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Risk Factors for Heart Failure with Preserved Systolic Function
S308
Journal of Cardiac Failure Vol. 11 No. 9 Suppl. 2005
P-029
P-031
Hospitalized Congestive Heart Failure Patients in the Setting of Emergency Department: Clinical Characteristic and Their Outcomes KOSHIRO MORITANI, TOSHIHIKO YAMAGATA, FUMIAKI NAKAO, MASATO OHMURA, TOSHIHIDE OHMIYA, YOSIO MATSUI Yamaguchi Prefecture Grand Medical Center, Yamaguchi, Japan
Risk Factors for Heart Failure with Preserved Systolic Function
Purpose: The aim of the study was to evaluate the characteristics and treatment outcomes of patients with heart failure who were emergently admitted to the community hospital. Method: Medical records were reviewed for all patients (pts) admitted to the emergency department of this hospital with a diagnosis of congestive heart failure (CHF) between January 1, 2004 and December 31, 2004. Result: Of 125 pts (67 males and 58 females) with CHF, all had dyspnea and wheeze at rest, 91% were above 60 years old, especially 74% above 70 years old. Forty two percents of pts were admitted at between 16 o’clock and 24 o’clock and 29% of pts at between 0 o’clock and 8 o’clock. Treatment in the emergency room included morphine, diuretics, nitroglycerin, inotoropic agents and oxygen therapy. Ten pts (8%) needed intubation and five (4%) deaths occurred in the hospital. Of 15 pts (12%) who had readmission in the observation period, two (1.6%) were dead suddenly out the hospital. Conclusion: Heart failure is placing an increasing burden on the community especially in elderly patients. In the setting of the emergency department, the majority of hospitalized CHF pts had responded to conventional managements except pts who had recurrence of heart failure.
KAZUAKI UCHINO, TOMOAKI ISHIGAMI, TERUYASU SUGANO, ICHIRO NAKAZAWA, HIDEYUKI OGAWA, TSUKASA KOBAYASHI, KOHEI MATSUSHITA, KATSUMI MATSUMOTO, TOSHIYUKI ISHIKAWA, SATOSHI UMEMURA Department of Cardiorenal Medicine, Yokohama City University, Yokohama, Japan Purpose: About 40% of patients with heart failure is reported to have preserved systolic cardiac function. However, risk factors for heart failure with preserved systolic function (HPS) have not been investigated. Methods: Heart failure patients hospitalized at Yokohama City University Hospital from the year 2000 to 2004 were retrospectively studied. Only the first hospitalization data of each patient was used. Heart failure with left ventricular (LV) ejection fraction (EF) more than 50% was classified as HPS. Heart failure with LVEF less than 35% was classified as heart failure with systolic dysfunction (HSD). Heart failure patients with LVEF between 35% and 50% were excluded. Results: 76 patients were classified as HPS and 78 patients were classified as HSD. Multivariate logistic regression analysis demonstrated hypertension (OR 2.393, 95% CI 1.109 to 5.167, P⫽0.026) and atrial fibrillation (OR 3.525, 95% CI 1.553 to 8.000, P⫽0.003) were the significant risk factors for HPS. On the contrary, history of myocardial infarction is associated with HSD (OR 0.113, 95% CI 0.032 to 0.400, P⫽0.001). LV wall in HPS is significantly thicker than in HSD. Conclusions: Hypertension and atrial fibrillation are the risk factors for HPS. Treatment of hypertension to prevent ventricular hypertrophy and management of atrial fibrillation are pivotal factors to prevent HPS.
P-030
P-032
Etiology of Acute Heart Failure From 1980 to 2004 in Cardiac Care Unit of Nippon Medical School NAOKI SATO1, TAKESHI YAMAMOTO1, NOBUHIKO FUJITA1, YU-KI IWASAKI1, KENJI YODOGAWA1, KOUJI KATO1, TERUO TAKANO2, KEIJI TANAKA1 1 Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan, 2The First Department of Internal Medicine
Kidney Function as a Predictor for Long-term Mortality in Patients with Stable Chronic Cardiovascular Disease YAYOI ISHIKAWA1, TOSHIO NISHIKIMI1, TAKESHI HORIO2, KIMIHIKO ISHIMURA1, NORITOSHI NAGAYA2, FUMIKI YOSHIHARA2, SHOGO KOSHIKAWA1, YOSUKE MORI1, YUHEI KAWANO2, HIROAKI MATSUOKA1 1 Department of Hypertension and Cardiorenal Medicine, Dokkyo University School of Medicine, 2Department of Medicine, National Cardiovascular Center
Goal: Ischemic heart disease (IHD) is a dominant cause of acute heart failure (AHF), 60–70%, in Western countries. However, we, in Japan, do not have data regarding this issue. Therefore, our purpose was to summarize the etiology of AHF. Method: Etiology, as shown in table, of AHF except acute myocardial infarction was examined from 1980 to 2004. Results: (table)Patients, n⫽1272, who were admitted with AHF, were examined. The frequency of HHD was decreased from 26.2% to 14.6%. IHD is a dominant cause, around 40%, but not remarkably increased. Interestingly, VD was still important, about 20%. Conclusion: Thus, the etiology of AHF might be different from Western countries. However, the present study was performed only in single institute, so that national survey should be performed in Japan.
Background: We tested the hypothesis that the levels of kidney function may be an independent risk factor for mortality in stable chronic cardiovascular disease by any cause. Methods: A cohort of 739 subjects with stable chronic cardiovascular disease who were hospitalized for further examination and/or treatment from 1993 to 1998 were followed up. We calculated estimated GFR (Cockroft and Gault formula) at baseline and the rate of death from all causes was determined after a median follow-up of six years. Results: The patients were classified into five groups; group 1 (GFR⬎80ml/min;n⫽164), group 2 (80⬎GFR⬎60;n⫽213), group 3 (60⬎GFR⬎40;n⫽214), group 4 (40⬎GFR⬎20;n⫽70), and group 5 (GFR⬍20ml/min;n⫽78). At follow-up, 111 patients had died. The survival rate was decreased according to the severity of renal dysfunction. Univariate analysis revealed that plasma BNP, plasma norepinephrine, GFR, age, systolic blood pressure, body mass index, and the presence of a history of diabetes, corebral infraction, heart failure, and atrial fibrillation were associated with the mortality. After adjusting for clinical and demographic variables, the only high levels of BNP and lower GFR were significant independent predictors of the mortality in patients with chronic stable cardiovascular disease. Conclusion: The level of GFR is an independent risk factor for all-cause mortality in patients with stable chronic cardiovascular disease by any cause.
Journal of Cardiac Failure Vol. 11 No. 9 Suppl. 2005
P-029
P-031
Hospitalized Congestive Heart Failure Patients in the Setting of Emergency Department: Clinical Characteristic and Their Outcomes KOSHIRO MORITANI, TOSHIHIKO YAMAGATA, FUMIAKI NAKAO, MASATO OHMURA, TOSHIHIDE OHMIYA, YOSIO MATSUI Yamaguchi Prefecture Grand Medical Center, Yamaguchi, Japan
Risk Factors for Heart Failure with Preserved Systolic Function
Purpose: The aim of the study was to evaluate the characteristics and treatment outcomes of patients with heart failure who were emergently admitted to the community hospital. Method: Medical records were reviewed for all patients (pts) admitted to the emergency department of this hospital with a diagnosis of congestive heart failure (CHF) between January 1, 2004 and December 31, 2004. Result: Of 125 pts (67 males and 58 females) with CHF, all had dyspnea and wheeze at rest, 91% were above 60 years old, especially 74% above 70 years old. Forty two percents of pts were admitted at between 16 o’clock and 24 o’clock and 29% of pts at between 0 o’clock and 8 o’clock. Treatment in the emergency room included morphine, diuretics, nitroglycerin, inotoropic agents and oxygen therapy. Ten pts (8%) needed intubation and five (4%) deaths occurred in the hospital. Of 15 pts (12%) who had readmission in the observation period, two (1.6%) were dead suddenly out the hospital. Conclusion: Heart failure is placing an increasing burden on the community especially in elderly patients. In the setting of the emergency department, the majority of hospitalized CHF pts had responded to conventional managements except pts who had recurrence of heart failure.
KAZUAKI UCHINO, TOMOAKI ISHIGAMI, TERUYASU SUGANO, ICHIRO NAKAZAWA, HIDEYUKI OGAWA, TSUKASA KOBAYASHI, KOHEI MATSUSHITA, KATSUMI MATSUMOTO, TOSHIYUKI ISHIKAWA, SATOSHI UMEMURA Department of Cardiorenal Medicine, Yokohama City University, Yokohama, Japan Purpose: About 40% of patients with heart failure is reported to have preserved systolic cardiac function. However, risk factors for heart failure with preserved systolic function (HPS) have not been investigated. Methods: Heart failure patients hospitalized at Yokohama City University Hospital from the year 2000 to 2004 were retrospectively studied. Only the first hospitalization data of each patient was used. Heart failure with left ventricular (LV) ejection fraction (EF) more than 50% was classified as HPS. Heart failure with LVEF less than 35% was classified as heart failure with systolic dysfunction (HSD). Heart failure patients with LVEF between 35% and 50% were excluded. Results: 76 patients were classified as HPS and 78 patients were classified as HSD. Multivariate logistic regression analysis demonstrated hypertension (OR 2.393, 95% CI 1.109 to 5.167, P⫽0.026) and atrial fibrillation (OR 3.525, 95% CI 1.553 to 8.000, P⫽0.003) were the significant risk factors for HPS. On the contrary, history of myocardial infarction is associated with HSD (OR 0.113, 95% CI 0.032 to 0.400, P⫽0.001). LV wall in HPS is significantly thicker than in HSD. Conclusions: Hypertension and atrial fibrillation are the risk factors for HPS. Treatment of hypertension to prevent ventricular hypertrophy and management of atrial fibrillation are pivotal factors to prevent HPS.
P-030
P-032
Etiology of Acute Heart Failure From 1980 to 2004 in Cardiac Care Unit of Nippon Medical School NAOKI SATO1, TAKESHI YAMAMOTO1, NOBUHIKO FUJITA1, YU-KI IWASAKI1, KENJI YODOGAWA1, KOUJI KATO1, TERUO TAKANO2, KEIJI TANAKA1 1 Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan, 2The First Department of Internal Medicine
Kidney Function as a Predictor for Long-term Mortality in Patients with Stable Chronic Cardiovascular Disease YAYOI ISHIKAWA1, TOSHIO NISHIKIMI1, TAKESHI HORIO2, KIMIHIKO ISHIMURA1, NORITOSHI NAGAYA2, FUMIKI YOSHIHARA2, SHOGO KOSHIKAWA1, YOSUKE MORI1, YUHEI KAWANO2, HIROAKI MATSUOKA1 1 Department of Hypertension and Cardiorenal Medicine, Dokkyo University School of Medicine, 2Department of Medicine, National Cardiovascular Center
Goal: Ischemic heart disease (IHD) is a dominant cause of acute heart failure (AHF), 60–70%, in Western countries. However, we, in Japan, do not have data regarding this issue. Therefore, our purpose was to summarize the etiology of AHF. Method: Etiology, as shown in table, of AHF except acute myocardial infarction was examined from 1980 to 2004. Results: (table)Patients, n⫽1272, who were admitted with AHF, were examined. The frequency of HHD was decreased from 26.2% to 14.6%. IHD is a dominant cause, around 40%, but not remarkably increased. Interestingly, VD was still important, about 20%. Conclusion: Thus, the etiology of AHF might be different from Western countries. However, the present study was performed only in single institute, so that national survey should be performed in Japan.
Background: We tested the hypothesis that the levels of kidney function may be an independent risk factor for mortality in stable chronic cardiovascular disease by any cause. Methods: A cohort of 739 subjects with stable chronic cardiovascular disease who were hospitalized for further examination and/or treatment from 1993 to 1998 were followed up. We calculated estimated GFR (Cockroft and Gault formula) at baseline and the rate of death from all causes was determined after a median follow-up of six years. Results: The patients were classified into five groups; group 1 (GFR⬎80ml/min;n⫽164), group 2 (80⬎GFR⬎60;n⫽213), group 3 (60⬎GFR⬎40;n⫽214), group 4 (40⬎GFR⬎20;n⫽70), and group 5 (GFR⬍20ml/min;n⫽78). At follow-up, 111 patients had died. The survival rate was decreased according to the severity of renal dysfunction. Univariate analysis revealed that plasma BNP, plasma norepinephrine, GFR, age, systolic blood pressure, body mass index, and the presence of a history of diabetes, corebral infraction, heart failure, and atrial fibrillation were associated with the mortality. After adjusting for clinical and demographic variables, the only high levels of BNP and lower GFR were significant independent predictors of the mortality in patients with chronic stable cardiovascular disease. Conclusion: The level of GFR is an independent risk factor for all-cause mortality in patients with stable chronic cardiovascular disease by any cause.