1
|
Kazmi S, Kambhampati C, Cleland JGF, Cuthbert J, Kazmi KS, Pellicori P, Rigby AS, Clark AL. Dynamic risk stratification using Markov chain modelling in patients with chronic heart failure. ESC Heart Fail 2022; 9:3009-3018. [PMID: 35736536 DOI: 10.1002/ehf2.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/03/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS Risk changes with the progression of disease and the impact of treatment. We developed a dynamic risk stratification Markov chain model using artificial intelligence in patients with chronic heart failure (CHF). METHODS AND RESULTS We described the pattern of behaviour among 7496 consecutive patients assessed for suspected HF. The following mutually exclusive health states were defined and assessed every 4 months: death, hospitalization, outpatient visit, no event, and leaving the service altogether (defined as no event at any point following assessment). The observed figures at the first transition (4 months) weres 427 (6%), 1559 (21%), 2254 (30%), 1414 (19%), and 1842 (25%), respectively. The probabilities derived from the first two transitions (i.e. from baseline to 4 months and from 4 to 8 months) were used to construct the model. An example of the model's prediction is that at cycle 4, the cumulative probability of death was 14%; leaving the system, 37%; being hospitalized between 12 and 16 months, 10%; having an outpatient visit, 8%; and having no event, 31%. The corresponding observed figures were 14%, 41%, 10%, 15%, and 21%, respectively. The model predicted that during the first 2 years, a patient had a probability of dying of 0.19, and the observed value was 0.18. CONCLUSIONS A model derived from the first 8 months of follow-up is strongly predictive of future events in a population of patients with chronic heart failure. The course of CHF is more linear than is commonly supposed, and thus more predictable.
Collapse
Affiliation(s)
- Syed Kazmi
- Department of Academic Cardiology, Hull University Teaching Hospital NHS Trust, Hull, UK.,Department of Computer Science and Technology, University of Hull, Hull, UK
| | | | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | - Joe Cuthbert
- Department of Academic Cardiology, Hull University Teaching Hospital NHS Trust, Hull, UK.,Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Hull, UK
| | | | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | - Alan S Rigby
- Hull York Medical School, University of Hull, Hull, UK
| | - Andrew L Clark
- Department of Academic Cardiology, Hull University Teaching Hospital NHS Trust, Hull, UK
| |
Collapse
|
2
|
Bazi Y, Al Rahhal MM, AlHichri H, Ammour N, Alajlan N, Zuair M. Real-Time Mobile-Based Electrocardiogram System for Remote Monitoring of Patients with Cardiac Arrhythmias. INT J PATTERN RECOGN 2019. [DOI: 10.1142/s0218001420580136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this study, we propose an electrocardiogram (ECG) system for the simultaneous and remote monitoring of multiple heart patients. It consists of three main components: patient, sever, and monitoring units. The patient unit uses a wearable miniature sensor that continuously measures ECG signals and sends them to a smart mobile phone via a Bluetooth connection. In the mobile device, the ECG signals can be stored, displayed on screen, and automatically transmitted to a distant server unit over the internet; the server stores ECG data from several patients. Health care stakeholders use a monitoring unit to retrieve the ECG signals of multiple patients at any time from the server for display and real-time automatic analysis. The analysis includes segmentation of the ECG signal into separate heartbeats followed by arrhythmia detection and classification. When compared to existing real-time ECG systems, where the detection of abnormalities is usually performed using simple rules, the proposed system implements a real-time classification module that is based on a support vector machine (SVM) classifier. Extensive experimental results on ECG data obtained from a TechPatientTM simulator, a real person, and 20 records from the MIT arrhythmia database are reported and discussed.
Collapse
Affiliation(s)
- Yakoub Bazi
- Computer Engineering Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
| | - Mohamad M. Al Rahhal
- Information Science Department, College of Applied Computer Science, King Saud University, Riyadh 11543, Saudi Arabia
| | - Haikel AlHichri
- Computer Engineering Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
| | - Nassim Ammour
- Computer Engineering Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
| | - Naif Alajlan
- Computer Engineering Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
| | - Mansour Zuair
- Computer Engineering Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
| |
Collapse
|
3
|
Petutschnigg J, Edelmann F. [Heart failure with preserved left ventricular ejection fraction]. Internist (Berl) 2019; 60:925-942. [PMID: 31432196 DOI: 10.1007/s00108-019-0653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Heart failure remains the number one diagnosis among patients receiving inpatient treatment in Germany. Heart failure with preserved ejection fraction (HFpEF) needs to be verified by signs and symptoms of HF, echocardiographic parameters as well as cardiac biomarkers. Based on etiological and pathophysiological considerations, a classification into systolic and diastolic heart failure and later heart failure with reduced ejection fraction (HFrEF) and HFpEF was proposed. The inhomogeneous group of patients with HFpEF accounts for half of all heart failure cases in the population. Effective treatment options are limited. This article discusses which verified treatments may help or may even be harmful. A glimpse is taken into the future and those substances that are in advanced stages of clinical trials are described.
Collapse
Affiliation(s)
- Johannes Petutschnigg
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland
| | - Frank Edelmann
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland. .,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland. .,Berliner Institut für Gesundheitsforschung, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland.
| |
Collapse
|
4
|
Abstract
The annual "heart report" published by the German Heart Foundation (Deutsche Herzstiftung) in December 2017 indicates that heart failure (ICD I50) remains the number one diagnosis of in-hospital-treated patients throughout Germany. For some time, the clinical diagnosis of heart failure has been verified by echocardiographic parameters as well as cardiac biomarkers that assist the clinician to rule in or rule out the presence of a failing heart, when used wisely. By introducing the term "heart failure with mid-range ejection fraction" (HFmrEF), the 2016 European Society of Cardiology (ESC) heart failure guidelines established a third heart failure entity, which was not necessarily seen as an improvement by the heart failure community. Nevertheless, half of all patients suffering from heart failure are now classified as having HFmrEF or heart failure with preserved ejection fraction (HFpEF), but the etiology and treatment options differ substantially. To elucidate this issue, the current review aims to highlight the key findings published to date. This should minimize the confusion that may have been generated by the new term "HFmrEF".
Collapse
|
5
|
Cuthbert JJ, Pellicori P, Clark AL. Interatrial shunt devices for heart failure with normal ejection fraction: a technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:123-132. [PMID: 28652826 PMCID: PMC5476655 DOI: 10.2147/mder.s113105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Heart failure with normal ejection fraction (HeFNEF) accounts for ~50% of heart failure admissions. Its pathophysiology and diagnostic criteria are yet to be defined clearly which may hinder the search for effective treatments. The clinical hallmark of HeFNEF is exertional breathlessness, often due to an abnormal increase in left atrial pressure during exercise. Creation of an interatrial communication to offload the left atrium is a possible therapeutic approach. There are two percutaneously delivered devices currently under investigation which are discussed in this review.
Collapse
Affiliation(s)
- Joseph J Cuthbert
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| | - Pierpaolo Pellicori
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| | - Andrew L Clark
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| |
Collapse
|
6
|
Sardu C, Santamaria M, Rizzo MR, Barbieri M, di Marino M, Paolisso G, Santulli G, Marfella R. Telemonitoring in heart failure patients treated by cardiac resynchronisation therapy with defibrillator (CRT-D): the TELECART Study. Int J Clin Pract 2016; 70:569-76. [PMID: 27291327 PMCID: PMC5813682 DOI: 10.1111/ijcp.12823] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
AIM Telemonitoring (TM) is a safe and efficient monitoring system for internal cardioverter defibrillator device (ICD) recipients. TM has been used to track info on the clinical status of heart failure patients treated by ICD and/or cardiac resynchronisation therapy defibrillator (CRT-D). The aim of this study was to investigate the impact of TM on clinical outcomes in a population of CRT-D patients with heart failure. METHODS In a multicentre, randomised study, patients with chronic heart failure, New York Heart Association (NYHA) functional class II or III, left bundle branch block, severe left ventricle ejection fraction reduction (LVEF < 35%) have been identified and screened. RESULTS One hundred and ninety-one patients have been randomised to receive either a CRT-D with TM or a CRT-D with traditional ambulatory monitoring (control group) and completed the 12-month study follow-up. Primary endpoints were all cause death, cardiac death and hospital admission for heart failure. Secondary endpoints were atrial fibrillation, sustained episodes, non-sustained and self terminated ventricular tachyarrhythmia, sustained ventricular tachycardia, and ventricular fibrillation, ICD shocks and percentage of CRT-D responder patients. Univariate analysis identified the following factors predicting hospitalisation: TM, age, chronic kidney disease, hypercholesterolaemia, LVEF and NYHA class. At multivariate analysis, TM was the only factor predicting heart failure hospitalisation (hazard ratio 0.6, 0.42-0.79, 95% CI, p = 0.002), without affecting overall mortality and cardiac deaths events. CONCLUSIONS Taken together, our data indicate the importance of TM in predicting heart failure hospitalisation in patients treated with CRT-D.
Collapse
Affiliation(s)
- C Sardu
- Department of Arrhythmias and Electrophysiology, 'John Paul II' Research and Care Foundation, Campobasso, Italy
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| | - M Santamaria
- Department of Arrhythmias and Electrophysiology, 'John Paul II' Research and Care Foundation, Campobasso, Italy
| | - M R Rizzo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| | - M Barbieri
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| | - M di Marino
- Department of Arrhythmias and Electrophysiology, 'John Paul II' Research and Care Foundation, Campobasso, Italy
| | - G Paolisso
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| | - G Santulli
- Columbia University Medical Center, New York, NY, USA
| | - R Marfella
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| |
Collapse
|
7
|
Albert NM. A systematic review of transitional-care strategies to reduce rehospitalization in patients with heart failure. Heart Lung 2016; 45:100-13. [PMID: 26831374 DOI: 10.1016/j.hrtlng.2015.12.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 11/16/2015] [Accepted: 12/02/2015] [Indexed: 01/19/2023]
Abstract
The objective of this review was to evaluate existing transition-of-care models and identify common themes that may minimize exacerbation and rehospitalization, and improve quality of life for patients with heart failure (HF). HF is a significant burden in the United States and a common reason for recurrent hospitalizations. When multidisciplinary health care providers function as liaisons and educators during transition from hospital to home, they help prepare patients for life with chronic HF and mitigate the need for readmission. Systematic literature searches were performed to identify research papers relevant to transition-of-care themes in HF. Eight common themes were identified that can be applied to patients with HF to improve long-term outcomes. This paper emphasizes ways in which health care providers can implement theme-based transitional care, including providing patients and caregivers with practical skills and services that promote knowledge and engagement in self-care and stimulate active communication with health care providers.
Collapse
Affiliation(s)
- Nancy M Albert
- Cleveland Clinic, 9500 Euclid Avenue, Mail code J3-4, Cleveland, OH 44195, USA.
| |
Collapse
|
8
|
Pellicori P, Kaur K, Clark AL. Fluid Management in Patients with Chronic Heart Failure. Card Fail Rev 2015; 1:90-95. [PMID: 28785439 PMCID: PMC5490880 DOI: 10.15420/cfr.2015.1.2.90] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
Congestion, or fluid overload, is a classic clinical feature of patients presenting with heart failure patients, and its presence is associated with adverse outcome. However, congestion is not always clinically evident, and more objective measures of congestion than simple clinical examination may be helpful. Although diuretics are the mainstay of treatment for congestion, no randomised trials have shown the effects of diuretics on mortality in chronic heart failure patients. Furthermore, appropriate titration of diuretics in this population is unclear. Research is required to determine whether a robust method of detecting - and then treating - subclinical congestion improves outcomes.
Collapse
Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| | - Kuldeep Kaur
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| |
Collapse
|
9
|
Pellicori P, Kallvikbacka-Bennett A, Dierckx R, Zhang J, Putzu P, Cuthbert J, Boyalla V, Shoaib A, Clark AL, Cleland JGF. Prognostic significance of ultrasound-assessed jugular vein distensibility in heart failure. Heart 2015; 101:1149-58. [PMID: 26006717 DOI: 10.1136/heartjnl-2015-307558] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/29/2015] [Indexed: 11/03/2022] Open
Abstract
AIMS Jugular venous distension is a classical sign of heart failure (HF) but it can be difficult to assess clinically. METHODS AND RESULTS Outpatients with HF and control subjects were assessed. Internal jugular vein diameter (JVD) was measured using a linear high-frequency ultrasound probe (10 MHz) at rest, after a Valsalva manoeuvre and during deep inspiration. JVD ratio was calculated as the maximum diameter during Valsalva to that measured at rest. 311 patients (mean age 71 years, mean left ventricular EF 42%, median (IQR) amino-terminal pro-brain natriuretic peptide 979 (441-2007) ng/L) and 66 controls were included. JVD (median and IQR range) at rest was smaller in controls (0.16 (0.14-0.20) cm) than in patients with HF (0.23 (0.17-0.33) cm; p<0.001) but similar during Valsalva (1.03 (0.90-1.16) cm vs 1.08 (0.90-1.25) cm; p=0.28). Consequently, JVD ratio was greater in controls (6.3 (4.9-7.6)) than in patients (4.5 (2.9-6.1); p<0.001). During a median follow-up of 516 (IQR 335-622) days, 48 patients (15%) with HF died or were hospitalised for HF. In multivariable models, among clinical, echocardiographic or biochemical variables, only increasing NT-proBNP and ultrasound assessment of internal jugular vein were independently associated with prognosis. Comparing top and bottom tertiles of JVD ratio (2.3 (IQR 1.7-2.9) versus 6.8 (6.1-7.7)), the tertile with lower values had a 10-fold greater risk of an adverse event (HR 10.05, 95% CI 3.07 to 32.93). CONCLUSIONS Ultrasound assessment of the internal jugular vein identifies outpatients with HF who have a higher risk of an adverse outcome. CLINICAL TRIAL REGISTRATION NCT01872299.
Collapse
Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Anna Kallvikbacka-Bennett
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Riet Dierckx
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Jufen Zhang
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Paola Putzu
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Joe Cuthbert
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Vennela Boyalla
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Ahmed Shoaib
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Andrew L Clark
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - John G F Cleland
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College, London, UK
| |
Collapse
|
10
|
Abstract
Many patients with heart failure (HF) have a normal left ventricular ejection fraction, and are labelled as having HF with preserved left ventricular ejection fraction (HFPEF). Hypertension, atrial fibrillation and age are important contributors to the development of HFPEF and, therefore, its prevalence is likely to increase in the next few decades. The pathophysiology of HFPEF is heterogeneous but with a final common pathway leading to congestion. HF remains a clinical diagnosis but the plasma concentration of B-type natriuretic peptide (eg BNP/N-terminal prohormone BNP (NT-proBNP)), a marker of congestion, is an essential component. Imaging, usually by echocardiography, is required to determine the cardiac phenotype (ie valve disease, left ventricular ejection fraction) underlying HF. A superficially normal echocardiogram does not exclude a diagnosis of HF. No treatment has been shown conclusively to alter the prognosis of HFPEF. However, treatments directed at congestion and hypertension, such as diuretics, mineralocorticoid receptor antagonists (MRAs) and angiotensin converting-enzyme inhibitors, may improve symptoms and probably do improve outcomes. No treatment has yet been shown to reverse the underlying myocardial pathology of HFPEF, although there is some hope that MRAs might.
Collapse
Affiliation(s)
| | - John G F Cleland
- Cardiovascular Biomedical Research Unit Royal Brompton and Harefield Hospitals, Imperial College, London, UK
| |
Collapse
|