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Vitamin D deficiency and treatment: impact in major outcomes and functional capacity in heart failure patients

Session Poster Session 3

Speaker Marcia Cravo

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session

Authors : M Cravo (Porto,PT), A Vigario (Porto,PT), T Ferreira (Porto,PT), R Rego (Porto,PT), I Marques (Porto,PT), C Mendonca (Porto,PT)

Authors:
M Cravo1 , A Vigario1 , T Ferreira1 , R Rego1 , I Marques1 , C Mendonca1 , 1Centro Hospitalar Universitário do Porto, Internal Medicine - Porto - Portugal ,

On behalf: GEstIC - Grupo de Estudo da Insuficiência Cardíaca

Citation:

Background: Vitamin D (VD) deficiency is very common in population. Low VD status is associated with poor prognosis in heart failure (HF) patients which increases cardiovascular events and mortality. Although, despite of the well established effects of the VD in the cardiovascular system, impact of it supplementation is still uncertain with disparities in various studies. In our HF clinic, VD deficit and bone disease are systematically screened using tools like Fracture Risk Assessment Tool (FRAX) and Dual-energy X-ray absorptiometry (DEXA) and treated, under a predefined protocol.

Purpose: Evaluate the prevalence of VD deficiency and the prognostic impact of its treatment in a cohort of HF patients admitted to a HF clinic at tertiary university hospital.

Methods: Retrospective observational study recruiting patients admitted to our HF clinic from January 2013 to December 2017. All patients with HF and VD deficiency (< 50nmol/L) were included after reviewing electronic medical records, performing a total of 232 patients. VD status was analyzed after oral supplementation, dividing the study population in two clusters: patients with normal and low VD levels. They were compared by functional variables: reduced ejection fraction (rEF), NYHA e Duke Activity Status Index (DASI); and vital outcomes: mortality, hospital readmission. Stage 5 kidney disease or loss of follow up excluded 68 patients.

Results: The 164 patients analyzed had a median age of 79 years old and 54.9% was female. At pre-VD supplementation, 39.6% of the population had rEF, 83.5% were symptomatic (NYHA class = II) and median DASI was 18.95 points. In the 84 evaluated DEXA, 15.9% were normal, 19.5% had osteopenia and 15.9% had osteoporosis. Bone fractures were identified in 9.8% of patients.

VD supplementation was prescribed to 151 patients, in which 75.6% (n=124) achieved normal VD levels. Comparing these with the cluster who maintained VD deficit, respectively: 12.7% vs. 5.6% (p=0.683) maintained or improved left ventricular ejection fraction (LVFE); NYHA class improved at least one class in 32.5% vs. 33.3% (p=0.924); median DASI improved to 20.0 vs. 19.5 (p=0.725). One-year mortality and re-hospitalization for HF post VD supplementation were 9.7% vs. 17.5% (p=0.253) and 25.8 % vs. 30% (p=0.271) in HF patients with normal vs. low VD levels, respectively.

Conclusions: VD deficiency was very prevalent in our cohort of HF patients. Oral supplementation was effective in the majority. Despite of VD normal levels were associated with improved LVFE and decreased mortality and re-hospitalization for HF, we could not find any significant statistical impact in these outcomes. These results must be validated in larger studies.

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