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Six-Minute Walk Distance Under 135 Meters Predicts Early and Frequent 30-day Heart Failure Readmissions in Patients with Stage C and D Heart Failure
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Journal of Cardiac Failure Vol. 24 No. 8S August 2018
181 Six-Minute Walk Distance Under 135 Meters Predicts Early and Frequent 30day Heart Failure Readmissions in Patients with Stage C and D Heart Failure Mirza M. Baig, Lisa Rein, Sergey Tarima, Mary Conti, Asim Mohammed; Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI Introduction: With a 30-day all cause readmission rate around 23%, individuals with heart failure (HF) are a medically high risk and costly patient population. Though predictive models have been developed for readmission based on descriptive variables, many of these tools are cumbersome and limited in prognosticative capacity. A few studies have examined the role of the six-minute walk test (6MWT) and found good predictive ability for both 30-day and 1-3-year readmission rates. The goal of this study was to further elucidate the prognostic ability of the 6MWT in stage C/D HF patients with NYHA class IIIb-VI symptoms. Methods: We prospectively enrolled 97 patients who from our step-down units with a primary diagnosis of heart failure between October 2016 and March 2017. Every patient who was enrolled had a standardized 6MWT prior to discharge. Multivariate logistic regression analysis was constructed to determine relationships between 6MW distance and 30-day survival free of readmission. Results: Baseline characteristics were compared between the 6minute walk test distance groups using Wilcoxon rank-sum tests for continuous variables and Fisher’s exact tests for categorical variables, and no significant differences were found between the patients. The 135-meter cut-point was selected as the threshold which maximizes the sum of sensitivity and specificity of a logistic regression model for 30-day readmission with 6-minute walk test distance as a continuous predictor. Approximately 25.7% of the patients walked less than 135 meters. Out of these about 32% were admitted within 30 days [p= .026]. Among the patients who walked > 135 meters, 11.1% were admitted within 30 days [p= 0.026]. Furthermore, patients who walked <135m, also had higher frequency of annual re-admissions (36% vs. 12.5%) compared to patients who walked more than 135 meters. Conclusions: 6MWT distance less than 135m was associated with not only increased risk of 30 day readmission but also correlated with increased frequency of admissions in patients admitted with stage C/D heart failure.
Of the 1521 patients included in the study 181 (11.2%) had EF recovery to >40%. The mean follow up was 4.9 years, the maximal follow up 5.6 years. The mean age of patients with HFrecEF was 61.5 years, 57.4% were male, 54.1% were Caucasian (Table 1). Overall, 384 (25.2%) patients died in the study cohort. The probability of age and sex adjusted all-cause death was significantly higher in the HFrEF group compared to the HFrecEF group (log-rank Chi-square = 9.8, 26.5% vs16%, p=0.0018). The Hazard Ratio for mortality over the study period was 0.60 (95% CI 0.41-0.87, p=0.008) for HFrEF vs. HFrecEF (Figure 1). Conclusions: HFrecEF in an urban teaching hospital is a heterogeneous group of patients with different demographics and comorbidities compared to HFrEF. Although patients with HFrecEF have lower all-cause mortality rate than HFrEF further investigations to determine the optimal medical management of this subgroup of patients are necessary. Table 1. Demographics and baseline clinical characteristics.
183 [abstract withdrawn]
184 Diabetes Mellitus is Associated with Increased Incidence of CHF Independent of Hypertension and Coronary Artery Disease: A Population Based Study Michael D. Klajda, Christopher G. Scott, Richard J. Rodeheffer, Horng H. Chen; Mayo Clinic, Rochester, MN
Figure 1. Probability of all-cause death.
182 Mortality in Patients with Heart Failure With Recovered Ejection Fraction Outcomes From an Urban Teaching Medical Center. Dmitry Yaranov, Pujan Patel, Wesam Ostwani, Justin Tinsley, Robert Percy, Alan Miller; University of Florida, Jacksonville, FL Background: Heart failure with recovered ejection fraction (HFrecEF) is a newly emerged subset of patients who previously had reduced ejection fraction (HFrEF), but had improvement or recovery by natural history or in response to therapy. The aim of this study was to determine survival of patients with HFrecEF and compare it to those with HFrEF. Methods: A retrospective cohort study was conducted including patients admitted to the University of Florida Jacksonville medical center with a new diagnosis of HFrEF from January 1, 2012 to December 31, 2015. Patients 18 years or older with a verified diagnosis of HFrEF, at least 2 echocardiograms within the study period on guideline directed medical therapy were identified from medical records. The diagnosis of HFrecEF was defined as the most current LVEF 40% and a previously documented LVEF <40%. Results of echocardiograms and etiology of HF as well as demographics and comorbidities were collected. Mortality status was determined via the social security death index. A Kaplan Meier curve was used to summarize the survival distribution. Cox proportional hazards model model was used for mortality end point. Statistical significance was set at p<0.05. Results:
Background: Diabetes mellitus (DM) is known to be associated with hypertension, coronary artery disease and poor cardiovascular outcomes. However, it is unclear what impact DM has on cardiovascular outcomes independent of coronary artery disease and hypertension. This study focuses on the impact of DM on cardiovascular disease and survival in a community population independent of hypertension and coronary artery disease. Objectives: To further delineate the longitudinal impact of Diabetes Mellitus on the development of cardiovascular diseases and mortality secondary to cardiovascular disease in a community population. Methods: Cross-sectional survey of 2,042 randomly selected residents of Olmsted County, aged 45 years or older from June 1997 through September 2000. All patients underwent Doppler echocardiographic assessment of systolic and diastolic function. The current analyses included all subjects with DM and were compared to a group of non DM subjects matched 1:2 for age, gender, hypertension and coronary artery disease. Baseline characteristics, laboratory findings and transthoracic echocardiogram findings between both groups were compared along with rates of mortality due to various cardiovascular conditions. Results: We identified 116 subjects with DM and compared to the 232 matched non-DM subjects. Subjects with DM had higher BMI (29 § 5vs 31§5, kg/m2; p=0.001), plasma insulin (5.8 [4,9]vs 8.5 [5,15], uU/ml; p<0.001), serum glucose(95 [90,102] vs 130 [107,167], mg/dL; p<0.001) and triglycerides (183§121 vs 146§80,mg/dL p<0.001) as compared to the non-DM. There was a higher prevalence of atrial fibrillation (9% vs 4%, p=0.034), metabolic syndrome (54% vs 23%, p<0.001) and CHF (3% vs 0%, p=0.026) at baseline in DM versus non-DM. While LV EF was similar, E/e’ ratio (9.66 vs 8.50, p=0.001) was higher in DM vs non-DM suggesting increased LV filling pressure in DM. Importantly, over a median followup of 10.8 years (IQR: 7.8-11.7), DM subjects had higher incidences of CHF, 21% vs 12%; HR 2.13(1.25, 3.62;p=0.012) compared to non-DM. Conclusions: In this community based cohort matched for age, gender, hypertension and coronary artery disease, subjects with diabetes have elevated LV filling pressures and increased incidence of CHF over a 10 year follow-up period. These findings suggest that DM is an independent risk factor for development of heart failure and supports the concept of DM cardiomyopathy.
Journal of Cardiac Failure Vol. 24 No. 8S August 2018
181 Six-Minute Walk Distance Under 135 Meters Predicts Early and Frequent 30day Heart Failure Readmissions in Patients with Stage C and D Heart Failure Mirza M. Baig, Lisa Rein, Sergey Tarima, Mary Conti, Asim Mohammed; Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI Introduction: With a 30-day all cause readmission rate around 23%, individuals with heart failure (HF) are a medically high risk and costly patient population. Though predictive models have been developed for readmission based on descriptive variables, many of these tools are cumbersome and limited in prognosticative capacity. A few studies have examined the role of the six-minute walk test (6MWT) and found good predictive ability for both 30-day and 1-3-year readmission rates. The goal of this study was to further elucidate the prognostic ability of the 6MWT in stage C/D HF patients with NYHA class IIIb-VI symptoms. Methods: We prospectively enrolled 97 patients who from our step-down units with a primary diagnosis of heart failure between October 2016 and March 2017. Every patient who was enrolled had a standardized 6MWT prior to discharge. Multivariate logistic regression analysis was constructed to determine relationships between 6MW distance and 30-day survival free of readmission. Results: Baseline characteristics were compared between the 6minute walk test distance groups using Wilcoxon rank-sum tests for continuous variables and Fisher’s exact tests for categorical variables, and no significant differences were found between the patients. The 135-meter cut-point was selected as the threshold which maximizes the sum of sensitivity and specificity of a logistic regression model for 30-day readmission with 6-minute walk test distance as a continuous predictor. Approximately 25.7% of the patients walked less than 135 meters. Out of these about 32% were admitted within 30 days [p= .026]. Among the patients who walked > 135 meters, 11.1% were admitted within 30 days [p= 0.026]. Furthermore, patients who walked <135m, also had higher frequency of annual re-admissions (36% vs. 12.5%) compared to patients who walked more than 135 meters. Conclusions: 6MWT distance less than 135m was associated with not only increased risk of 30 day readmission but also correlated with increased frequency of admissions in patients admitted with stage C/D heart failure.
Of the 1521 patients included in the study 181 (11.2%) had EF recovery to >40%. The mean follow up was 4.9 years, the maximal follow up 5.6 years. The mean age of patients with HFrecEF was 61.5 years, 57.4% were male, 54.1% were Caucasian (Table 1). Overall, 384 (25.2%) patients died in the study cohort. The probability of age and sex adjusted all-cause death was significantly higher in the HFrEF group compared to the HFrecEF group (log-rank Chi-square = 9.8, 26.5% vs16%, p=0.0018). The Hazard Ratio for mortality over the study period was 0.60 (95% CI 0.41-0.87, p=0.008) for HFrEF vs. HFrecEF (Figure 1). Conclusions: HFrecEF in an urban teaching hospital is a heterogeneous group of patients with different demographics and comorbidities compared to HFrEF. Although patients with HFrecEF have lower all-cause mortality rate than HFrEF further investigations to determine the optimal medical management of this subgroup of patients are necessary. Table 1. Demographics and baseline clinical characteristics.
183 [abstract withdrawn]
184 Diabetes Mellitus is Associated with Increased Incidence of CHF Independent of Hypertension and Coronary Artery Disease: A Population Based Study Michael D. Klajda, Christopher G. Scott, Richard J. Rodeheffer, Horng H. Chen; Mayo Clinic, Rochester, MN
Figure 1. Probability of all-cause death.
182 Mortality in Patients with Heart Failure With Recovered Ejection Fraction Outcomes From an Urban Teaching Medical Center. Dmitry Yaranov, Pujan Patel, Wesam Ostwani, Justin Tinsley, Robert Percy, Alan Miller; University of Florida, Jacksonville, FL Background: Heart failure with recovered ejection fraction (HFrecEF) is a newly emerged subset of patients who previously had reduced ejection fraction (HFrEF), but had improvement or recovery by natural history or in response to therapy. The aim of this study was to determine survival of patients with HFrecEF and compare it to those with HFrEF. Methods: A retrospective cohort study was conducted including patients admitted to the University of Florida Jacksonville medical center with a new diagnosis of HFrEF from January 1, 2012 to December 31, 2015. Patients 18 years or older with a verified diagnosis of HFrEF, at least 2 echocardiograms within the study period on guideline directed medical therapy were identified from medical records. The diagnosis of HFrecEF was defined as the most current LVEF 40% and a previously documented LVEF <40%. Results of echocardiograms and etiology of HF as well as demographics and comorbidities were collected. Mortality status was determined via the social security death index. A Kaplan Meier curve was used to summarize the survival distribution. Cox proportional hazards model model was used for mortality end point. Statistical significance was set at p<0.05. Results:
Background: Diabetes mellitus (DM) is known to be associated with hypertension, coronary artery disease and poor cardiovascular outcomes. However, it is unclear what impact DM has on cardiovascular outcomes independent of coronary artery disease and hypertension. This study focuses on the impact of DM on cardiovascular disease and survival in a community population independent of hypertension and coronary artery disease. Objectives: To further delineate the longitudinal impact of Diabetes Mellitus on the development of cardiovascular diseases and mortality secondary to cardiovascular disease in a community population. Methods: Cross-sectional survey of 2,042 randomly selected residents of Olmsted County, aged 45 years or older from June 1997 through September 2000. All patients underwent Doppler echocardiographic assessment of systolic and diastolic function. The current analyses included all subjects with DM and were compared to a group of non DM subjects matched 1:2 for age, gender, hypertension and coronary artery disease. Baseline characteristics, laboratory findings and transthoracic echocardiogram findings between both groups were compared along with rates of mortality due to various cardiovascular conditions. Results: We identified 116 subjects with DM and compared to the 232 matched non-DM subjects. Subjects with DM had higher BMI (29 § 5vs 31§5, kg/m2; p=0.001), plasma insulin (5.8 [4,9]vs 8.5 [5,15], uU/ml; p<0.001), serum glucose(95 [90,102] vs 130 [107,167], mg/dL; p<0.001) and triglycerides (183§121 vs 146§80,mg/dL p<0.001) as compared to the non-DM. There was a higher prevalence of atrial fibrillation (9% vs 4%, p=0.034), metabolic syndrome (54% vs 23%, p<0.001) and CHF (3% vs 0%, p=0.026) at baseline in DM versus non-DM. While LV EF was similar, E/e’ ratio (9.66 vs 8.50, p=0.001) was higher in DM vs non-DM suggesting increased LV filling pressure in DM. Importantly, over a median followup of 10.8 years (IQR: 7.8-11.7), DM subjects had higher incidences of CHF, 21% vs 12%; HR 2.13(1.25, 3.62;p=0.012) compared to non-DM. Conclusions: In this community based cohort matched for age, gender, hypertension and coronary artery disease, subjects with diabetes have elevated LV filling pressures and increased incidence of CHF over a 10 year follow-up period. These findings suggest that DM is an independent risk factor for development of heart failure and supports the concept of DM cardiomyopathy.