A Method To Personalize Blood Chemistry Reference Intervals: Getting To Patient Centric Laboratory Medicine Using Electronic Medical Record Data In Chronic Heart Failure Patients

Abdelal, Qassem; Conte, Jorge; Lorenzo, christian; George, Justin; Wiese-Rometsch, Wilhelmine

doi:10.1016/j.cardfail.2020.09.349

Cited by 1 publication

(4 citation statements)

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“…A prior abstract demonstrated a protective effect (odds ratio <1) against the composite outcome of hospital death and hospice discharge for HF patients with average serum sodium levels between 134–142 mmol/L. 12 These outcomes were not studied in this analysis, and these minor variances may be related to inter‐provider management differences in fluid restriction and diuresis strategies.…”

Section: Discussionmentioning

confidence: 96%

“…Haemodynamic stress, LV remodelling, and functional outcomes have been shown to be associated with changes in cardio‐centric biomarkers such as amino‐terminal pro‐B‐type natriuretic peptide (NT‐pro‐BNP) 11 . Furthermore, even within ‘normal’ reference intervals, a multitude of serum laboratory values such as potassium, sodium, and bicarbonate have also been shown to pose risk to poor prognostic outcomes 12 …”

Section: Introductionmentioning

confidence: 99%

“…11 Furthermore, even within 'normal' reference intervals, a multitude of serum laboratory values such as potassium, sodium, and bicarbonate have also been shown to pose risk to poor prognostic outcomes. 12 Significant advancement in HF treatment plans, including guideline-directed medical therapy (GDMT), cardiac devices, coronary revascularization strategies, and valvular repair have promoted LV reverse remodelling, attempting to ameliorate negative trajectories. 13,14 However, the extremely relevant 'syndromic' HF patient burdened with MCC and serum biomarker abnormalities (in a background of what appears to be guideline-directed management strategies) is increasingly common and a global health concern.…”

Section: Introductionmentioning

confidence: 99%

“… 11 Furthermore, even within ‘normal’ reference intervals, a multitude of serum laboratory values such as potassium, sodium, and bicarbonate have also been shown to pose risk to poor prognostic outcomes. 12 …”

Section: Introductionmentioning

confidence: 99%

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Heart failure ejection fraction class conversions: impact of biomarkers, co‐morbidities, and pharmacotherapy

et al. 2022

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Aims Temporal conversions among ejection fraction (EF) classes can occur across the heart failure (HF) spectrum reflecting amended structural and functional outcomes unaccounted for by current taxonomy. This retrospective study aims to investigate the differences in serum laboratory values, guideline-directed medical therapy (GDMT), and co-morbidity burden across EF conversion groups. Methods and resultsHeart failure patients at least 18-year-old who obtained at least two echocardiograms between January 2018 and January 2020 were identified using ICD-10 codes. Analysis of variance, chi-square tests, and analysis of means for proportions were used as appropriate to identify associations with class conversion groups. A total of 874 patients who underwent 1748 echocardiograms on unique visits were categorized according to initial EF as HF with preserved EF (HFpEF) (n = 531, 61%), HF with mildly reduced or midrange EF (HFmrEF) (n = 132, 15%), or HF with reduced EF (HFrEF) (n = 211, 24%). In accordance with follow-up EF, class conversions were categorized into HF with improved EF (HFiEF) (n = 143, 16%), HF with worsened EF (HFwEF) (n = 171, 20%), or HF with stable EF (HFsEF) (n = 560, 64%). The average age was 75 ± 13 years old; 54% were male, 85% were Caucasian, 11% were African American, and 4% other. The mean time between EF assessments was 208.6 ± 170.2 days. Serum sodium levels were greater in HFwEF (139 ± 3 mmol/L) when compared with HFsEF (138 ± 4 mmol/L) (P = 0.05). Pro-BNP levels were higher in HFiEF (12 150 ± 19 554 pg/mL) versus HFsEF (6671 ± 10 525 pg/ mL) (P = 0.007). Angiotensin receptor-neprilysin inhibitors (ARNI) were more frequently ordered on index visit in HFiEF (P = 0.03), but no other significant differences in GDMT were identified. Despite similar Elixhauser Co-morbidity Measure (ECM) scores, ECM categorical analysis revealed that HFwEF was more likely to have an established diagnosis of depression (P = 0.03) and a spectrum of psychiatric illnesses (P = 0.03) on preliminary visit. HFsEF was less likely to have an established diagnosis of blood loss anaemia (P = 0.04). Metastatic cancer was more likely to have been diagnosed in HFiEF and less likely in HFsEF (P = 0.002). Conclusions Despite similar ECM scores, EF class conversion groups demonstrated salient differences in average serum sodium and pro-BNP levels. Inpatient ARNI orders, psychiatric, hematologic, and oncologic co-morbidity patterns were also significantly different. Findings demonstrate blood-based biomarker patterns and targetable co-morbid conditions which may play a role in future EF class conversion. Dedicated studies evaluating measurements related to GDMT dose-titration, quality of life, and functionality are the next steps in this field of HF.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%