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Registry of Severe Acute Heart Failure. Impact of Renal Insufficiency for In-Hospital Mortality and Readmissions

Session Poster Session 3

Speaker Daniel Viveros Filartiga

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : MA Quintana Da Silva (Asuncion,PY), D Viveros (Asuncion,PY), J Gimenez (Asuncion,PY), D Bedoya (Asuncion,PY), J Martinez (Asuncion,PY), D Venialgo (Asuncion,PY)

Authors:
MA Quintana Da Silva1 , D Viveros1 , J Gimenez1 , D Bedoya1 , J Martinez1 , D Venialgo1 , 1Migone Hospital, Cardiovascular Institute - Asuncion - Paraguay ,

Citation:

Background: There is a great variation of data regarding in-hospital mortality and readmission rate at 60 days in patients with different clinical forms of severe acute heart failure (AHF) who develop acute renal insufficiency (ARI) or aggravate a chronic renal insufficiency (ACRI).

Purpose: To assess rates of in-hospital mortality and readmission at 60 days in patients with severe forms of presentation of AHF, de novo AHF or acute decompensated chronic heart failure (ADCHF), with o without renal insufficiency (RI), stratified by left ventricle ejection fraction (LVEF) ranges.

Methods: From August 2015 to August 2018, patients with diagnosis of severe AHF who required admission to a cardiovascular intensive care unit were consecutively included. Severity of the AHF was validated by the high values of the MEESSI and the GWTG Scores. Cardiorenal insufficiency was defined according to NHLBI recommendations. Forms of AHF were classified into de novo AHF and ADCHF, renal insufficiency was classified into ARI or ACRI and LVEF was stratified by ranges in accordance with the new guidelines of the ESC. For univariate analysis, the qualitative variables were expressed in percentages and the quantitative variables by means with their standard deviations of 95%. For the bivariate analysis, chi squared was performed for qualitative variables and T test for quantitative variables. Logistic regression was performed for the independent variables.

Results: A total of 305 consecutive patients were evaluated. The mean age was 75 ± 12, 41% women, 42% hypertension, 52% dyslipidemia, 48% obesity, 42% diabetes type II and smoking 31%. De novo AHF were 31% and 70% were classified as ADCHF. RI was present in 37%. Of these, 24% had ARI and 76% had ACRI. The mean EF was 51 ± 15 %; preserved 57%, intermediate 19% and reduced 25%. Overall IH mortality was 7.9% and 60-day readmission rate was 23%. The bivariate analysis showed that the IH mortality was 13.15% in AHF patient who had RI and 4.7% en AHF patients with no RI (p<0.001), whereas for 60 day-readmission was 43% in AHF patients with RI and 44.2% in AHF patients without RI (p=NS), ARI was observed as an independent variable of IH mortality in patients with AHF (p<0.001), independently of the clinical forms of presentation of AHF and EF ranges. ACRI was observed as an independent variable (p = 0.002) for readmissions at 60 days, independently of the clinical forms of presentation of AHF and EF ranges. The multivariate analysis showed that only the presence of ARI remains statistically significant for IH mortality (p<0.001); whereas readmission was significantly higher among patients with ACRI (p = 0.044).

Conclusion: In patients with severe AHF, the presence of acute renal insufficiency is an independent variable of in-hospital mortality and the presence of acute on chronic renal insufficiency was associated with hospital readmissions at 60 days, in both cases independently of the clinical forms of AHF and EF ranges.

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