New research was presented at HFSA 2015, the annual scientific meeting of the Heart Failure Society of America, from September 26 to 29 in Washington, DC. The features below highlight some of the studies that emerged from the conference.
Cognitive Impairment in HF Patients
The Particulars: Researchers have hypothesized that significant cognitive impairment could be a contributing factor in the disease course of patients with heart failure (HF), as these patients often require multiple and complex lifestyle and pharmacologic interventions. However, few studies have explored the detection of cognitive impairment in HF patients.
Data Breakdown: For a study, the prevalence of cognitive impairment among patients with HF was compared with that of patients without HF. Despite similar Mini-Mental Status Exam (MMSE) scores, HF patients had higher prevalence of moderate-to-severe cognitive impairment than age-matched controls across multiple domains.
Take Home Pearl: Stable patients with chronic HF and normal MMSE results appear to have a high prevalence of moderate-to-severe cognitive impairment.
CPR Outcomes in Hospitalized HF Patients
The Particulars: Data indicate that CPR preferences among patients hospitalized with heart failure (HF) may be influenced by beliefs about the success of CPR. However, the frequency and outcomes of CPR following in-hospital cardiac arrest in patients with HF are not well known.
Data Breakdown: The outcomes of nearly 16,000 patients hospitalized for HF who underwent CPR for in-hospital cardiac arrest were assessed for a study. Among participants, 16% were eventually discharged directly home, among whom 44% required home healthcare. Nearly 10% of patients were transferred to a skilled nursing facility, and 73% died prior to discharge.
Take Home Pearl: Survival following CPR for in-hospital cardiac arrest appears to be low for hospitalized patients with HF.
Prognostic Implications of Serum Chloride
The Particulars: Although evidence suggests that serum chloride levels are routinely checked in patients with heart failure (HF), the prognostic significance of these levels has not been well defined in this patient population.
Data Breakdown: Study investigators checked serum chloride levels of non-acute coronary syndrome patients with a history of HF over 5 years in a study. Participants underwent elective diagnostic coronary angiography. Lower serum chloride levels were associated with increased mortality. Every 1 meq/L increase in serum chloride was associated with a 7% reduction in mortality risk.
Take Home Pearl: Serum chloride level appears to be a strong, independent predictor of mortality in patients with stable HF.
A1C & Hospitalization in HF Patients With Diabetes
The Particulars: Optimal treatment strategies for heart failure (HF) patients with comorbid diabetes remain poorly defined. Specifically, little is known about the association between glycemic control and outcomes among this patient population.
Data Breakdown: Researchers in New York measured the association between A1C levels and all-cause hospitalization, HF hospitalization, and mortality in HF patients with diabetes. Patients with A1C levels of 6.5%, 6.5% to 6.9%, 7.0& to 7.9%, and 9.0% or higher had adjusted hazard ratios for all-cause hospitalization of 1.03, 1.05, 1.03, and 1.13, respectively, when compared with patients who had A1C levels that were less than 6.5%. Patients with an A1C level of 9.0% or higher had an increased risk of HF hospitalization and a non-significant increased risk of mortality.
Take Home Pearl: Among HF patients with diabetes, those with an A1C higher than 9.0% appear to be at increased risk for hospitalization.
Poor Communication in ICD Recipients
The Particulars: Research has shown that it is critically important to define healthcare goals for older patients with initial or replacement implantable defibrillators (ICDs). However, the quality of communication between this patient population and their providers is not well known.
Data Breakdown: For a study, phone interviews were conducted with older ambulatory patients with ICDs who were identified as being at high risk for short-term mortality. Results showed that 45% of participants had undergone ICD generator replacements in addition to an initial implant, but less than 40% reported being asked about overall goals of care and less than 10% reported discussing their prognosis with a cardiologist. More than 90% of patients did not discuss the possibility of ICD deactivation at the time of implant and more than 80% did not have such discussions since receiving their implant. Less than one-half of patients were aware that ICDs can be turned off, only 35% had completed a living will, and just 45% had selected a healthcare proxy. However, patients had generally high overall satisfaction rates with decision making, and 70% felt their ICD had “greatly” or “somewhat” improved their quality of life.
Take Home Pearls: Older patients with ICDs appear to report generally positive quality of life and satisfaction with decision making. However, gaps in communication, knowledge, and advance care planning appear to be unaddressed in many of these patients.
For more information on these studies and others that were presented at HFSA 2015, go to www.hfsa.org/upcoming-meetings/19th-annual-scientific-meeting-september-26-29-2015.