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W Wilson H Tang - One of the best experts on this subject based on the ideXlab platform.
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effect on survival of concurrent hemoconcentration and increase in creatinine during treatment of acute Decompensated Heart Failure
American Journal of Cardiology, 2019Co-Authors: Matthew Griffin, P Raghavendra, Jeffrey M Turner, Devin Mahoney, Alan S Maisel, Juan Betuel Iveymiranda, Lesley A. Inker, James Fleming, Nicholas Wettersten, W Wilson H TangAbstract:Hemoconcentration during the treatment of acute Decompensated Heart Failure is a surrogate for plasma volume reduction and is associated with improved survival, but most definitions only allow for hemoconcentration to be determined retrospectively. An increase in serum creatinine can also be a marker of aggressive decongestion, but in isolation is not specific. Our objective was to determine if combined hemoconcentration and worsening creatinine could better identify patients that were aggressively treated and, as such, may have improved postdischarge outcomes. A total of 4,181 patients hospitalized with acute Decompensated Heart Failure were evaluated. Those who experienced both hemoconcentration and worsening creatinine at any point had a profile consistent with aggressive in-hospital treatment and longer length of stay (p
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predictive value of spot urine sodium during the treatment of acute Decompensated Heart Failure
Journal of Cardiac Failure, 2019Co-Authors: Hiroyuki Kono, W Wilson H Tang, Takeshi Kitai, Yasuhiro Sasaki, Toshiaki Toyota, Kitae Kim, Natsuhiko Ehara, Atsushi Kobori, Makoto Kinoshita, Shuichiro KajiAbstract:Background A mainstay of treatment for acute Decompensated Heart Failure is decongestion by diuresis commonly monitored with urine output. The aim of this study was to examine whether a spot urine sodium (UNa) measurement can predict diuretic response as well as in-hospital outcomes. Methods A total of 613 consecutive patients (age: 77±12 years, male: 60%) who were admitted to our institution due to acute Decompensated Heart Failure (ADHF), were retrospectively reviewed. Spot urine samples were obtained within 24 hours after hospitalization. Patients were divided into two groups according to the value of UNa: UNa ≥50 mEq/L (high-UNa) and UNa Results The UNa level was 107.9 ±1.5 mEq/L in high-UNa (n=484) and 30.9 ±2.8 mEq/L in low-UNa (n=129). Although there were no significant differences between the two groups regarding age, gender, Left ventricular ejection fraction, diuretics use before admission and total dose of intravenous furosemide within 24 hours (high-UNa vs low-UNa, 65 ±3 vs 74 ±7 mg, P=0.24), high-UNa was associated with higher sodium level (138.4 ±0.2 vs 135.7 ±0.4 mEq/L, P Conclusion Higher urine sodium excretion was associated with larger amount of urine output, lower incidence of WRF and lower in-hospital mortality. Spot urine sodium measurement may be useful in the management of ADHF.
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substantial discrepancy between fluid and weight loss during acute Decompensated Heart Failure treatment
The American Journal of Medicine, 2015Co-Authors: Jeffrey M Testani, Meredith A Brisco, Chirag R Parikh, Steven G Coca, Robb D Kociol, Daniel Jacoby, Lavanya Bellumkonda, W Wilson H TangAbstract:Abstract Background Net fluid and weight loss are used ubiquitously to monitor diuretic response in acute Decompensated Heart Failure research and patient care. However, the performance of these metrics has never been evaluated critically. The weight and volume of aqueous fluids such as urine should be correlated nearly perfectly and with very good agreement. As a result, significant discrepancy between fluid and weight loss during the treatment of acute Decompensated Heart Failure would indicate measurement error in 1 or both of the parameters. Methods The correlation and agreement (Bland-Altman method) between diuretic-induced fluid and weight loss were examined in 3 acute Decompensated Heart Failure trials and cohorts: (1) Diuretic Optimization Strategies Evaluation (DOSE) (n = 254); (2) Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) (n = 348); and (3) Penn (n = 486). Results The correlation between fluid and weight loss was modest (DOSE r = 0.55; ESCAPE r = 0.48; Penn r = 0.51; P P ≤ .002). A consistent pattern of baseline characteristics or in-hospital treatment parameters that could identify patients at risk of discordant fluid and weight loss was not found. Conclusions Considerable discrepancy between fluid balance and weight loss is common in patients treated for acute Decompensated Heart Failure. Awareness of the limitations inherent to these commonly used metrics and efforts to develop more reliable measures of diuresis are critical for both patient care and research in acute Decompensated Heart Failure.
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hyponatremia in acute Decompensated Heart Failure depletion versus dilution
Journal of the American College of Cardiology, 2015Co-Authors: Frederik H Verbrugge, W Wilson H Tang, Paul Steels, Lars Grieten, Petra Nijst, Wilfried MullensAbstract:Abstract Hyponatremia frequently poses a therapeutic challenge in acute Decompensated Heart Failure (ADHF). Treating physicians should differentiate between depletional versus dilutional hyponatremia. The former is caused by diuretic agents, which enhance sodium excretion, often with concomitant potassium/magnesium losses. This can be treated with isotonic saline, whereas potassium/magnesium administration may be helpful if plasma concentrations are low. In contrast, as impaired water excretion, rather than sodium deficiency, is the culprit in dilutional hyponatremia, isotonic saline administration may further depress the serum sodium concentration. Because free water excretion is achieved by continuous sodium reabsorption in distal nephron segments with low water permeability, diuretic agents that impair this mechanism (e.g., thiazide-type diuretic agents and mineralocorticoid receptor antagonists) should be avoided, and proximally acting agents (e.g., acetazolamide and loop diuretic agents) are preferred. Vasopressin antagonists, which promote low water permeability in the collecting ducts and, hence, free water excretion, remain under investigation for dilutional hyponatremia in ADHF.
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nesiritide renal function and associated outcomes during hospitalization for acute Decompensated Heart Failure results from the acute study of clinical effectiveness of nesiritide and Decompensated Heart Failure ascend hf
Circulation, 2014Co-Authors: Vincent M Van Deursen, Christopher M Oconnor, Justin A. Ezekowitz, Robert M. Califf, Randall Starling, Stephen S Gottlieb, Amanda Stebbins, Vic Hasselblad, Adrian F Hernandez, W Wilson H TangAbstract:Background— Contradictory results have been reported on the effects of nesiritide on renal function in patients with acute Decompensated Heart Failure. We studied the effects of nesiritide on renal function during hospitalization for acute Decompensated Heart Failure and associated outcomes. Methods and Results— A total of 7141 patients were randomized to receive either nesiritide or placebo and creatinine was recorded in 5702 patients at baseline, after infusion, discharge, peak/nadir levels until day 30. Worsening renal function was defined as an increase of serum creatinine >0.3 mg/dL and a change of ≥25%. Median (25th–75th percentile) baseline creatinine was 1.2 (1.0–1.6) mg/dL and median baseline blood urea nitrogen was 25 (18–39) mmol/L. Changes in both serum creatinine and blood urea nitrogen were similar in nesiritide-treated and placebo-treated patients ( P =0.20 and P =0.41) from baseline to discharge. In a multivariable model, independent predictors of change from randomization to hospital discharge in serum creatinine were a lower baseline blood urea nitrogen, higher systolic blood pressure, lower diastolic blood pressure, previous weight gain, and lower baseline potassium (all P <0.0001). The frequency of worsening renal function during hospitalization was similar in the nesiritide and placebo group (14.1% and 12.8%, respectively; odds ratio with nesiritide 1.12; confidence interval, 0.95–1.32; P =0.19) and was not associated with death alone and death or rehospitalization at 30 days. However, baseline, discharge, and change in creatinine were associated with death alone and death or rehospitalization for Heart Failure (all tests, P <0.0001). Conclusions— Nesiritide did not affect renal function in patients with acute Decompensated Heart Failure. Baseline, discharge, and change in renal function were associated with 30-day mortality or rehospitalization for Heart Failure. Clinical Trial Registration— URL: . Unique identifier: [NCT00475852][1]. # CLINICAL PERSPECTIVE {#article-title-38} [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00475852&atom=%2Fcirculationaha%2F130%2F12%2F958.atom
Gregg C Fonarow - One of the best experts on this subject based on the ideXlab platform.
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timing of immunoreactive b type natriuretic peptide levels and treatment delay in acute Decompensated Heart Failure an adhere acute Decompensated Heart Failure national registry analysis
Journal of the American College of Cardiology, 2008Co-Authors: Alan S Maisel, Janet Wynne, W F Peacock, Gregg C Fonarow, Nolan Mcmullin, Robert Jessie, Roger M MillsAbstract:Objectives We undertook this analysis to determine whether there is a relationship between the time to measurement of immunoreactive B-type natriuretic peptide (iBNP) and early intervention for acutely Decompensated Heart Failure (ADHF) and whether these variables are associated with morbidity and mortality in ADHF patients. Background Although natriuretic peptides (NPs) can aid emergency department (ED) physicians in the diagnosis of ADHF, the relationship between the time to measurement of NP levels and time to treatment is not clear. In addition, the impact of time to treatment on clinical outcomes has not been demonstrated. Methods Patients from ADHERE (Acute Decompensated Heart Failure National Registry) who were admitted to the ED and who received intravenous diuretics were included. Recordings of iBNP levels and the timing of intravenous diuretic therapy were documented. Patients were divided by quartiles of time to treatment and iBNP levels, creating 16 categories. Results In 58,465 ADHF episodes from 209 hospitals, patients with the longest average time to iBNP draw also had the longest time to treatment. Mean ED time increased with increased time-to-treatment quartiles. Rales on initial examination were associated with early recognition of HF and earlier institution of therapy. The later the treatment took place, the fewer patients were asymptomatic at the time of hospital discharge. Within the time-to-treatment quartiles, mortality increased with increasing iBNP. Treatment delay was independently, but modestly, associated with increased in-hospital mortality with a risk-adjusted odds ratio 1.021, 95% confidence interval 1.010 to 1.033, and p Conclusions In the ED setting, delayed measurement of iBNP levels and delay in treatment for ADHF were strongly associated. These delays were linked with modestly increased in-hospital mortality, independent of other prognostic variables. The adverse impact of delay was most notable in patients with greater iBNP levels (Registry for Acute Decompensated Heart Failure Patients; NCT00366639).
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morphine and outcomes in acute Decompensated Heart Failure an adhere analysis
Emergency Medicine Journal, 2008Co-Authors: W F Peacock, Judd E Hollander, Margarita Lopatin, Gregg C Fonarow, Deborah B Diercks, Charles L. EmermanAbstract:Objective: Morphine is a long-standing therapy in acute Decompensated Heart Failure (ADHF), despite few supporting data. A study was undertaken to compare the outcomes of patients who did and did not receive morphine for ADHF. Methods: The study was a retrospective analysis of the Acute Decompensated Heart Failure National Registry (ADHERE) which enrols hospitalised patients with treatment for, or a primary discharge diagnosis of, ADHF. Patients were stratified into cohorts based on whether or not they received intravenous morphine. ANOVA, Wilcoxon and χ 2 tests were used in univariate analysis, followed by multivariate analysis controlling for parameters previously associated with mortality. Analyses were repeated for ejection fraction subgroups and in patients not on mechanical ventilation. Results: There were 147 362 hospitalisations in ADHERE at December 2004, 20 782 of whom (14.1%) received morphine and 126 580 (85.9%) did not. There were no clinically relevant differences between the groups in the initial age, Heart rate, blood pressure, blood urea nitrogen, creatinine, haemoglobin, ejection fraction or atrial fibrillation. A higher prevalence of rest dyspnoea, congestion on chest radiography, rales and raised troponin occurred in the morphine group. Patients on morphine received more inotropes and vasodilators, were more likely to require mechanical ventilation (15.4% vs 2.8%), had a longer median hospitalisation (5.6 vs 4.2 days), more ICU admissions (38.7% vs 14.4%), and had greater mortality (13.0% vs 2.4%) (all p Conclusions: Morphine is associated with increased adverse events in ADHF which includes a greater frequency of mechanical ventilation, prolonged hospitalisation, more ICU admissions and higher mortality.
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admission b type natriuretic peptide levels and in hospital mortality in acute Decompensated Heart Failure
Journal of the American College of Cardiology, 2007Co-Authors: Gregg C Fonarow, W F Peacock, Michael M Givertz, Christopher O Phillips, Margarita LopatinAbstract:Objectives This study was designed to determine whether admission B-type natriuretic peptide (BNP) levels are predictive of in-hospital mortality in acute Decompensated Heart Failure (HF). Background Levels of BNP have been demonstrated to facilitate the diagnosis of HF and predict mortality in chronic systolic HF. Methods B-type natriuretic peptide levels within 24 h of presentation were obtained in 48,629 (63%) of 77,467 hospitalization episodes entered in ADHERE (Acute Decompensated Heart Failure National Registry). In-hospital mortality was assessed by BNP quartiles in the entire cohort and in patients with reduced (n = 19,544) as well as preserved (n = 18,164) left ventricular systolic function using chi-square and logistic regression models. Results Quartiles (Q) of BNP were Q1 ( Conclusions An elevated admission BNP level is a significant predictor of in-hospital mortality in acute Decompensated HF with either reduced or preserved systolic function, independent of other clinical and laboratory variables. (Registry for Acute Decompensated Heart Failure Patients; http://www.clinicaltrials.gov/show/NCT00366639; NCT00366639).
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impact of early initiation of intravenous therapy for acute Decompensated Heart Failure on outcomes in adhere
The Cardiology, 2007Co-Authors: Franklin W Peacock, Charles L. Emerman, Roger M Mills, Gregg C Fonarow, Janet WynneAbstract:Background: Since most acute Decompensated Heart Failure (ADHF) patients present for hospital care via the emergency department (ED), we sought to determine the impact of early ED i
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clinical presentation management and in hospital outcomes of patients admitted with acute Decompensated Heart Failure with preserved systolic function a report from the acute Decompensated Heart Failure national registry adhere database
Journal of the American College of Cardiology, 2006Co-Authors: Clyde W Yancy, Teresa De Marco, Margarita Lopatin, Lynne W Stevenson, Gregg C FonarowAbstract:Clinical Presentation, Management, and In-Hospital Outcomes of Patients Admitted With Acute Decompensated Heart Failure With Preserved Systolic Function: A Report From the Acute Decompensated Heart...
Margarita Lopatin - One of the best experts on this subject based on the ideXlab platform.
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impact of intravenous loop diuretics on outcomes of patients hospitalized with acute Decompensated Heart Failure insights from the adhere registry
The Cardiology, 2009Co-Authors: Franklin W Peacock, Janet Wynne, Maria Rosa Costanzo, Teresa De Marco, Margarita Lopatin, Roger M Mills, Charles L. EmermanAbstract:The optimal use of diuretics in Decompensated Heart Failure remains uncertain. We analyzed data from the ADHERE registry to look at the impact of diuretic dosing. 62,866 patients receiving
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morphine and outcomes in acute Decompensated Heart Failure an adhere analysis
Emergency Medicine Journal, 2008Co-Authors: W F Peacock, Judd E Hollander, Margarita Lopatin, Gregg C Fonarow, Deborah B Diercks, Charles L. EmermanAbstract:Objective: Morphine is a long-standing therapy in acute Decompensated Heart Failure (ADHF), despite few supporting data. A study was undertaken to compare the outcomes of patients who did and did not receive morphine for ADHF. Methods: The study was a retrospective analysis of the Acute Decompensated Heart Failure National Registry (ADHERE) which enrols hospitalised patients with treatment for, or a primary discharge diagnosis of, ADHF. Patients were stratified into cohorts based on whether or not they received intravenous morphine. ANOVA, Wilcoxon and χ 2 tests were used in univariate analysis, followed by multivariate analysis controlling for parameters previously associated with mortality. Analyses were repeated for ejection fraction subgroups and in patients not on mechanical ventilation. Results: There were 147 362 hospitalisations in ADHERE at December 2004, 20 782 of whom (14.1%) received morphine and 126 580 (85.9%) did not. There were no clinically relevant differences between the groups in the initial age, Heart rate, blood pressure, blood urea nitrogen, creatinine, haemoglobin, ejection fraction or atrial fibrillation. A higher prevalence of rest dyspnoea, congestion on chest radiography, rales and raised troponin occurred in the morphine group. Patients on morphine received more inotropes and vasodilators, were more likely to require mechanical ventilation (15.4% vs 2.8%), had a longer median hospitalisation (5.6 vs 4.2 days), more ICU admissions (38.7% vs 14.4%), and had greater mortality (13.0% vs 2.4%) (all p Conclusions: Morphine is associated with increased adverse events in ADHF which includes a greater frequency of mechanical ventilation, prolonged hospitalisation, more ICU admissions and higher mortality.
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admission b type natriuretic peptide levels and in hospital mortality in acute Decompensated Heart Failure
Journal of the American College of Cardiology, 2007Co-Authors: Gregg C Fonarow, W F Peacock, Michael M Givertz, Christopher O Phillips, Margarita LopatinAbstract:Objectives This study was designed to determine whether admission B-type natriuretic peptide (BNP) levels are predictive of in-hospital mortality in acute Decompensated Heart Failure (HF). Background Levels of BNP have been demonstrated to facilitate the diagnosis of HF and predict mortality in chronic systolic HF. Methods B-type natriuretic peptide levels within 24 h of presentation were obtained in 48,629 (63%) of 77,467 hospitalization episodes entered in ADHERE (Acute Decompensated Heart Failure National Registry). In-hospital mortality was assessed by BNP quartiles in the entire cohort and in patients with reduced (n = 19,544) as well as preserved (n = 18,164) left ventricular systolic function using chi-square and logistic regression models. Results Quartiles (Q) of BNP were Q1 ( Conclusions An elevated admission BNP level is a significant predictor of in-hospital mortality in acute Decompensated HF with either reduced or preserved systolic function, independent of other clinical and laboratory variables. (Registry for Acute Decompensated Heart Failure Patients; http://www.clinicaltrials.gov/show/NCT00366639; NCT00366639).
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clinical presentation management and in hospital outcomes of patients admitted with acute Decompensated Heart Failure with preserved systolic function a report from the acute Decompensated Heart Failure national registry adhere database
Journal of the American College of Cardiology, 2006Co-Authors: Clyde W Yancy, Teresa De Marco, Margarita Lopatin, Lynne W Stevenson, Gregg C FonarowAbstract:Clinical Presentation, Management, and In-Hospital Outcomes of Patients Admitted With Acute Decompensated Heart Failure With Preserved Systolic Function: A Report From the Acute Decompensated Heart...
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clinical presentation management and in hospital outcomes of patients admitted with acute Decompensated Heart Failure with preserved systolic function a report from the acute Decompensated Heart Failure national registry adhere database
Journal of the American College of Cardiology, 2006Co-Authors: Clyde W Yancy, Teresa De Marco, Margarita Lopatin, Lynne W Stevenson, Gregg C FonarowAbstract:Clinical Presentation, Management, and In-Hospital Outcomes of Patients Admitted With Acute Decompensated Heart Failure With Preserved Systolic Function: A Report From the Acute Decompensated Heart Failure National Registry (ADHERE) Database Clyde W. Yancy, Margarita Lopatin, Lynne Warner Stevenson, Teresa De Marco, Gregg C. Fonarow, for the ADHERE Scientific Advisory Committee and Investigators Approximately 50% of patients hospitalized for Heart Failure have preserved systolic function. These patients are more likely to be older, women, and hypertensive. Their duration of hospitalization is similar to that of Heart Failure patients with systolic dysfunction, but their in-hospital mortality risk is lower. This mortality risk is increased in the setting of renal insufficiency, and the two most important risk predictors are elevated blood urea nitrogen and systolic blood pressure ≤125 mm Hg. Medical treatment strategies for patients with preserved systolic function are inconsistent and reflect the need for efficacious evidence-based treatment regimens. Objectives The aims of this analysis were to describe the clinical characteristics, management, and outcomes of patients hospitalized for acute Decompensated Heart Failure (HF) with preserved systolic function (PSF). Background Clinically meaningful characteristics of these patients have not been fully studied in a large database. Methods Data from >100,000 hospitalizations from the Acute Decompensated Heart Failure National Registry (ADHERE) database were analyzed. Results Heart Failure with PSF was present in 50.4% of patients with in-hospital assessment of left ventricular function. When compared with patients with systolic dysfunction, patients with PSF were more likely to be older, women, and hypertensive and less likely to have had a prior myocardial infarction or be receiving an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker. In-hospital mortality was lower in patients with PSF compared with patients with systolic dysfunction (2.8% vs. 3.9%; adjusted odds ratio [OR]: 0.86; p = 0.005), but duration of intensive care unit stay and total hospital length of stay were similar. Serum creatinine >2 mg/dl was associated with increased in-hospital mortality in both systolic function groups (PSF: 4.8%; systolic dysfunction: 8.4%; p 37 mg/dl (OR: 2.53; 95% confidence interval [CI]: 2.22 to 2.87) and systolic blood pressure ≤125 mm Hg (OR: 2.58; 95% CI: 2.33 to 2.86). Conclusions Heart Failure with PSF is common and is characterized by a unique patient profile. Event rates are worrisome and reflect a need for more effective management strategies.
Janet Wynne - One of the best experts on this subject based on the ideXlab platform.
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impact of intravenous loop diuretics on outcomes of patients hospitalized with acute Decompensated Heart Failure insights from the adhere registry
The Cardiology, 2009Co-Authors: Franklin W Peacock, Janet Wynne, Maria Rosa Costanzo, Teresa De Marco, Margarita Lopatin, Roger M Mills, Charles L. EmermanAbstract:The optimal use of diuretics in Decompensated Heart Failure remains uncertain. We analyzed data from the ADHERE registry to look at the impact of diuretic dosing. 62,866 patients receiving
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timing of immunoreactive b type natriuretic peptide levels and treatment delay in acute Decompensated Heart Failure an adhere acute Decompensated Heart Failure national registry analysis
Journal of the American College of Cardiology, 2008Co-Authors: Alan S Maisel, Janet Wynne, W F Peacock, Gregg C Fonarow, Nolan Mcmullin, Robert Jessie, Roger M MillsAbstract:Objectives We undertook this analysis to determine whether there is a relationship between the time to measurement of immunoreactive B-type natriuretic peptide (iBNP) and early intervention for acutely Decompensated Heart Failure (ADHF) and whether these variables are associated with morbidity and mortality in ADHF patients. Background Although natriuretic peptides (NPs) can aid emergency department (ED) physicians in the diagnosis of ADHF, the relationship between the time to measurement of NP levels and time to treatment is not clear. In addition, the impact of time to treatment on clinical outcomes has not been demonstrated. Methods Patients from ADHERE (Acute Decompensated Heart Failure National Registry) who were admitted to the ED and who received intravenous diuretics were included. Recordings of iBNP levels and the timing of intravenous diuretic therapy were documented. Patients were divided by quartiles of time to treatment and iBNP levels, creating 16 categories. Results In 58,465 ADHF episodes from 209 hospitals, patients with the longest average time to iBNP draw also had the longest time to treatment. Mean ED time increased with increased time-to-treatment quartiles. Rales on initial examination were associated with early recognition of HF and earlier institution of therapy. The later the treatment took place, the fewer patients were asymptomatic at the time of hospital discharge. Within the time-to-treatment quartiles, mortality increased with increasing iBNP. Treatment delay was independently, but modestly, associated with increased in-hospital mortality with a risk-adjusted odds ratio 1.021, 95% confidence interval 1.010 to 1.033, and p Conclusions In the ED setting, delayed measurement of iBNP levels and delay in treatment for ADHF were strongly associated. These delays were linked with modestly increased in-hospital mortality, independent of other prognostic variables. The adverse impact of delay was most notable in patients with greater iBNP levels (Registry for Acute Decompensated Heart Failure Patients; NCT00366639).
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bronchodilator therapy in acute Decompensated Heart Failure patients without a history of chronic obstructive pulmonary disease
Annals of Emergency Medicine, 2008Co-Authors: Adam J Singer, Douglas M Char, Janet Wynne, Lois Kellerman, Douglas J Kirk, Judd E Hollander, Thomas J Heywood, Richard L Summers, Charles L. Emerman, W F PeacockAbstract:Study objective Inhaled bronchodilators are often used in the emergency department (ED) before a definitive diagnosis is made. We evaluated the association between inhaled bronchodilators and outcomes in acute Decompensated Heart Failure patients without chronic obstructive pulmonary disease. Methods We conducted an analysis of the Acute Decompensated Heart Failure National Registry Emergency Module registry of patients with a principal discharge diagnosis of acute Decompensated Heart Failure enrolled at 76 academic or community EDs. Dichotomous outcomes (mortality, ED discharges, ICU admission, ED IV vasodilator use, new dialysis, ED or in patient endotracheal intubation, ED BiPAP, and asymptomatic at discharge) in patients without a history of chronic obstructive pulmonary disease who were given bronchodilators were compared to those who were not given bronchodilators using logistic regression; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated; and propensity score adjustments were made. Results Of the 10,978 patients enrolled, 7299 (66.5%) did not have a history of chronic obstructive pulmonary disease. Bronchodilators were administered by the EMS or in the ED to 2317 (21%) patients. Patients without chronic obstructive pulmonary disease given bronchodilators were more likely to receive ED IV vasodilators (28.4% vs. 16.9%; propensity adjusted OR 1.40 [95% CI 1.18-1.67]) and in-patient mechanical ventilation (6.0% vs. 2.4%; propensity adjusted OR 1.69 [95% CI 1.21-2.37]) than patients without chronic obstructive pulmonary disease who were not given bronchodilators. Hospital mortality in patients without chronic obstructive pulmonary disease was similar regardless of bronchodilator treatment (3.4% vs. 2.6%, propensity adjusted OR 1.02 [95% CI 0.67, 1.56]). Conclusion Many acute Decompensated Heart Failure patients without a history of chronic obstructive pulmonary disease receive inhaled bronchodilators. Bronchodilator use was associated with a greater need for aggressive interventions and monitoring, and this may reflect an adverse effect of bronchodilators or it may be a marker for patients with more severe disease.
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impact of early initiation of intravenous therapy for acute Decompensated Heart Failure on outcomes in adhere
The Cardiology, 2007Co-Authors: Franklin W Peacock, Charles L. Emerman, Roger M Mills, Gregg C Fonarow, Janet WynneAbstract:Background: Since most acute Decompensated Heart Failure (ADHF) patients present for hospital care via the emergency department (ED), we sought to determine the impact of early ED i
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in hospital mortality in patients with acute Decompensated Heart Failure requiring intravenous vasoactive medications an analysis from the acute Decompensated Heart Failure national registry adhere
Journal of the American College of Cardiology, 2005Co-Authors: William T Abraham, Maria Rosa Costanzo, Gregg C Fonarow, Kirkwood F Adams, Robert Berkowitz, Thierry H Lejemtel, Mei L Cheng, Janet WynneAbstract:Objectives We sought to compare the in-hospital mortality of patients with acute Decompensated Heart Failure (ADHF) who were receiving parenteral treatment with one of four intravenous vasoactive medications. Background There are limited data regarding the effects of the choice of intravenous vasoactive medication on in-hospital mortality in patients hospitalized with ADHF. Methods This was a retrospective analysis of observational patient data from the Acute Decompensated Heart Failure National Registry (ADHERE), a multicenter registry designed to prospectively collect data on each episode of hospitalization for ADHF and its clinical outcomes. Data from the first 65,180 patient episodes (October 2001 to July 2003) were included in this analysis. Cases in which patients received nitroglycerin, nesiritide, milrinone, or dobutamine were identified and reviewed (n = 15,230). Risk factor and propensity score-adjusted odds ratios (ORs) for in-hospital mortality were calculated. Results Patients who received intravenous nitroglycerin or nesiritide had lower in-hospital mortality than those treated with dobutamine or milrinone. The risk factor and propensity score-adjusted ORs for nitroglycerin were 0.69 (95% confidence interval [CI] 0.53 to 0.89, p ≤ 0.005) and 0.46 (94% CI 0.37 to 0.57, p ≤ 0.005) compared with milrinone and dobutamine, respectively. The corresponding values for nesiritide compared with milrinone and dobutamine were 0.59 (95% CI 0.48 to 0.73, p ≤ 0.005) and 0.47 (95% CI 0.39 to 0.56, p ≤ 0.005), respectively. The adjusted OR for nesiritide compared with nitroglycerin was 0.94 (95% CI 0.77 to 1.16, p = 0.58). Conclusions Therapy with either a natriuretic peptide or vasodilator was associated with significantly lower in-hospital mortality than positive inotropic therapy in patients hospitalized with ADHF. The risk of in-hospital mortality was similar for nesiritide and nitroglycerin.
Christopher M Oconnor - One of the best experts on this subject based on the ideXlab platform.
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prevalence predictors and clinical outcome of residual congestion in acute Decompensated Heart Failure
International Journal of Cardiology, 2018Co-Authors: Jorge Rubiogracia, Christopher M Oconnor, Jozine M Ter Maaten, Biniyam G Demissei, John G F Cleland, Marco Metra, Piotr Ponikowski, John R Teerlink, Gad Cotter, Beth A DavisonAbstract:Abstract Background Congestion is the main reason for hospital admission for acute Decompensated Heart Failure (ADHF). A better understanding of the clinical course of congestion and factors associated with decongestion are therefore important. We studied the clinical course, predictors and prognostic value of congestion in a cohort of patients admitted for ADHF by including different indirect markers of congestion (residual clinical congestion, brain natriuretic peptides (BNP) trajectories, hemoconcentration or diuretic response). Methods and results We studied the prognostic value of residual clinical congestion using an established composite congestion score (CCS) in 1572 ADHF patients. At baseline, 1528 (97.2%) patients were significantly congested (CCS ≥ 3), after 7 days of hospitalization or discharge (whichever came first), 451 (28.7%) patients were still significantly congested (CCS ≥ 3), 751 (47.8%) patients were mildly congested (CCS = 1 or 2) and 370 (23.5%) patients had no signs of residual congestion (CCS = 0). The presence of significant residual congestion at day 7 or discharge was independently associated with increased risk of re-admissions for Heart Failure by day 60 (HR [95%CI] = 1.88 [1.39–2.55]) and all-cause mortality by day 180 (HR [95%CI] = 1.54 [1.16–2.04]). Diuretic response provided added prognostic value on top of residual congestion and baseline predictors for both outcomes, yet gain in prognostic performance was modest. Conclusion Most patients with acute Decompensated Heart Failure still have residual congestion 7 days after hospitalization. This factor was associated with higher rates of re-hospitalization and death. Decongestion surrogates, such as diuretic response, added to residual congestion, are still significant predictors of outcomes, but they do not provide meaningful additive prognostic information.
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nesiritide renal function and associated outcomes during hospitalization for acute Decompensated Heart Failure results from the acute study of clinical effectiveness of nesiritide and Decompensated Heart Failure ascend hf
Circulation, 2014Co-Authors: Vincent M Van Deursen, Christopher M Oconnor, Justin A. Ezekowitz, Robert M. Califf, Randall Starling, Stephen S Gottlieb, Amanda Stebbins, Vic Hasselblad, Adrian F Hernandez, W Wilson H TangAbstract:Background— Contradictory results have been reported on the effects of nesiritide on renal function in patients with acute Decompensated Heart Failure. We studied the effects of nesiritide on renal function during hospitalization for acute Decompensated Heart Failure and associated outcomes. Methods and Results— A total of 7141 patients were randomized to receive either nesiritide or placebo and creatinine was recorded in 5702 patients at baseline, after infusion, discharge, peak/nadir levels until day 30. Worsening renal function was defined as an increase of serum creatinine >0.3 mg/dL and a change of ≥25%. Median (25th–75th percentile) baseline creatinine was 1.2 (1.0–1.6) mg/dL and median baseline blood urea nitrogen was 25 (18–39) mmol/L. Changes in both serum creatinine and blood urea nitrogen were similar in nesiritide-treated and placebo-treated patients ( P =0.20 and P =0.41) from baseline to discharge. In a multivariable model, independent predictors of change from randomization to hospital discharge in serum creatinine were a lower baseline blood urea nitrogen, higher systolic blood pressure, lower diastolic blood pressure, previous weight gain, and lower baseline potassium (all P <0.0001). The frequency of worsening renal function during hospitalization was similar in the nesiritide and placebo group (14.1% and 12.8%, respectively; odds ratio with nesiritide 1.12; confidence interval, 0.95–1.32; P =0.19) and was not associated with death alone and death or rehospitalization at 30 days. However, baseline, discharge, and change in creatinine were associated with death alone and death or rehospitalization for Heart Failure (all tests, P <0.0001). Conclusions— Nesiritide did not affect renal function in patients with acute Decompensated Heart Failure. Baseline, discharge, and change in renal function were associated with 30-day mortality or rehospitalization for Heart Failure. Clinical Trial Registration— URL: . Unique identifier: [NCT00475852][1]. # CLINICAL PERSPECTIVE {#article-title-38} [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00475852&atom=%2Fcirculationaha%2F130%2F12%2F958.atom
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nesiritide renal function and associated outcomes during hospitalization for acute Decompensated Heart Failure
Circulation, 2014Co-Authors: Vincent M Van Deursen, Christopher M Oconnor, Justin A. Ezekowitz, Robert M. Califf, Stephen S Gottlieb, Amanda Stebbins, Vic Hasselblad, Randall C Starling, Adrian F Hernandez, W Wilson H TangAbstract:Background—Contradictory results have been reported on the effects of nesiritide on renal function in patients with acute Decompensated Heart Failure. We studied the effects of nesiritide on renal function during hospitalization for acute Decompensated Heart Failure and associated outcomes. Methods and Results—A total of 7141 patients were randomized to receive either nesiritide or placebo and creatinine was recorded in 5702 patients at baseline, after infusion, discharge, peak/nadir levels until day 30. Worsening renal function was defined as an increase of serum creatinine >0.3 mg/dL and a change of ≥25%. Median (25th–75th percentile) baseline creatinine was 1.2 (1.0–1.6) mg/dL and median baseline blood urea nitrogen was 25 (18–39) mmol/L. Changes in both serum creatinine and blood urea nitrogen were similar in nesiritide-treated and placebo-treated patients (P=0.20 and P=0.41) from baseline to discharge. In a multivariable model, independent predictors of change from randomization to hospital discharge...
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effects of nesiritide and predictors of urine output in acute Decompensated Heart Failure results from ascend hf acute study of clinical effectiveness of nesiritide and Decompensated Heart Failure
Journal of the American College of Cardiology, 2013Co-Authors: Stephen S Gottlieb, Christopher M Oconnor, Justin A. Ezekowitz, Robert M. Califf, Amanda Stebbins, Adriaan A Voors, Vic Hasselblad, Randall C Starling, Adrian F HernandezAbstract:Objectives This study sought to determine if nesiritide increases diuresis in congestive Heart Failure patients. Background In the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure), 7,141 patients hospitalized with acute Decompensated Heart Failure (ADHF) were randomized to receive nesiritide or placebo for 24 to 168 h, in addition to standard care. There were minimal effects of nesiritide on survival, future hospitalizations, and symptoms. However, whether or not nesiritide increases diuresis in ADHF patients is unknown. Methods Urine output was measured in 5,864 subjects; of these, 5,320 received loop diuretics and had dose data recorded. Loop diuretics other than furosemide were converted to furosemide equivalent doses. A total of 4,881 patients had complete data. We used logistic regression models to identify the impact of nesiritide on urine output and the factors associated with high urine output. Results Median (25th, 75th percentiles) 24-h urine output was 2,280 (1,550, 3,280) ml with nesiritide and 2,200 (1,550, 3,200) ml with placebo (p = NS). Loop diuretic dose (furosemide equivalent) was 80 (40, 140) mg with both nesiritide and placebo. Diuretic dose was a strong predictor of urine output. Other independent predictors included: male sex, greater body mass index, higher diastolic blood pressure, elevated jugular venous pressure, recent weight gain, and lower blood urea nitrogen. The addition of nesiritide did not change urine output. None of the interaction terms between nesiritide and predictors affected the urine output prediction. Conclusions Nesiritide did not increase urine output in patients with ADHF. Higher diuretic dose was a strong predictor of higher urine output, but neurohormonal activation (as evidenced by blood urea nitrogen concentration) and lower blood pressure limited diuresis.
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nesiritide administration in patients hospitalized for acute Decompensated Heart Failure does timing matter
Journal of Cardiac Failure, 2013Co-Authors: Y Wong, Christopher M Oconnor, Justin A. Ezekowitz, Robert M. Califf, Randall C Starling, Michael G Felker, Gretchen Heizer, Paul W Armstrong, John J V Mcmurray, Vic HasselbladAbstract:Background: It is unclear if early administration of nesiritide in patients with acute Decompensated Heart Failure (ADHF) is associated with better patient reported or clinical outcomes. We sought to identify if time to study medication administration from hospital presentation is associated with these outcomes. Methods: Using data from the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF), we examined the associations of time to study medication administration with moderate/marked improvement in dyspnea at 6 hours (7-point Likert scale) and 30-day all-cause death or re-hospitalization using multivariable lo- gistic regression. Furthermore, we examined if there is a differential effect of time to study medication administration on outcomes depending on treatment assignments (nesiritide vs. placebo). Linear splines (# and O 10 hours after admission) were ap- plied to time to study medication administration due to non-linear relationship with dyspnea improvement at 6 hours. Results: Of the 7003 patients, median time to study drug administration was 16.7 hours (25th, 75th percentiles 5 6.5, 23.1) with signif- icant regional variations (Figure). After adjusting for pre-randomization therapies and known predictors of outcomes, each hour delay in administrating study medication after the first 10 hours was associated with modestly reduced odds of achieving mod- erate/marked dyspnea improvement 6 hours after starting treatment (adjusted OR 0.98, 95% CI 0.98, 0.99; P!0.0001), but not 30-day outcomes (unadjusted OR 1.01, 95% CI 1.00, 1.02; P50.07). There was no significant differential effects of time to study medication administration on outcomes between treatment assignments (P values for interactions O0.1). Conclusion: Time to treatment with study medica- tion varied significantly across regions. Earlier administration of nesiritide was asso- ciated with modestly higher odds of moderate or marked dyspnea improvement at 6 hours but not 30-day outcomes. These findings may have implications for interpreta- tion of ADHF studies and future study designs.
