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Parissis J.T.,National and Kapodistrian University of Athens | Rafouli-Stergiou P.,National and Kapodistrian University of Athens | Mebazaa A.,University Paris Diderot | Ikonomidis I.,National and Kapodistrian University of Athens | And 8 more authors.
International Journal of Cardiology | Year: 2012

Objective/methods: ALARM-HF was an in-hospital observational survey that included 4953 patients admitted for acute heart failure (AHF) in six European countries, Mexico and Australia. This article is a secondary analysis of the survey which evaluates differences in clinical phenotype, treatment regimens and in-hospital outcomes in AHF patients with diabetes mellitus (DM) compared to non-diabetics. The data were collected retrospectively by the investigators, and the diagnosis of AHF (reported at discharge) was based on the definition and classification of ESC guidelines, while the diagnosis of DM was based on medical record (past medical and medication history). Results: This sub-analysis demonstrates substantial differences regarding both baseline features and in-hospital outcome among diabetic and non-diabetic AHF patients. Diabetic patients (n = 2229, 45%) presented more frequently with acute pulmonary edema (p < 0.001) than non-diabetics, had more often acute coronary syndrome (p < 0.001) as precipitating factors of AHF, and multiple comorbidities such as renal dysfunction (p < 0.001), arterial hypertension (p < 0.001), anemia (p < 0.001) and peripheral vascular disease (p < 0.001). All-cause in-hospital mortality of diabetics was higher compared to non-diabetics (11.7% vs 9.8%, p = 0.01). The multivariate analysis revealed that older age (p = 0.032), systolic blood pressure < 100 mm Hg (p < 0.001), acute coronary syndrome and non compliance as precipitating factors (p = 0.05 and p = 0.005, respectively), history of arterial hypertension (p = 0.022), LVEF < 50% (p < 0.001), serum creatinine > 1.5 mg/dl (p = 0.029), absence of life saving therapies such as ACE inhibitors/ARBs (p < 0.001) and beta-blockers (p = 0.014) at admission, as well as absence of interventional treatment by PCI (p < 0.001), were independently associated with adverse in-hospital outcome. Conclusion: Diabetics with AHF have higher in-hospital mortality than non-diabetics despite their intensive treatment regimens (regarding care for HF and ACS), possibly due to underlying ischemic heart disease and the presence of multiple comorbidities. © 2011 Elsevier Ireland Ltd. All rights reserved.

Parissis J.T.,National and Kapodistrian University of Athens | Nikolaou M.,National and Kapodistrian University of Athens | Mebazaa A.,University Paris Diderot | Ikonomidis I.,National and Kapodistrian University of Athens | And 6 more authors.
European Journal of Heart Failure | Year: 2010

AimsAcute pulmonary oedema (APE) is the second, after acutely decompensated chronic heart failure (ADHF), most frequent form of acute heart failure (AHF). This subanalysis examines the clinical profile, prognostic factors, and management of APE patients (n = 1820, 36.7) included in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). Methods and resultsALARM-HF included a total of 4953 patients hospitalized for AHF in Europe, Latin America, and Australia. The final diagnosis was made at discharge, and patients were classified according to European Society of Cardiology guidelines. Patients with APE had higher in-hospital mortality (7.4 vs. 6.0, P = 0.057) compared with ADHF patients (n = 1911, 38.5), and APE patients exhibited higher systolic blood pressures (P < 0.001) at admission and higher left ventricular ejection fraction (LVEF, P < 0.01) than those with ADHF. These patients also had a higher prevalence of diabetes (P < 0.01), arterial hypertension (P < 0.001), peripheral vascular disease (P < 0.001), and chronic renal disease (P < 0.05). They were also more likely to receive intravenous (i.v.) diuretics (P < 0.001), i.v. nitrates (P < 0.01), dopamine (P < 0.05), and non-invasive ventilation (P < 0.001). Low systolic blood pressure (P < 0.001), low LVEF (<0.05), serum creatinine ≥1.4 mg/dL (P < 0.001), history of cardiomyopathy (P < 0.05), and previous cardiovascular event (P < 0.001) were independently associated with increased in-hospital mortality in the APE population. ConclusionAPE differs in clinical profile, in-hospital management, and mortality compared with ADHF. Admission characteristics (systolic blood pressure and LVEF), renal function, and history may identify high-risk APE patients. © 2010 The Author.

Parissis J.T.,National and Kapodistrian University of Athens | Mantziari L.,University Hospital | Kaldoglou N.,National and Kapodistrian University of Athens | Ikonomidis I.,National and Kapodistrian University of Athens | And 8 more authors.
International Journal of Cardiology | Year: 2013

Aim and methods: Gender-related differences in clinical phenotype, in-hospital management and prognosis of acute heart failure (AHF) patients have been previously reported in European and US registries. The ALARM-HF survey is the first to include a cohort of 4953 patients hospitalized for AHF in 666 hospitals in 6 European countries, Mexico and Australia. Results: Women accounted for 37% of the study population, were older and had higher rates of de novo heart failure (45% vs 36%, p < 0.001) than men. An acute coronary syndrome (ACS) was the predominant precipitating factor in both genders, but to a lesser extent in females (30% vs 42%, p < 0.001). Between genders comparison showed higher incidence of atrial fibrillation, valvular heart disease, diabetes, obesity, anemia and depression in women (p < 0.05). Similarly, women had higher left ventricular ejection fraction (LVEF) on admission (42 ± 15% vs 36 ± 13%, p < 0.001) and systolic blood pressure (135 ± 40 mm Hg vs 131 ± 39 mm Hg, p = 0.001) than men. On the other hand, men had more often coronary artery disease, renal failure and chronic obstructive pulmonary disease (p < 0.05). Importantly, in-hospital mortality was similar in both genders (11.1% in females vs 10.5% in males, p = 0.475), and its common predictors were: systolic blood pressure at admission, creatinine > 1.5 mg/dL and diabetes. Furthermore, recent ACS, valvular heart disease and dementia contributed to prognosis in women, while LVEF, hypertension and anemia were independent predictors in men. Conclusion: Among patients with AHF, there are significant differences in co-morbidities, precipitating factors and predictors of in-hospital mortality between genders. Nevertheless, in-hospital mortality remains similar between genders. © 2012 Elsevier Ireland Ltd. All rights reserved.

Follath F.,University of Zurich | Yilmaz M.B.,Cumhuriyet University | Yilmaz M.B.,French Institute of Health and Medical Research | Delgado J.F.,Heart Failure and Transplant Unit | And 8 more authors.
Intensive Care Medicine | Year: 2011

Purpose: We performed a survey on acute heart failure (AHF) in nine countries in four continents. We aimed to describe characteristics and management of AHF among various countries, to compare patients with de novo AHF versus patients with a pre-existing episode of AHF, and to describe subpopulations hospitalized in intensive care unit (ICU) versus cardiac care unit (CCU) versus ward. Methods and results: Data from 4,953 patients with AHF were collected via questionnaire from 666 hospitals. Clinical presentation included decompensated congestive HF (38.6%), pulmonary oedema (36.7%) and cardiogenic shock (11.7%). Patients with de novo episode of AHF (36.2%) were younger, had less comorbidities and lower blood pressure despite greater left ventricular ejection fraction (LVEF) and were more often admitted to ICU. Overall, intravenous (IV) diuretics were given in 89.7%, vasodilators in 41.1%, and inotropic agents (dobutamine, dopamine, adrenaline, noradrenaline and levosimendan) in 39% of cases. Overall hospital death rate was 12%, the majority due to cardiogenic shock (43%). More patients with de novo AHF (14.2%) than patients with a pre-existing episode of AHF (10.8%) (p = 0.0007) died. There was graded mortality in ICU, CCU and ward patients with mortality in ICU patients being the highest (17.8%) (p < 0.0001). Conclusions: Our data demonstrated the existence of different subgroups based on de novo or pre-existing episode(s) of AHF and the site of hospitalization. Recognition of these subgroups might improve management and outcome by defining specific therapeutic requirements. © 2010 Copyright jointly held by Springer and ESICM.

Salamonsen R.F.,Monash University | Pellegrino V.,Alfred Hospital | Fraser J.F.,University of Queensland | Hayes K.,Alfred Health | And 4 more authors.
Artificial Organs | Year: 2013

This multicenter study examines in detail the spontaneous increase in pump flow at fixed speed that occurs in exercise. Eight patients implanted with the VentrAssist rotary blood pump were subjected to maximal and submaximal cycle ergometry studies, the latter being completed with patients supine and monitored with right heart catheter and echocardiography. Maximal exercise studies conducted in each patient at three different pump speeds on separate days established initially the magnitude and consistency of increases in pump flow that correlated well with changes in heart rate. However, there was considerable variation, coefficients of variation for mean heart rate and pump flow being 47.9 and 49.3%, respectively. Secondly, these studies indicated that increasing pump flows caused significant improvements in maximal exercise capacity. An increase of 2.1L/min (35%) in maximum blood flow caused 12W (16%) further increase in achievable work, 1.26 (9.3%) mL/kg/min in maximal oxygen uptake, and 2.3 (23%) mL/kg/min in anaerobic threshold. Mean increases in lactate were 0.85mm (24%), but mean B-type natiuretic peptide fell by 126mm, (-78%). From submaximal supine exercise studies, multiple linear regression of pump flow on factors thought to underlie the spontaneous increase in pump flow indicated that it was associated with increases in heart rate (P=0.039), pressure gradient across the left ventricle (P=0.032), and right atrial pressure (P=0.003). These changes have implications for the recently reported Starling-like controller for pump flow based on pump pulsatility values, which emulates the Starling curve relating pump output to left ventricular preload. Unmodified, the controller would not permit the full benefits of this effect to be afforded to patients implanted with rotary blood pumps. A modification to the pump control algorithm is proposed to eliminate this problem. © 2013 Wiley Periodicals, Inc. and International Center for Artificial Organs and Transplantation.

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