A growing number of elderly patients hospitalized for Acute Heart Failure (AHF) are being managed in cardiogeriatrics departments, but their characteristics and prognosis are poorly known. This study ...aimed to investigate the profile and outcome (rehospitalization at 90 days) of patients hospitalized for AHF in cardiogeriatrics departments in the Val-de-Marne area in the suburbs of Paris, and to compare them to AHF patients hospitalized in cardiology departments in the same area.
Observational study, ICREX-94, conducted in seven cardiology departments in France and three specific cardiogeriatrics departments in Val-de-Marne.
A total of 308 patients were hospitalized for AHF between October 2017 and January 2019. During the 90 days following discharge, 29.6% patients were readmitted to the hospital. Compared with patients hospitalized in cardiology departments, patients in cardiogeriatrics departments were older (p < 0.001), less independent (living more often alone or in an institution) (p < 0.001), more often depressed (p < 0.001), had more often major neurocognitive disorder (p < 0.001), had a higher Human Development Index (HDI, p < 0.001), and were less often diagnosed with amyloidosis (p < 0.001). There was no difference in outcome whether patients were discharged from cardiology or cardiogeriatrics departments. The most frequent precipitating factors underlying AHF decompensation between the first and second hospitalization were arrhythmia and infection.
AHF patients discharged from cardiogeriatrics departments, compared to cardiology departments, showed clinical differences but had the same prognosis regarding AHF rehospitalization at 90 days.
Aims
Cardiac amyloidosis (CA) is an under‐diagnosed cause of heart failure (HF) and has a worse prognosis than other forms of HF. The frequency of death or rehospitalization following discharge for ...acute heart failure (AHF) in CA (relative to other causes) has not been documented. The study aims to compare hospital readmission and death rates 90 days after discharge for AHF in patients with vs. without CA and to identify risk factors associated with these events in each group.
Methods and results
Patients with HF and CA (HF + CA+) were recruited from the ICREX cohort, after screening of their medical records. The cases were matched 1:5 by sex and age with control HF patients without CA (HF + CA−). There were 27 HF + CA + and 135 HF + CA− patients from the ICREX cohort included in the study. Relative to the HF + CA− group, HF + CA+ patients had a higher heart rate (P = 0.002) and N‐terminal prohormone of brain natriuretic peptide levels (P < 0.001) and lower blood pressure (P < 0.001), weight, and body mass index values (P < 0.001) on discharge. Ninety days after discharge, the HF + CA+ group displayed a higher death rate, a higher all‐cause hospital readmission rate, and a higher hospital readmission rate for AHF. Death and hospital readmissions occurred sooner after discharge in the HF + CA+ group than in the HF + CA− group.
Conclusions
The presence of CA in patients with HF was associated with a three‐fold greater risk of death and a two‐fold greater risk of all‐cause hospital readmission 90 days after discharge. These findings emphasize the importance of close, active management of patients with CA and AHF.
We report three cases of sustained monomorphic ventricular tachycardia(VT) in the setting of coronary artery disease,resistant to beta-blockers in two patients and to amiodarone in all,successfully ...terminated by low doses of intravenous(IV) epinephrine.VT was the first manifestation of coronary artery disease in one patient,whereas the other two patients had a previous history of myocardial infarction and were recipients of an implantable cardioverter-defibrillator(ICD).One of these two patients experienced an arrhythmic storm.All had hemodynamic instability at the time of epinephrine administration.A single slow administration of IV epinephrine(0.5 to 1 mg administered over 30 to 60 s) restored sinus rhythm after 30-90 s with only minor side effects.In the ICD patient with recurrent VT and several cardioversions due to transformation of VT to ventricular fibrillation,epinephrine injection led to the avoidance of further shocks.Although potentially harmful,low doses of IV epinephrine used alone or in combination with beta-blocker treatment and electrical cardioversion may be an alternative effective therapy for sustained monomorphic VT refractory to amiodarone.The role of epinephrine in the termination of VT should be studied further,especially in patients pre-treated with amiodarone in combination with beta-blockers.
In the context of hospitalization for acute heart failure (AHF), patients’ characteristics and outcome depending on the department of management (cardiologic or cardiogeriatric) are unknown. The aims ...of this study were to determine the profile and the outcome (rehospitalizations at 90 days) of patients hospitalized for HF in the Val de Marne area, a district in the suburbs of Paris, depending on whether they were hospitalized in cardiology or in a specific cardiogeriatric centre; and to analyze the modes and the precipitating factors triggering rehospitalizations in the two type of centre.
We conducted the ICREX-94 observatory within seven French cardiologic departments and three specific cardiogeriatric departments in the Val de Marne district, France.
308 patients were hospitalized for AHF between October 2017 and January 2019. During the 3 months following discharge, 52 (17%) patients were rehospitalized for AHF. Compared with patients hospitalized in cardiogeriatric centre, patients from cardiologic department were younger (P<0.001), with better autonomy (living less often alone or in institution) (P<0.001), less often depressive (P<0.001), with less often major neurocognitive disorder (P<0.001), had worse Human Development Index (HDI, P<0.001), and had more frequent amyloidosis diagnosed (P<0.001). There was no difference for the outcome whether patients were discharged from a cardiologic or a cardiogeriatric centre. The more frequent precipitating factors underlying AHF decompensation between the first and second hospitalization were an arrhythmia, infection and very severe patients.
Compared to cardiogeriatric centres, AHF patients discharged from cardiologic centers had clinical differences, but we found that they had the same prognosis regarding AHF rehospitalization at 90 days.
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