AimsThe epidemiology of the five stages of chronic kidney disease (CKD) in systolic heart failure (HF) patients has predominantly been described in hospitalized White patients, with little known about the prevalence in outpatient Blacks and Hispanics. The purpose of this study was to compare the prevalence of the five stages of CKD by race, ethnicity (Whites, Blacks, and Hispanics), and gender in an outpatient systolic HF population and also to evaluate the impact of CKD on mortality. Methods and resultsWe conducted a prospective study of 1301 patients recruited from two hospital facilities in Louisiana and Florida, USA. All patients were enrolled in a systolic HF disease management programme (HFDMP), which enrolled patients with an ejection fraction of ≤40% by echocardiography. The estimated glomerular filtration rate was calculated using the abbreviated Modification of Diet in Renal Disease Study equation. Patients were classified into five stages of CKD according to the National Kidney Foundation classification system. A total of 338 patients (26%) were found to have CKD. Patients with CKD were older, more likely to be Hispanics, to have less education, New York Heart Association class III, elevated systolic blood pressure, and diabetes. There was no statistical difference in prevalence by gender. Survival was reduced in patients with CKD. ConclusionThe prevalence of CKD in an outpatient systolic HFDMP is high, with over one in four patients affected. CKD patients had significantly lower survival rates compared with patients without CKD.--

BackgroundMetabolic syndrome (MetS) is a risk factor for diabetes, cardiovascular disease, and heart failure, but little is known about the impact of MetS in patients who already have heart failure (HF).HypothesisMetS increases mortality in HF.MethodsWe performed an analysis in 865 indigent HF patients enrolled in a HF disease management program at the Chabert Medical Center in Louisiana. All subjects were classified as having MetS if they met three or more of the National Cholesterol Education Program criteria. Mortality was defined using the Social Security Death Index. We calculated the relative hazard (RH) of death for those patients with and without MetS.ResultsThe prevalence of MetS was 40% (95% confidence interval [CI]: 37–43). These subjects had similar ages (54.3±13.4 vs 55.7±12.8 years), more likely to be female (43% vs 33%), had similar baseline ejection fraction (31.4±9.7 vs 30.0±11.0), and New York Heart Association (NYHA) classification (2.20±0.9 vs 2.15±0.9). After 2.6±2.2 years of follow‐up 24% of the MetS group died compared to 16% in the non‐MetS group (p < 0.01). The RH of death for the MetS group was 1.5 (95% CI: 1.1–2.1) when compared to the non‐MetS group after adjustment demographics, use of angiotensin‐converting enzyme (ACE) inhibitor and β‐blocker, hematocrit, creatinine, educational level, and baseline ejection fraction.ConclusionsThe prevalence of MetS is high in indigent HF patients, and it increases the risk of death. Physicians treating patients with HF need to address the current MetS epidemic in HF. Copyright © 2009 Wiley Periodicals, Inc.

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Healthy People 2010 aims at immunizing 60% of high-risk adults annually against influenza and once against pneumococcal disease. The aim of this study was to evaluate the use of a standardized approach to improve vaccination rates in patients with heart failure (HF); to determine whether disparities exist based on age, race, ethnicity, or sex at baseline and follow-up; and to evaluate the impact of clinical variables on the odds of being vaccinated. A prospective study of 549 indigent patients enrolled in a systolic HF disease management program (HFDMP) began enrollment from August 2007 to January 2009 at Jackson Memorial Hospital. Patients were interviewed at their initial visit for immunization status; those without vaccinations were offered the vaccines. Prevalence of vaccination (POV) for influenza and pneumococcal disease was obtained at baseline and at follow-up. The odds ratio for being vaccinated was calculated using logistic regression. The study population comprised mostly Hispanic (56%), black (37%), and male (70%) patients, with a mean age of 56 ± 12 years and a mean ejection fraction of 25% ± 10%. The initial POV for both was 22% at baseline. At follow-up, POV improved to 60.5%. Of those not vaccinated at baseline, 17.5% refused vaccination. Odds ratios at baseline for age, race/ethnicity, and sex were 0.99 (P=.99), 0.63 (P=.08), and 0.62 (P=.14), respectively. These did not change significantly at follow-up. Prevalence of vaccination in our cohort was low. Enrollment into the HFDMP improved immunization prevalence without creating age, race, ethnicity, or sex disparities.

More than 5 million people live with heart failure (HF) in the United States, and this number is expected to rise due to several factors including increased life expectancy brought about by medical therapy and the aging of the population. HF and peripheral arterial disease (PAD) share many risk factors. A review of the literature reveals several studies supporting a higher prevalence of HF in patients with PAD than in those without PAD. However, no study was found that estimates the prevalence of PAD in patients with HF. Moreover, the prevalence of PAD by US race/ethnic groups with HF has not been studied. The authors conducted a cross‐sectional multicenter study of patients enrolled in an HF disease management program in Louisiana (n=330) and Florida (n=464). All patients with an ejection fraction ≤40% and a measured ankle‐brachial index (ABI) were included in the study. PAD was defined as an ABI <0.9. The overall prevalence of PAD was 17.1%. The prevalence of PAD was 25.9% for white, 13.4% for Hispanic, and 13.7% for black patients. White patients had a higher prevalence of PAD than black or Hispanic patients (P<.001). Routine ABI measurements in these groups would enhance efforts to detect subclinical PAD. Congest Heart Fail. 2010;16:118–121. © 2010 Wiley Periodicals, Inc.