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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
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
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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
36. Basic Science
37. Miscellanea
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Does Atrial Fibrillation influence the performance of survival scores for advanced heart failure?
Session:
Painel 1 - Insuficiencia cardiaca 5
Speaker:
Francisco Albuquerque
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Francisco Albuquerque; Francisco Fernandes Gama; Pedro Freitas; Carlos Aguiar; Jorge Santos Ferreira; António Ventosa; António Tralhão; Christopher Strong; Catarina Brízido; Anai Durazzo; Marisa Trabulo; Miguel Mendes
Abstract
<p><strong>Background and aim: </strong>The prognostic evaluation of ambulatory patients with advanced heart failure and reduced ejection fraction (HFrEF) is essential to guide treatment decisions, such as listing for transplantation. Multiparameter scores and cardiopulmonary exercise testing (CPET) are recommended in this context. We evaluated whether atrial fibrillation (AF) affects the prognostic value of four prognostic scores for HFrEF.</p> <p><strong>Methods: </strong>Single-centre retrospective cohort study of consecutive HFrEF patients undergoing CPET for functional and prognostic assessment from October 1996 till May 2018. The Heart Failure Survival Score (HFSS), Seattle Heart Failure Model (SHFM), Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) and Metabolic Exercise Cardiac Kidney Index (MECKI) were calculated for each patient. Primary endpoint was all cause mortality or urgent transplant (whichever came first within 2 years of follow-up). Cox-regression and ROC curve comparison analyses were performed to assess the added discriminative power of AF on top of each score.</p> <p><strong>Results: </strong>Overall, 387 patients were included in the analysis, median age 58 (IQR 49 - 65) years, and 77% were male. Ischemic heart disease was the most common aetiology for HFrEF (54%). Median peak oxygen consumption was 15,7 mL/kg/min (IQR 12,8 - 20,0). Permanent AF was present in 47 (12.1%) patients. Over the 2-year follow-up period, 48 patients died, and 52 underwent heart transplantation (of which 25 were urgent). HFSS showed the weakest (c-statistic 0,581; 95% [CI] 0,54-0,71) and MECKI score the strongest (c-statistic 0,848; 95% [CI] 0,76-0,88) discriminatory ability for the outcome. Adding the occurrence of AF to the MAGGIC and HFSS improved their prognostic ability, although it did not reach statistical significance. (see Table). In contrast, adding AF on top of the MECKI score significantly reduced its prognostic ability (p <0.001).</p> <p><strong>Conclusion: </strong> The presence of AF did not add significant prognostic information on top of current available HFrEF survival scores.</p>
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