Prediction model of in-hospital mortality in elderly patients with acute heart failure based on retrospective study

学习是开发在老病人的在里面医院死亡是预兆的一个临床的风险模型的这的 ObjectivesThe 目的与尖锐的心就医了失败(AHF ) 从医院里的心病学部门的特别护理单位 60 岁以上的 .Methods2486 病人被分析。为在里面医院死亡的独立风险因素被二进制逻辑回归获得然后过去常建立风险预言分数系统(RPSS ) 。在接收装置操作符特征和 C 统计数值测试的曲线(AUC ) 下面的区域被采用估计 RPSS 的性能并且与指南心失败(GWTG-HF ) 与以前的 get 作比较 .ResultsBy 二进制代码逻辑回归分析，心率(或：1.043， 95% CI：1.030-1.057， P < 0.001 ) ，左室的喷射部分(或：0.918， 95% CI：0.833-0.966， P < 0.001 ) ， pH 价值(或：0.001， 95% CI：0.000-0.002， P < 0.001 ) ，肾的机能障碍(或：0.120， 95% CI：0.066-0.220， P < 0.001 ) 并且 NT 职业人员 BNP (或：3.463， 95% CI：1.870-6.413， P < 0.001 ) 是为老 AHF 病人的在里面医院死亡的独立风险因素。另外， RPSS，它是所有创作了上述参数，比 GWTG-THF 提供了更好的风险预言(AUC：0.873 对 0.818， P = 0.016 ).ConclusionsOur 风险预言模型， RPSS，在老病人为在里面医院死亡向好预言提供了 AHF。

Failure to Rescue as a Quality Metric in Congenital Heart Surgeries in a High-Complexity Service Provider Institution Located in a Middle-Income Country

Background:Failure to rescue has been an effective quality metric in congenital heart surgery.Conversely,mor-bidity and mortality depend greatly on non-modifiable individual factors and have a weak correlation with better-quality performance.We aim to measure the complications,mortality,and risk factors in pediatric patients undergoing congenital heart surgery in a high-complexity institution located in a middle-income country and compare it with other institutions that have conducted a similar study.Methods:A retrospective observational study was conducted in a high-complexity service provider institution,in Cali,Colombia.All pediatric patients undergoing any congenital heart surgery between 2019 and 2022 were included.The main outcomes evaluated in the study were complication,mortality,and failure to rescue rate.Univariate and multivariate logistic regression analysis was performed with mortality as the outcome variable.Results:We evaluated 308 congenital heart sur-geries.Regarding the outcomes,201(65%)complications occurred,23(7.5%)patients died,and the FTR of the entire cohort was 11.4%.The presence of a postoperative complication(OR 14.88,CI 3.06–268.37,p=0.009),age(OR 0.79,CI 0.57–0.96,p=0.068),and urgent/emergent surgery(OR 8.14,CI 2.97–28.66,p<0.001)were the most significant variables in predicting mortality.Conclusions:Failure to rescue is an effective and comparable quality measure in healthcare institutions and is the major contributor to postoperative mortality in congenital heart surgeries.Despite our higher mortality and complication rate,we obtained a comparable failure to rescue rate to high-income countries’health institutions.

Effect of dapagliflozin on uric acid in patients with chronic heart failure and hyperuricemia

BACKGROUND Patients with chronic heart failure(CHF)frequently develop hyperuricemia,an elevated serum uric acid level,associated with adverse outcomes.Dapagliflozin,a sodium-glucose cotransporter-2 inhibitor,demonstrates reduction in cardiovascular mortality and hospitalization in patients with CHF and ejection fraction(HFrEF),irrespective of diabetes.However,dapagliflozin’s effect on the uric acid levels in patients with CHF and hyperuricemia remain unclear.AIM To investigate the effects of dapagliflozin on uric acid levels in CHF patients with hyperuricemia.METHODS We conducted a randomized,double-blind,placebo-controlled trial in 200 patients with CHF and hyperuricemia,with HFrEF and serum uric acid levels≥7 mg/dL(≥416μmol/L).The participants were randomly assigned to receive a daily dose of 10 mg dapagliflozin or placebo for 24 months.The primary endpoint was the change in serum uric acid level from baseline to 24 months.Secondary endpoints included changes in left ventricular ejection fraction(LVEF),Nterminal pro-B-type natriuretic peptide(NT-proBNP),and quality of life(QoL)scores,as well as the incidence of cardiovascular death and hospitalization for heart failure.RESULTS At 24 months,dapagliflozin significantly reduced serum uric acid levels by 1.2 mg/dL(71μmol/L)compared with placebo(95%CI:-1.5 to-0.9;P<0.001).Dapagliflozin also significantly improved LVEF by 3.5%(95%CI:2.1-4.9;P<0.001),NT-proBNP by 25%(95%CI:18-32;P<0.001),and QoL scores by 10 points(95%CI:7-13;P<0.001)and reduced the risk of cardiovascular death and hospitalization for heart failure by 35%(95%CI:15–50;P=0.002)compared with the placebo.Adverse events were similar between the two groups,except for a higher rate of genital infections in the dapagliflozin group(10%vs 2%,P=0.01).CONCLUSION Dapagliflozin significantly lowered serum uric acid levels and improved the clinical outcomes in patients with CHF and hyperuricemia.Therefore,dapagliflozin may be a useful therapeutic option for this high-risk population.

Comparison of different versions of the quick sequential organ failure assessment for predicting in-hospital mortality of sepsis patients:A retrospective observational study

BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality prediction.To enhance its effectiveness,researchers have developed various revised versions of the qSOFA by adding other parameters,such as the lactate-enhanced qSOFA(LqSOFA),the procalcitonin-enhanced qSOFA(PqSOFA),and the modified qSOFA(MqSOFA).This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department(ED).METHODS:This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31,2019.Receiver operating characteristic(ROC)curve analyses were performed to determine the area under the curve(AUC),with sensitivity,specificity,and positive and negative predictive values calculated for the various scores.RESULTS:Among the 936 enrolled cases,there were 835 survivors and 101 deaths.The AUCs of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 0.740,0.731,0.712,and 0.705,respectively.The sensitivity of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 64.36%,51.40%,71.29%,and 39.60%,respectively.The specificity of the four scores were 70.78%,80.96%,61.68%,and 91.62%,respectively.The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.CONCLUSIONS:Among patients with sepsis in the ED,the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA.As the added parameter of the MqSOFA was more convenient compared to the LqSOFA,the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.

Heart failure mortality compared between elderly and non-elderly Thai patients

Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients.Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure(ICD-10-TM code:150.9)during 2008-2012 according to three major Thailand reimbursement systems(civil servant,social security,and universal coverage systems).Patients were categorized into either the elderly group(age>65 years)or the non-elderly group(age<65 years).Mortality rate and survival analysis were compared between groups.Demographic,underlying disease and comorbid condition data were collected.Cardiovascular and non-cardiovascular death was also analyzed.Results A total of 201,709 patients were included.The average age of patients was 64.9±14.8 years,and the gender proportion breakdown was 84,155(41.7%)males and 117,554(58.3%)females.Just over half of patients(107,325 patients;53.2%)were elderly.Overall mortality rate was 50.8%.The mortality rate at one month,six months,one year,and three years was 11.0%,24.5%,32.5%,and 46.3%,respectively.Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio(OR)of 1.47(95%CI:1.46-1.49)for all-cause mortality,an OR of 1.25(95%CI:1.23-1.27)for cardiovascular death,and an OR of 1.72(95%CI:1.68-1.75)for non-cardiovascular death(all P<0.001).After adjusting for potential confounders,elderly status remained the second strongest factor associated with increased risk of mortality after heart failure hospitalization following chronic kidney disease.Conclusions The overall mortality rate after heart failure hospitalization was a very high 50.8%.Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization.This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.

Increased mortality in elderly heart failure patients receiving infusion of furosemide compared to elderly heart failure patients receiving bolus injection

Heart failure(HF)is a condition of cardiac dysfunction and fluid overload.Neurohormonal activation via the reninangiotensin-aldosterone system and the sympathetic nervous system are the pathophysiological cornerstones.[1]Furthermore,HF is a disorder widely associated with grave adverse outcomes and poor prognosis.[2]A loop diuretic is the fundamental drug used to prevent multiorgan failure and improve symptoms in these patients.[3]

Hypertension and Heart Failure as Predictors of Mortality in an Adult Congenital Heart Defect Population

Early intervention to prevent premature mortality is vital for adults with congenital heart defects(CHD).Anatomic complexity and comorbid conditions are thought to contribute to CHD mortality.Since hypertension(HTN)and heart failure(HF)are the comorbid conditions among the most prevalent causes of death in the United States,and commonly accompany CHD,it is crucial to evaluate whether they are reliable predictors of mortality for adults with CHD(ACHD)independent of anatomic CHD complexity.A retrospective cross-sectional analysis of ACHD,aged 18–64,with concomitant HTN and/or HF and at least one health care encounter during 2008–2010 were assessed.Of 5,397 ACHD patients(18.3%HTN without HF,4.4%HF without HTN,8.3%with both),3.0%died(n=163)during the study period.Overall,the sample was 45.1%white,61.4%female,and 29.0%had a complex CHD.Among those who died,23.3%had HTN without HF,17.2%had HF without HTN,and 42.3%had both.Crude analyses revealed that older age,male gender,black race,and having public health insurance were associated with increased mortality during the three-year study period compared to ACHD patients who were younger,female gender,white race,and covered by private health insurance.ACHD patients diagnosed with non-complex CHD lesions(i.e.,shunts,valves,or shunts+valves)were at greater risk of dying compared to those with severe complex CHDs.When CHD type was assessed separately,those with valve lesions were more likely to die compared to those with complex CHD lesions.After adjustment for age,gender,race,insurance and CHD complexity,ACHD patients with HF,with or without HTN,were equally likely to die during the study period.However,ACHD patients with HF,without or without HTN,who had valve defects were more likely to die during the three-year study period compared to patients with complex CHDs.

Systematic review on the risk-benefit ratio of morphine for acute heart failure

Objective:To evaluate morphine's risk-benefit profile in the treatment of acute heart failure.Method:Different electronic databases,including PubMed,MEDLINE,Cochrane Library,and Google Scholar,as well as clinicaltrails.gov,were searched for articles published between 2012 and 2022.The risk of bias in the present study was evaluated by employing randomized controlled trials(RCTs)checklist that assesses the effectiveness of new interventions through random assignment of participants to different treatment groups.The two-part tool was used to address the five specific domains such as selection bias,performance bias,detection bias,attrition bias,and selective reporting bias.Evaluation of the quality of diagnostic accuracy studies was conducted using the RevMan software(version 5.4),a quality assessment tool.Results:A total of 13 studies were included in the present review,in which there were 5 retrospective studies,3 randomized-control studies,2 prospective studies,1 multicenter pharmacodynamics study,1 multicenter cardiac magnetic resonance imaging study,and 1 open-label,cross-over study.The mortality of acute heart failure patients treated with morphine was higher compared to those without morphine.Conclusions:Acute heart failure patients who do not receive morphine have a lower mortality rate compared to those who receive morphine.Considering the adverse effects,including mortality associated with morphine,there is a pressing need for further research to explore alternative and effective treatment options in acute heart failure.

Red blood cell distribution width in heart failure: A narrative review

The red blood cell distribution width(RDW) is a simple, rapid, inexpensive and straightforward hematological parameter, reflecting the degree of anisocytosis in vivo. The currently available scientific evidence suggests that RDW assessment not only predicts the risk of adverse outcomes(cardiovascular and all-cause mortality, hospitalization for acute decompensation or worsened left ventricular function) in patients with acute and chronic heart failure(HF), but is also a significant and independent predictor of developing HF in patients free of this condition. Regarding the biological interplay between impaired hematopoiesis and cardiac dysfunction, many of the different conditions associated with increased heterogeneity of erythrocyte volume(i.e., ageing, inflammation, oxidative stress, nutritional deficiencies and impaired renal function), may be concomitantly present in patients with HF, whilst anisocytosis may also directly contribute to the development and worsening of HF. In conclusion, the longitudinal assessment of RDW changes over time may be considered an efficient measure to help predicting the risk of both development and progression of HF.

The relevance of serum albumin among elderly patients with acute decompensated heart failure

Objective To assess the prognostic utility of serum albumin among elderly patients admitted for acute decompensated heart failure(ADHF)in terms of all-cause mortality and also to identify the predictors of hypoalbuminemia.Methods Retrospective cohort study of 119 elderly patients admitted for ADHF.Elderly patients were defined as patients over the age of 65 years.The patients were followed up for approximately 11 years.Patients with advanced renal failure,liver disease not due to HF,cancer and other causes of low life expectancy were excluded.Hypoalbuminemia was defined as serum albumin≤2.9 g/dL.Results The study was made up of 65 females and 54 males with age ranging from 65 to 96 years.Of the 119 elderly patients with ADHF,there were 26 deaths.A significantly higher proportion of patients in the mortality group had an admission serum albumin level of≤2.9 g/dL than those surviving(P=0.011).After Cox’s logistic regression,low albumin(P=0.016),elevated direct bilirubin(P=0.03),age greater than 85(P=0.008),lack of use of beta blockers(P=0.0001)and left ventricular ejection fraction less than 35%(P=0.005)increased the risk of death.Elevated serum creatinine(P=0.0357)was the only predictor of hypoalbuminemia following multiple linear regression.Conclusions Hypoalbuminemia may be an unrecognized marker of death in elderly patients with ADHF.

Short-term outcomes in heart failure patients with chronic obstructive pulmonary disease in the community

AIM:To establish the short term outcomes of heart failure(HF)patients in the community who have concurrent chronic obstructive pulmonary disease(COPD).METHODS:We evaluated 783 patients(27.2%)with left ventricular systolic dysfunction under the care of a regional nurse-led community HF team between June 2007 and June 2010 through a database analysis.RESULTS:One hundred and one patients(12.9%)also had a diagnosis of COPD;94% of patients were treated with loop diuretics,83% with angiotensin converting enzyme inhibitors,74% with β-blockers;10.6% with bronchodilators;and 42% with aldosterone an-tagonists.The mean age of the patients was 77.9 ± 5.7 years;43% were female and mean New York Heart Association class was 2.3 ± 0.6.The mean follow-up was 28.2 ± 2.9 mo.β-blocker utilization was markedly lower in patients receiving bronchodilators compared with those not taking bronchodilators(overall 21.7% vs 81%,P < 0.001).The 24-mo survival was 93% in patients with HF alone and 89% in those with both comorbidities(P = not significant).The presence of COPD was associated with increased risk of HF hospitalization [hazard ratio(HR):1.56;95% CI:1.4-2.1;P < 0.001] and major adverse cardiovascular events(HR:1.23;95% CI:1.03-1.75;P < 0.001).CONCLUSION:COPD is a common comorbidity in ambulatory HF patients in the community and is a powerful predictor of worsening HF.It does not however appear to affect short-term mortality in ambulatory HF patients.

Prognostic factors in heart failure patients with cardiac cachexia

Objective To clarify whether cardiac cachexia(CC)alters the prognostic impact of other general risk factors in patients with heart failure(HF).Methods This was an observational study.CC was defined as the combination of a body mass index of<20 kg/m^2 and at least one of the following biochemical abnormalities:C-reactive protein>5 mg/L;hemoglobin<12 g/dL;and/or albumin<3.2 g/d L.We divided 1608 hospitalized HF patients into a CC group(n=176,10.9%)and a non-CC group(n=1432,89.1%).The primary endpoints were cardiac event and all-cause death.Results The presence of CC showed significant interactions with other risk factors including cancer,estimated glomerular filtration rate(eGFR),and sodium in predicting these endpoints.Multiple Cox proportional analysis revealed that use of a blockers[hazard ratio(HR)=1.900,95%confidence interval(CI):1.045–3.455,P=0.035]and eGFR(HR=0.989,95%CI:0.980–0.998,P=0.018)were independent predictors of cardiac event in the CC group,while age(HR=1.020,95%CI:1.002–1.039,P=0.029)and hemoglobin(HR=0.844,95%CI:0.734–0.970,P=0.017)were independent predictors of all-cause death.The survival classification and regression tree analysis showed the optimal cut-off points for cardiac event(eGFR:59.9 m L/min per 1.73 m^2)and all-cause death(age,83 years old;hemoglobin,10.1 g/dL)in the CC group.Conclusions In predicting prognosis,CC showed interactions with several risk factors.Renal function,age,and hemoglobin were pivotal markers in HF patients with CC.

Is oxygen therapy beneficial for normoxemic patients with acute heart failure?A propensity score matched study

Background:The clinical efficiency of routine oxygen therapy is uncertain in patients with acute heart failure(AHF)who do not have hypoxemia.The aim of this study was to investigate the association between oxygen therapy and clinical outcomes in normoxemic patients hospitalized with AHF using real-world data.Methods:Normoxemic patients diagnosed with AHF on intensive care unit(ICU)admission from the electronic ICU(eICU)Collaborative Research Database were included in the current study,in which the study population was divided into the oxygen therapy group and the ambient air group.Propensity score matching(PSM)was applied to create a balanced covariate distribution between patients receiving supplemental oxygen and those exposed to ambient air.Linear regression and logistic regression models were performed to assess the associations between oxygen therapy and length of stay(LOS),and all-cause in-hospital as well as ICU mortality rates,respectively.A series of sensitivity and subgroup analyses were conducted to further validate the robustness of our findings.Results:A total of 2922 normoxemic patients with AHF were finally included in the analysis.Overall,42.1%(1230/2922)patients were exposed to oxygen therapy,and 57.9%(1692/2922)patients did not receive oxygen therapy(defined as the ambient air group).After PSM analysis,1122 pairs of patients were matched:each patient receiving oxygen therapy was matched with a patient without receiving supplemental oxygen.The multivariable logistic model showed that there was no significant interaction between the ambient air and oxygen therapy for all-cause in-hospital mortality[odds ratio(OR)=1.30;95%confidence interval(CI)0.92–1.82;P=0.138]or ICU mortality(OR=1.39;95%CI 0.83–2.32;P=0.206)in the post-PSM cohorts.In addition,linear regression analysis revealed that oxygen therapy was associated with prolonged ICU LOS(OR=1.11;95%CI 1.06–1.15;P<0.001)and hospital LOS(OR=1.06;95%CI 1.01–1.10;P=0.009)after PSM.Furthermore,the absence of an effect of supplemental oxygen on mortality was consistent in all subgroups.Conclusions:Routine use of supplemental oxygen in AHF patients without hypoxemia was not found to reduce all cause in-hospital mortality or ICU mortality.

Heart failure in COVID-19 patients:Critical care experience

Patients with heart failure(HF)may be at a higher risk of coronavirus disease 2019(COVID-19)infection and may have a worse outcome due to their comorbid conditions and advanced age.In this narrative review,we aim to study the interaction between COVID-19 and HF from a critical care perspective.We performed a systematic search for studies that reported HF and critical carerelated outcomes in COVID-19 patients in the PubMed and Medline databases.From a total of 1050 papers,we identified 26 that satisfied the eligibility criteria for our review.Data such as patient demographics,HF,intensive care unit(ICU)admission,management,and outcome were extracted from these studies and analyzed.We reported outcomes in heart-transplant patients with COVID-19 separately.In hospitalized patients with COVID-19,the prevalence of HF varied between 4%and 21%.The requirement for ICU admission was between 8%and 33%.HF patients with COVID-19 had an overall mortality rate between 20%and 40%.We identified that HF is an independent predictor of mortality in hospitalized COVID-19 patients,and patients with HF were more likely to require ventilation,ICU admission and develop complications.Patients with HF with reduced ejection fraction did worse than those with HF with midrange ejection fraction,and HF with preserved ejection fraction.COVID-19 patients with HF should be identified early and managed aggressively in an attempt to improve outcomes in this cohort of patients.

Heart failure in the elderly-some aspects in pathophysiology,diagnosis and therapy that require special attention

Approximately 50% of all heart failure patients in the US are above 75 years of age, which is almost similar to most European countries and the Middle and the Far East. Even though aging is an independent molecular process with a multitude of genetic predetermination and biochemical mediations, aging itself does not automatically result in cardiac insufficiency. On the other hand, with increasing age, cardioprotective mechanisms in response to stress are lost, and progressive cardiomyocyte degeneration with replace- ment fibrosis is often seen in older hearts, even though the exact triggers are not completely understood. Older patients with heart failure have distinct features that require special attention in diagnosis as well as therapy. The elderly more frequently suffer from multiple co-morbidities and might have atypical clinical presentations. Several precautions are essential in the treatment of heart failure in the elderly due to co-existing morbidities and the pharmacokinetic and pharmacodynamic changes related to increased age. Also, treatment expectations, compliance, mental status and cognitive function might play a major role regarding optimized treatment and monitoring options in the elderly suffering from heart failure. This review summarizes current issues of heart failure management in the elderly.

Heart Failure with Preserved Ejection Fraction:Time to Revisit the Stiff Heart

In the current era of cardiovascular disease,the diagnosis of heart failure with preserved ejection fraction(HFpEF)is a well-recognized clinical entity that is equally prevalent but distinctly different from heart failure with reduced ejection fraction(HFrEF).Despite normal EF patients with this disease have similar morbidity and mortality rates compared with HFrEF,as well as a rising rate of hospitalizations.The pathophysiology of HFpEF is incompletely understood.The number of therapies with proven effi cacy at improving longterm cardiovascular outcomes is limited.Women with heart failure syndromes,particularly the elderly,are much more likely to have a HFpEF phenotype at the time of their diagnosis.The purpose of this paper is to review the epidemiology,pathophysiology,clinical features,and current management strategies in HFpEF,especially as it pertains to women.

Outcomes of Patients with Heart Failure followed in a Cardiological Setting to Parakou from 2016 to 2020

Introduction: Heart failure (HF) is a serious pathology whose evolution is made of episodes of acute decompensation, rhythmic and thromboembolic complications, causes of iterative hospitalizations and death. The objective of this study was to describe the outcomes of patients followed for heart failure in a cardiological setting in Parakou from 2016 to 2020. Methods: This was a longitudinal, descriptive and analytical retrospective study of heart failure patients followed in consultation and/or hospitalization over a period of 5 years (October 2016 to July 2020) in cardiology units of Parakou. The outcome of HF was assessed by the NYHA symptomatic stage, rehospitalization, complications and death. Epidata 3.1 fr and SPSS 21 software were used for data processing and analysis. Results: Of the 4902 cardiovascular admissions, 453 cases of HF (9.24%) were observed. At the onset of care, 51.50% of patients were at NYHA stage IV and 69.46% had left ventricular systolic dysfunction. During the follow-up period, there was a symptomatic improvement in the first 06 months but at one year of follow-up, 45.28% of the subjects were seen with a deteriorated stage. At one year of follow-up, the rehospitalization rate was 23.58%. The complications noted were arrhythmias in 8.32% of cases. The mortality rate was 30.37%. Advanced age > 60 years, Charlson score ≥ 3, hypokalemia and poor adherence to treatment were the factors associated with unfavorable outcomes. Conclusion: HF is associated with significant morbidity and mortality. This highlights the importance of its prevention, its better etiological research and patient’s therapeutic education.

Long-term outcomes and independent predictors of mortality in patients presenting to emergency departments with acute heart failure in Beijing:a multicenter cohort study with a 5-year follow-up

Background:Acute heart failure(AHF)is the most common disease in emergency departments(EDs).However,clinical data exploring the outcomes of patients presenting AHF in EDs are limited,especially the long-term outcomes.The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.Methods:This prospective,multicenter,cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1,2011 and September 23,2012.Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.Results:The 5-year mortality and cardiovascular death rates were 55.4%and 49.6%,respectively.The median overall survival was 34 months.Independent predictors of 5-year mortality were patient age(hazard ratio[HR]:1.027,95 confidence interval[CI]:1.023-1.030),body mass index(BMI)(HR:0.971,95%CI:0.958-0.983),fatigue(HR:1.127,95%CI:1.009-1.258),ascites(HR:1.190,95%CI:1.057-1.340),hepatic jugular reflux(HR:1.339,95%CI:1.140-1.572),New York Heart Association(NYHA)class III to IV(HR:1.511,95%CI:1.291-1.769),heart rate(HR:1.003,95%CI:1.001-1.005),diastolic blood pressure(DBP)(HR:0.996,95%CI:0.993-0.999),blood urea nitrogen(BUN)(HR:1.014,95%CI:1.008-1.020),B-type natriuretic peptide(BNP)/N-terminal pro-B-type natriuretic peptide(NT-proBNP)level in the third(HR:1.426,95%CI:1.220-1.668)or fourth quartile(HR:1.437,95%CI:1.223-1.690),serum sodium(HR:0.980,95%CI:0.972-0.988),serum albumin(HR:0.981,95%CI:0.971-0.992),ischemic heart diseases(HR:1.195,95%CI:1.073-1.331),primary cardiomyopathy(HR:1.382,95%CI:1.183-1.614),diabetes(HR:1.118,95%CI:1.010-1.237),stroke(HR:1.252,95%CI:1.121-1.397),and the use of diuretics(HR:0.714,95%CI:0.626-0.814),(3-blockers(HR:0.673,95%CI:0.588-0.769),angiotensin-converting enzyme inhibitors(ACEIs)(HR:0.714,95%CI:0.604-0.845),angiotensin-II receptor blockers(ARBs)(HR:0.790,95%CI:0.646-0.965),spironolactone(HR:0.814,95%CI:0.663-0.999),calcium antagonists(HR:0.624,95%CI:0.531-0.733),nitrates(HR:0.715,95%CI:0.631-0.811),and digoxin(HR:0.579,95%CI:0.465-0.721).Conclusions:The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF.Age,BMI,fatigue,ascites,hepatic jugular reflux,NYHA class III to IV,heart rate,DBP,BUN,BNP/NT-proBNP level in the third or fourth quartile,serum sodium,serum albumin,ischemic heart diseases,primary cardiomyopathy,diabetes,stroke,and the use of diuretics,P-blockers,ACEIs,ARBs,spironolactone,calcium antagonists,nitrates,and digoxin were independently associated with 5-year all-cause mortality.

Effect of aliskiren on postdischarge mortality and heart failure readmissions among patients hospitalized for heart failure:The ASTRONAUT randomized trial

ABSTRACT Importance Hospitalizations for heart failure （HHF） represent a major health burden, with high rates of early postdischarge rehospitalization and mortality. Objective To investigate whether aliskiren, a direct renin inhibitor, when added to standard therapy, would reduce the rate of cardiovascular （CV） death or HF rehospitalization among HHF patients. Design, Setting, and Participants International, double-blind, placebo-controlled study that randomized hemodynamically stable HHF patients a median 5 days after admission. Eligible patients were 18 years or older with left ventricular ejection fraction （LVEF） 40% or less,