Journal of Cardiac Failure最新文献

{"title":"Windy City Breakthroughs: Highlights from the American Heart Association Scientific Sessions 2024","authors":"ALEXANDER G. HAJDUCZOK , DEVIN STIVES , MATTEO FABBRI , ELENA M. DONALD , JENNIFER MANING , ROBERT J. MENTZ","doi":"10.1016/j.cardfail.2024.11.006","DOIUrl":"10.1016/j.cardfail.2024.11.006","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 4","pages":"Pages 717-720"},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Focus: Rates of Heart Failure Medicines and Hospital Readmission: An explanation of “Prescription Patterns in the Management of Heart Failure and its Association with Readmissions: A Retrospective Analysis”","authors":"SPENCER CARTER MD , JENNIFER T. THIBODEAU MD, MSCS","doi":"10.1016/j.cardfail.2024.09.008","DOIUrl":"10.1016/j.cardfail.2024.09.008","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 4","pages":"Pages 646-647"},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription Patterns in Management of Heart Failure and Its Association With Readmissions: A Retrospective Analysis","authors":"SIMRAN AGRAWAL ,&nbsp;ZAYD ALHADDAD ,&nbsp;SARAH NABIA ,&nbsp;OBAID UR REHMAN ,&nbsp;MADIHA KIYANI ,&nbsp;AJAY KUMAR ,&nbsp;NRIPESH REGMI ,&nbsp;ADHVITHI PINGILI ,&nbsp;TUSHAR GARG ,&nbsp;RAKESH ALLAMANENI ,&nbsp;AMRIT PAUDEL ,&nbsp;GREG C. FONAROW ,&nbsp;ANUP AGARWAL","doi":"10.1016/j.cardfail.2024.08.059","DOIUrl":"10.1016/j.cardfail.2024.08.059","url":null,"abstract":"<div><h3>Background</h3><div>The American Heart Association/American College of Cardiology/Heart Failure Society of America recently added sodium-glucose cotransporter-2 inhibitors in addition to renin–angiotensin–aldosterone system inhibitors, beta-blockers, and mineralocorticoid receptor antagonists to form the 4 pillars of guideline-directed medical therapy (GDMT) for the management of heart failure with reduced ejection fraction (HFrEF). Despite strong evidence suggesting improved outcomes with inpatient initiation of GDMT at target doses, significant lag has been noted in prescription practices. We sought to study GDMT prescription rates in patients with HFrEF at the time of hospital discharge and evaluate its association with various patient characteristics and all-cause readmission rates.</div></div><div><h3>Methods and Results</h3><div>We used a modified version of Heart Failure Collaboratory (HFC) score to characterize patients into 2 groups (those with an HFC score of &lt;3 and an HFC score of ≥3) and to examine various socioeconomic and biomedical factors affecting GDMT prescription practices. Out of the eligible patients, the prescription rates for beta-blockers was 77.9%, renin–angiotensin–aldosterone system inhibitor was 70.3%, and mineralocorticoid receptor antagonists was 41%. Furthermore, prescription rates for sacubitril/valsartan was 27.7% and sodium-glucose cotransporter-2 inhibitors was 17%. Only 1% of patients had an HFC score of 9 (drugs from all 4 classes at target doses). Patients of black ethnicity, those admitted on teaching service and those with HFrEF as the primary cause of admission were more likely to have an HFC of ≥3 at discharge. An HFC of ≥3 was associated with lower rates of 1-month all-cause readmissions.</div></div><div><h3>Conclusions</h3><div>Consistent with the prior research, our data show significant gaps in prescription of GDMT in HFrEF. Further implementation research should be done to improve GDMT prescription during inpatient stay.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 4","pages":"Pages 635-645"},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Differences of Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction","authors":"HIDEMI SORIMACHI MD, PhD ,&nbsp;MASARU OBOKATA MD, PhD ,&nbsp;KAZUNORI OMOTE MD, PhD ,&nbsp;YOGESH N.V. REDDY MBBS, MSc ,&nbsp;DANIEL BURKHOFF MD, PhD ,&nbsp;SANJIV J. SHAH MD ,&nbsp;BARRY A. BORLAUG MD","doi":"10.1016/j.cardfail.2024.08.042","DOIUrl":"10.1016/j.cardfail.2024.08.042","url":null,"abstract":"<div><h3>Background</h3><div>Potential race differences in cardiac structure and function among patients with heart failure with preserved ejection fraction (HFpEF) are not well-understood, but may have pathophysiological and treatment implications.</div></div><div><h3>Methods and Results</h3><div>In this study, patients with HFpEF who self-identified as Asian (<em>n</em> = 360), White (<em>n</em> = 787), and Black (<em>n</em> = 171) from 3 institutions underwent comprehensive transthoracic echocardiography to evaluate for potential differences. The Asian HFpEF group was oldest and the Black HFpEF group was youngest (75 ± 12 years vs 73 ± 13 years vs 62 ± 12 years; <em>P</em> &lt; .0001). Women constituted the lowest proportion of patients with HFpEF among Asian individuals, but were the largest among Black patients (49% vs 56% vs 73%; <em>P</em> &lt; .0001). Body mass index and obesity prevalence were highest in Black patients with HFpEF and were lowest in Asian patients. Black individuals with HFpEF had greater left ventricular (LV) wall thickening and concentricity, smaller LV chamber size, leftward-shifted LV end-diastolic pressure–volume relationship, indicating greater LV stiffening, smallest left atrial volumes, and the most right ventricular dilatation. Asian individuals with HFpEF had greater LV and left atrial dilation, more rightward shifted LV end-diastolic pressure–volume relationship, and the highest arterial stiffness.</div></div><div><h3>Conclusions</h3><div>In summary, we show that patients with HFpEF of Asian, Black, and White race display key differences in clinical, anthropometric, and cardiac structure-function indices, indicating that consideration of race-related differences might important to individualize treatment strategies in HFpEF.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 4","pages":"Pages 624-634"},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wearable Accelerometer-Derived Measures of Physical Activity in Heart Failure: Insights From the DETERMINE trials","authors":"KIERAN F. DOCHERTY MBChB, PhD ,&nbsp;RUBEN BUENDIA LOPEZ PhD ,&nbsp;FOLKE FOLKVALJON MSc ,&nbsp;RUDOLF A. DE BOER MD, PhD ,&nbsp;JERSEY CHEN MD ,&nbsp;ANN Hammarstedt PhD ,&nbsp;DALANE W. KITZMAN MD ,&nbsp;MIKHAIL N. KOSIBOROD MD ,&nbsp;ANNA MARIA LANGKILDE MD, PhD ,&nbsp;BARRY REICHER MD ,&nbsp;MICHELE SENNI MD ,&nbsp;ULRICA WILDERÄNG PhD ,&nbsp;SUBODH VERMA MD ,&nbsp;MARTIN R. COWIE MD ,&nbsp;SCOTT D. SOLOMON MD ,&nbsp;JOHN J.V. MCMURRAY MD","doi":"10.1016/j.cardfail.2024.10.439","DOIUrl":"10.1016/j.cardfail.2024.10.439","url":null,"abstract":"<div><h3>Introduction</h3><div>Wearable accelerometers allow continuous assessment of physical activity during normal living conditions and may be useful in evaluating the effects of treatment for heart failure. We explored the relationships between accelerometer measures of physical activity and 6-minute walk distance and patient-reported measures of functional limitation in participants across the entire spectrum of left ventricular ejection fraction in the DETERMINE (Dapagliflozin EffecT on ExeRcise capacity using a 6-MINutE walk test in patients with heart failure) trials.</div></div><div><h3>Methods</h3><div>A subgroup of patients in the DETERMINE trials wore a waist-based accelerometer during 7-day periods at 3 points during the trial: between screening and randomization and during weeks 8 and 14. Patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) and 6-minute walk distance (6MWD) at baseline and at weeks 8 and 16.</div></div><div><h3>Results</h3><div>Of the 817 patients randomized, 319 (39%) had adequate baseline accelerometer data. Patients with lower levels of physical activity had lower (ie, worse) KCCQ scores and 6MWD, higher NT-proBNP levels and BMIs, worse kidney function, and a greater likelihood of diabetes and atrial fibrillation. Baseline accelerometer values had weak correlations with KCCQ summary scores (Pearson r = 0.06–0.21) and weak to moderate correlations with 6MWD (Pearson r = 0.20–0.31). The change from baseline to 16 weeks in accelerometer-measured physical activity correlated weakly with the change in KCCQ summary scores (Pearson r = 0–0.18) and 6MWD (r = 0.01–0.10).</div></div><div><h3>Conclusions</h3><div>In the DETERMINE trials, accelerometer-based measures of physical activity correlated modestly with KCCQ summary scores and 6MWD. Accelerometer-based assessments of physical activity may provide additional information complementing that obtained from standard measures of functional limitation in patients with heart failure.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 4","pages":"Pages 689-703"},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance and Alert-based Multiparameter Monitoring to Reduce Worsening Heart Failure Events: Results From SCALE-HF 1","authors":"MARAT FUDIM MD, MHS ,&nbsp;UGOCHUKWU EGOLUM MD ,&nbsp;AMIR HAGHIGHAT MD ,&nbsp;ANUPAMA KOTTAM MD ,&nbsp;ANDREW J. SAUER MD ,&nbsp;HIRAK SHAH MD ,&nbsp;PRIYA KUMAR MD ,&nbsp;VALERA RAKITA MD ,&nbsp;RENATO D. LOPES MD, MHS ,&nbsp;COREY CENTEN ,&nbsp;KIVANC OZONAT MS, PhD ,&nbsp;SARAH SMITH ,&nbsp;JAY PANDIT MD ,&nbsp;ADAM D. DeVORE MD, MHS","doi":"10.1016/j.cardfail.2024.08.050","DOIUrl":"10.1016/j.cardfail.2024.08.050","url":null,"abstract":"<div><h3>Background</h3><div>There is a need for better noninvasive remote monitoring solutions that prevent hospitalizations through the early prediction and management of heart failure (HF). SurveillanCe and Alert-Based Multiparameter Monitoring to ReducE Worsening Heart Failure Events (SCALE-HF 1) evaluated the performance of a novel congestion index that alerts to fluid accumulation preceding HF events.</div></div><div><h3>Methods and Results</h3><div>SCALE-HF 1 was a multicenter, prospective, observational study investigating HF event prediction using data from the cardiac scale. Participants with HF took measurements at home by standing barefoot on the scale for approximately 20 seconds each day. The congestion index was applied retrospectively, and an alert was generated when the index exceeded a fixed threshold established in prior studies. HF events were defined as unplanned administration of IV diuretics or admissions with a primary diagnosis of HF. Sensitivity was defined as the ratio of correctly identified HF events to the total number of HF events. We enrolled 329 participants (mean age 64 ± 14 years; 43% women; 32% Black; 56% with reduced ejection fraction) across 8 sites with 238 participant-years of follow-up and 69 usable HF events. The congestion index predicted 48 of the 69 HF events (70%) at 2.58 alerts per participant-year. In contrast, the standard weight rule (weight gain of &gt;3 lb in 1 day or &gt;5 lb in 7 days) predicted only 24 of the 69 HF events (35%) at 4.18 alerts per participant-year. The congestion index alerts had a significantly higher sensitivity (<em>P</em> &lt; .01) at a lower alert rate than the standard weight rule.</div></div><div><h3>Conclusions</h3><div>The congestion index alerts demonstrated sensitive prediction of HF events at a low alert rate, significantly exceeding the performance of weight-based monitoring.</div></div><div><h3>ClinicalTrials.gov Identifier</h3><div>NCT04882449</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 4","pages":"Pages 661-675"},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Without Known Cause: Contextualizing the Body","authors":"DARLENE ANITA SCOTT BA","doi":"10.1016/j.cardfail.2024.12.014","DOIUrl":"10.1016/j.cardfail.2024.12.014","url":null,"abstract":"<div><div>The author describes her personal experience with a cardiac diagnosis to demonstrate how wellness disparities are often rooted in historical constructions of “ideal” physical presentation that are both racialized and gendered. Her experiential analysis contends that failure to contextualize patients and divorce them from these historically problematic constructions is used to justify their profound disability and death.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 4","pages":"Pages 753-755"},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale and Design of the DECONGEST (Diuretic Treatment in Acute Heart Failure With Volume Overload Guided by Serial Spot Urine Sodium Assessment) Study","authors":"SIMON VANHENTENRIJK MD, PharmD ,&nbsp;JOHAN VERBEECK MSc, PhD ,&nbsp;THEODOROS KALPAKOS MD ,&nbsp;VINCENT VANDOREN MD ,&nbsp;LAURA BRAECKEVELDT MD ,&nbsp;WOUTER L'HOYES MD ,&nbsp;ELEFTHERIOS CHOUSTOULAKIS MD, MSc ,&nbsp;BRAM ROOSENS MD, PhD ,&nbsp;W.H. WILSON TANG MD ,&nbsp;JAN VERWERFT MD ,&nbsp;FREDERIK H. VERBRUGGE MD, PhD, MSc","doi":"10.1016/j.cardfail.2024.08.044","DOIUrl":"10.1016/j.cardfail.2024.08.044","url":null,"abstract":"<div><h3>Aims</h3><div>To evaluate whether early-combination diuretic therapy guided by serial post-diuretic urine sodium concentration (UNa⁺) assessments in acute heart failure (AHF) facilitates safe and effective decongestion.</div></div><div><h3>Methods</h3><div>The Diuretic Treatment in Acute Heart Failure with Volume Overload Guided by Serial Spot Urine Sodium Assessment (DECONGEST) study is a pragmatic, 2-center, randomized, parallel-arm, open-label study aiming to enroll 104 patients with AHF and clinically evident fluid overload requiring treatment with intravenous loop diuretics. Patients are randomized to receive standard of care or a bundled approach comprising: (1) systematic post-diuretic UNa⁺ assessments until successful decongestion, defined as no remaining clinical signs of fluid overload with a post-diuretic UNa⁺ ≤ 80 mmol/L; (2) thrice-daily intravenous loop diuretic bolus therapy, with dosing according to estimated glomerular filtration rate; (3) upfront use of intravenous acetazolamide (500 mg once daily [OD]); and (4) full nephron blockade with high-dose oral chlorthalidone (100 mg OD) and intravenous canreonate (200 mg OD) for diuretic resistance, defined as persisting signs of fluid overload with a post-diuretic UNa⁺ ≤ 80 mmol/L. The primary endpoint of the DECONGEST study is a hierarchical composite of (1) survival at 30 days; (2) days alive and out of hospital or care facility up to 30 days; and (3) greater relative decrease in natriuretic peptide levels from baseline to day 30.</div></div><div><h3>Conclusion</h3><div>The DECONGEST study aims to determine whether an intensive diuretic regimen focused on early combination therapy, guided by serial post-diuretic UNa+ assessments, safely enhances decongestion, warranting further evaluation in a larger trial powered for clinical events.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 4","pages":"Pages 651-660"},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Machine Learning-derived Risk Score Improves Prediction of Outcomes After LVAD Implantation: An Analysis of the INTERMACS Database","authors":"JIN JOO PARK MD, PhD ,&nbsp;SONYA JOHN MD ,&nbsp;CLAUDIO CAMPAGNARI PhD ,&nbsp;AVI YAGIL PhD ,&nbsp;BARRY GREENBERG MD ,&nbsp;ERIC ADLER MD","doi":"10.1016/j.cardfail.2024.09.013","DOIUrl":"10.1016/j.cardfail.2024.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Significant variability in outcomes after left ventricular assist device (LVAD) implantation emphasize the importance of accurately assessing patients' risk before surgery. This study assesses the Machine Learning Assessment of Risk and Early Mortality in Heart Failure (MARKER-HF) mortality risk model, a machine learning-based tool using 8 clinical variables, to predict post-LVAD implantation mortality and its prognostic enhancement over the Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS) profile.</div></div><div><h3>Methods</h3><div>Analyzing 25,365 INTERMACS database patients (mean age 56.8 years, 78% male), 5,663 (22.3%) and 19,702 (77.7%) received HeartMate 3 and other types of LVAD, respectively. They were categorized into low, moderate, high, and very high-risk groups based on MARKER-HF score. The outcomes of interest were in-hospital and 1-year postdischarge mortality.</div></div><div><h3>Results</h3><div>In patients receiving HeartMate 3 devices, 6.2% died during the index hospitalization. In-hospital mortality progressively increased from 4.4% in low-risk to 15.2% in very high-risk groups with MARKER-HF score. MARKER-HF provided additional risk discrimination within each INTERMACS profile. Combining MARKER-HF score and INTERMACS profile identified patients with the lowest (3.5%) and highest in-hospital mortality rates (19.8%). The postdischarge mortality rate at 1 year was 5.8% in this population. In a Cox proportional hazard regression analysis adjusting for both MARKER-HF and INTERMACS profile, only MARKER-HF score (hazard ratio 1.27, 95% confidence interval 1.11–1.46, <em>P</em> &lt; .001) was associated with postdischarge mortality. Similar findings were observed for patients receiving other types of LVADs.</div></div><div><h3>Conclusions</h3><div>The MARKER-HF score is a valuable tool for assessing mortality risk in patients with HF undergoing HeartMate 3 and other LVAD implantation. It offers prognostic information beyond that of the INTERMACS profile alone and its use should help in the shared decision-making process for LVAD implantation.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 4","pages":"Pages 679-688"},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Worsening Renal Function Is Common and Associated With Higher Mortality in Cardiogenic Shock: A Cardiogenic Shock Working Group Report.","authors":"Rachna Kataria, Shashank S Sinha, Song Li, Qiuyue Kong, Manreet Kanwar, Jaime Hernandez-Montfort, A Reshad Garan, Jacob Abraham, Elric Zweck, Van-Khue Ton, David M Dudzinski, Anthony Faugno, Maryjane Farr, Esther Vorovich, Shelley Hall, Maya Guglin, Mohit Pahuja, Kevin John, Ajar Kochar, Vanessa Blumer, Saraschandra Vallabhajosyula, Sandeep Nathan, Neil M Harwani, Gavin W Hickey, Andrew D Schwartzman, Wissam Khalife, Claudius Mahr, Ju H Kim, Arvind Bhimaraj, Paavni Sangal, Karol D Walec, Peter Zazzali, Justin Fried, Daniel Burkhoff, Navin K Kapur","doi":"10.1016/j.cardfail.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.cardfail.2025.03.012","url":null,"abstract":"<p><strong>Background: </strong>Outcomes associated with worsening renal function (WRF) in cardiogenic shock (CS) remain poorly understood.</p><p><strong>Objectives: </strong>To study the incidence of WRF in heart failure-CS (HF-CS) and acute myocardial infarction CS (AMI-CS), examine its association with in-hospital mortality (IHM), define the trajectory of renal function in CS, and identify independent predictors of WRF in HF-CS versus AMI-CS.</p><p><strong>Methods: </strong>Patients in the Cardiogenic Shock Working Group registry (CSWG) from 2021-2024 were analyzed; those with baseline end-stage renal disease were excluded. WRF was defined as an increase in creatinine ≥0.3 mg/dl, a decrease in eGFR >25%, or initiation of renal replacement therapy (RRT) within 72 hours of CS diagnosis.</p><p><strong>Results: </strong>Of 6269 CS patients, 35% developed WRF, including 32% of HF-CS and 41% of AMI-CS patients. Patients who developed WRF were more likely to be transferred from other hospitals (63% vs 50%, p<0.001). Baseline right atrial pressure (RAP) was higher in both HF-CS (15 mmHg vs 12 mmHg, p<0.001) and AMI-CS (13 mmHg vs 11 mmHg, p=0.02) patients with WRF compared to patients without WRF. Incidence of WRF was higher among patients exposed to both tMCS and vasoactive agents as compared to vasoactive drugs alone (46% vs. 29%, p<0.001). Overall rate of RRT initiation was 20% throughout admission with higher rates in patients with acute on chronic versus de novo HF-CS and in patients with STEMI-CS versus NSTEMI-CS in the first 24 hours. IHM was higher in patients with WRF (41% vs 21%, p<0.001). In patients with WRF, median eGFR declined steadily throughout the first 72 hours after CS diagnosis. Key independent predictors of WRF included RAP, lactate, transfer status, in patients with HF-CS and CKD, lactate and transfer status in patients with AMI-CS.</p><p><strong>Conclusion: </strong>WRF is common and deleterious in both HF- and AMI-CS. Given the early association with worse outcomes, WRF may not only be prognostic but also represent a potential therapeutic target in future CS studies.</p>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}