Short-term outcomes after hospital discharge in patients admitted with heart failure in Abeokuta,Nigeria: Data from the Abeokuta Heart Failure Registry

Heart failure (HF) has emerged as a global epidemic in at-risk populations, including those living in high-income countries and, as recently described, in low- to middle-income regions of the world, such as sub-Saharan Africa.11-4 While there are well-established HF registries to capture both the characteristics and health outcomes among those hospitalised with AHF in Europe,5,6 North America,7,8 and the Asia–Pacific region,3,9,10 there are few reports from sub-Saharan Africa.11 This includes Nigeria (the most populous country in the region), where HF has emerged as a potentially large public health problem.1Although there have been many therapeutic gains in the management of chronic HF,12 leading to improved overall survival rates,13 there has been very little parallel success (pending further evaluation of the recently reported RELAX trial14 with regard to AHF). This is particularly important when one considers the high proportion of patients who still require hospitalisation for acute HF, and associated high levels of in-patient case fatality and poor short- to medium-term health outcomes.Given the paucity of data describing health outcomes in unselected patients hospitalised with AHF in Nigeria (and indeed the wider sub-Saharan Africa), we examined short- (30 days) to medium-term outcomes (180 days) in consecutive subjects with AHF recruited into the Abeokuta HF registry over a period of six months. Standardised data collected via the registry were used to both describe the baseline characteristics of the cohort and identify correlates of mortality during the six-month follow up.     

心力衰竭管理模式探讨

目的:评价不同管理模式对慢性收缩性心力衰竭(心衰)患者神经内分泌、心功能、心脏事件、生活质量和医疗费用的影响。方法:120例慢性心功能不全患者,在常规治疗心衰的前提下,随机分为心衰管理组和心衰非管理组各60例,治疗后两年其对神经内分泌、心功能、心脏事件、生活质量和医疗费用的影响。结果:心衰管理组治疗后心功能、生活质量、神经内分泌较心衰非管理组治疗后改善(P<0.05),心衰恶化再入院减少(P<0.05),心脏事件较心衰非管理组明显减少(P<0.05),年心衰治疗费用较后者减少(P<0.05),差异均有统计学意义。结论:通过心衰管理能改善心功能及生活质量,减少心衰医疗费用、心脏事件的发生。     

In-Hospital and Three-Year Outcomes of Heart Failure Patients in South India: The Trivandrum Heart Failure Registry

Background

Long-term data on outcomes of participants hospitalized with heart failure (HF) from low- and middle-income countries are limited.

Comparison of Plasma BNP and ET-1 Levels With Hemodynamics in Patients Admitted for Decompensated Heart Failure

Objectives This study addressed to compare plasma B-type natriuretic peptide （BNP） and endothelin-1 （ET-1） levels with hemodynamics in heart failure（HF） patients. Methods Plasma BNP and ET-1 levels were obtained from 75 patients with HF by rapid immunofluorescence assay and radio-immunity method, respectively, and left ventricular end-diastolic diameter （LVEDD） were observed by echocardiogram. Hemodynamic data of 53 HF patients were determined by Swan-Ganz catheterization. Results Hemodynamics （PCWP, MPAP and RAP） and plasma BNP, ET-1 levels were proportional to New York Heart Association （NYHA） class（P〈 0.001-0.05）. Both BNP and ET-1 had positive linear relations with PCWP, MPAP, RAP （P〈 0.05- 001 ）. Moreover, plasma ET-1 was an independent and significant predictor of BNP （P〈0.001）. Plasma levels of BNP （968.23±478.63 pg/ml）and ET-1 （129.45± 88.56 pg/ml）in group with LVEDD （n=31） ≥60 mm were much higher than those in LVEDD （n = 44） 〈 60 mm group （BNP：286.26 ±156.89 pg/mL, ET-1 ： 87.45±43.65 pg/mL, P〈 0.001）. Conclusions BNP level is as a direct result of ventricular volume expansion and pressure overload. BNP is a sensitive biochemical maker of left ventricular injury and ET-1 may stimulate the secretion of cardiac BNP independent of hemodynamics in patients with HF.     

Biomedical and Psychosocial Predictors of Early Rehospitalization Among Children With Insulin-dependent Diabetes Mellitus: A Longitudinal Study

The purpose of the present study was to determine the cumulative probability of the first diabetes-related rehospitalization within the initial 2.5 years after the onset of insulin-dependent diabetes mellitus (IDDM) among newly diagnosed children, and to identify risk factors that can be determined shortly after IDDM-onset. The sample consisted of 88 children, 8 to 13 years old at the onset of IDDM, who had been participating in a longitudinal study. In this sample, there was a 0.25 cumulative probability of an early readmission. Poor control was the most frequent reason for readmissions. Four variables significantly increased the risk of early rehospitalization: severity of child's externalizing symptoms at IDDM-onset, lower socio-economic status, younger age at onset of IDDM, and higher levels of glycosylated haemoglobin, reflecting poorer metabolic control. Because externalizing symptoms and poor control are amenable to change, some early rehospitalizations can potentially be prevented. Furthermore, information about the risk of early rehospitalization should be part of initial diabetes education in order to better prepare families for the possibility of such an event.     

National Heart Failure Registry,India: Design and methods

ObjectiveHeart failure (HF) has emerged as a global public health problem that affects both low and high-income countries. The high HF burden and the need for resource-intensive treatments often lead to health system crisis in resource-poor settings. Data on prevailing practice patterns and long-term clinical outcomes of HF are scarce from the low and middle-income countries. Nationally representative HF data from India are not available.MethodsThe National Heart Failure Registry (NHFR) is a multicentric, hospital-based registry of HF patients from 53 centers across India. Consecutive patients admitted with the diagnosis of acute decompensated HF satisfying the European Society of Cardiology (ESC) 2016 criteria will be enrolled into the registry from January 2019 to December 2019. Each participating center is expected to contribute 200 patients into the registry (i.e., more than 10,000 HF patients from India). We are collecting demographics, clinical, laboratory, imaging, and other diagnostic data at baseline from all registered patients in the registry by using a structured document. Additionally, we are collecting the details of treatment practices and the usage of guideline-directed therapy from all participants. We intend to obtain the in-hospital, 3-months, 6-months and one-year outcome data on mortality, cause of death, and repeated hospitalization events.ConclusionsIn summary, NFHR will be the first nationally representative HF registry aimed at providing crucial information on prevailing etiology, distribution and current practices in the management of HF.     

Antibodies to Oxidized LDL as Predictors of Morbidity and Mortality in Patients With Chronic Heart Failure

BackgroundOxidative stress appears to play a significant role in the pathogenesis of heart failure (HF). Antibodies to oxidized low-density lipoprotein (Ox LDL Abs) reflect an immune response to LDL over a prolonged period and may thus represent oxidative stress over an extended time. Ox LDL Abs have been shown to correlate with clinical control in HF patients. We evaluated the predictive power of Ox LDL Abs on the outcome in patients with HF.Methods and ResultsBaseline levels of Ox LDL Abs were determined by enzyme-linked immunosorbent assay in 284 consecutive outpatients with severe chronic HF who were being treated in the cardiology services of our medical center. Their mean New York Heart Association (NYHA) Class was 2.8. The mean follow-up for the group was 3.7 years, during which 107 (37%) died. The mean time from symptom onset to first hospital admission from HF was 25.8 months. Ox LDL Abs were found to predict morbidity and mortality as evaluated by a Cox multivariate regression analysis with a hazard ration of 1.013 (P < .013), whereas N-terminal pro-B-type natriuretic peptide (NT pro-BNP) levels achieved a HR of 1.028 (P < .099).ConclusionsOx LDL Abs level maybe a useful parameter for monitoring and planning better management of patients with HF. It was superior to pro-BNP as a predictor of clinical course as expressed by time to hospitalization.     

Predictors of Memory Performance Among Taiwanese Postmenopausal Women With Heart Failure

BackgroundThere are no studies describing the nature of memory deficits among women with heart failure (HF).ObjectivesThe aims of this study were to examine memory performance among Taiwanese women with HF compared with age- and education-matched healthy women, and to evaluate factors that explain memory performance in women with HF.Methods and ResultsSeventy-six women with HF and 64 healthy women were recruited in Taiwan. Women completed working, verbal, and visual memory tests; HF severity was collected from the medical records. Women with HF performed significantly worse than healthy women on tests of working memory and verbal memory. Among women with HF, older age explained poorer working memory, and older age, higher HF severity, more comorbidities, and systolic HF explained poorer verbal memory. Menopausal symptoms were not associated with memory performance.ConclusionsResults of the study validate findings of memory loss in HF patients from the United States and Europe in a culturally different sample of women. Working memory and verbal memory were worse in Taiwanese women with HF compared with healthy participants. Studies are needed to determine mechanisms of memory deficits in these women and develop interventions to improve memory.     

Predicting Survival in Patients With Heart Failure With an Implantable Cardioverter Defibrillator: The Heart Failure Meta-Score

Background

Prognostic evaluation in heart failure (HF) is important to predict future events and decide timely management. Many HF patients are treated with the use of an implantable cardioverter-defibrillator (ICD). This study aimed to validate a meta-analytically derived prognostic score to predict survival in ICD-HF patients.

First-Ever Stroke and Outcome in Patients Admitted to Perugia Stroke Unit: Predictors for Death,Dependency, and Recurrence of Stroke within the First Three Months

Predictors of poor outcome after first-ever stroke within 3 months in consecutive patients admitted to our Stroke Unit were defined. Factors included age, sex, risk factors, occurrence of transient ischemic attacks, extension of cerebral infarction, presumed cause of stroke, clinical findings, and demographic characteristics. Multiple regression models were used to analyze predictors of mortality, dependency and stroke recurrence. A total of 435 patients with first-ever stroke were included. Of these, 358 patients had ischemic stroke and 77 hemorrhagic stroke. Three-month mortality rate was 20.5%. After the same period, 24.6% of survivors were dependent (mRS ≥3) and 5.0% of patients had recurrent stroke. Age, the presence of atrial fibrillation, impaired consciousness on admission, and stroke severity were related to mortality. The presence of stroke due to an undetermined cause or small vessel disease was associated with lower mortality. Partial anterior circulation syndrome or lacunar syndrome were both related to better outcome. The best predictors for dependency after 3 months were age and stroke severity. The only variable identified as the best predictor for recurrence was the presence of diabetes mellitus.     

Hypertensive Heart Failure in Nigerian Africans: Insights from the Abeokuta Heart Failure Registry

Data from the Abeokuta Heart Failure Registry were used to determine the clinical characteristics, mode of treatment, and short‐ and medium‐term outcomes of patients with hypertensive heart failure. A total of 320 patients were consecutively studied, comprising 184 men (57.5%) and 136 women (42.5%) aged 58.4±12.4 and 60.6±14.5 years, respectively. Most patients (80%) presented with New York Heart Association functional class III or IV and around one third (35%) had preserved systolic function. Median hospital stay was 9 days (interquartile range 5–21) while intra‐hospital mortality was 3.4%. The 30‐day, 90‐day, and 180‐day mortality rates were 0.9% (95% confidence interval, −0.2 to 3.5), 3.5% (95% confidence interval, −1.7 to 7.3), and 11.7% (95% confidence interval, −7.8 to 17.5), respectively. In a multiple logistic regression analysis, only serum creatinine was an independent predictor of mortality at 180 days (adjusted odds ratio, 1.76; 95% confidence interval, −1.17 to 2.64). Hypertension is the most common etiological risk factor for heart failure in Nigeria. Most patients present in the fourth decade of life with severe heart failure and secondary valvular dysfunction and significant in‐hospital mortality.

High blood pressure (BP) is the leading risk factor for cardiovascular (CV) diseases (CVDs) and CV‐related morbidity and mortality globally. It is responsible for about 7.5 million deaths every year worldwide.¹, ², ³ More than 80% of these deaths occur in young and middle‐aged men and women in developing/low‐income countries.², ⁴ It has been projected that hypertension will increase by 89% in countries in sub‐Saharan Africa compared with a rate of 24% in advanced countries.² In a recent report on the national, regional, and global trends in systolic BP (SBP) since 1980, Danaei and colleagues¹ showed that while SBP fell in many developed countries, it actually rose in many developing countries including countries in East and West Africa.In Nigeria, for example, the pooled prevalence of high BP in the country increased from 8.6% during the period from 1970–1979 to 22.5% during 2000–2011. Awareness, treatment, and control of hypertension are generally low with an attendant high burden of hypertension‐related complications. Hypertension is the most common risk factor for heart and kidney disease in Nigeria.⁵, ⁶, ⁷, ⁸, ⁹, ¹⁰ Recently, hypertension and other noncommunicable diseases have been included as a point of emphasis for global initiative. It has been added to the agenda of the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), especially the new global standardized treatment initiative for hypertension.¹¹ The aim of this study is to describe the sociodemographic characteristics, clinical and echocardiographic characteristics, and clinical outcome of individuals with hypertensive heart failure (HHF) in Abeokuta, Nigeria.     

比索洛尔对慢性心力衰竭室性心律失常和心率变异性的影响

目的 :观察比索洛尔对慢性心力衰竭患者的室性心律失常和心率变异性的影响。方法 :86例慢性心力衰竭 (CHF)患者在常规抗心衰药物治疗的基础上 ,随机分成两组 ,比索洛尔组每日口服比索洛尔 1.2 5～ 10mg ,对照组口服安慰剂 ,疗程 12个月 ,观察治疗前后心率、室性心律失常和心率变异性的变化。结果 :比索洛尔组室性心律失常明显减少 ,心率变异性参数显著改善。结论 :长期使用比索洛尔可降低CHF恶性室性心律失常的发生 ,改善心率变异性     

左西孟旦治疗失代偿性心力衰竭的临床效果及不良反应研究

目的探讨左西孟旦治疗失代偿性心力衰竭的临床效果及不良反应。方法选取2012年3月—2013年3月我院收治的失代偿性心力衰竭患者72例,将其随机分为试验组38例和对照组34例,对照组在常规治疗的基础上予以多巴酚丁胺治疗,试验组在常规治疗的基础上予以左西孟旦注射液治疗,比较两组的临床疗效,并观察两组不良反应发生率和治疗前后心功能指标改善情况,包括B型脑利钠肽(BNP)、每搏输出量(SV)和左室射血分数(LVEF)。结果对照组总有效率为73.5%(25/34),低于试验组的97.4%(37/38)(P0.05)。治疗前两组BNP、SV及LVEF比较,差异无统计学意义(P0.05);治疗后试验组BNP低于对照组,SV和LVEF高于对照组(P0.05)。对照组不良反应发生率为44.1%(15/34),高于试验组的10.5%(4/38)(P0.05)。结论左西孟旦治疗失代偿性心力衰竭能明显改善患者BNP、SV和LVEF,疗效显著,且不良反应少,值得临床进一步推广。     

Heart Failure With Recovered Ejection Fraction in African Americans: Results From the African-American Heart Failure Trial

Background

Recent studies have described the entity of heart failure with recovered ejection fraction (HFrecEF), but population-specific studies remain lacking. The aim of this study was to characterize patients enrolled in the African-American Heart Failure Trial (A-HeFT) who had significant improvement in their ejection fraction (EF) during the 1st 6 months of follow-up.

不同起源部位室性早搏对心力衰竭患者预后的影响

目的:探讨不同起源部位的室性早搏对心力衰竭(心衰)患者预后的影响。方法:回顾性分析2007-11到2010-12期间在我院住院患者中左心室射血分数≤40%的心衰患者206例,随访1年,8例失访。分析临床各项指标和不同起源部位室性心律失常与心血管死亡间的关系。根据患者是否死亡,将患者分为生存组(n=161)和心血管死亡组(n=37)。结果:与生存组比较,心血管死亡组房室传导阻滞(AVB),24小时平均心率,室性早搏(室早)LOWN分级4A、4B级,室早,非持续性室速发生率;非持续性室速阵数及最快频率,起源于左心室流入道的室早、起源于左心室流入道的非持续性室速均增加,无房室传导阻滞,室早LOWN分级0、1、2、3级发生率均减少,差异有统计学意义(P<0.05)。logistic回归分析表明:收缩压、糖尿病、Ca2+、左心室射血分数、24小时平均心率、室早次数、起源左心室流入道的室早、非持续性室速的阵数是心血管死亡的独立危险因素。结论:室早对判断患者预后有重要价值,起源于左心室流入道室早增加心衰患者心血管死亡率。