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Journal Cover JACC : Heart Failure
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   Full-text available via subscription Subscription journal
   ISSN (Online) 2213-1779
   Published by American College of Cardiology Homepage  [1 journal]
  • Learning From Our Predictions The HeartMate Risk Score in INTERMACS
    • Authors: Stewart GC.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
  • Association of Nasal Mucosal Vascular Alterations, Gastrointestinal
           Arteriovenous Malformations, and Bleeding in Patients With
           Continuous-Flow Left Ventricular Assist Devices
    • Authors: Patel SR; Madan S, Saeed O, et al.
      Abstract: ObjectivesThis study sought to determine whether the nasal mucosa can serve as a surrogate for evaluating arteriovenous malformations (AVMs) related gastrointestinal (GI) bleeding in patients supported by continuous-flow left ventricular assist devices (CF LVADs).BackgroundBleeding from the mucosal surfaces of GI tract, particularly AVMs, is the most common complication of CF LVAD support. The pathophysiology of AVM formation during CF LVAD support is of critical interest yet poorly understood; in large part because of the length and accessibility of the GI tract. Nasal endoscopy is a minimally invasive, bedside test giving access to a mucosal surface possibly representative of the GI tract.MethodsEighty subjects (35 with CF LVAD, 30 with heart failure reduced ejection fraction [HFrEF], and 15 controls without heart failure) underwent nasal endoscopy for systematic evaluation of the intranasal mucosa for the presence of hypervascularity (HV). Patient records were reviewed for episodes and etiology of GI bleeding.ResultsNasal HV was present in 63%, 57%, and 20% of the LVAD, HFrEF, and control groups, respectively (p = 0.018). Although the prevalence was similar, the severity of nasal HV was significantly higher in the CF LVAD group compared with the HFrEF group. Of the baseline characteristics in the entire cohort, only a history of heart failure was associated with HV (odds ratio: 4.8; 95% confidence interval: 1.02 to 22.31; p = 0.040) in adjusted logistic regression modeling. HV was strongly associated with GI bleeding in the CF LVAD cohort: the incidence was 32% in subjects with HV compared with 0% in subjects with normal mucosa (p = 0.023).ConclusionsIn this pilot study, HV of the nasal mucosa was associated with GI bleeding in subjects with CF LVADs. Nasal endoscopy has significant potential to further investigation into mechanisms of bleeding and risk stratification during CF LVAD support.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
  • Severe Obesity and Acute Decompensated Heart Failure New Insights Into
           Prevalence and Prognosis ∗
    • Authors: Alpert MA.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
  • Association of 30-Day Readmission Metric for Heart Failure Under the
           Hospital Readmissions Reduction Program With Quality of Care
           and Outcomes
    • Authors: Pandey A; Golwala H, Xu H, et al.
      Abstract: ObjectivesThis study sought to determine whether processes of care and long-term clinical outcomes for heart failure (HF) admissions across Get With The Guidelines-Heart Failure (GWTG-HF) program participating centers differ according to HF-specific risk-adjusted 30-day readmission rates (excess readmission ratio [ERR]) as determined by the Hospital Readmission Reduction Program (HRRP).BackgroundHRRP penalizes hospitals with higher than expected risk-adjusted 30-day readmission rates (ERR >1) for common conditions including HF. However, it is unclear whether the differences in this metric of hospital performance used by HRRP and related penalties are associated with measured quality of care and long-term outcomes.MethodsWe analyzed data from the GWTG-HF registry linked to Medicare claims from July 2008 to June 2011. Using publically available data on HF-ERR in 2013, we stratified the participating centers into groups with low (HF-ERR ≤1) versus high (HF-ERR >1) risk-adjusted readmission rates. We compared the care quality, in-hospital, and 1-year clinical outcomes across the 2 groups in unadjusted and multivariable adjusted analysis.ResultsThe analysis included 171 centers with 43,143 participants; 49% of centers had high risk-adjusted 30-day readmission rates (HF-ERR >1). There were no differences between the low and high risk-adjusted 30-day readmission groups in median adherence rate to all performance measures (95.7% vs. 96.5%; p = 0.37) or median percentage of defect-free care (90.0% vs. 91.1%; p = 0.47). The composite 1-year outcome of death or all-cause readmission rates was also not different between the 2 groups (median 62.9% vs. 65.3%; p = 0.10). The high HF-ERR group had higher 1-year all-cause readmission rates (median 59.1% vs. 54.7%; p = 0.01). However, the 1-year mortality rates were lower among high versus low HF-ERR group with a trend toward statistical significance (median 28.2% vs. 31.7%; p = 0.07).ConclusionsQuality of care and clinical outcomes were comparable among hospitals with high versus low risk-adjusted 30-day HF readmission rates. These findings raise questions about the validity of the HRRP performance metric in identifying and penalizing low-performance centers.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
  • Whose Metric Is It, Anyway' Time for Patients to Assert Quality
           Control ∗
    • Authors: Konstam MA.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
  • The HeartMate Risk Score Identifies Patients With Similar Mortality Risk
           Across All INTERMACS Profiles in a Large Multicenter Analysis
    • Authors: Adamo L; Tang Y, Nassif ME, et al.
      Abstract: ObjectivesThis study sought to assess the performance of the HeartMate Risk Score (HMRS) in a large multicenter cohort, with a focus on its performance as a function of disease severity.BackgroundThe HMRS has been proposed as a simple tool for risk stratification of LVAD recipients, but subsequent studies have challenged its validity.MethodsWe performed a retrospective, longitudinal, comparative study using the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database. The HMRS was calculated for each patient and its association with mortality was assessed using Cox models, including a pre-specified interaction by INTERMACS profile groups (1 vs. 2 vs. 3 vs 4+).ResultsAmong 10,847 patients with a mean age of 57.0 ± 12.9 years, 78.9 % were male; and 14.1%, 37.4%, 30.4%, and 18.2% were in INTERMACS profile groups 1, 2, 3, and ≥4, respectively. The HMRS showed moderate discrimination for both short-term (90-day, C-index 0.62) and long-term (2-years, C-index 0.60) mortality, with no significant difference between axial and centrifugal devices. Patients in the highest HMRS group had a relative risk of 90-day mortality 2.8 times greater than those in the lowest HMRS group (13.0% vs. 4.7%; p < 0.001). Importantly, the relative risks of higher HMRS scores were similar across INTERMACS profile groups, with subgroups of patients in INTERMACS profile 1 and 2 having comparable or lower mortality than some in INTERMACS profile 4+.ConclusionsThe HMRS is a valid means of risk-stratifying patients across all INTERMACS profiles and may be superior to traditional INTERMACS classification. Risk stratification with the HMRS showed that patients within each INTERMACS profile groups have a wide spectrum of mortality risk and low INTERMACS profiles should therefore not be considered a contraindication to mechanical support.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
  • Living Without Heart Failure Contemporary Concepts in Prevention ∗
    • Authors: Wang TJ.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
  • Prevalence, Profile, and Prognosis of Severe Obesity in Contemporary
           Hospitalized Heart Failure Trial Populations
    • Authors: Joyce E; Lala A, Stevens SR, et al.
      Abstract: ObjectivesThis study evaluated the prevalence, profile, and prognosis of severe obesity in a large contemporary acute heart failure (AHF) population.BackgroundBetter prognosis has been reported for obese heart failure (HF) patients than nonobese HF patients, but in other cardiovascular populations, this effect has not been demonstrated for severely obese patients.MethodsA cohort of 795 participants with body mass index (BMI) measured at time of admission and complete follow-up were identified from enrollment in 3 contemporary AHF trials (DOSE [Diuretic Strategies Optimization Evaluation], CARRESS-HF [Cardiorenal Rescue Study in Acute Decompensated Heart Failure], and ROSE [Renal Optimization Strategies Evaluation in Acute Heart Failure]). Patients were divided into 4 BMI categories according to standard World Health Organization criteria, as follows: normal weight: 18.5 to 25 kg/m2 [n = 128]; overweight: 25 to 29.9 kg/m2 [n = 209]; mild-to-moderate obese: 30 to 39.9 kg/m2 [n = 301]; and severely obese: ≥40 kg/m2 [n = 157]). The relationship between BMI and 60-day composite outcome (death, rehospitalization, or unscheduled provider visit) was investigated.ResultsPatients with severe obesity (19.7%) were younger, more often female, hypertensive, diabetic, and more likely to have higher blood pressures and left ventricular ejection fraction, and lower N-terminal pro-B-type natriuretic peptide and troponin I levels than other BMI category patients. Following admission for AHF, patients with normal weight showed the highest risk of 60-day composite outcome, followed by patients who were severely obese. Overweight and mild-moderately obese patients showed lowest risk.ConclusionsNearly one-fifth of AHF patients enrolled in contemporary randomized clinical trials are severely obese. A U-shaped curve for short-term prognosis according to BMI is seen in AHF. These findings may help to better inform both HF clinical care and future clinical trial planning.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
  • Not Your Mother’s FDA
    • Authors: O’Connor CM.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
  • VAD Why Does It Bleed' ∗
    • Authors: Strueber M.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
  • The FDA in the 21st Century How Is the FDA Responding to the New
           World' A Focus on Heart Failure Devices ∗
    • Authors: Hillebrenner M; Zuckerman B, Fiuzat M, et al.
      Abstract: Regulatory decisions to approve or deny marketing applications for new drugs and devices for heart failure (HF) care often garner significant publicity and highlight the impact of the U.S. Food and Drug Administration (FDA) on HF care. However, there are a number of other activities and discussions occurring throughout the year that are also critical to the health of patients with HF. These activities involve scientific interchange about new product development and post-marketing assessment of risks and benefits. The influence of the FDA’s scientific expertise in the device ecosystem may raise awareness or affect disease burden and the future of patient health in this disease area. We aim to summarize recent regulatory activities that we deem important in this field. This commentary, which is focused on initiatives that have an impact on the regulation of HF devices, will be the first of a series of papers highlighting a specific area of FDA activity.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
  • Hypertension, Obesity, Diabetes, and Heart Failure–Free Survival The
           Cardiovascular Disease Lifetime Risk Pooling Project
    • Authors: Ahmad FS; Ning H, Rich JD, et al.
      Abstract: ObjectivesThis study was designed to quantify the relationship between the absence of heart failure risk factors in middle age and incident heart failure, heart failure-free survival, and overall survival.BackgroundQuantification of years lived free from heart failure in the context of risk factor burden in mid-life may improve risk communication and prevention efforts.MethodsWe conducted a pooled, individual-level analysis sampling from communities across the United States as part of 4 cohort studies: the Framingham Heart, Framingham Offspring, Chicago Heart Association Detection Project in Industry, and ARIC (Atherosclerosis Risk In Communities) studies. Participants with and without hypertension (blood pressure ≥140/90 mm Hg or treatment), obesity (body mass index ≥30 kg/m2), or diabetes (fasting glucose ≥126 mg/dl or treatment), and combinations of these factors, at index ages of 45 years and 55 years through 95 years. Competing risk-adjusted Cox models, a modified Kaplan-Meier estimator, and Irwin’s restricted mean were used to estimate the association between the absence of risk factors at mid-life and incident heart failure, heart failure-free survival, and overall survival.ResultsFor participants at age 45 years, over 516,537 person-years of follow-up, 1,677 incident heart failure events occurred. Men and women with no risk factors, compared to those with all 3, had 73% to 85% lower risks of incident heart failure. Men and women without hypertension, obesity, or diabetes at age 45 years lived on average 34.7 years and 38.0 years without incident heart failure, and they lived on average an additional 3 years to 15 years longer free of heart failure than those with 1, 2, or 3 risk factors. Similar trends were seen when stratified by race and at index age 55 years.ConclusionsPrevention of hypertension, obesity, and diabetes by ages 45 years and 55 years may substantially prolong heart failure-free survival, decrease heart failure-related morbidity, and reduce the public health impact of heart failure.
      PubDate: Thu, 01 Dec 2016 00:00:00 GMT
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