Clinical presentation, management, in-hospital and 90-day outcomes of heart failure patients in Trivandrum, Kerala, India: the Trivandrum Heart Failure Registry.
Eur J Heart Fail. 2015 May 23;
Authors: Harikrishnan S, Sanjay G, Anees T, Viswanathan S, Vijayaraghavan G, Bahuleyan CG, Sreedharan M, Biju R, Nair T, Suresh K, Rao AC, Dalus D, Huffman MD, Jeemon P, Trivandrum Heart Failure Registry
OBJECTIVE: To evaluate the presentation, management, and outcomes of patients hospitalized for heart failure (HF) in Trivandrum, India.
METHODS: The Trivandrum Heart Failure Registry (THFR) enrolled consecutive admissions from 13 urban and five rural hospitals in Trivandrum with a primary diagnosis of HF from January to December 2013. Clinical characteristics at presentation, treatment, in-hospital outcomes, and 90-day mortality data were collected. ‘Guideline-based’ medical treatment was defined as the combination of beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aldosterone receptor blockers in patients with left ventricular systolic dysfunction (LVSD).
RESULTS: We enrolled 1205 cases (834 men, 69%) into the registry. Mean (standard deviation) age was 61.2 (13.7) years. The most common HF aetiology was ischaemic heart disease (IHD) (72%). Heart failure with preserved ejection fraction (≥45%) constituted 26% of the population. The median hospital stay was 6 days (interquartile range = 4-9 days) with an in-hospital mortality rate of 8.5% (95% confidence interval 6.9-10.0). The 90-day all-cause mortality rate was 2.43 deaths per 1000 person-days (95% confidence interval 2.11-2.78). Guideline-based medical treatment was given to 19% and 25% of patients with LVSD during hospital admission and at discharge, respectively. Older age, lower education, poor ejection fraction, higher serum creatinine, New York Heart Association functional class IV, and suboptimal medical treatment were associated with higher risk of 90-day mortality.
CONCLUSION: Patients hospitalized with HF in the THFR were younger, more likely to be men, had a higher prevalence of IHD, reported longer length of hospital stay, and higher mortality compared with published data from other registries. We also identified key areas for improving hospital-based HF medical care in Trivandrum.
PMID: 26011246 [PubMed - as supplied by publisher]
A simple validated method for predicting the risk of hospitalization for worsening of heart failure in ambulatory patients: the Redin-SCORE.
Eur J Heart Fail. 2015 May 23;
Authors: Álvarez-García J, Ferrero-Gregori A, Puig T, Vázquez R, Delgado J, Pascual-Figal D, Alonso-Pulpón L, González-Juanatey JR, Rivera M, Worner F, Bardají A, Cinca J, investigators of the Spanish Heart Failure Network (REDINSCOR)
AIMS: Prevention of hospital readmissions is one of the main objectives in the management of patients with heart failure (HF). Most of the models predicting readmissions are based on data extracted from hospitalized patients rather than from outpatients. Our objective was to develop a validated score predicting 1-month and 1-year risk of readmission for worsening of HF in ambulatory patients.
METHODS AND RESULTS: A cohort of 2507 ambulatory patients with chronic HF was prospectively followed for a median of 3.3 years. Clinical, echocardiographic, ECG, and biochemical variables were used in a competing risk regression analysis to construct a risk score for readmissions due to worsening of HF. Thereafter, the score was externally validated using a different cohort of 992 patients with chronic HF (MUSIC registry). Predictors of 1-month readmission were the presence of elevated natriuretic peptides, left ventricular (LV) HF signs, and estimated glomerular filtration rate (eGFR) <60 mL/min/m(2) . Predictors of 1-year readmission were elevated natriuretic peptides, anaemia, left atrial size >26 mm/m(2) , heart rate >70 b.p.m., LV HF signs, and eGFR <60 mL/min/m(2) . The C-statistics for the models were 0.72 and 0.66, respectively. The cumulative incidence function distinguished low-risk (<1% event rate) and high-risk groups (>5% event rate) for 1-month HF readmission. Likewise, low-risk (7.8%), intermediate-risk (15.6%) and high-risk groups (26.1%) were identified for 1-year HF readmission risk. The C-statistics remained consistent after the external validation (<5% loss of discrimination).
CONCLUSION: The Redin-SCORE predicts early and late readmission for worsening of HF using proven prognostic variables that are routinely collected in outpatient management of chronic HF.
PMID: 26011392 [PubMed - as supplied by publisher]
Clinical characteristics and outcomes of patients with and without diabetes in the Surgical Treatment for Ischemic Heart Failure (STICH) trial.
Eur J Heart Fail. 2015 May 26;
Authors: MacDonald MR, She L, Doenst T, Binkley PF, Rouleau JL, Tan RS, Lee KL, Miller AB, Sopko G, Szalewska D, Waclawiw MA, Dabrowski R, Castelvecchio S, Adlbrecht C, Michler RE, Oh JK, Velazquez EJ, Petrie MC
AIMS: Hypothesis 1 of the Surgical Treatment for Ischemic Heart Failure (STICH) trial enrolled 1212 patients with an LVEF of ≤35% and CAD amenable to coronary artery bypass grafting (CABG). Patients were randomized to CABG and optimal medical therapy (MED) or MED alone. The objective was to assess whether or not patients with diabetes mellitus (DM) enrolled in the STICH trial would have greater benefit from CABG than patients without DM.
METHODS AND RESULTS: The characteristics and clinical outcomes of patients with and without DM randomized to CABG and MED or MED alone were compared. DM was present in 40%. At baseline, patients with DM had more triple vessel CAD, higher LVEF, and smaller left ventricular volumes. In patients with DM, the primary outcome of all-cause mortality occurred in 39% of patients in the MED group and 39% in the CABG group [hazard ratio (HR) with CABG 0.96, 95% confidence interval (CI) 0.73-1.26]. In patients without DM, the primary outcome occurred in 41% of patients in the MED group and 32% in the CABG group (HR with CABG 0.80, 95% CI 0.63-1.02). While numerically it would appear that the treatment effect of CABG is blunted in patients with DM, there was no significant interaction between DM and treatment group on formal statistical testing.
CONCLUSIONS: Patients with DM enrolled in the STICH trial had more triple vessel disease, smaller hearts, and higher LVEF than those without DM. CABG did not exert greater benefit in patients with DM.
PMID: 26011509 [PubMed - as supplied by publisher]
Baroreflex Activation Therapy for the Treatment of Heart Failure with a Reduced Ejection Fraction: Safety and Efficacy in Patients with and without Cardiac Resynchronization Therapy.
Eur J Heart Fail. 2015 May 25;
Authors: Zile MR, Abraham WT, Weaver FA, Butter C, Ducharme A, Halbach M, Klug D, Lovett EG, Müller-Ehmsen J, Schafer JE, Senni M, Swarup V, Wachter R, Little WC
AIMS: Increased sympathetic and decreased parasympathetic activity contribute to heart failure (HF) symptoms and disease progression. Carotid baroreceptor stimulation (baroreflex activation therapy; BAT) results in centrally mediated reduction of sympathetic and increase in parasympathetic activity. Because patients treated with cardiac resynchronization therapy (CRT) may have less sympathetic / parasympathetic imbalance, we hypothesized that there would be differences in the response to BAT in patients with CRT versus those without CRT.
METHODS AND RESULTS: NYHA Class III patients with ejection fraction (EF) ≤35% were randomized (1:1) to ongoing guideline-directed medical and device therapy (GDMT, Control) or ongoing GDMT plus BAT. Safety endpoint was system-/procedure-related major adverse neurological and cardiovascular events (MANCE). Efficacy endpoints were Minnesota Living with Heart Failure Quality of Life (QoL), 6-minute hall walk distance (6MHWD), NT-proBNP, LVEF, and HF hospitalization rate. 146 patients were randomized (70 Control; 76 BAT), 140 activated, 45 with CRT and 95 without CRT. MANCE-free rate at 6 months was 100% in CRT and 96% in no-CRT group. At 6 months, in the no-CRT group, QoL score, 6MHWD, LVEF, NTpro-BNP and HF hospitalizations were significantly improved in BAT patients compared to Controls. Changes in efficacy endpoints in the CRT group favored BAT; however the improvements were less than in the no-CRT group and were not statistically different from Control.
CONCLUSIONS: BAT is safe and significantly improved QoL, exercise capacity, NTpro-BNP, EF, and rate of HF hospitalizations in GDMT-treated NYHA Class III HF patients; These effects were most pronounced in patients not treated with CRT.
PMID: 26011593 [PubMed - as supplied by publisher]
Maintenance of serum potassium with sodium zirconium cyclosilicate (ZS-9) in heart failure patients: results from a phase 3 randomized, double-blind, placebo-controlled trial.
Eur J Heart Fail. 2015 May 23;
Authors: Anker SD, Kosiborod M, Zannad F, Piña IL, McCullough PA, Filippatos G, Van Der Meer P, Ponikowski P, Rasmussen HS, Lavin PT, Singh B, Yang A, Deedwania P
AIMS: Hyperkalaemia in heart failure (HF) patients limits use of cardioprotective renin-angiotensin-aldosterone-system inhibitors (RAASi). Sodium zirconium cyclosilicate (ZS-9) is a selective K(+) ion trap (SKIT), whose mechanism of action may allow for potassium binding in the upper GI as early as the duodenum following oral administration. ZS-9 previously demonstrated the ability to reduce elevated potassium levels into the normal range with a median time of normalization of 2.2h and sustain normal potassium levels for 28 days in HARMONIZE-a Phase 3, double-blind, randomized, placebo-controlled trial. Here we evaluated management of serum potassium with daily ZS-9 over 28 days in HF patients from HARMONIZE, including those receiving RAASi therapies.
METHODS AND RESULTS: HF patients with evidence of hyperkalaemia (serum potassium≥5.1 mmol/L; N=94) were treated with open-label ZS-9 for 48h. Patients (n=87; 60 receiving RAASi) who achieved normokalaemia (potassium 3.5-5.0 mmol/L) were randomized to daily ZS-9 (5, 10, or 15g) or placebo for 28 days. Mean potassium and proportion of patients maintaining normokalaemia during days 8-29 post-randomization were evaluated. Despite RAASi doses being kept constant, patients on 5g, 10g, and 15g ZS-9 maintained lower potassium (4.7, 4.5, and 4.4 mmol/L, respectively) than the placebo group (5.2 mmol/L; P<0.01 vs. each ZS-9 group); greater proportions of ZS-9 patients (83%, 89%, and 92%, respectively) maintained normokalaemia than placebo (40%; P<0.01 vs. each ZS-9 group). Safety profile was consistent with previously reported overall study population.
CONCLUSION: Compared with placebo, all 3 ZS-9 doses lowered potassium and effectively maintained normokalaemia for 28 days in HF patients without adjusting concomitant RAASi, while maintaining a safety profile consistent with the overall study population.
PMID: 26011677 [PubMed - as supplied by publisher]
Children’s Temperament and Academic Skill Development During First Grade: Teachers’ Interaction Styles as Mediators.
Child Dev. 2015 May 22;
Authors: Viljaranta J, Aunola K, Mullola S, Virkkala J, Hirvonen R, Pakarinen E, Nurmi JE
The present study followed 156 Finnish children (Mage = 7.25 years) during the first grade of primary school to examine to what extent parent- and teacher-rated temperament impacts children’s math and reading skill development during the first grade, and the extent to which this impact would be mediated by teachers’ interaction styles with the children. The results showed that the impact of children’s low task orientation and negative emotionality on their math skill development was mediated via teachers’ behavioral control and, among girls, also by psychological control. The negative impact of children’s inhibition on math skill development, in turn, was not mediated via teachers’ interaction styles. Temperament did not predict the children’s reading skill development during first grade.
PMID: 26011028 [PubMed - as supplied by publisher]
Attention to Faces Expressing Negative Emotion at 7 Months Predicts Attachment Security at 14 Months.
Child Dev. 2015 May 22;
Authors: Peltola MJ, Forssman L, Puura K, van IJzendoorn MH, Leppänen JM
To investigate potential infant-related antecedents characterizing later attachment security, this study tested whether attention to facial expressions, assessed with an eye-tracking paradigm at 7 months of age (N = 73), predicted infant-mother attachment in the Strange Situation Procedure at 14 months. Attention to fearful faces at 7 months predicted attachment security, with a smaller attentional bias to fearful expressions associated with insecure attachment. Attachment disorganization in particular was linked to an absence of the age-typical attentional bias to fear. These data provide the first evidence linking infants’ attentional bias to negative facial expressions with attachment formation and suggest reduced sensitivity to facial expressions of negative emotion as a testable trait that could link attachment disorganization with later behavioral outcomes.
PMID: 26011101 [PubMed - as supplied by publisher]
Geriatric Syndromes in Older HIV-Infected Adults.
J Acquir Immune Defic Syndr. 2015 Jun 1;69(2):161-167
Authors: Greene M, Covinsky KE, Valcour V, Miao Y, Madamba J, Lampiris H, Cenzer IS, Martin J, Deeks SG
BACKGROUND: Geriatric syndromes such as falls, frailty, and functional impairment are multifactorial conditions used to identify vulnerable older adults. Limited data exist on these conditions in older HIV-infected adults, and no studies have comprehensively examined these conditions.
METHODS: Geriatric syndromes including falls, urinary incontinence, functional impairment, frailty, sensory impairment, depression, and cognitive impairment were measured in a cross-sectional study of HIV-infected adults aged 50 years and older who had an undetectable viral load on antiretroviral therapy. We examined both HIV and non-HIV-related predictors of geriatric syndromes including sociodemographics, number of comorbidities and nonantiretroviral medications, and HIV-specific variables in multivariate analyses.
RESULTS: We studied 155 participants with a median age of 57 (interquartile range: 54-62) and 94% were men. Prefrailty (56%), difficulty with instrumental activities of daily living (46%), and cognitive impairment (47%) were the most frequent geriatric syndromes. Lower CD4 nadir incidence rate ratio [IRR: 1.16, 95% (confidence interval) CI: 1.06 to 1.26], non-white race (IRR: 1.38, 95% CI: 1.10 to 1.74), and increasing number of comorbidities (IRR: 1.09, 95% CI: 1.03 to 1.15) were associated with increased risk of having more geriatric syndromes.
CONCLUSIONS: Geriatric syndromes are common in older HIV-infected adults. Treatment of comorbidities and early initiation of antiretroviral therapy may help to prevent development of these age-related complications. Clinical care of older HIV-infected adults should consider incorporation of geriatric principles.
PMID: 26009828 [PubMed - as supplied by publisher]
Reductions in Plasma Cystatin C After Initiation of Antiretroviral Therapy Are Associated With Reductions in Inflammation: ACTG A5224s.
J Acquir Immune Defic Syndr. 2015 Jun 1;69(2):168-177
Authors: Longenecker CT, Kitch D, Sax PE, Daar ES, Tierney C, Gupta SK, McComsey GA, AIDS Clinical Trials Group Study A5224s Team
BACKGROUND: Among patients with HIV infection, changes in the kidney filtration marker cystatin C after initiation of antiretroviral therapy (ART) may be related to changes in body composition or biomarkers of inflammation.
METHODS: ACTG A5224s was a substudy of A5202, which randomly assigned ART-naive HIV-infected subjects to blinded abacavir/lamivudine (ABC/3TC) or tenofovir/emtricitabine (TDF/FTC) with open-label efavirenz (EFV) or ritonavir-boosted atazanavir. This analysis explored changes in cystatin C from 0 to 96 weeks.
RESULTS: Of the 269 subjects, 85% were male and 66% white non-Hispanics; baseline mean CD4 count was 236 cells per cubic millimeter and cystatin C was 0.89 mg/L. Cystatin C decreased significantly within each arm; however, ritonavir-boosted atazanavir attenuated the beneficial effects of ART on cystatin C compared to EFV. Compared to ABC/3TC, TDF/FTC led to a marginally significant attenuation for percent change analyses only. Higher baseline body mass index and HIV RNA were associated with larger reductions in cystatin C in multivariable models. At baseline, cystatin C was positively correlated with high-sensitivity C-reactive protein (Spearman r = 0.25), interleukin 6 (r = 0.34), soluble intercellular adhesion molecule (r = 0.36), soluble vascular cell adhesion molecule (r = 0.54), tumor necrosis factor α (r = 0.57), and soluble TNF-α receptor I (r = 0.70, all P < 0.001). Reductions in cystatin C from 0 to 96 weeks correlated with reductions in all inflammatory biomarkers (r = 0.39-0.58, P < 0.001) except for high-sensitivity C-reactive protein (r = 0.01, P = 0.89) and IL-6 (r = 0.08, P = 0.24).
CONCLUSIONS: The beneficial effect of ART on cystatin C concentrations is attenuated by boosted ATV when compared to EFV. Reductions in cystatin C after ART are associated with reductions in systemic inflammation.
PMID: 26009829 [PubMed - as supplied by publisher]
Meconium Atazanavir Concentrations and Early Language Outcomes in HIV-Exposed Uninfected Infants With Prenatal Atazanavir Exposure.
J Acquir Immune Defic Syndr. 2015 Jun 1;69(2):178-186
Authors: Himes SK, Huo Y, Siberry GK, Williams PL, Rice ML, Sirois PA, Frederick T, Hazra R, Huestis MA, Pediatric HIVAIDS Cohort Study (PHACS)
OBJECTIVE: To investigate whether prenatal atazanavir (ATV) exposure, assessed by meconium antiretroviral (ARV) quantification, predicts early child language outcomes. Prenatal ATV exposure previously was associated with poorer language development in 1-year olds.
METHODS: Pregnant women with HIV and their uninfected infants enrolled in the Surveillance Monitoring of Antiretroviral Therapy Toxicities study. Meconium ARV concentrations were quantified by liquid chromatography-tandem mass spectrometry. Language development at 1 year was assessed with MacArthur-Bates Communicative Development Inventory (CDI) and Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III). Late language emergence was defined as ≥1 of 4 CDI scores ≤10th percentile for age. Associations between fetal ATV exposure timing and duration, meconium ATV concentration, and language outcomes were evaluated, adjusting for potential confounders.
RESULTS: Through 2013, meconium samples were available from 175 of 432 infants with prenatal ATV exposure. Valid Bayley-III (n = 93) and CDI (n = 106) assessments also were available. After adjustment for potential confounders, higher ATV meconium concentrations were associated with lower late language emergence risk (P = 0.04) and cumulative ATV exposure duration also was associated with higher Bayley-III Language scores (P = 0.03). Maternal ATV duration and initiation week correlated with ATV meconium concentrations (positively and negatively, respectively).
CONCLUSIONS: Higher meconium ATV concentrations were protective against developmental language delays at 1 year, suggesting the importance of fetal ATV detoxification into meconium. This information supports ATV exposure safety for infant language development. ATV is a preferred ARV for pregnant women with HIV, suggesting the importance of ATV safety investigations. Additionally, further pursuit of the influences on language development in HIV-exposed uninfected infants is required.
PMID: 26009830 [PubMed - as supplied by publisher]