1412Effect of beta-blocker dose on the prognosis in chronic heart failure patients depending on the presence of atrial fibrillation. Data from FAR NHL (FARmacology and NeuroHumoraL activation) registry

Abstract Background Beta-blockers (BB) decrease morbidity and mortality in heart failure patients and are part of the first line treatment together with inhibitors of angiotensin converting enzyme. New metaanalysis from year 2014 of main BB studies in chronic heart failure showed no benefit of BB in patients with atrial fibrillation (AF). Methods 1088 at least one month stable chronic heart failure patients with ejection fraction &lt;50% were included in FAR NHL (FARmacology and NeuroHumoraL activation) registry. Three centers with speciality in heart failure in the Czech Republic were participating from November 2014 to December 2015. Results 80% patients were male with median age 66 years. Aetiology of heart failure was in 49.4% ischemic heart disease, in 42.3% dilated cardiomyopathy, in 0.5% hypertrophy cardiomyopathy. From those receiving beta-blockers 20% received low dose similar to the starting dose, 57% medium dose and 17% high dose which was set as the target BB dose. Nearly 93.8% of patients received BB. But only 17.0% received the high dose of BB. 6.2% of patients were not treated by BB at all. One third of patients (34.5%) had atrial fibrillation in medical history or newly recorded on electrocardiogram. Patients with AF were much older (median 63 vs. 70 years, respectively; p&lt;0.001), had higher heart rate (72 vs. 74 /min; p&lt;0.006) and were also in higher class of NYHA (New York Heart Association; p=0.005). The primary endpoint was set as all cause death, mechanical circulatory support implantation, orthotopic heart transplantation or hospitalization for acute heart failure. Patients with AF survived without primary endpoint in 70.6%, patients without AF in 78.8% (p=0.005) even after age standardization. There was significantly different survival according to dose of beta-blocker, the higher was dose of BB, the higher was survival. Patients with no beta-blocker survived without primary endpoint in 63.9%, with low dose survived in 72.6%, medium dose in 77.0% and with high dose in 80.9%. We devided FAR NHL patients into two groups according to atrial fibrillation. Patients without AF had the better survival without primary endpoint. The higher dose of beta-blockers they got, the better survival they had (69.5%, 76.7%, 78.9%, 85.1%; p=0.007). Also patients with AF had better survival without primary endpoint, the higher dose of beta-blocker they got, the higher was their survival without endpoitnt (56.0%, 63.6%, 73.0%, 75.8%; p=0.007). Conclusion In FAR NHL registry of stable chronic heart failure patietnts was one third of patients with atrial fibrillation. Nearly 94% of patients received beta-blocker. But only 17% received the target dose. Pacients even with or without atrial fibrillation had the significantly better survival without primary endpoint the higher was the dose of beta-blocker. </jats:sec

P3542Natriuretic peptides added to clinical parameters predict two-year prognosis of patients with chronic heart with mid-range and reduced ejection fraction

Abstract Background The guidelines recommend to determine natriuretic peptides, clinical status (NYHA classification) and comorbidities in order to predict the prognosis in patients with heart failure. The aim ofthis registry was to develop a prognostic score in chronic heart failure patients, using clinical status, comorbidities and natriuretic peptides. Methods Consecutive 1088 patients with stable chronic heart failure with reduced ejection fraction (HFrEF) (LVEF&lt;40%) and mid-range EF (HFmrEF) (LVEF 40–49%) were enrolled. Two-year all-cause mortality, heart transplantation and/or LVAD implantation were defined as the primary endpoint (MACE). Results The occurrence of MACE was 14.9% and increased with higher NYHA, 4.9% (NYHA I), 11.4% (NYHA II) and 27.8% (NYHA III-IV) (p&lt;0.001). The occurrence of MACE was 3%, 10% and 15–37% in patients with NT-proBNP levels ≤125pg/ml, 126–1000pg/ml and &gt;1000pg/ml respectively. Discrimination abilities of NYHA and NT-proBNP were (AUC 0.670; p&lt;0.001 and AUC 0.722; p&lt;0.001). The predictive value of the developed clinical model, which took account of older age, advanced heart failure (NYHA III+IV), anaemia, hyponatraemia, hyperuricaemia and taking a higher dose of loop diuretics (&gt;40 mg furosemide daily) (AUC 0.773; p&lt;0.001) was increased by adding the NT-proBNP level (AUC 0.790). Conclusion Natriuretic peptides, clinical status and comorbiditis predict two year prognosis and they can help to a better identification of a high-risk groups of patients with heart failure with reduced and mid range ejection fraction in which more intense treatment should be considered, mainly LVAD implantation or listing to heart transplantation waiting list. Acknowledgement/Funding None </jats:sec

Prediction of serum NGAL levels using comorbidity AHEAD score and two-year prognosis in stable chronic heart failure patients (FAR NHL registry)

Abstract Background Neutrophil gelatinase-associated lipocalin (NGAL) is marker of renal function and is strongly associated with presence of comorbidities. AHEAD comorbidity score is commonly used to predict survival in acute heart failure patients and could predict events even in chronic heart failure. Methods 547 stable patients with chronic heart failure patients with left ventricular ejection fraction &amp;lt;50% were included in FARmacology and NeuroHumoraL activation (FAR NHL) registry. Three cardiological centres from The Czech Republic with speciality in heart failure were participating. Results Median age was 66 years, 80.3% were men. The etiology of heart failure was in 54% ischemic heart disease, in 40% dilatated cardiomyopathy, in 0.5% hypertrophic cardiomyopathy. 60% of patients were in NYHA class II. In the first two years of follow-up, 74 events (13.5%) occurred, including all-cause death, left ventricle assist device implantation or orthotopic heart transplantation. The AHEAD comorbidity score (Atrial fibrillation, low Haemoglobin level &amp;lt;120 g/L in female or &amp;lt;130 g/L in male, Elderly &amp;gt;70 years; Abnormal renal parameters with creatinine &amp;gt;130 μmol/L, Diabetes mellitus; 1 point for each comorbidity present) was set in this registry. Patients with AHEAD 0–1 survived without event in 89.2%, AHEAD 2–3 in 82.4% and AHEAD 4–5 only in 63.5% (p&amp;lt;0.001; pairwise comparison 0.034, &amp;lt;0.001, 0.021). Also levels of NGAL are higher when comorbidities from AHEAD score are present: Atrial fibrillation (62 vs. 50 ng/mL; p&amp;lt;0.001), Haemoglobin level (Spearman's rank correlation coefficient −0.240; p&amp;lt;0.001), Eldery (Spearman's coefficient 0.425; p&amp;lt;0.001), Abnormal creatinine level (Spearman's coefficient 0.528; p&amp;lt;0.001), Diabetes mellitus (57 vs. 51 ng/mL; p=0.006). NGAL levels are singificantly higher in patients with higher AHEAD score. Mean level of NGAL in AHEAD 0–1 (N=320) is 51 ng/mL, in AHEAD 2–3 (N=190) is 78 ng/mL and in AHEAD 4–5 (N=37) is 142 ng/mL (Kruskal-Wallis test p&amp;lt;0.001, pairwise comparision all &amp;lt;0.001). Conclusion In stable chronic heart failure registry FAR NHL, comorbidity score AHEAD can predict events. Serum NGAL level is significantly higher when AHEAD score comorbidities are present: Atrial fibrillation, low Haemoglobin, Eldery, Abnormal renal function and Diabetes mellitus. Funding Acknowledgement Type of funding source: None </jats:sec