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“I NEED HELP”: unleashing the full potential of the acronym for the management of patients with heart failure and reduced ejection fraction
Session:
Sessão de Posters 38 - Insuficiência cardíaca avançada
Speaker:
Mariana Sousa Paiva
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Sousa Paiva; Maria Rita Lima; Ana Rita Bello; Débora Silva Correia; Daniel A. Gomes; Sérgio Maltês; Bruno M. Rocha; Catarina Brízido; Christopher Strong; António Tralhão; Carlos Aguiar; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Background</span></strong><span style="font-family:Times">: </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times"><span style="color:black">The acronym "I NEED HELP", comprising nine readily obtainable clinical, laboratory, and imaging characteristics, serves as a valuable tool to guide physician referrals to heart failure (HF) specialists. Despite its practicality, the specific impact of each criterion on adverse outcomes remains underexplored. Our aim with this study was to assess the individual weight of each criterion in predicting morbidity and mortality among ambulatory patients with chronic HF and reduced ejection fraction (HFrEF).</span></span></span></span></p> <p> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Methods</span></strong><span style="font-family:Times">: </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times"><span style="color:black">Single-center retrospective cohort study of consecutively enrolled patients with HFrEF (<50%) who underwent both transthoracic echocardiography (TTE) and cardiac MRI from 2018 to 2023. The "I NEED HELP" acronym was translated into the following variables: (<strong>I</strong>) need for intravenous inotropes; (<strong>N</strong>) NYHA functional class III-IV or NT-proBNP ≥1000 pg/mL; (<strong>Erh</strong>) renal dysfunction (GFR ≤ 30 mL/min/1.73m² by MDRD formula) or hepatic dysfunction (serum total bilirubin ≥ 1.8 mg/dL); (<strong>Ef</strong>) EF ≤25%; (<strong>D</strong>) appropriate defibrillator shocks; (<strong>H</strong>) at least one HF hospitalization in the previous year; (<strong>Ed</strong>) daily furosemide dose ≥100 mg or combination of diuretics; (<strong>L</strong>) systolic blood pressure (SBP) ≤90 mmHg; (<strong>P</strong>) intolerance to beta-blockers or renin-angiotensin-aldosterone inhibitors. Cox regression analysis was conducted to evaluate the relationship between these variables and outcomes, specifically HF hospitalizations, and a composite of all-cause mortality, orthotopic heart transplant (OHT), or left ventricular assist device placement (LVAD).</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Results</span></strong><span style="font-family:Times">: </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">A total of 439 patients were included (median age 65 years (IQR: 55-75), 75% male, 21% in NYHA II-III, mean EF 34±9% by TTE), of whom 55% had HF for more than 18 months. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">Over a median follow-up of 33 months (IQR 21-51), notable outcomes were observed: 85 (19.4%) patients experienced at least one hospitalization for decompensated HF, 5 (1.1%) received an OHT, 5 (1.1%) underwent LVAD implantation, and 78 (17.8%) patients deceased.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">In our multivariate Cox analysis for the event of HF hospitalization, criteria (<strong>N</strong>), (<strong>Erh</strong>), and (<strong>L</strong>) held significantly elevated risks (all p<0.001). Subsequently, patient stratification based on the presence or absence of these risk features demonstrated significance in our Kaplan-Meier (KM) curve analysis (log-rank <0.001) – <strong><span style="color:#0070c0">Figure 1A</span></strong>.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">Analyzing the relationship of criteria with our composite outcome, (<strong>N</strong>), (<strong>Erh</strong>), (<strong>Eef</strong>), (<strong>Ed</strong>), and (<strong>H</strong>) emerged as independent predictors (all p<0.05). This was further affirmed by our KM curve analysis (log-rank=0.004) – <strong><span style="color:#0070c0">Figure 1B</span></strong>.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Conclusion</span></strong><span style="font-family:Times">: </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">In this real-world study, the deconstruction of the acronym “I NEED HELP” held significant prognostic value in identifying patients with high-risk features for HF hospitalization (“<strong>L-Erh-N</strong>” subgroup) and a composite of death/OHT/LVAD ("<strong>H-Erh-Eef-Ed-N</strong>" subgroup). Further studies will be crucial to validate our findings.</span></span></span></p>
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