390 Poster Session 4
10 cases (10%), hypertensive push in 6 cases (6%), anemia in 4 cases (4%) and a
lung infection in 4 cases (4%).
Conclusion: Heart Failure rehospitalization within 6 months’ follow-up occurred
in 11% of our cohort. The highest rates of readmission were noted in those with
a diet gap and patients who discontinued maintenance therapy. Education and
improvement of living conditions are the main objectives to address this public health
problem.
P1782
Co-morbidities and age differences in patients hospitalized for acute
decompensated chronic heart failure - does it really matter?
T Teodora Zaninovic Jurjevic1; G Brumini2; Z Matana Kastelan3; N Jurjevic4;
L Skorup5; A Ruzic1; L Zaputovic1
1Clinical Hospital Center Rijeka , Rijeka, Croatia; 2Rijeka University School of
Medicine, Department of Medical Informatics, Rijeka, Croatia; 3Clinical Hospital
Center Rijeka, Department of Radiology, Rijeka, Croatia; 4Rijeka University School
of Medicine, Rijeka, Croatia; 5Primorsko Goranska County, Department of
Emergency Medicine, Rijeka, Croatia
Purpose: To analyse co-morbidities in two age groups of patients, hospitalized with
acute decompensated chronic heart failure (ADCHF).
Methods:We performed single-centre retrospective study of patients consecutively
hospitalized for ADCHF. The study was approved by the institution’s Ethics Committee.
The retrospective analysis included 1534 patients older than 18 years, enrolled
in a Department of Cardiovascular Diseases, from June 2006 to June 2012. Only
patients discharged alive were included in further analysis. The patients were divided
in two groups according to their age (1340<85 and 194 ≥ 85 years old). We have
considered the following comorbidities: arterial hypertension (AH), diabetes mellitus
(DM), peripheral arterial disease (PAD), cerebrovascular disease (CVD), ischemic
heart disease (IHD) and anaemia. The difference between two groups according to
their co-morbidities and possible impact of co-morbidities on the length of hospitalization
was analyzed. In all tests P value of <0,05 was considered statisticaly
significant.
Results: The mean patients age in both groups was 74.7 ±10.1 years, in those<85
was 72.8±9.3 years and in ≥ 85 was 88.0±2.7 years (P<0.001). There were 917
(68.4%) patients with AH<85 years versus 152 (78.3%) ≥ 85 years (P=0.005).
Likewise, 535 (39.9%) patients<85 years had DM versus 60 (30.9%) ≥ 85 years
(P=0.016). In patients<85 years there were 75 (5.6%)with PAD versus 4 (2.1%) ≥ 85
years (P=0.037). In patients<85 years 315 (23.5%) had one, 410 (30.6%) had two,
334 (24.9%) had three, 140 (10.4%) had four and 29 (2.2%) had five co-morbidities,
while in patients ≥ 85 years, 39 (20.1%) had one, 71 (36.6%) had two, 64 (33.0%)
had three and 11 (5.7%) had four co-morbidities. (P=0.003). The length of hospital
stay was 10.8±6.1 days for patients<85 years and 10.2±9.1 for those ≥ 85 years
old, (P=0.293).
Conclusion: There was statistically significant difference according to AH, DM and
PAD between the analyzed groups, but there was no statistical difference between
groups according to CVD, IHD and anaemia. The difference, considering the number
of co-morbidities between age groups, was found to be statistically significant.
Data from the literature show that co-morbidities could extend the length of hospitalization
in patients with heart failure. However, in the analyzed groups of patients
co-morbidities did not affect the length of stay (P>0.005).
P1784
Cardio-hepatic syndrome and its influence on acute decompensated heart
failure patients in a single tertiary cardiology center
I Ilir Sharka1; S Myftiu1; A Quka2; A Shkoza3; E Dado4; L Gjyli1; G Knuti4;
J Diamandi4
1University Hospital Center Mother Theresa, Department of Cardiology & Cardiac
Surgery, Tirana, Albania; 2University Hospital Center Mother Theresa, Tirana,
Albania; 3University Hospital Center Mother Theresa, Department of Biomedical
and Experimental Sciences, Tirana, Albania; 4Hygeia Hospital of Tirana,
Department of Cardiology, Tirana, Albania
Purpose: cardio-hepatic syndrome (CHS) is a newly emerging definition for acute
liver injury in acutely decompensated heart failure (ADHF) patients (pts); it may be
associated with cardio-renal syndrome (CRS); recent data have demonstrated the
implication of CHS in HF management and prognosis; the aim of the study was to
evaluate the presence of CHS in ADHF patients in a tertiary cardiology center; main
predictors of CHS occurrence and the influence of CHS during in-hospital management
of ADHF patients.
Methods: we prospectively analyzes clinical and laboratory records on 365 consecutive
ADHF patients from 2012 to September 2014; liver function tests were used
for the screening of CRS (a ratio of ALT/LDH <1.5 was considered a cardiogenic
injury), a MELD score evaluation was performed on a daily basis; ADHF patients
were stratified into three levels: I (CHS absent), II (CHS present), III (CHS & CRS
present); a composite endpoint (use of intravenous inotropes, diuretic resistance, a
prolonged in-hospital treatment > a week, cardiac death) was defined a complicated
clinical course; a Cox proportional hazards model was used to define the relation of
CRS presence to the complicated in-hospital clinical course.
Results: CHS was present in 237 (64.9%) pts; between CHS and non CHS patients
there were no significant differences in age (67.4 ±0.3 vs 62.3±0.7, p>.05), sex
(males) (57.3% vs 53%, p>.05), diabetes (32.4% vs 29.2%, p>.05); but there
were significant differences in MELD score (39.4±7.7 vs 16.2±8.5, p<.0001);
re-hospitalizations for AHF 4 (2 to 6) vs 2 (0 to 3), p<.05; cardiac index <1.5
l/min/m2 (61.5% vs 17.6%, p<.0001); PASP (53±18 vs 38±12 mmHg, p<.001);
use of inotropes (61.1% vs 19.7%, p<.0001);); Charlson Comorbidity index (CCI)
≥4 (67.4% vs 46.2%, p<.001); diuretic resistance (26,8% vs 8.6%, p<.0001). main
predictors of CHS occurrence in Cox regression were: low cardiac index; high PASP;
re-hospitalization for AHF; diuretic resistance; HR (95%CI) of level II to I of ADH
patients was 1.86 (1.24 - 2.67, p=.0025) and level III to I was 3.69 (2.14 - 6.87,
p<.0001).
Conclusions: cardio-hepatic syndrome seems to be a clinically important member
of the constellation of end-organ involvements in ADHF patients, which presence
offers significant clinical and prognostic implications in our daily cardiology practice;
identifying patientsmore susceptible to CHS would help to reduce clinical complications
in HF management and thus lower costs of treatment imposed by a prolonged
hospitalization; further studies are needed to help clinicians in CHS treatment guidelines.
CHRONIC HEART FAILURE
P1785
Survival analysis of adult patients with congenital heart disease and heart
failure
K Kristina Andjelkovic1; D Kalimanovska Ostric1; V Karadzic1; D Vasic1; S
Matic1; I Andjelkovic2
1School of Medicine, University of Belgrade, Cardiology Clinic, CCS, Belgrade,
Serbia; 2University of Belgrade, School of Electrical Engineering, Belgrade, Serbia
Purpose: Adult patients with congenital heart disease (ACHD) are commonly faced
with various complications due to residual defects, interventions and disease
course. The most frequent are heart failure (HF), arrhythmias, pulmonary hypertension,
and infective endocarditis which contribute to significant increase in morbidity
and mortality of these patients. The aim of this study is survival analysis and identification
of mortality predictors in ACHD patients and HF.
Methods: We retrospectively reviewed 173 adult patients with CHD (40% males
and 60% females), followed-up for 36 months since their admission at the Department
for congenital heart disease in adults of the Clinical center of Serbia, due to
complications such as heart failure, arrhythmias, infective endocarditis, pulmonary
hypertension, or until death as end-point. They were classified into 3 groups according
to CHD complexity (simple, moderate and severe). NYHA functional class at
admission, medical history data, physical and echocardiography findings were analyzed
variables. Kaplan-Meier techniques were used to assess all-cause mortality.
Log-rank testing was used to identify association between heart failure and major
events, and multivariate Cox proportional-hazards regression model was used to
identify predictors of the worst outcome.
Results: According to CHD type, 45% pts had simple, 28% moderate, and 27%
severe CHD complexity. Heart failure was diagnosed in 28% (n=48) patients. Overall
mortality rate was 8.1% (n=14), and mortality rate among those with heart failure
was 22% (n=11) of patients. Mean survival time in our group of patients with congenital
heart disease was 33.8 months, SE 0.635, 95% CI 32.6 to 35.0. Log rank
test showed that the survival time is higher in group of patients without HF. Median
survival time in group of patients without HF was 35.6 months, SE 0.32, 95% CI
35.0 to 36.2 and in group with HF was 29.0 months, SE 2.0, 95% CI 25.0 to 33.1;
p<0.001. In a multivariate Cox proportional-hazards regression model, NYHA functional
class was highlighted as significant predictor of the worst outcome in ACHD
patients with heart failure (hazard ratio [HR]=6.1, 95% CI 1.5 to 25.4, p=0.013),
among others analyzed variables. Higher NYHA class is associate with higher risk of
mortality.
Conclusions: Survival analysis showed that adult patients with congenital heart
disease and heart failure have higher mortality risk. NYHA functional class is an
independent predictor of mortality rate in these patients.
© 2015 The Authors
European Journal of Heart Failure © 2015 European Society of Cardiology, 17 (Suppl. 1), 5–441