BVA-Guided Treatment Improves Hospital LOS & Outcomes
For a study, John Strobeck, MD, PhD, and colleagues analyzed data on 245 consecutive HF admissions to a community hospital for whom total blood volume (TBV), red blood cell volume (RBCV), and plasma volume (PV) were measured. Date of blood volume analysis (BVA) was compared with hospital admission and discharge dates, which allowed Dr. Strobeck and team to calculate pre- and post-BVA length of stay (LOS) for all patients. Post-BVA LOS (4.87 days) was less than that for a control group (5.6 days). Patients who received BVA on the day of admission had a highly significantly lower total LOS (2.04 days) than that of controls (4.56 days); this subset also had highly significantly improvements when compared with controls in 30-day readmission (12.7% vs 25.4%) and 1-year mortality (4.2% vs 27.1%). “The significant shortening of LOS for the subset of patients receiving BVA on day of admission suggests that the significant improvements of outcomes (lower mortality and readmission) can be achieved efficiently,” wrote Dr. Strobeck and team.
Symptom Status Improves With Social Support
To better understand if the association between physical HF symptom status and perceived social support is mediated by subjective norm, perceived behavioral control, and attitude toward following a low-sodium diet (LSD), Chin-Yen Lin, PhD, RN and colleagues performed a secondary analysis of data from the BMI-HF observational study of patients with HF. The team observed a significant direct effect of perceived social support on physical symptom status, indicating less severe symptom status among those who perceived more support. Attitude, subjective norm, and perceived behavioral control were significantly associated with social support. Through its effect on perceived behavioral control, perceived social support indirectly affected physical symptom status. The findings “suggest that it is important to screen patients’ social support, as well as their perceived behavioral control toward following a LSD
to identify patients at risk for worse symptom status,” wrote Dr. Lin and colleagues.
HFrEF-Associated Mitral Regurgitation Improved With Sac/Val
Data are limited on the improvement of mitral regurgitation (MR), regardless of background guideline-directed medical therapy (GDMT), among patients with HFrEF who are treated with sacubitril/valsartan (sac/val). Thus, James Januzzi, MD, and colleagues examined this association among 794 participants of the Prospective Study of Biomarkers, Symptom Improvement, and Ventricular Remodeling During Sacubitril/Valsartan Therapy for Heart Failure (PROVE-HF) who had HF and left ventricular ejection fraction (LVEF) less than 40% and among whom sac/val was initiated and titrated to a maximally tolerated dose. Dr. Januzzi and team observed relative 45.0% and 44.7% reductions in prevalence of three to more than four MRs by 6 months and 12 months, respectively. “The baseline clinical and echocardiographic characteristics of those with 3-4+ MR who had a reduction to ≤2+ MR by 12 months were similar to those who had persistent 3-4+ MR by 12 months and both groups had comparable baseline LVEF, LV volumes, and ratio of MR severity to [LV end-diastolic volume index] despite comparable degrees of MR at baseline,” wrote Dr. Januzzi and colleagues. “Thus, predicting presence of MR due to LV dilation versus intrinsic valve dysfunction without a course of sac/val treatment may be difficult.”
Early, Sustained Results in DELIVER Trial
For an analysis of Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure (DELIVER) trial data, Muthiah Vaduganathan, MD, MPH, and colleagues assessed the time to first occurrence of worsening HF (hospitalization for HF or urgent HF requiring IV therapy) or cardiovascular death (primary endpoints) among 6,263 patients with symptomatic HF, left ventricular ejection fraction greater than 40%, elevated natriuretic peptide levels, and evidence of structural heart disease who was randomized to dapagliflozin 10 mg or placebo. The incidence rate per 100 patient-years for primary endpoint events was 8.7 during a median of 2.3 years’ follow-up. The time to first nominal statistical significance for the primary endpoint was 13 days (HR, 0.45), with significance sustained after day 15. By day 16 after randomization, first and sustained statistical significance was achieved for worsening HF events (HR, 0.45). At 30 days, 90 days, 6 months, 1 year, 2 years, and final follow-up, significant benefits were sustained for both the primary endpoint and worsening HF events.
Sequential Nephron Blockade Predicts Mortality & Time to Hospitalization
Evidence indicates that sequential nephron blockade (SNB) with a thiazide diuretic may be utilized in some patients with HF to overcome diuretic resistance and increase diuretic effectiveness. To evaluate all-cause mortality and time to first HF hospitalization in patients requiring SNB, Jeffery Budweg, MD, and colleagues reanalyzed data from the GUIDE-IT study. Overall, they found no significant difference in all-cause mortality mean survival time between patients who did (610.22 days) and did not (605.10 days) utilize SNB. However, mean survival time did differ significantly among patients receiving brain natriuretic peptide (BNP)-guided therapy (no SNB, 570.43 days; SNB, 624.86 days). Time to first HF hospitalization was reduced with SNB in both a control group (no SNB, 400.97 days: SNB, 257.11 days) and the BNP-guided group (no SNB, 409.56 days; SNB, 289.99 days). Dr. Budweg said these findings “may be attributed to rapid up titration of diuretics to lower BNP or suggest that BNP nonresponse was a signal of more advanced heart failure state destined to poorer outcomes.”