Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function

Ahmed, Ali; Aronow, Wilbert S.; Fleg, Jerome L.

doi:10.1016/j.ahj.2005.03.066

Cited by 179 publications

(130 citation statements)

References 19 publications

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“…In contrast to previous studies, 35,36 NYHA class was not associated with CHF re-hospitalization in the present study. Small sample size, and higher rate of elderly subjects in the present study might explain the difference.…”

Section: Other Factors Related To Re-hospitalization For Chfcontrasting

confidence: 56%

Decreased Renal Function as an Independent Predictor of Re-Hospitalization for Congestive Heart Failure

Komukai

Ogawa

Yagi

et al. 2008

Circ J

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atients with congestive heart failure (CHF) are frequently re-hospitalized, worsening their quality of life, and re-hospitalization for CHF is also associated with increased mortality rates. 1,2 Therefore, re-hospitalization for CHF should be avoided. Renal insufficiency increases the risk of CHF, [3][4][5] but most studies that have investigated the role of renal function in CHF have included only subjects with no known CHF or mild-to-moderate CHF and excluded patients with severe renal dysfunction. Patients hospitalized for CHF have more severe disease and impaired renal function, but little is known about the relation between renal dysfunction and re-hospitalization because of CHF. Thus, the aim of the present study was to investigate whether renal dysfunction is associated with rehospitalization for CHF after successful discharge. MethodsThe study protocol was approved by the Ethics Committee of The Jikei University School of ).Patients with CHF who had been admitted from January 2003 through December 2004 and followed up after discharge at the outpatient clinic were reviewed. CHF was diagnosed by 2 or more cardiologists on the basis of the Framingham criteria. Patients were excluded if they had CHF complicated by acute myocardial infarction, were undergoing or starting dialysis during the follow-up period, or had undergone cardiac surgery during the follow-up period. With these selection criteria, 109 patients were enrolled. The duration of follow-up was 6-1,466 days (mean, 496 days; median, 348 days). The estimated glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease equation 6 coefficient modified for Japanese patients: estimated GFR = 0.741×175× Cr -1.154 × age -0.203 (ml · min -1 · 1.73 m -2 ). For women, the estimated GFR was multiplied by a correction factor of 0.742.The 109 patients were divided into 2 groups: decreased renal function (estimated GFR on admission <45 ml·min -1 · 1.73 m -2 ; 42 patients) and preserved renal function (estimated GFR on admission ≥45 ml·min -1 ·1.73 m -2 ; 67 patients). The 2 groups were compared on the basis of age, sex, New York Heart Association (NYHA) class on admission, prescribed anti-CHF drugs at discharge, and the rates of coronary artery disease, valvular heart disease, cardiomyopathy, atrial fibrillation, hypertension, diabetes mellitus (DM), dyslipidemia, anemia, systolic dysfunction, previous hospitalization for CHF, and worsening renal function during hospitalization. Cardiomyopathy was defined according to heart catheterization or previous diagnosis. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or previous history. DM was defined as fasting plasma glucose concentration ≥126 mg/dl, Background Patients with congestive heart failure (CHF) are often re-hospitalized, worsening both their quality of life and prognosis. Although renal dysfunction reportedly increases the risk of CHF, the association between renal dysfunction and re-hospitalization for CHF remains unclear...

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Section: Other Factors Related To Re-hospitalization For Chfcontrasting

confidence: 56%

Decreased Renal Function as an Independent Predictor of Re-Hospitalization for Congestive Heart Failure

Komukai

Ogawa

Yagi

et al. 2008

Circ J

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“…The risk of adverse outcomes, including death, is normally related to underlying disease severity. 23,24 In the current evaluation, patients in the lowest quartile of PCWP had higher mean cardiac output with lower mean systemic vascular resistance and right atrial pressure than the patients in the other 3 PCWP quartiles combined, suggesting that patients in the lowest PCWP quartile had less severe heart failure. Despite this, many of these patients received HDDs and administration of HDDs significantly increased the risks of hypotension, acute SCr elevation, and death for patients in this quartile.…”

Section: Resultsmentioning

confidence: 63%

Hemodynamics, Diuretics, and Nesiritide: A Retrospective VMAC Analysis

Young

Cheng

Mills

2009

Clinical Cardiology

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Hypothesis: Hypotension has been proposed as the cause of nesiritide-associated increases in serum creatinine (SCr); however, this hypothesis has not been tested. Methods: This retrospective evaluation of patients who had a pulmonary artery catheter and received nesiritide in the Vasodilation in the Management of Acute Congestive Heart Failure (VMAC) trial assessed hypotension, SCr elevation, concomitant therapy, and mortality. Patients were categorized by baseline pulmonary capillary wedge pressure (PCWP) and analyzed both for overall population and by diuretic dose. Results: Compared with patients with PCWP >23 mm Hg (n = 105), patients with PCWP ≤23 mm Hg (n = 49) had more hypotension within 24 hours of initiating nesiritide (16% vs 7%), but neither more SCr elevation by nominal day 30 (29% vs 28%) nor higher mortality (30 days: 8.2% vs 7.7%; 6 months: 29.0% vs 29.3%). The risk of hypotension was directly related to high dose diuretics (25% vs 6%; relative risk [RR]: 4.2; 95% confidence interval [CI]: 1.10-15.82) and was not significantly increased in patients without this concomitant treatment (10% vs 7%; RR: 1.4; 95% CI: 0.34-5.93). Additionally, high dose diuretics significantly increased the risk of SCr elevation (RR: 2.6; 95% CI: 1.03-6.64) and 6 month mortality (hazard ratio: 3.6; 95% CI: 1.19-10.63) in patients with PCWP ≤23 mm Hg. Conclusions: Hypotension is not the primary etiology for nesiritide-associated increases in SCr. High dose diuretics increase the risk of adverse outcomes in patients with PCWP ≤23 mm Hg and should be reserved for patients in whom PCWPs are known to be markedly elevated.

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“…Previous studies have indicated that this cohort constitutes 1.2% of all the patients with HFpEF and are at eight times greater risk of death [69]. These patients have preserved systolic function without known scar or fibrotic tissue burden, which is considered a potential substrate for arrhythmias in the systolic HF group.…”

Section: Non-icd Populationmentioning

confidence: 99%

Management of arrhythmias in heart failure. What a practicing physician should know in the current times

Ramineni¹,

Bheemarasetti²,

Baranchuk³

et al. 2012

Cardiol J

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Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function

Abstract: Background-The association between New York Heart Association (NYHA) class and outcomes in heart failure patients with preserved systolic function is not well known.

Cited by 179 publications

References 19 publications

Decreased Renal Function as an Independent Predictor of Re-Hospitalization for Congestive Heart Failure

Decreased Renal Function as an Independent Predictor of Re-Hospitalization for Congestive Heart Failure

Hemodynamics, Diuretics, and Nesiritide: A Retrospective VMAC Analysis

Management of arrhythmias in heart failure. What a practicing physician should know in the current times

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