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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
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F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Predicting readmissions in patients with heart failure: a novel and easy-to-apply scoring model
Session:
Posters 5 - Écran 5 - Insuficiência Cardíaca
Speaker:
Inês Ricardo
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Inês Aguiar Ricardo; João Pedro Ribeiro Agostinho; Joana Rigueira; Rafael Santos; Afonso Nunes Ferreira; Tiago Graça Rodrigues; Nelson P. Cunha; Pedro Silvério António; Maria Mónica Mendes Pedro; Fátima Veiga; Fausto José Pinto; Dulce Brito
Abstract
<p><strong>Introduction</strong>: Acute heart failure (HF) is the main cause of hospitalization in patients (pts) >65 years. Readmission (reH) rates are high in this population, being a relevant cause of impaired quality of life, and a main negative prognostic determinant. The identification of pts at a higher risk of reH is at utmost relevance. </p> <p><strong>Objective</strong>: Development of an easy-to-apply score, useful for prediction of all-cause reH during the first year after discharge (index-hospitalization for acute HF).</p> <p><strong>Methods</strong>: Retrospective study with prospective data registry of consecutive pts discharged after an index-hospitalization due to acute HF. All pts were submitted to clinical, laboratorial, electrocardiographic and echocardiographic evaluations. Cox Regression was used to analyse predictors of readmission; ROC curve method and Kaplan-Meier survival analysis were used to evaluate score efficacy.</p> <p><strong>Results</strong>: 156 pts were included (mean age: 68.1 ± 12.4 years, 60.1% males). The mean LVEF was 36.4 ± 15.9% (LVEF < 40% in 60.3%). 70 (44.8%) pts were discharged in NYHA I functional class, 51.9% in class II and 3.2% in class III. Mean follow-up time was 11.1 ± 2.6 months. The reH rate during follow-up was 46.2% and the mortality rate (all-causes) was 10.3%. Previous ischemic stroke (iS) (HR = 2.3, CI = 1.3-4.1, p = 0.004), history of malignancy (hNeo) (HR = 2.6, CI = 1.4-4.9, p = 0.025), on-admission values of hemoglobin (Hb) < 12g/dL (HR = 2.3, CI = 1.4-3.6, p = 0.001), total bilirubin (TBil) > 1.2mg/dL (HR = 2.1, CI = 1.2-3.5, p = 0.007), alkaline phosphatase (ALP) > 105 U/L (HR = 2.0, CI = 1.2-3.3, p = 0.027) and thyroid-stimulating hormone (TSH) > 4.1uU/mL (HR = 2.3, CI = 1.4-3.6, p = 0.003), and values of NTproBNP > 4250pg/mL (HR = 2.1, CI = 1.1-4.1, p = 0.011) and blood nitrogen urea (BUN) > 67mg/dL (HR = 3.3, CI = 2.0-5.6, p = 0.004) at-discharge were independent predictors of reH. A length of stay (LOS) > 17days (HR = 2.1, CI = 1.2-3.4, p = 0.028) was also an independent predictor of reH. According to the HR was attributed 1 point to iS, Hb < 12g/dL, TBil > 1.2mg/dL, ALP > 105U/L, TSH > 4.1uU/mL, NTproBNP > 4250pg/mL and LOS > 17days; and 1.5 points to BUN > 67mg/dL and hNeo, with a maximum score of 10 points. This model showed a good accuracy to predict reH during the first year after discharge (AUC = 0.81). Based on tercile distribution the population was classified as low-risk (score ≤ 1; reH rate: 13.2%), intermediate-risk (score > 1 and < 3; reH rate: 48%) and high-risk (score ≥ 3; reH rate: 77.4%). ub-group analysis based on LVEF is shown in Figure 1. The score kept a good accuracy to discriminate between low-risk, intermediate-risk and high-risk pts.</p> <p> </p> <p><strong>Conclusion</strong>: This new scoring model showed good accuracy in predicting all-cause readmissions during the first year after discharge. As it is based on clinical and laboratorial standard parameters, it may be a useful and easy-to-apply tool for the identification of HF patients requiring a closer follow-up after discharge.</p>
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