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PubMed | Heart Failure Center and Chang Gung University
Type: Journal Article | Journal: Acta Cardiologica Sinica | Year: 2016

Heart failure (HF) readmission results in substantial expenditure on HF management. This study aimed to evaluate the readmission rate, outcome, and predictors of HF readmission.Patients with reduced left ventricular ejection fraction (LVEF < 40%) who were admitted for acute decompensation of de novo HF were enrolled to analyze readmission rate, mortality and predictors of readmission.A total of 433 de novo HF patients with LVEF < 40% were enrolled during the period August 2013 to December 2014. The in-hospital and 6-month mortality rates were 3.9% and 15.2%, respectively. In those patients surviving the index HF hospitalization, the 30-day and 6-month readmission rates were 10.9% and 27%, respectively. At the end of the 6-month follow-up, the readmission group had higher mortality than the non-readmission group (27.66% vs. 10.36%; p = 0.001). The survivors of the 30-day readmission had similar mortality rates at 6 months, regardless of the cause of readmission (cardiovascular vs. non-cardiovascular: 25% vs. 30.43%, p = 0.677). Among all the parameters, prescription of beta blockers independently reduced the risk of 30-day readmission (odds ratio 0.15; 95% confidence interval 0.02-0.99; p = 0.049).Those HF patients who suffered from 30-day readmission had worse prognosis at the 6-month follow-up. Regardless of the readmission causes, the patients surviving the 30-day readmission had similar mortality rates at 6-month follow-up. These results underscored the importance of reducing readmission as a means to improve HF outcome.


Amir O.,Technion - Israel Institute of Technology | Amir O.,Heart Failure Center | Smith Y.,Hebrew University of Jerusalem | Zafrir B.,Technion - Israel Institute of Technology | And 4 more authors.
Journal of Cardiac Failure | Year: 2012

Objective: The Del322-325 polymorphism of the α2c- adrenoceptor is considered to be a possible risk factor for heart failure (HF). We investigated the possible clinical association between the presence or absence of the deletion allele and mortality. Methods and Results: Of 261 chronic systolic HF patients evaluated, 216 (83%) carried no α2c-adrenoceptor Del322-325 alleles (designated II); 28 patients (11%) were heterozygous (ID) and 17 patients (6%) homozygous (DD) for the deletion. Similar genetic distribution of α2c-adrenoceptor Del322-325 subgroups was found in a control group of 96 healthy individuals. Mortality was significantly higher in HF patients in whom the deletion allele was absent than in HF patients who carried it: 67 (31%) patients in the II subgroup died compared with 7 (15.5%) in the ID/DD subgroup (P =.01). The odds ratio for death in HF patients who carried no α2c-adrenoceptor Del322-325 alleles compared with HF patients with ≥1 allele was 2.45 (95% confidence interval 1.045.74). There were no differences in other relevant clinical parameters between the 2 subgroups of HF patients. Conclusions: The mortality rate of chronic systolic HF patients carrying no α2c- adrenoceptor Del322-325 alleles was significantly higher (almost 2.5-fold) than that of HF patients carrying ≥1 allele. © 2012 Elsevier Inc. All rights reserved.


Amir O.,Heart Failure Center | Amir O.,Technion - Israel Institute of Technology | Rogowski O.,Tel Aviv Sourasky Medical Center | David M.,Carmel Medical Center | And 4 more authors.
Israel Medical Association Journal | Year: 2010

Background: Interleukin-10 is an anti-inflammatory cytokine and consequently is considered by many to have a protective role in heart failure, as opposed to the notorious tumor nec-rosis factor-alpha. Objectives: To test the hypothesis of the possible beneficial impact of IL-10 on mortality in systolic heart failure patients in relation to their circulating TNFα levels. Methods: We measured circulating levels of IL-10 and TNFα in 67 ambulatory systolic heart failure patients (age 65 ± 13 years). Results: Mortality was or tended to be higher in patients with higher levels (above median level) of circulating TNFα (9/23, 39% vs. 6/44, 14%; P = 0.02) or IL-10 (10/34, 30% vs. 5/33, 15%; P = 0.10). However, mortality was highest in the subset of patients with elevation of both markers above median (7/16, 44% vs. 8/51, 16%; P = 0.019). Elevation of both markers was associated with more than a threefold hazard ratio for mortality (HR 3.67, 95% confidence interval 1.14-11.78). Conclusions: Elevated circulating IL-10 levels in systolic heart failure patients do not have a protective counterbalance effect on mortality. Moreover, patients with elevated IL-10 and TNFα had significantly higher mortality, suggesting that the possible interaction in the complex inflammatory and anti-inflammatory network may need further study.


Amir O.,Heart Failure Center | Barak-Shinar D.,WideMed Ltd. | Wolff R.,Heart Failure Center | Smart F.W.,Morristown Memorial Hospital | Lewis B.S.,Heart Failure Center
Cardiovascular Engineering and Technology | Year: 2010

Cheyne-Stokes breathing (CSB) has been associated with advanced heart failure for two centuries. However, the current conventional method of CSB detection is via a full-night polysomnographic test which is a complex, expensive and inconvenient for the patients. Accordingly, the purpose of the current study was to assess a more practical method for CSB detection in heart failure (HF) patients and investigate its prognostic applications. We describe here risk stratification for mortality and morbidity over 6 months of follow-up by using standard pulse oximeter analyzed with an innovative automated program for CSB detection. A total of 109 consecutive HF out-patients, 93 men and 16 women underwent a full-night sleep studies performed at home, using a standard pulse oximeter for detection of CSB during sleep. Data was analyzed by an innovative algorithm-based system. Of the 109 patients, our analysis identified 46 (42%) patients with episodes of CSB. Within the 6-month follow-up period, 8 (17.4%) of these patients died or were urgently transplanted, and 14 (30.4%) were hospitalized for HF. Multiple regression testing with several known prognostic parameters, showed that CSB was the most significant predictor of mortality or heart failure hospitalizations (p < 0.001). Heart failure patients with CSB have increased mortality and morbidity over the next 6 months. The detection of CSB is feasible via a simple and reliable method using a standard pulse oximeter, which may be more suitable for sick HF patients than the complex and inconvenient full-night polysomnography. © 2010 Biomedical Engineering Society.


Amir O.,Heart Failure Center | Barak-Shinar D.,WideMed Ltd. | Wolff R.,Heart Failure Center | Paz H.,Heart Failure Center | And 3 more authors.
Sleep and Breathing | Year: 2011

Purpose: Cheyne-Stokes respiration (CSR) is a known controversial prognostic marker in patients with heart failure (HF). Little is known, moreover, about the development and progress of CSR in such patients. The CSR progress over time may be indicative for clinical deterioration in patients with HF disease Methods: Prospective cohort sleep studies, with algorithm-based analyses of continuously or periodically monitored changes over time using standard pulse oximeter. Home testing for 4 months of patients recruited from the cardiology department of a large community medical center in Haifa, Israel. A total of 36 patients, 31 men and five women, aged between 50 and 74 years, with symptomatic chronic HF. Results: Out of the 36 patients, 15 (42%) patients were found to have CSR. The CSR cycle length was chosen as the characteristic parameter which determines the periodicity of the event and its length. Analyses of CSR cycle length and duration in the 15 patients showed changes over time in the length of the CSR event only in patient with New York Heart Association (NYHA) 4 classification. Conclusions: Nocturnal CSR in patients with HF show small variations over time in the prevalence or duration of the cycle length and could be a marker for entering stage 4 or deterioration in the NYHA class of HF patient. Moreover, it may take years for HF patients to develop CSR or to increase the length of the cycle length of existing CSR, if they develop it at all. © Springer-Verlag 2010.


Zafrir B.,Technion - Israel Institute of Technology | Paz H.,Heart Failure Center | Wolff R.,Technion - Israel Institute of Technology | Wolff R.,Heart Failure Center | And 7 more authors.
European Journal of Internal Medicine | Year: 2011

Background: There are conflicting reports regarding the characteristics and mortality rates of heart failure patients with preserved (HFPSF) vs. reduced systolic left ventricular function (SHF). Methods: We evaluated the clinical profiles, mortality rates and modes of death in 481 consecutive symptomatic heart failure patients. In 317(66%) patients LVEF was < 40% (SHF), and in 164(34%) LVEF ≥ 40% (HFPSF). Results: Compared to the HFPSF group, SHF patients were predominantly younger males with ischemic etiology and less cardiovascular comorbidities such as obesity, hypertension, diabetes mellitus and atrial fibrillation. Over a mean follow-up period of 2 years, 148(31%) patients died. Overall mortality was similar between the two groups: 53(32%) HFPSF patients and 95(30%) SHF patients died (p = 0.6), even after adjusting for baseline variables, including age, gender and comorbidities (hazard ratio 1.09; 95% confidence interval 0.74-1.61; p = 0.67). In contrast to the similar mortality rates, the modes of death were different. SHF patients had higher death rates due to pump failure compared to the HFPSF group {32/95(34%) vs. 9/53(17%) patients, p = 0.03}. A trend towards higher rate of non-cardiac death was observed in HFPSF group {33/53(62%) patients vs. 45/95(47%) patients, respectively, p = 0.08}. The prevalence of arrhythmic death was similar in both groups {17/95(18%) vs. 10/53(19%) patients, p = 0.9}. Conclusions: Although the characteristics of HFPSF and SHF patients are distinctively different, the mortality rates are similar. The mode of death is different among the two groups of patients, as pump failure death is significantly higher in SHF patients, while non-cardiac mortality is more prevalent in HFPSF patients. © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.


Goren Y.,Rosetta Genomics | Meiri E.,Rosetta Genomics | Hogan C.,Rosetta Genomics | Mitchell H.,Rosetta Genomics | And 5 more authors.
American Journal of Cardiology | Year: 2014

Atrial fibrillation (AF) is associated with poor prognosis in patients with heart failure (HF). Although platelets play an important role in rendering a prothrombotic state in AF, the exact mechanism by which the effect is mediated is still debated. MicroRNAs (miRNAs), which have been shown to be involved in a variety of cardiovascular conditions, are abundant in platelets and in a cell-free form in the circulation. In the present study, we performed a genome-wide screen for miRNA expression in platelets of patients with systolic HF and in controls without cardiac disease, in pursuit of specific miRNAs that are associated with the presence of AF. MiRNA expression was measured in platelets from 50 patients with systolic HF and 50 controls, of which, samples from 41 patients with HF and 35 controls were used in the final analysis because of a quality control process. MiR-150 expression was 3.2-fold lower (p = 0.0003) in platelets of patients with HF with AF relative to those without AF. A similar effect was seen in serum samples from the same patients, in which miR-150 levels were 1.5-fold lower (p = 0.004) in patients with HF with AF. Furthermore, the serum levels of miR-150 were correlated to platelet levels in patients with AF (r = 0.65, p = 0.0087). In conclusion, miR-150 expression levels in platelets of patients with systolic HF with AF are significantly reduced and correlated to the cell-free circulating levels of this miRNA. © 2014 Elsevier Inc. All rights reserved.


Zafrir B.,Technion - Israel Institute of Technology | Zafrir B.,Heart Failure Center
Journal of Cardiopulmonary Rehabilitation and Prevention | Year: 2013

Pulmonary arterial hypertension (PAH) is characterized by reduced functional capacity and health-related quality of life. Despite the progress made in recent years in disease-targeted therapies with improvement in prognosis, PAH patients often experience progressive exercise intolerance. Exercise rehabilitation is beneficial and has become a standard of care in patients with systolic heart failure and chronic obstructive pulmonary disease. However, although PAH patients present with similar exertional limitation and often share common hemodynamic, ventilatory, and skeletal muscle derangements, exercise rehabilitation was discouraged in PAH patients because of concerns of clinical deterioration and adverse outcomes. In recent years, several small-scale studies have demonstrated that closely supervised and monitored exercise training programs may have potential benefits in the management of stable PAH patients, improving exercise capacity and quality of life, with an acceptable low risk of adverse events in the studied populations. This review describes the emerging clinical data supporting the efficacy and safety of exercise training in PAH patients. The review provides a perspective on the pathophysiological impairments contributing to exercise intolerance in these patients and critically project from the proven evidence-based benefits of cardiopulmonary rehabilitation in chronic heart failure and chronic obstructive pulmonary disease on the PAH population. © 2013 Wolters Kluwer Health Lippincott Williams and Wilkins.


Rogowski O.,Tel Aviv University | Shnizer S.,Carmel Diagnostics Ltd. formerly Lumitest | Wolff R.,Heart Failure Center | Lewis B.S.,Heart Failure Center | And 3 more authors.
Cardiology | Year: 2011

Objectives: Inflammation and serum oxidative stress (OS) are important components in heart failure (HF) deterioration. In this study we tested the hypothesis that an increase in patients' sera OS levels is associated with acute HF (AHF) readmissions. Methods: Thirty consecutive patients (mean age 71 ± 10 years) admitted with AHF were included in the study. Serum OS in these patients was measured in-hospital and repeatedly after discharge over a period of 8 weeks of follow-up in which we reordered patients' HF readmissions. Of the 30 patients, 13 (43%) were readmitted (RAD group) and 17 (57%) did not require readmission (NRAD group). Results: OS levels before discharge from the first hospital admission in the 2 groups were similar (p = 0.84 and p = 0.56, respectively). However, using repeated measures ANOVA, we found that the interaction between the time points and the 2 groups of patients (RAD and NRAD) was statistically significant (p = 0.037). It is important to note that OS serum levels were more predictive of HF readmissions than were repeated simultaneous serum measurements of NT-proBNP (p = 0.97). Conclusions: Increased OS levels in AHF patients, after they have been discharged from the hospital, are associated with higher HF readmission rates. In AHF, OS is a dynamic parameter associated with HF deterioration. Copyright © 2011 S. Karger AG, Basel.


Zafrir B.,Lady Davis Carmel Medical Center | Zafrir B.,Heart Failure Center | Adir Y.,Pulmonary Institute | Shehadeh W.,Technion - Israel Institute of Technology | And 5 more authors.
Respiratory Medicine | Year: 2013

Background: The term "obesity paradox", refers to lower mortality rates in obese patients, and is evident in various chronic cardiovascular disorders. There is however, only scarce data regarding the clinical implication of obesity and pulmonary hypertension (PH). Therefore, in the current study, we evaluated the possible prognostic implications of obesity in PH patients. Methods: We assessed 105 consecutive PH patients for clinical and hemodynamic parameters, focusing on the possible association between Body Mass Index (BMI) and mortality. Follow-up period was 19 ± 13 months. Results: Sixty-one patients (58%) had pre-capillary PH and 39 patients (37%) out-of-proportion post-capillary PH. During follow-up period, 30 patients (29%) died. Death was associated with reduced functional-class, inverse-relation with BMI, higher pulmonary artery and right atrial pressures, pulmonary vascular resistance and signs of right ventricular failure. In multivariate analysis, obesity (BMI ≥ 30 kg/m), was the variable most significantly correlated with improved survival [H.R 0.2, 95% C.I 0.1-0.6; p = 0.004], even after adjustment for baseline characteristics. Obese and very-obese (BMI ≥ 35 kg/m) patients had significantly less mortality rates during follow-up (12% and 8%, respectively) than non-obese patients (41%), p = 0.01. The tendency of survival benefit for the obese vs. non-obese patients was maintained both in the pre-capillary (10% vs. 46% mortality, p = 0.008) and disproportional post-capillary PH patients (11% vs. 40% mortality, p = 0.04). Conclusions: Obesity was significantly associated with lower mortality in both pre-capillary and disproportional post-capillary PH patients. It seems that in PH, similarly to other chronic clinical cardiovascular disease states, there may be a protective effect of obesity, compatible with the "obesity paradox". © 2012 Published by Elsevier Ltd.

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