiac Failure (MACARF) program in Northern Sydney, into HFpEF (n = 1956, 37.3%) and HFrEF (n = 3280, 62.6%) patients using a cut-off left ventricular ejection fraction of 50%. Cox proportional hazards models were used for analysis of discharge medications. Results: Compared to HFrEF, the precipitant of hospitalisation for patients with HFpEF was more commonly infection (31.3% vs. 26.3%), and less likely to be ischaemia (18.7% vs. 23.3%). Although the predominant presenting symptom for all patients was dyspnoea, HFpEF patients were more likely to present with peripheral oedema (52.6% vs. 43.4%), whilst HFrEF patients were more likely to present with paroxysmal nocturnal dyspnoea, fatigue, weight gain, nausea and angina. Mortality rates at 30-days and 1-year were similar however HFpEF patients had higher 1-year readmission rates (45.4% vs. 40.7%) due to increased non-HF readmissions (34.7% vs. 29.8%). Adjusted hazard ratios showed improved survival for HFpEF patients discharged with beta blockers (HR 0.74; 95% CI: 0.60-0.88) and statins (HR 0.68; 95% CI: 0.53-0.88). Conclusion: Our study provides insight into differences between heart failure patients with preserved and reduced ejection fraction, and provides clues for prevention of hospitalisation and improved outcome. http://dx.doi.org/10.1016/j.hlc.2017.06.228
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228 Prevalence of Iron Deficiency in Heart Failure Patients P. Roy 1,3 , A. Dashwood 1,∗ , D. Platts 1,2 , G. Javorsky 1 , W. Chan 1,2 , W. Wong 1,2 , S. McKenzie 1,2 1 The Prince Charles Hospital, Brisbane, Australia 2 School of Medicine University of Queensland, Brisbane, Australia 3 Greenslopes Private Hospital, Brisbane, Australia
Background: Iron deficiency is an independent prognostic marker in heart failure. Treating iron deficiency in heart failure patients improves functional status. The 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure defined iron deficiency in heart failure as being demonstrated if either ferritin <100 ng/ml or ferritin <300 ng/ml and transferrin saturation <20%. The prevalence of iron deficiency in an Australian heart failure population is not established. Methods: Retrospective analysis of 100 consecutive patients who presented to our Advanced Heart Failure Clinic, and had iron studies within 2 months of clinic review. Variables assessed: gender, age, ejection fraction (EF), NYHA class, ferritin, transferrin saturation, haemoglobin, estimated glomerular filtration rate (eGFR) (by modification of diet in renal disease formula). Results: Overall prevalence of iron deficiency = 53%. Population: males = 67%, females = 33%. Mean age: 59 years. Mean ferritin in females: 161.27, mean ferritin in males: 176.5. Ferritin < 100 ng/ml in 36%. Ferritin <300 ng/ml and transferrin saturation <20% in 44%. Prevalence of iron deficiency if eGFR < 60 ml/min = 33.9% (18). Rate of iron deficiency by EF: EF 41-49% = 20.75% (11) EF ≤ 40% = 41.5% (22). Mean Hb Of overall cohort = 136.04 g/L, for iron deficient = 131.47 g/L, for iron replete = 141.19 (p = 0.007). Mean NYHA in iron deficient = 2.09, in iron replete = 1.680 (p = 0.0185). Conclusion: Iron deficiency is common in patients managed within an advanced heart failure service. Evaluation and management of patients with heart failure should include routine practices to engage in systematic screening for iron deficiency. http://dx.doi.org/10.1016/j.hlc.2017.06.229 229 Prognostic Value of an Abnormal Left Ventricular Contractile Reserve; A Systematic Review S. Mirzaee ∗ , A. Nasis, J. Cameron Monash Heart, Monash Health, Melbourne, Australia Background: An abnormal left ventricular contractile reserve (LVCR) is not always related to angiographically obstructive coronary artery disease. The prognostic value of