New research was presented at HFSA 2019, the 23rd Annual Scientific Meeting of the Heart Failure Society of America, from September 13-16 in Philadelphia. The features below highlight some of the studies that emerged from the conference.
Predicting Incident Risk in Chronic Kidney Disease
Prior research suggests that chronic kidney disease (CKD) is associated with increased heart failure (HF) risk, with several pathophysiologic pathways activated in CKD that may lead to HF. To test the hypothesis that a multi-marker panel can aid in identifying patients with CKD who are at risk for HF, researchers assessed data on more than 3,500 patients with CKD without prevalent HF who had undergone serum/plasma assays for 11 biomarkers. Participants were randomized into derivation and validation cohorts. After multiple adjustments, C-X-C Motif Chemokine Ligand 12 (CXCL12), fractalkine, fibrinogen, high-sensitivity troponin, and fibroblast growth factor 23 (FGF23) were associated with HF in both the derivation and validation cohorts. Incidence of HF increased with the number of biomarkers above median from 3% (score of 0) to 34% (score of 5) in the derivation cohort and from 1% (score of 0) to 38% (score of 5) in the validation cohort.
Polypharmacy Ups Readmissions
Data indicate that heart failure (HF) prevalence is increasing along with the aging population and associated increases in comorbidities, as well as an expected concomitant increase in prescribed non-cardiac medications. To test the hypothesis that polypharmacy due to non-HF-related medications at discharge following a HF exacerbation increases the risk of all-cause readmission, study investigators tested data for difference in hospital readmission rates for HF at 30 and 90 days against the number of non-HF medications groups in eight incremental categories. A statistically significant association between increasing number of non-HF medications and 90-day readmission was observed, with rates ranging from 27.10% for patients discharged on 0-3 non-HF medications to 48.20% for those on more than 21. Corresponding rates for 30-day readmission were 15.71% and 32.50%, respectively.
The Predictive Ability of Salt Taste Sensitivity
For a study, researchers tested the hypothesis that an increase in salt taste sensitivity from admission to 12-week follow-up would be associated with fewer days rehospitalized and higher Kansas City Cardiomyopathy Questionnaire clinical summary scores (KCCQ-CSS) compared with no such increase among patients with heart failure. Salt taste sensitivity was assessed by measuring changes in salt taste recognition threshold on enrollment, discharge, 1, 4, and 12-weeks follow-up using Salsave test strips standardized with 0.6-1.6 mg/cm2 NaCl solution. The enrollment salt taste recognition threshold was higher (1.19 vs. 0.76 mg/cm2), and the 12-week threshold was lower (0.71 vs. 0.86 mg/cm2) in the group with increased salt taste sensitivity. Average number of hospital days were 5.45 in the increased sensitivity group and 11.00 in the non-increased group. KCCQ-CSS at 12-weeks trended higher in the group with an increase in salt taste sensitivity: (64.24 vs. 56.25).
Ventilatory Inefficiency Predicts HF Prognosis
Minute ventilation-carbon dioxide production relationship (VE/VCO2 slope) has previously been shown to indicate ventilatory inefficiency. Although a single VE/VCO2 slope threshold defining abnormal of 34 to 36 is used clinically across heart failure (HF) categories, the threshold has been validated mostly in patients with reduced left ventricular ejection fraction (LVEF). To examine the associations between VE/VCO2 slope categories and a composite outcome of all-cause mortality and HF hospitalization across the spectrum of HF patients defined by LVEF, researchers conducted a single-center retrospective cohort study of 1347 patients with heart failure clinically referred for cardiopulmonary exercise testing (CPET) between 2010 and 2016. Patients with HF were categorized based on LVEF into heart failure with reduced (HFrEF, LVEF <40%), mid-range (HFmrEF, 40% ≤ LVEF<50%) and preserved (HFpEF, LVEF ≥50%) ejection fraction. VE/VCO2 slope was divided into four ventilatory categories (VC) – VC-I: VE/VCO2≤29, VC-II: 29<VE/VCO2<36, VC-III: 36≤VE/VCO2<45, VC-IV: VE/VCO2 ≥45. Across the entire cohort, increases in VC category were associated with increasing risk of 2-year composite outcome (deaths and HF hospitalizations). Compared with patients in VC-I, patients in VC-II were at increased risk of having 2-year composite outcome in both HFrEF and HFpEF cohorts. Patients in VC III and IV had incremental increases in the likelihood of 2-year composite outcome across all HF cohorts.
Weight Loss Barriers Are Common in HFpEF
Although previous research indicates that weight loss is beneficial for obese patients with heart failure with preserved ejection fraction (HFpEF), substantial barriers to weight loss in this patient population may exist. For a study, researchers performed chart reviews of obese patients presenting to an HFpEF clinic between January 2015 and September 2018. Comorbid conditions were common and included hypertension (85%), hyperlipidemia (70%), and diabetes (59%). Among those for whom a STOP-BANG score was calculated, 96% met criteria for high risk of obstructive sleep apnea. Weight loss barriers were also common and included anxiety, depression, and frailty. Most patients did not achieve 500 MET-minutes per week of exercise, and more than half reported no exercise. Less than one-third had received an outpatient dietitian consultation, less than half of whom met criteria for bariatric surgery were offered it, and although three-quarters with indications for cardiac rehabilitation were referred, many did not have Medicare-reimburses indications. “Opportunities exist to facilitate weight loss and improve quality of life in HFpEF through multidisciplinary interventions to address these challenges,” conclude the study authors.