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Survival free of events during the vulnerable phase of heart failure

Session Poster Session 3

Speaker Clara Ines Saldarriaga

Event : Heart Failure 2019

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

Authors : CI Saldarriaga (Medellin,CO), G Gonzalez (Bogota,CO), S Navarrete (Bogota,CO), LE Echeverria (Bucaramanga,CO), MJ Novoa (medelin,CO), N Murillo (cali,CO), A Rivera (Pereira,CO), MJ Rodriguez (Bogota,CO), B Rolong (barranquilla,CO), G Trout (Santa Marta,CO), C Martinez (Medellin,CO), CV Arguello (medellin,CO), L Semanche (barranquilla,CO), E Contreras (cali,CO), J Vanegas (manizales,CO)

Authors:
CI Saldarriaga1 , G Gonzalez2 , S Navarrete3 , LE Echeverria4 , MJ Novoa5 , N Murillo6 , A Rivera7 , MJ Rodriguez8 , B Rolong9 , G Trout10 , C Martinez1 , CV Arguello11 , L Semanche12 , E Contreras13 , J Vanegas14 , 1Cardiovascular Clinic Santa Maria, Universityof Antioquia cardiology department - Medellin - Colombia , 2Fundacion Santa Fe de Bogota , Heart Failure - cardiology - Bogota - Colombia , 3Hospital Military Central, cardiology - Bogota - Colombia , 4Fundacion cardiovascular , Heart failure - Bucaramanga - Colombia , 5clinica del Norte, cardiology - medelin - Colombia , 6Angiografia de Occidente, Cardiology - cali - Colombia , 7Clinica Rosales, Cardiology - Pereira - Colombia , 8Foundation Cardioinfantil, Heart failure- cardiology - Bogota - Colombia , 9fundacion cardiotoracica, cardiology - barranquilla - Colombia , 10Universidad del Magdalena , cardiology - Santa Marta - Colombia , 11clinica Leon XIII, cardiology - medellin - Colombia , 12clinica del norte, Cardiology - barranquilla - Colombia , 13clinica de occidente, cardiology - cali - Colombia , 14Fundacion cardiovascular , instituto del corazón - manizales - Colombia ,

On behalf: OPTIMIZE COLOMBIA

Citation:

A period of vulnerability is observed after acute heart failure,  there is an increased risk of death or rehospitalization , especially during the first 30 days after the initial admission. The OPTIMIZE COLOMBIA PROGRAM was a strategy implemented at hospital discharge that included: education , uptitration of medications , and early initiation of ivabradine to obtain a target heart rate of 60–70 bpm.
Objective:  To identify the clinical factors related to the risk of a new event (any  hospitalization, emergency room visit, or death) 30 days after the initial admission for acute heart failure and to analyze event-free survival in patients with and without ivabradine.
Methods: prospective cohort study.  Correlation between variables was studied using the Chi square test. Event-free survival was calculated using the Kaplan-Meier method. (Statistical significance: P = 0.05.)
Results: 267 patients with HRrEF who completed the 30-day follow-up were included (67.8% male, mean age 66±14 years, mean LVEF 32%). Ivabradine was used by 42%. The 30-day rate of events was as follows: rehospitalization 3%, emergency room visits 4.1%, death 0.7% (5.6%  had more than 1 event). The correlation between the clinical characteristics and the occurrence of a new event is presented in Table 1. The use of ivabradine was the only factor that decreased the risk of a new event (20% with ivabradine vs 52.4% without ivabradine, P = 0.015). Event-free survival was 97.6% with ivabradine vs 90.9% without ivabradine.
Conclusion:  Optimization of heart failure treatment  with ivabradine during the hospitalization decrease the risk of a new hospitalization , emergency room visit  death during the next 30 days of the admission.

30 days new event (hospitalization , emergency room visit or death)

Factor

Without an event

With an event

p

n

%

n

%

DIABETES

63

25.1%

5

35.7%

0.360

CKD

60

23.8%

4

26.7%

0.761

COPD

45

17.9%

1

6.7%

0.480

STROKE

12

4.8%

0

0.0%

0.980

AF

30

16.3%

5

38.5%

0.052

EF ?30%

112

44.8%

9

60%

0.251

HR?100

13

5.2%

0

0.0%

0.367

NYHA IV

55

22.3%

2

13.3%

0.701

Ivabradine

132

52.4%

3

20%

0.015

The correlation between the clinical characteristics and the presence of a new event

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