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Prognostic Significance of Atrial Fibrillation in Acute Heart Failure Admissions: The New Zealand Heart Failure Registry
CSANZ 2012 Abstracts
S89
215
216
Prevalence of Heart Failure and Use of Beta-Blockers in Australian General Practice
Prevalence of Hyponatraemia in Acute Heart Failure Admissions and Short Term Outcomes: The New Zealand Heart Failure Registry
H. Krum 1,∗ , M. Best 2 , A. Tonkin 1 , C. Hayward 3 , D. Hare 4 , A. Sindone 5 , L. Valenti 6 , H. Britt 6 , D. Flanagan 7 1 Monash
University, Australia Perth Hospital, Australia 3 St Vincent’s Hospital, Sydney, Australia 4 Austin Hospital, Australia 5 Concord Hospital, Australia 6 University of Sydney, Australia 7 South Coast Medical, Blairgowrie, Australia 2 Royal
Background: Australian studies have demonstrated that beta-blockers are under-prescribed and used at suboptimal doses in patients with chronic heart failure (CHF). In this study we estimated the prevalence of CHF and aspects of beta-blocker utilisation using data from BEACH – a continuous, national, cross-sectional study of general practice activity in Australia from April 2010 to March 2011 and a SAND sub-study that collected CHF data from 2952 general practice patients from November 2010 to January 2011. Results: The prevalence of CHF in Australia was estimated as 1.9% (95% CI: 1.4–2.4%). Of general practice encounters with patients with CHF, 75.4% of patients were aged ≥75 years. The proportions of male and female patients were 48.5% and 51.5%, respectively. The proportions of patients with NYHA grading Class I, II, III and IV were 28.3%, 47.5%, 20.0% and 2.5%, respectively. Of the 123 respondents with medication data in the sub-study, 118 (95.9%) were taking medication for CHF, including 74 (60.2%) taking a beta blocker. Of the 315 listed medications for CHF, 88 (27.9%) were diuretics and 74 (23.5%) were beta blockers. Of the beta blockers, 39 (52.7%) were specifically indicated for CHF, and 13 (17.6%) were at target dose. Thus only 4.1% of the listed medications were beta blockers indicated for CHF at target dose. The most common reasons for not using a beta blocker were advanced age (57.1%), diabetes (16.3%) and renal impairment (16.3%). Conclusion: This data highlights the suboptimal use of beta blockers in CHF patients in an Australian community setting. http://dx.doi.org/10.1016/j.hlc.2012.05.225
V. Pera 1,∗ , R. Troughton 2 , M. Lund 3 , R. Doughty 4 , G. Devlin 1 1 Waikato
Hospital, Hamilton, New Zealand Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand 2 Christchurch
Background: Hyponatraemia is the most common electrolyte abnormality in hospitalised heart failure patients. We report the prevalence and prognostic significance of hyponatremia in New Zealand Heart Failure Registry (NZHFR). Methods: NZHFR is a national, prospective, observational web-based registry. We compared the short-term outcomes of hospitalised heart failure patients with hyponatraemia (p-sodium < 136 mmol/L) vs. normonatraemia (p-sodium > 136 mmol/L). Results: A total of 1609 patients were enrolled, between July 2006 and February 2012 with 90-day follow-up data available in 92% (1478/1609). 375 patients (23%) had hyponatraemia (mean p-sodium 131 ± 4) on admission compared to 1234 patients (77%) with normal sodium (mean p-sodium 140 ± 3). Patients with hyponatraemia were older (mean age 72.7 ± 15 vs. 69 ± 15, P ≤ 0.0001) with higher BNP values (median BNP 700 vs. 508, P = 0.0002). Discharge medication and outcomes are shown in the table. Discharge Medications
Hyponatraemia
Normonatraemia
Diuretics Mean Frusemide dose (mg) ACE-I/ARB’s Beta blockers Spironolactone
341/348 (99%) 148 ± 150 277/348 (80%) 256/348 (74%) 138/348 (40%)
1158/1196 (97%) 110 ± 101 980/1196 (82%) 945/1196 (79%) 360/1196 (30%)
P value 0.36 <0.0001* 0.35 0.034* 0.001*
Conclusion: Hyponatraemia in heart failure admissions is associated with prolonged hospitalisation, higher inhospital and 90 day mortality and readmission rates. http://dx.doi.org/10.1016/j.hlc.2012.05.226 217 Prognostic Significance of Atrial Fibrillation in Acute Heart Failure Admissions: The New Zealand Heart Failure Registry V. Pera 1,∗ , R. Troughton 2 , M. Lund 3 , R. Doughty 4 , G. Devlin 1 1 Waikato
Hospital, Hamilton, New Zealand Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand 2 Christchurch
Background: There is limited data available regarding the prognostic implication of atrial fibrillation (AF) in heart failure patients with preserved systolic function (HFPSF). We report our experience with the New Zealand Heart Failure Registry (NZHFR).
ABSTRACTS
Heart, Lung and Circulation 2012;21:S1–S142
S90
Heart, Lung and Circulation 2012;21:S1–S142
CSANZ 2012 Abstracts
ABSTRACTS
Methods: NZHFR is a national, prospective, observational web-based registry. We compared the short-term outcomes of patients in AF vs. sinus rhythm (SR) in hospitalised patients with HFPSF and those with impaired systolic function (HFISF). Results: A total of 1609 patients were enrolled, between July 2006 and February 2012 and 1224 with echocardiograms were included in this analysis with 90-day follow-up data available in 92% (1126/1224). Atrial fibrillation was present at baseline in 461 (51%) patients with HFISF (LVEF < 50%) and in 199 (62%) patients with HFPSF (LVEF > 50%). BNP levels were similar in both AF and SR patients (mean BNP 897 vs. 839, P = 0.47 in HFISF and 677 vs. 662, P = 0.89 in HFPSF). Outcomes are shown in the table. Outcome
AF and HFISF
SR and HFISF
P Value
AF and HFPSF
SR and HFPSF
P Value
Length of stay (mean ±SD) In-hospital mortality Mortality at 90-day F/U Re-admission at 90-day F/U
9.4 ± 8 days
8.4 ± 8
0.06
10.2 ± 10
9.1 ± 8
0.28
21/461 (5%)
10/443 (2%)
0.07
12/199 (6%)
5/121 (4%)
0.61
71/435 (15%)
43/405 (10%)
0.01*
37/183 (19%)
12/103 (10%)
0.04*
61/435 (13%)
44/405 (10%)
0.15
23/183 (12%)
7/103 (6%)
0.11
Conclusion: AF is associated with higher 90 day mortality compared to SR in both HFISF and HFPSF, but similar in-hospital mortality and readmission rates.
218 Prospectively Isolated, Hypoxic-Preconditioned Mesenchymal Stem Cells Significantly Attenuate Myocardial Infarction-Induced Ventricular Dysfunction In Rats Paton 3 ,
Frost 1,2 ,
http://dx.doi.org/10.1016/j.hlc.2012.05.228 219 Radiation Dose Received by Patients Undergoing Workup for Heart Transplantation
http://dx.doi.org/10.1016/j.hlc.2012.05.227
Richardson 1,2,3,∗ ,
was induced via surgical ligation of the left anterior descending artery in 35 Sprague-Dawley rats. Left ventricular ejection fraction (EF) was assessed by cardiac magnetic resonance prior to MI, then one and four weeks later. Allogeneic MSCs were delivered in 20 animals by trans-epicardial injection (mean dose 1.5 × 106 cells, 100 l volume) at repeat thoracotomy one week after MI. 15 control animals received injection of vehicle only. Results: MI reduced EF of the control group from 58.5 ± 1.2% to 22.1 ± 2.0% at one week, with no subsequent improvement by week 4 (19.5 ± 1.5%). In the MSC treatment group, EF also fell from 57.8 ± 1.2% to 25.1 ± 2.2%, but significantly improved to 38.8 ± 1.4% by week 4 (p < 0.001). Accordingly, EF between the groups = 19.3 ± 3.1 (p < 0.0001) at four weeks. Conclusion: An optimised allogeneic MSC population, derived via prospective isolation and hypoxic preconditioning, provides substantial improvements in left ventricular function in rats following MI. These optimisation strategies offer significant potential to improve therapeutic efficacy of stem cell therapy and require further evaluation.
Carbone 1,2 ,
S. L. A. J. A. Bertaso 1 , A. Nelson 1,2 , P. Psaltis 1,2,3 , D. Wong 1,2 , M. Worthley 1,2 , S. Gronthos 2,3 , A. Zannettino 2,3 , S. Worthley 1,2,3 1 Cardiovascular
Research Centre, Royal Adelaide Hospital, Australia 2 Department of Medicine, University of Adelaide, Adelaide, SA, Australia 3 Centre for Stem Cell Research, University of Adelaide, Adelaide, SA, Australia Background: Stem cell therapy has been advocated as a means to regenerate damaged myocardium after infarction (MI). However, only modest benefits have been observed in clinical trials thus far. Optimisation of stem cells prior to transplantation might advance therapeutic efficacy. We evaluated the impact on ventricular function of a prospectively isolated, hypoxic-conditioned mesenchymal stem cell (MSC) population in a rat model of MI. Methods: Bone marrow was recovered from donor Sprague-Dawley rats and the target cell population was prospectively isolated using a magnetic activated cell sorting CD45-depletion strategy. MSCs were subjected to hypoxic incubation (5% O2 ) during primary culture. Immunophenotype and in vitro differentiation assays confirmed their multi-lineage differentiation potential. MI
S. McKenzie 1,2,∗ , M. Brown 1,2 , D. Platts 1,2 , G. Javorsky 1 , J. Maddicks-Law 1 , M. Whitby 3 1 Advanced Heart Failure and Cardiac Transplant Unit, The Prince Charles Hospital, Australia 2 University of Queensland, Australia 3 Medical Imaging, The Prince Charles Hospital, Australia
Introduction: There is increasing concern regarding patient radiation exposure as a result of diagnostic imaging studies. To date there has been no publication of the radiation doses received by patients with end stage heart failure (ESHF) undergoing heart transplant as a result of their pre and post transplant imaging studies. Method: We performed a retrospective analysis of patients undergoing cardiac transplant assessment as identified in our institutions transplant database. All patients from January 2009 to December 2010 were included. Radiation doses were calculated using dose parameters recorded routinely by radiographic staff. Imaging studies performed from the commencement of transplant assessment until the end of the first year after heart transplantation or after transplant workup for those not transplanted were included. Results: Forty-three patients analysed, mean age 45 years, 18 female. Mean number of radiological studies = 30.5. Fifteen of 43 patients were transplanted with mean number of radiological studies 54.1 vs. 17.8 studies for those not transplanted. Sixty-six percent of all studies were chest X-rays, 11% fluoroscopy, 9% CT. Median dose was 40 msV (range 20–78 msV) which is double the recommended averaged annual occupational radiation dose.
S89
215
216
Prevalence of Heart Failure and Use of Beta-Blockers in Australian General Practice
Prevalence of Hyponatraemia in Acute Heart Failure Admissions and Short Term Outcomes: The New Zealand Heart Failure Registry
H. Krum 1,∗ , M. Best 2 , A. Tonkin 1 , C. Hayward 3 , D. Hare 4 , A. Sindone 5 , L. Valenti 6 , H. Britt 6 , D. Flanagan 7 1 Monash
University, Australia Perth Hospital, Australia 3 St Vincent’s Hospital, Sydney, Australia 4 Austin Hospital, Australia 5 Concord Hospital, Australia 6 University of Sydney, Australia 7 South Coast Medical, Blairgowrie, Australia 2 Royal
Background: Australian studies have demonstrated that beta-blockers are under-prescribed and used at suboptimal doses in patients with chronic heart failure (CHF). In this study we estimated the prevalence of CHF and aspects of beta-blocker utilisation using data from BEACH – a continuous, national, cross-sectional study of general practice activity in Australia from April 2010 to March 2011 and a SAND sub-study that collected CHF data from 2952 general practice patients from November 2010 to January 2011. Results: The prevalence of CHF in Australia was estimated as 1.9% (95% CI: 1.4–2.4%). Of general practice encounters with patients with CHF, 75.4% of patients were aged ≥75 years. The proportions of male and female patients were 48.5% and 51.5%, respectively. The proportions of patients with NYHA grading Class I, II, III and IV were 28.3%, 47.5%, 20.0% and 2.5%, respectively. Of the 123 respondents with medication data in the sub-study, 118 (95.9%) were taking medication for CHF, including 74 (60.2%) taking a beta blocker. Of the 315 listed medications for CHF, 88 (27.9%) were diuretics and 74 (23.5%) were beta blockers. Of the beta blockers, 39 (52.7%) were specifically indicated for CHF, and 13 (17.6%) were at target dose. Thus only 4.1% of the listed medications were beta blockers indicated for CHF at target dose. The most common reasons for not using a beta blocker were advanced age (57.1%), diabetes (16.3%) and renal impairment (16.3%). Conclusion: This data highlights the suboptimal use of beta blockers in CHF patients in an Australian community setting. http://dx.doi.org/10.1016/j.hlc.2012.05.225
V. Pera 1,∗ , R. Troughton 2 , M. Lund 3 , R. Doughty 4 , G. Devlin 1 1 Waikato
Hospital, Hamilton, New Zealand Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand 2 Christchurch
Background: Hyponatraemia is the most common electrolyte abnormality in hospitalised heart failure patients. We report the prevalence and prognostic significance of hyponatremia in New Zealand Heart Failure Registry (NZHFR). Methods: NZHFR is a national, prospective, observational web-based registry. We compared the short-term outcomes of hospitalised heart failure patients with hyponatraemia (p-sodium < 136 mmol/L) vs. normonatraemia (p-sodium > 136 mmol/L). Results: A total of 1609 patients were enrolled, between July 2006 and February 2012 with 90-day follow-up data available in 92% (1478/1609). 375 patients (23%) had hyponatraemia (mean p-sodium 131 ± 4) on admission compared to 1234 patients (77%) with normal sodium (mean p-sodium 140 ± 3). Patients with hyponatraemia were older (mean age 72.7 ± 15 vs. 69 ± 15, P ≤ 0.0001) with higher BNP values (median BNP 700 vs. 508, P = 0.0002). Discharge medication and outcomes are shown in the table. Discharge Medications
Hyponatraemia
Normonatraemia
Diuretics Mean Frusemide dose (mg) ACE-I/ARB’s Beta blockers Spironolactone
341/348 (99%) 148 ± 150 277/348 (80%) 256/348 (74%) 138/348 (40%)
1158/1196 (97%) 110 ± 101 980/1196 (82%) 945/1196 (79%) 360/1196 (30%)
P value 0.36 <0.0001* 0.35 0.034* 0.001*
Conclusion: Hyponatraemia in heart failure admissions is associated with prolonged hospitalisation, higher inhospital and 90 day mortality and readmission rates. http://dx.doi.org/10.1016/j.hlc.2012.05.226 217 Prognostic Significance of Atrial Fibrillation in Acute Heart Failure Admissions: The New Zealand Heart Failure Registry V. Pera 1,∗ , R. Troughton 2 , M. Lund 3 , R. Doughty 4 , G. Devlin 1 1 Waikato
Hospital, Hamilton, New Zealand Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand 2 Christchurch
Background: There is limited data available regarding the prognostic implication of atrial fibrillation (AF) in heart failure patients with preserved systolic function (HFPSF). We report our experience with the New Zealand Heart Failure Registry (NZHFR).
ABSTRACTS
Heart, Lung and Circulation 2012;21:S1–S142
S90
Heart, Lung and Circulation 2012;21:S1–S142
CSANZ 2012 Abstracts
ABSTRACTS
Methods: NZHFR is a national, prospective, observational web-based registry. We compared the short-term outcomes of patients in AF vs. sinus rhythm (SR) in hospitalised patients with HFPSF and those with impaired systolic function (HFISF). Results: A total of 1609 patients were enrolled, between July 2006 and February 2012 and 1224 with echocardiograms were included in this analysis with 90-day follow-up data available in 92% (1126/1224). Atrial fibrillation was present at baseline in 461 (51%) patients with HFISF (LVEF < 50%) and in 199 (62%) patients with HFPSF (LVEF > 50%). BNP levels were similar in both AF and SR patients (mean BNP 897 vs. 839, P = 0.47 in HFISF and 677 vs. 662, P = 0.89 in HFPSF). Outcomes are shown in the table. Outcome
AF and HFISF
SR and HFISF
P Value
AF and HFPSF
SR and HFPSF
P Value
Length of stay (mean ±SD) In-hospital mortality Mortality at 90-day F/U Re-admission at 90-day F/U
9.4 ± 8 days
8.4 ± 8
0.06
10.2 ± 10
9.1 ± 8
0.28
21/461 (5%)
10/443 (2%)
0.07
12/199 (6%)
5/121 (4%)
0.61
71/435 (15%)
43/405 (10%)
0.01*
37/183 (19%)
12/103 (10%)
0.04*
61/435 (13%)
44/405 (10%)
0.15
23/183 (12%)
7/103 (6%)
0.11
Conclusion: AF is associated with higher 90 day mortality compared to SR in both HFISF and HFPSF, but similar in-hospital mortality and readmission rates.
218 Prospectively Isolated, Hypoxic-Preconditioned Mesenchymal Stem Cells Significantly Attenuate Myocardial Infarction-Induced Ventricular Dysfunction In Rats Paton 3 ,
Frost 1,2 ,
http://dx.doi.org/10.1016/j.hlc.2012.05.228 219 Radiation Dose Received by Patients Undergoing Workup for Heart Transplantation
http://dx.doi.org/10.1016/j.hlc.2012.05.227
Richardson 1,2,3,∗ ,
was induced via surgical ligation of the left anterior descending artery in 35 Sprague-Dawley rats. Left ventricular ejection fraction (EF) was assessed by cardiac magnetic resonance prior to MI, then one and four weeks later. Allogeneic MSCs were delivered in 20 animals by trans-epicardial injection (mean dose 1.5 × 106 cells, 100 l volume) at repeat thoracotomy one week after MI. 15 control animals received injection of vehicle only. Results: MI reduced EF of the control group from 58.5 ± 1.2% to 22.1 ± 2.0% at one week, with no subsequent improvement by week 4 (19.5 ± 1.5%). In the MSC treatment group, EF also fell from 57.8 ± 1.2% to 25.1 ± 2.2%, but significantly improved to 38.8 ± 1.4% by week 4 (p < 0.001). Accordingly, EF between the groups = 19.3 ± 3.1 (p < 0.0001) at four weeks. Conclusion: An optimised allogeneic MSC population, derived via prospective isolation and hypoxic preconditioning, provides substantial improvements in left ventricular function in rats following MI. These optimisation strategies offer significant potential to improve therapeutic efficacy of stem cell therapy and require further evaluation.
Carbone 1,2 ,
S. L. A. J. A. Bertaso 1 , A. Nelson 1,2 , P. Psaltis 1,2,3 , D. Wong 1,2 , M. Worthley 1,2 , S. Gronthos 2,3 , A. Zannettino 2,3 , S. Worthley 1,2,3 1 Cardiovascular
Research Centre, Royal Adelaide Hospital, Australia 2 Department of Medicine, University of Adelaide, Adelaide, SA, Australia 3 Centre for Stem Cell Research, University of Adelaide, Adelaide, SA, Australia Background: Stem cell therapy has been advocated as a means to regenerate damaged myocardium after infarction (MI). However, only modest benefits have been observed in clinical trials thus far. Optimisation of stem cells prior to transplantation might advance therapeutic efficacy. We evaluated the impact on ventricular function of a prospectively isolated, hypoxic-conditioned mesenchymal stem cell (MSC) population in a rat model of MI. Methods: Bone marrow was recovered from donor Sprague-Dawley rats and the target cell population was prospectively isolated using a magnetic activated cell sorting CD45-depletion strategy. MSCs were subjected to hypoxic incubation (5% O2 ) during primary culture. Immunophenotype and in vitro differentiation assays confirmed their multi-lineage differentiation potential. MI
S. McKenzie 1,2,∗ , M. Brown 1,2 , D. Platts 1,2 , G. Javorsky 1 , J. Maddicks-Law 1 , M. Whitby 3 1 Advanced Heart Failure and Cardiac Transplant Unit, The Prince Charles Hospital, Australia 2 University of Queensland, Australia 3 Medical Imaging, The Prince Charles Hospital, Australia
Introduction: There is increasing concern regarding patient radiation exposure as a result of diagnostic imaging studies. To date there has been no publication of the radiation doses received by patients with end stage heart failure (ESHF) undergoing heart transplant as a result of their pre and post transplant imaging studies. Method: We performed a retrospective analysis of patients undergoing cardiac transplant assessment as identified in our institutions transplant database. All patients from January 2009 to December 2010 were included. Radiation doses were calculated using dose parameters recorded routinely by radiographic staff. Imaging studies performed from the commencement of transplant assessment until the end of the first year after heart transplantation or after transplant workup for those not transplanted were included. Results: Forty-three patients analysed, mean age 45 years, 18 female. Mean number of radiological studies = 30.5. Fifteen of 43 patients were transplanted with mean number of radiological studies 54.1 vs. 17.8 studies for those not transplanted. Sixty-six percent of all studies were chest X-rays, 11% fluoroscopy, 9% CT. Median dose was 40 msV (range 20–78 msV) which is double the recommended averaged annual occupational radiation dose.