Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
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
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Prognostic impact of worsening renal function in B-type acute heart failure patients on decongestion
Session:
Painel 2 -Insuficiencia cardiaca 2
Speaker:
João Presume
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
João Presume; Sérgio Maltês; Gonçalo Lopes Da Cunha; Luis Landeiro; Marta Roldão; Sara Trevas; Maria Inês Silva; Margarida Madeira; Catarina Rodrigues; Luis Campos; Inês Araújo; Cândida Fonseca
Abstract
<p>BACKGROUND</p> <p>Guidelines recommend usage of the lowest possible dose of diuretics, arguing that higher doses worsen renal function and prognostic. On the other hand, authors report that deterioration of renal function with decongestion is not a predictor of worse prognosis. Rise in serum creatinine often develops after the beginning of decongestive therapy in acute heart failure and may lead to subsequent inappropriate decrease in diuretic dose in order to preserve renal function. The aim of this study was to evaluate the prognostic impact of acute kidney injury (AKI) and worsening renal failure in response to diuretic treatment (WRF) on long term hospitalization and mortality of patients hospitalized for acute HF.</p> <p> </p> <p>METHODS</p> <p>We analysed a retrospective cohort of patients admitted for decompensated heart failure with B-type clinical profile (warm and wet) in a dedicated HF clinic. Exclusion criteria were CKD on hemodialysis, need for renal replacement therapy or ultrafiltration, and unknown previous creatinine. AKI was defined as a rise in serum creatinine (Cr) =0,3 mg/dL from outpatient to admission and WRF was defined as an elevation of Cr =0,3 mg/dL during the first 48h of hospitalization. The combined endpoint was mortality by any cause and hospitalization for cardiovascular cause.</p> <p> </p> <p>RESULTS</p> <p>A total of 249 patients were included (m=77±12,5 years old), 46,6% male, 62,2% HFpEF and 30,5% ischemic etiology. 139 patients had CKD and median creatinine level in outpatient setting (when stable) was 1,08 mg/dL.</p> <p>Patients were assigned to 1 of 4 groups according to their Cr evolution: no AKI/no WRF (n=137); with AKI/no WRF (n=63); no AKI/with WRF (n=36); with AKI/with WRF (n=13).</p> <p>When comparing the study groups, we found statistically significant differences regarding age (p=0,028); ejection fraction (EF) (p=0,001); hemoglobin (p=0,001) and NT-proBNP at admission (p=0,001);</p> <p>Kaplan-Meier survival analysis found statistically significant differences (log-rank test - p<0,001) in the composite outcome between groups (Figure). Survival at 1 year for each group was: no AKI/no WRF - 67.7%; with AKI/no WRF - 51,6%; no AKI/with WRF - 33.3%; with AKI/with WRF - 15.4%.</p> <p>After adjusted Cox model (for age, EF, daily furosemide intake, number of comorbidities, admission hemoglobin, NTproBNP, and urea), this association remained significant (with AKI/no WRF (HR 1,880; 95%CI 1,114-3,172); no AKI/with WRF (HR 2,308; 95%CI 1,314-4,051); with AKI/with WRF (HR 2,625; 95%CI 1,170-5,888).</p> <p> </p> <p>CONCLUSION</p> <p>In this population of acute congestive HF patients (B-type profile), the presence of AKI on admission and the development of WRF with diuretic therapy were associated with increased incidence of all-cause mortality and cardiovascular hospitalization in patients with acute heart failure, and concomitant WRF and AKI confers worse prognosis.</p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site