Prognostic Implications of Different Biochemical Parameters for Iron Deficiency Diagnosis in Heart Failure Patients

The 20th Annual Scientific Meeting Association Between KCCQ-OS Score and Change Score and Morbidity/Mortality Endpoint

Primary composite CV Death HF Hospitalization All-cause death

Adjusted

Hazard Ratio

Baseline score

Change score

Over 4 months

Per 5 point lower baseline

Increased ≥ 5 points

Decreased ≥ 5 points

1.05 (1.03–1.06, P < .001) 1.05 (1.04–1.07, P < .001) 1.05 (1.03–1.07, P < .001) 1.05 (1.03–1.06, P < .001)

0.89 (0.78–1.01, P = .08) 0.89 (0.76–1.05, P = .18) 0.88 (0.74–1.05, P = .16) 0.93 (0.80–1.08, P = .36)

1.19 (1.05–1.36, P = .008) 1.24 (1.05–1.45, P = .009) 1.28 (1.08–1.51, P = .004) 1.31 (1.14–1.52, P < .001)

•

HFSA

S93

those patients who lived at least one year past discharge, echocardiography was found to be normal in 55 patients (53.9%). Of the remaining surviving patients, 40 were found to have HFpEF (39.2%), 14 were found to have HFrEF (13.7%), and 6 were found to have RV dysfunction (5.9%). Of the 9 patients who expired within one year of discharge, echocardiography was found to be normal in 1 patient (11.1%). The remaining patients demonstrated HFpEF (55.6%), HFrEF (44.4%), and RV dysfunction (33.3%). Discussion: The combination of high mortality and rapid—though often overlooked—onset make VTE a uniquely vexing condition. The Simplified Pulmonary Embolism Severity Index (sPESI) evaluates 30-day PE outcomes including mortality, recurrent VTE, and non-fatal hemorrhage by measuring such metrics as age, cancer history, cardiopulmonary disease history, heart rate, systolic blood pressure, and oxygen saturation. Though effective in identifying low-risk patients, the positive predictive value of risk stratification models such as sPESI in the identification of high-risk patients may improve with the use of echocardiogram to evaluate for right and left heart failure.

267 Prognostic Implications of Different Biochemical Parameters for Iron Deficiency Diagnosis in Heart Failure Patients Jaqueline Rodrigues Souza Gentil, Pedro Vellosa Schwartzmann, Fabiana Marques, Marcus Vinicius Simoes; University of Sao Paulo, Ribeirao Preto, Brazil Introduction: Iron deficiency (ID) is a common comorbidity in chronic heart failure patients that can be routinely diagnosed by serum laboratorial tests showing reduced ferritin and/or transferrin saturation (TSAT) levels. However, it is not clear the impact on survival of different biochemical tests widely used for ID diagnosis. Hypothesis: We hypothesized that different laboratorial tests for ID diagnosis also implies in different prognostic values in heart failure patients. Methods: We performed a cohort study with 108 chronic and stable heart failure patients, attended in an outpatient clinic. The mean age was 59 ± 14 years, 53% were male, 31% had Chagas Disease, and 35% were NYHA functional class III/IV. The mean follow-up time was 712 ± 277 days, and the primary endponint investigated was all-cause death. We analysed biochemical levels of ferritin, serum iron, and latent iron binding capacity, which were used to estimate TSAT. Cut-off values for serum ferritin was <100 ng/dL and TSAT <20%. Combined values of ferritin and TSAT determined three metabolic states: iron depleted stores (ferritin <100 ng/dL with TSAT >20%), functional iron deficiency (TSAT <20% ferritin >100 ng/dL), and absolute iron deficiency (ferritin <100 ng/dL to TSAT <20%). Results: During the study, 31 (28.7%) deaths were reported. A univariate analysis showed a higher mortality rate in patients with serum sodium <130 mmol/L (P < .001), advanced NYHA functional class (III/IV) (P < .05), systolic blood pressure <90 mmHg (P < .01), and creatinine clearance <60 mL/min (P < .01). In the univariate analysis for ID assessments, only TSAT <20% was associated with poor survival (P < .01). On metabolic iron states investigation, functional (P < .05) and absolute iron deficiency (P < .01) were associated with worse prognosis. In a multivariate model TSAT <20% (HR 2.15 P < .005) and functional iron deficiency (TSAT <20% with ferritin >100 ng/dL) (P < .005; HR 1.81) remained independent prognostic factors. Iron depleted stores, diagnosed solely by ferritin <100 ng/dL, had no correlation with survival. Conclusions: Iron deficiency, diagnosed when TSAT parameter <20%, identified heart failure patients with higher mortality, independent of ferritin values.

268 Mortality Risk in Pulmonary Embolism with Right and Left Heart Failure at a Community Teaching Hospital Uri Goldberg, Sameera Ishtiaq, Mohamed Alibakhiet, Wazhma Nasiri, Rajat Mukherji, Madhumati Kalavar; Kingsbrook Jewish Medical Center, Brooklyn, NY Objective: Though venous thromboembolism (VTE) is thought to be underdiagnosed in the general population, roughly 900,000 people are estimated to be affected by VTE each year in the U.S. According to CDC figures, VTE accounts for roughly 60,000 to 100,000 annual deaths. Recent research has recommended the inclusion of additional metrics, such as cardiac dysfunction, to current pulmonary embolism (PE) risk stratification scores. We have sought to evaluate the mortality risk of PE in patients with right and/or left heart failure. Methods: This is an ongoing retrospective cohort study examining the mortality risk of PE with comorbid cardiac dysfunction among patients admitted to an urban community teaching hospital between January 2011 and March 2015. Radiological findings for patients who underwent computed tomography angiography (CTA) and echocardiogram were reviewed. Mortality risk was stratified by presence or absence of right ventricular (RV) dysfunction, left heart failure with reduced ejection fraction (HFrEF), and left heart failure with preserved ejection fraction (HFpEF). Results: Results of 1777 CTAs were reviewed of which 160 demonstrated a positive finding of PE: 103 women (64.4%) and 57 men (35.6%). Echocardiography was performed on 111 of the 160 patients who were found to have PE. Of the evaluated patients, 9 expired within one year of discharge (8.1%). Among

269 Clinical Effectiveness of Hydralazine-Isosorbide Dinitrate in Vha Heart Failure Patients by Ethnicity Boback Ziaeian1, Gregg C. Fonarow2, Paul Heidenreich3; 1UCLA-VA, Los Angeles, CA; 2UCLA, Los Angeles, CA; 3VA Palo Alto, Palo Alto, CA Background: Among African American patients with heart failure (HF) with reduced ejection fraction (HFrEF), the combination of hydralazine and isosorbide dinatrate (H-ISDN) in addition to usual care was found to improve quality of life, lower HF hospitalization and mortality rates in the A-HEFT randomized control trial. Few studies have evaluated the effectiveness in a real world setting. Methods: VA patients with a primary HF admission between 2007 to 2013 were screened for inclusion in an observational cohort. Inclusion criteria included African American ethnicity, left ventricular ejection fraction <40%, and received regular medications through the VA pharmacy. Patients were excluded if they had contraindications to receiving H-ISDN, a creatinine greater 2.0, or intolerance to angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB). Hazard ratios (HR) were calculated for patients who received H-ISDN 6 months prior to admission compared to those that did not receive H-ISDN using inverse probability weighting of propensity scores and a time to death analysis with 18 months of follow-up. Propensity scores were generated using patient characteristics, vitals, lab values, and hospital characteristics. Results: The final cohort included 5168 African American HF patients (age 65.19) with 15.2% treated with H-ISDN prior to index admission. After 18 months of follow-up from index admission, there were 1275 reported deaths (24.7%). The unadjusted HR was 0.88, (P = .11), adjusted HR using inverse probability weighting of propensity scores were 0.85, (P = .006). Adjusted mortality at 18 months was 22.1% for H-ISDN treatment and 25.2% for untreated (P = .009). Conclusions: H-ISDN remains underutilized in African American patients with HFrEF for unclear reasons. In this observational cohort, we find a significant mortality advantage associated with H-ISDN use in African American HFrEF patients at 18 months when adjusting for patient and hospital factors using an inverse probability weighted propensity score model.

270 Paradoxical Discordance between “Actual” and “Scheduled” Check-in Times at a Heart Failure Clinic Eiran Z. Gorodeski, David O. Taylor, Emer Joyce, W.H. Wilson Tang, Randall C. Starling, Rory Hachamovitch; Cleveland Clinic, Cleveland, OH Introduction: A 2015 Institute Of Medicine statement “Transforming Health Care Scheduling and Access: Getting to Now”, has increased concerns regarding patient wait times. Although waiting times have been widely studied, little attention has been paid to the