Normal Left Ventricular Ejection Fraction in Older Persons With Congestive Heart Failure

Aronow, Wilbert S.; Ahn, Chul; Kronzon, Itzhak

doi:10.1378/chest.113.4.867

Cited by 81 publications

(20 citation statements)

References 6 publications

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“…In fact, in a similar population, as many as 75% to 80% of older CHF patients have some level of diastolic dysfunction. 28 Moreover, Aronow et al 31 have determined that old age and female sex are the only independent predictors of diastolic dysfunction.…”

Section: Limitationsmentioning

confidence: 99%

“…Thus, despite the epidemiological relevance of CHF among older individuals, there is a paucity of data to elucidate optimal management strategies of the more typical patients with CHF. 29,30 In fact, old age and female sex are both independent predictors of CHF associated with preserved systolic function, 31 a condition that may affect as many as 74% of older CHF patients. 28,31 To address some of these issues, we conducted a retrospective cohort study comparing the effects of therapy with an ACE inhibitor or with digoxin on allcause mortality, hospitalization, and physical function in very old patients (mean age, 85 years) with heart failure.…”

mentioning

confidence: 99%

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Effects of Angiotensin-Converting Enzyme Inhibitors and Digoxin on Health Outcomes of Very Old Patients With Heart Failure

Gambassi

Lapane²,

Sgadari³

et al. 2000

Arch Intern Med

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Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

Effects of Angiotensin-Converting Enzyme Inhibitors and Digoxin on Health Outcomes of Very Old Patients With Heart Failure

Gambassi

Lapane²,

Sgadari³

et al. 2000

Arch Intern Med

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“…Tale distribuzione risulta sovrapponibile ai dati epidemiologici riferiti alla popolazione generale italiana ospedalizzata per scompenso cardiaco [4], come pure l'etiologia [4], con maggior prevalenza di pazienti affetti da cardiopatia ischemica (40%), rispetto alla causa ipertensiva (21%) o valvolare (19%). Anche la percentuale di scompenso diastolico sul totale dei casi (FE > 45%) rispecchiava quanto atteso [38] per una popolazione anziana ovvero i soggetti con funzione sistolica conservata rappresentavano il 53% del totale, mentre il 25% dell'intero campione presentava un pattern trans-mitralico restrittivo. La prescrizione di farma-ci di provata efficacia era alta in relazione al fatto che si trattava di una popolazione che in larga parte aveva già avuto contatto con l'ospedale: il 37% era stato precedentemente riconosciuto affetto da scompenso cardiaco durante una visita cardiologica e/o un ricovero per DRG 127 (Tabella I).…”

Section: Caratteristiche Basali Della Popolazioneunclassified

BNP-guided therapy optimizes the timing of discharge and the medium term risk stratification in patients admitted for congestive heart failure

Valle

Aspromonte

Carbonieri³

et al. 2016

Monaldi Arch Chest Dis

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PremesseSebbene i trials sullo scompenso cardiaco mostrino un graduale calo della mortalità post-dimissione [1], i dati provenienti dalle casistiche non selezionate rivelano che il 30-50% dei pazienti viene riammesso in ospedale per scompenso entro sei mesi dalla dimissione ed un ulteriore 20% decede nello stesso intervallo di tempo [2,3,4,7]. Nonostante la disponibilità e la "intensa" applicazione delle linee guida [5,6] lo scompenso cardiaco è ancora una condizione morbosa cronica caratterizzata dall'alternarsi di peLa terapia guidata dal BNP consente l'ottimizzazione del timing di dimissione e la stratificazione del rischio a medio termine nel paziente ricoverato per scompenso cardiaco Objective: The aim of the study was to evaluate if plasma levels of BNP would provide an index to guide drug treatment and to predict medium-term prognosis in HF patients (pts) after hospital discharge. Methods and Results:We evaluated 200 consecutive pts (age 77±10 (35-96) years, 49% male versus 51% female) hospitalized for HF (DRG 127). Standard echocardiography was performed and left ventricular systolic/diastolic function was assessed; plasma BNP levels were measured with a rapid point-of-care assay (Triage BNP Test, Biosite Inc, San Diego, CA) on days 1 and after initial treatment. Using a cut-off of 240 pg/ml and/or changes in plasma BNP (days 2-3 after admission), 2 groups were identified: the low BNP group-responders (n= 68, BNP <240 pg/ml and/or > 30% reduction) and the high BNP group-non responders (n = 132, BNP >= 240 pg/ml and/or < 30% reduction). The high BNP group showed a different pattern of clinical variables according to the severity of the disease New York Heart Association (NYHA) functional class, left ventricular ejection fraction, ischemic etiology and age. A sustained elevation of plasma BNP (> 240 pg/mL) indicated the presence of a clinical unstable condition requiring further intervention whereas pts with low BNP values were discharged after 24 hours. During a mean follow-up period of 3 months, there were 62 cardiac events, including 15 cardiac deaths, 22 readmissions for worsening heart failure and 25 clinical decompensation requiring diuretic treatment. The incidence of clinical events was significantly greater in pts with higher levels of BNP (admission and discharge) than in those with lower levels (42% vs. 10%) and plasma values > 500 pg/ml identified a subgroup at high risk of death.Conclusions: The influence of BNP in the clinical course and prognosis of patients hospitalized for HF has not been studied. After initial treatment pts need to be risk stratified by means of the BNP test, to guide further management and to identify subjects with poor prognosis. An aggressive therapeutic and follow-up strategy may be justified for pts with high BNP levels and/or no changes after hospital admission for worsening HF. The changes in plasma BNP level at discharge were significantly related to cardiac events.

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“…This has been shown experimentally in animal models (4) but is thought to be unusual as a primary cause of HF (1,3). Preserved systolic function is however prevalent in HF (5), and even more common in elderly HF patients (6), which indicates that other pathophysiologic mechanisms, like tachyarrythmias or diastolic dysfunction may be the primary cause of HF in many patients.…”

mentioning

confidence: 94%

Congestive heart failure with and without atrial fibrillation – different patient populations?

Waldenhjort

Mejhert

Edner

et al. 2009

Scandinavian Cardiovascular Journal

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Normal Left Ventricular Ejection Fraction in Older Persons With Congestive Heart Failure

Cited by 81 publications

References 6 publications

Effects of Angiotensin-Converting Enzyme Inhibitors and Digoxin on Health Outcomes of Very Old Patients With Heart Failure

Effects of Angiotensin-Converting Enzyme Inhibitors and Digoxin on Health Outcomes of Very Old Patients With Heart Failure

BNP-guided therapy optimizes the timing of discharge and the medium term risk stratification in patients admitted for congestive heart failure

Congestive heart failure with and without atrial fibrillation – different patient populations?

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