Predictability of Inpatient Mortality of Different Comorbidities in Both Types of Acute Decompensated Heart Failure: Analysis of National Inpatient Sample

Museedi, Abdulrahman; Alshami, Abbas; Douedi, Steven; Ajam, Firas; Varon, Joseph

doi:10.14740/cr1186

Cited by 6 publications

(4 citation statements)

References 34 publications

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“…A COPD diagnosis was associated with increased in-hospital death in those with HFrEF, but not in those with HFpEF, which is surprising, given that COPD is suggested to be more severe in the latter group 20. In contrast with our report, previous studies found that risk of death is increased in those with COPD-HFpEF compared with COPD-HFrEF21 22; however, these may be confounded by a lack of validity of EF status (inferred by ICD codes rather than echocardiography) or spirometry to confirm COPD status, consideration of long-term rather than short-term effects on mortality, or by including chronic rather than hospitalised HF. Our result therefore may be explained by poor uptake of disease-modifying treatments available for HFrEF in those with COPD,17 which has been previously reported and could be more pronounced in a cohort of patients newly admitted for HF.…”

Section: Discussioncontrasting

confidence: 98%

Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis

et al. 2022

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ObjectiveTo evaluate the association between having concomitant chronic obstructive pulmonary disease (COPD) or asthma, and in-patient mortality and post-discharge management among patients hospitalised for acute heart failure (HF).SettingData were obtained from patients enrolled in the National Heart Failure Audit.Participants217 329 patients hospitalised for HF in England–Wales between March 2012 and 2018.OutcomesIn-hospital mortality, referrals to cardiology follow-up and prescriptions for HF medications were compared between patients with comorbid COPD (COPD-HF) or asthma (asthma-HF) versus HF-alone using mixed-effects logistic regression.ResultsPatients with COPD-HF were more likely to die during hospitalisation, and those with asthma-HF had a reduced likelihood of death, compared with patients who had HF-alone ((adjusted)ORadj, 95% CI: 1.10, 1.06 to 1.14 and ORadj, 95% CI: 0.84, 0.79 to 0.88). In patients who survived to discharge, referral to HF follow-up services differed between groups: patients with COPD-HF had reduced odds of cardiology follow-up (ORadj, 95% CI 0.79, 0.77 to 0.81), while cardiology referral odds for asthma-HF were similar to HF-alone. Overall, proportions of HF medication prescriptions at discharge were low for both COPD-HF and asthma-HF groups, particularly prescriptions for beta-blockers.ConclusionsIn this nationwide analysis, we showed that COPD and asthma significantly impact the clinical course in patients hospitalised for HF. COPD is associated with higher in-patient mortality and lower cardiology referral odds, while COPD and asthma are both associated with lower use of prognostic HF therapies on discharge. These data highlight therapeutic gaps and a need for better integration of cardiopulmonary services to improve healthcare provision for patients with HF and coexisting respiratory disease.

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Section: Discussioncontrasting

confidence: 98%

Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis

et al. 2022

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“…28 However, obesity was determined to be a predictor of mortality. 29 This study showed a decrease of NT-proBNP level in all patients irrespective of their weight at follow-up. Furthermore, NT-proBNP was higher in non-obese than in obese patients at baseline.…”

Section: Discussionsupporting

confidence: 48%

“…Well‐tolerated treatment showed better outcomes in HFrEF patients 28 . However, obesity was determined to be a predictor of mortality 29 . Further studies are necessary to investigate the risk of obesity in HFrEF patients treated with sacubitril/valsartan.…”

Section: Discussionmentioning

confidence: 99%

Incidence of atrial and ventricular arrhythmias in obese patients with heart failure with reduced ejection fraction treated with sacubitril/valsartan

Abumayyaleh

Demmer

Krack

et al. 2023

Diabetes Obesity Metabolism

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AimTo compare clinical outcomes among patients with heart failure and reduced ejection fraction (HFrEF) according to body mass index (BMI) after initiating treatment with an angiotensin‐receptor neprilysin inhibitor (ARNI).MethodsWe gathered data from 2016 to 2020 at the University Medical Center Mannheim; 208 consecutive patients were divided into two groups according to BMI (< 30 kg/m2; n = 116, ≥ 30 kg/m2; n = 92). Clinical outcomes, including mortality rate, all‐cause hospitalizations and congestion, were systematically analysed.ResultsAt the 12‐month follow‐up, the mortality rate was similar in both groups (7.9% in BMI < 30 kg/m2 vs. 5.6% in BMI ≥ 30 kg/m2; P = .76). All‐cause hospitalization before ARNI treatment was comparable in both groups (63.8% in BMI < 30 kg/m2 vs. 57.6% in BMI ≥ 30 kg/m2; P = .69). After ARNI treatment, the hospitalization rate was also comparable in both groups at the 12‐month follow‐up (52.2% in BMI < 30 kg/m2 vs. 53.7% in BMI ≥ 30 kg/m2; P = .73). Obese patients experienced more congestion compared with non‐obese patients at follow‐up, without statistical significance (6.8% in BMI < 30 kg/m2 vs. 15.5% in BMI ≥ 30 kg/m2; P = .11). Median left ventricular ejection fraction (LVEF) improved in both groups, but significantly more in non‐obese compared with obese patients at the 12‐month follow‐up (from 26% [3%‐45%] [min.‐max.] vs. 29% [10%‐45%] [min.‐max.] [P = .56] to 35.5% [15%‐59%] [min.‐max.] vs. 30% [13%‐50%] [min.‐max.] [P = .03], respectively). The incidence of atrial fibrillation (AF), non‐sustained (ns) and sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) was less in non‐obese than in obese patients after initiation of sacubitril/valsartan at the 12‐month follow‐up (AF: 43.5% vs. 53.7%; P = .20; nsVT: 9.8% vs. 28.4%; P = .01; VT: 14.1% vs. 17.9%; P = .52; VF: 7.6% vs. 13.4%; P = .23).ConclusionsThe incidence of congestion in obese patients was higher compared with non‐obese patients. LVEF improved significantly more in non‐obese compared with obese HFrEF patients. Furthermore, AF and the ventricular tachyarrhythmia rate were revealed more in obesity compared with those without obesity at the 12‐month follow‐up.

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“…In this analysis, we observed higher mortality, ICU admission, and assisted ventilation rates in SHF compared to DHF within the influenza cohort. Historically, SHF has demonstrated increased mortality compared to DHF [ 18 - 19 ], along with significant differences in its mortality predictors [ 20 ]. This could be explained by a poor contractile reserve in SHF and, therefore, a higher risk for vasopressor support and ICU admission, especially when encountering the extra burden of a systemic illness such as influenza.…”

Section: Discussionmentioning

confidence: 99%

Worse In-Hospital Outcomes Among Patients With Heart Failure (HF) and Concomitant Influenza Infection

Torres¹,

Shahi²,

Quelal³

et al. 2022

Cureus

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Introduction: A sizable proportion of heart failure (HF) admissions is precipitated by respiratory infections. Influenza has been linked to higher rates of HF hospitalizations and in-hospital morbidity and mortality.Aim/Objective: We aim to describe the in-hospital outcomes of systolic HF vs. diastolic HF admissions with concomitant influenza infection in US hospitalizations from 2016 to 2017.Materials and Methods: We queried the National Inpatient Sample (NIS) from 2016 to 2017 for discharge diagnosis for SHF and DHF and influenza per ICD-10 CM codes. Using binominal logistic regression analysis and adjusting for demographic and comorbid conditions, we compared the outcomes of SHF vs. DHF admissions with concomitant influenza as an independent risk factor for inpatient mortality, acute respiratory failure, ICU admission, assisted ventilation, as well as length of stay, and total hospital costs.Results: A total of 7,490,596 HF weighted admissions were analyzed, among which 0.9% had concomitant influenza infection. SHF and DHF admissions with influenza had higher mortality, ICU admission, ventilation assistance, and acute respiratory failure when compared to those without influenza. Among influenza admissions, those with SHF had higher mortality (6.6% vs. 5%, adjusted odds ratio -aOR 1.31, p<0.001) compared to DHF. While intensive care unit (ICU) admission (7.8% vs. 5.2%, aOR 1.30, p<0.001) and ventilation assistance rates (22.1% vs. 18.9%, aOR 1.15, p<0.001) were greater among SHF patients with influenza, acute respiratory failure was more common amongst diastolic HF with influenza (46.6% vs. 51.2%, aOR 0.86, p<0.001). Finally, SHF patients with concomitant influenza had higher inpatient costs ($82,788) when compared to diastolic HF patients ($66,373) and a longer in-hospital stay (7.29 days compared to 6.98 days in the diastolic HF group) p <0.001. Conclusion:Concomitant influenza infection in hospitalized patients with HF is associated with higher mortality, ICU admission, and the need for assisted ventilation, especially in those with SHF. A greater emphasis on vaccination against influenza may improve in-patient outcomes among HF patients.

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Predictability of Inpatient Mortality of Different Comorbidities in Both Types of Acute Decompensated Heart Failure: Analysis of National Inpatient Sample

Cited by 6 publications

References 34 publications

Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis

Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis

Incidence of atrial and ventricular arrhythmias in obese patients with heart failure with reduced ejection fraction treated with sacubitril/valsartan

Worse In-Hospital Outcomes Among Patients With Heart Failure (HF) and Concomitant Influenza Infection

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