Readmission following both cardiac and non-cardiac acute dyspnoea is associated with a striking risk of death

Readmission and mortality are the most common and often combined endpoints in acute heart failure (AHF) trials, but an association between these two outcomes is poorly investigated. The aim of this study was to determine whether unplanned readmission is associated with a greater subsequent risk of death in patients with acute dyspnoea due to cardiac and non-cardiac causes.; Derivation cohort (1371 patients from the LEDA study) and validation cohort (1986 patients from the BASEL V study) included acute dyspnoea patients admitted to the emergency department. Cox regression analysis was used to determine the association of 6 month readmission and the risk of 1 year all-cause mortality in AHF and non-AHF patients and those readmitted due to cardiovascular and non-cardiovascular causes. In the derivation cohort, 666 (49%) of patients were readmitted at 6 months and 282 (21%) died within 1 year. Six month readmission was associated with an increased 1 year mortality risk in both the derivation cohort [adjusted hazard ratio (aHR) 3.0 (95% confidence interval, CI 2.2-4.0), P < 0.001] and the validation cohort (aHR 1.8, 95% CI 1.4-2.2, P < 0.001). The significant association was similarly observed in AHF (aHR 3.2, 95% CI 2.1-4.9, P < 0.001) and other causes of acute dyspnoea (aHR 2.9, 95% CI 1.9-4.5, P < 0.001), and it did not depend on the aetiology [aHR 2.2, 95% CI 1.6-3.1 for cardiovascular readmissions; aHR 4.1, 95% CI 2.9-5.7 for non-cardiovascular readmissions (P < 0.001 for both)] or timing of readmission. CONCLUSION​S: Our study demonstrated a long-lasting detrimental association between readmission and death in AHF and non-AHF patients with acute dyspnoea. These patients should be considered 'vulnerable patients' that require personalized follow-up for an extended period

Incidentally Diagnosed Malignant Coronary Artery Anomaly: A Clinical Case

The incidence of congenital coronary artery anomalies is estimated to range between 1% and 2% in the general population. The separate types of coronary artery anomalies are even rarer – the left main coronary artery arising from the right coronary sinus and passing between the thoracic aorta and the pulmonary artery is one of them. In this case, the segment of the artery that courses between the aorta and the pulmonary artery is prone to compression, especially during heavy exercise. Outcomes may be fatal due to myocardial hypoperfusion, which is associated with sudden cardiac death especially among children, young adults, and athletes. Nowadays, innate coronary artery anomalies may be incidentally diagnosed in older age using new investigation methods such as computed tomography angiography

Correalation between subjective evaluation of dyspnoea and objective clinical signs of respiratory insufficiency in patients with acute dyspnoea

Introduction: Dyspnoea is one of the most frequent symptoms, causing patients (pts) to present to the emergency department (ED) [1]. It is a subjective symptom and for this reason, physicians have a difficult task—to assess dyspnoea objectively along with respiratory failure (RF) signs (respiratory rate (RR) higher than 25 breaths per minute, blood oxygen saturation (SaO2) less than 90%) and determine the underlying primary cause of dyspnoea. Therefore, it is very important to identify the correlation between a subjective symptom—shortness of breath (SOB), as described by the pts—and objective signs of RF [2–4]. Aim: To evaluate acute dyspnoea and compare its severity with clinical signs of RF for pts presenting at the ED. Objectives: 1. To evaluate acute dyspnoea using visual analogy scale (VAS) and its correlation with objective RF parameters, such as RR, SaO2, heart rate (HR), systolic blood pressure (SPB) and lung auscultation parameters. 2. To determine the most common reasons for dyspnea at the ED. Methods: We evaluated 147 pts with acute dyspnoea who presented to the ED at the Hospital of Lithuanian University of Health Sciences. Objective symptoms of RF that were evaluated included RR, SaO2, HR, SBP and lung auscultation parameters. Pts had to respond to the question: “On a scale from 0 to 10, how bad is your SOB, with score 1 being weak SOB and score 10—the worst SOB you could ever imagine?” according to the use of VAS methodology. In our statistical analysis P < ,05 was considered significant. Results: From a sample of 147 pts, 25 participants (17%) rated dyspnoea score of 5 points, 18 pts (12,2%)—6 points, 22 pts (15%)—7 points, 30 pts (20,4%)—8 points and 19 pts (12,9%)—9 points; other VAS scores were chosen by few pts (less than 10%). According to Spearman correlation coefficient, pts with higher dyspnoea score had lower SaO2 (r = −0,197; P = ,024) and higher RR[...]

Adherence to treatment guidelines and its association with length of hospital stay for patients with decompensated heart failure and reduced ejection fraction

Funding Acknowledgements: The work was supported by the Research Council of Lithuania, grant Nr. MIP-049/2015 and approved by Lithuanian Bioethics Com- mittee, Nr. L-15-01. Introduction: Heart failure (HF) is a major and growing public health problem. Currently, HF is the main reason of hospitalisation for patients aged over 65 and it imposes a significant economic burden on health care systems. Medication onadherence is associated with an increased risk of all-cause mortality and car- diovascular hospitalisations in patients with HF. Purpose: We aimed to investigate adherence to HF guidelines for drug therapy and the association between adherence and length of hospital stay for HF patients hos- pitalised due to acute dyspnea. Methods: Prospective observational cohort study enrolled 837 consecutive patients admitted to the emergency department with acute dyspnea between March 2015 and December 2016. Out of 837 examined patients, 187 patients (22.3%) were included in the analysis after being hospitalised and discharged with final diag- nosis of acute HF with reduced left ventricular ejection fraction (LVEF 40% (9.2%), cardiac arrhyth- mia (8.8%), pulmonary embolism (6.9%), pulmonary infection (6.8%), acute coronary syndrome (4.5%), chronic obstructive pulmonary disease (4.3%), cancer (3.0%), hypertension (1.8%), anxiety (1.6%) were excluded. Adherence was evaluated using guideline adherence indicator (GAI3), which is defined as the proportion of care across main three therapeutic classes (angiotensin-converting-enzyme inhibitors (ACEIs), beta-blockers (BBs) and mineralocorticoid receptor antagonists (MRAs) ) according to current European Society of Cardiology (ESC) HF treatment guidelines. Patients were categorised into 3 groups based on the GAI3 values (good, 100% intermediate, 50–67% poor, 0-33%). A general linear model was used to assess the effect of pre-hospital GAI3 [...]

Right ventricular longitudinal systolic dysfunction is associated with worse clinical outcomes in acute dyspnea patients

Introduction: Acute right ventricular (RV) failure is a complex clinical syndrome which has been poorly studied worldwide. So far just few data have been pub- lished on the incidence and characteristic of the RV dysfunction including its association with clinical outcomes, functional parameters of left ventricle (LV) and co-morbidities.urpose: To evaluate the association of longitudinal RV systolic dysfunction (RVSD) with 1-year rehospitalisations and deaths in patients with acute dyspnea; to study clinical findings and co-morbidities typical for patients having RVSD. Methods: Prospective multicentre observational cohort study enrolled consecu- tive patients admitted to the emergency department in two university hospitals with acute dyspnea due to decompensated heart failure, exacerbation of chronic obstructive pulmonary disease, pneumonia, pulmonary embolism and other con- ditions. Demographic, clinical, echocardiographic data, co-morbidities and clinical outcomes of 307 patients were included in the analysis. Echocardiography was per- formed during the first 48 hours after the presentation to hospital. The longitudinal RVSD was defined by reduced tricuspid annular plane systolic excursion (TAPSE) of < 17 mm. Rehospitalisations and deaths were assessed after 1-year follow-up period. For statistical analysis Mann Whitney U and Pearson Chi-Square tests were used. P-value < 0.05 was considered statistically significant. Kaplan-Meier curves illustrate the survival analysis. Results: In analysed cohort mean age was 69.1 ± 12.3 years and 189 pts (61.56%) were female. The first (I) study group consisted of 166 (54.1%) patients with longitudinal RVSD; in the second (II) group 141 (45.9 %) patients had normal RV longitudinal function (TAPSE ≥ 17 mm). Rehospitalisations and deaths in 1-year follow-up period occurred significantly more often in the group with longitudinal RV dysfunction than in group II: 37 (15.0 %) vs. 14 [...]

Characteristic echocardiographic parameters of right ventricular systolic dysfunction in acute dyspnea patients

Funding Acknowledgements: The work was supported by the Research Council of Lithuania, grant Nr. MIP-049/2015 and approved by Lithuanian Bioethics Com- mittee, Nr. L-15-01. Introduction: There is still a discussion about the best echocardiographic parame- ters of acute right ventricular systolic dysfunction (RVSD) in acute settings. Aim: To estimate the prevalence and to characterize RVSD by novel ultrasound parameters of RV longitudinal function, morphometric right heart parameters, asso- ciation with left ventricular (LV) systolic function and brain natriuretic peptide (BNP) level in acute dyspnea patients. Methods: Prospective study enrolled consecutive patients admitted to the emer- gency department of two university centers with acute dyspnea due to decom- pensated heart failure (HF) and other reasons. Data of 323 patients (mean age 68.8 ± 12.7 years, 39.3% women) were analysed. Echocardiography focused on RV parameters was performed during the first 48 hours after admission. TAPSE (tricus- pid annular plane systolic excursion), RV S’ (velocity of the tricuspid annular systolic motion), FAC (fractional area change), right atrial (RA) area, RV basal diameter, RV strain of 3 and 6 segments were measured. Blood sample for BNP level was taken during the first 4 hours. The RVSD was defined by reduced FAC 1000 ng/l – 47.78% (p = 0.006).[...]

Biologically Active Adrenomedullin (bio-ADM) is of potential value in identifying congestion and selecting patients for neurohormonal blockade in acute dyspnea

PURPOSE: . This study was designed to evaluate the role of bio-ADM in congestion assessment and risk stratification in acute dyspnea. METHODS: . This is a sub-analysis of Lithuanian Echocardiography Study of Dyspnea in Acute Settings. Congestion was assessed by means of clinical (peripheral oedema, rales) and sonographic (estimated right atrial pressure [eRAP]) parameters. Ninety-day mortality was chosen for outcome analysis. RESULTS: . 1188 patients were included. Bio-ADM concentration was higher in patients with peripheral oedema at admission (48.2 [28.2-92.6] vs 35.4 [20.9-59.2] ng/L, p 35.5 ng/L were at more than two-fold increased risk of dying (p<0.001). Survival in those with high bio-ADM was significantly modified by neurohormonal blockade at admission (p<0.05), especially if NT-proBNP levels were lower than the median (p = 0.002 for interaction). CONCLUSION: . Bio-ADM reflects the presence and the degree of pulmonary, peripheral, and intravascular volume overload and is strongly related to 90-day mortality in acute dyspnea. Patients with high bio-ADM levels demonstrated survival benefit from neurohormonal blockade