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All content in this area was uploaded by Ercole Vellone on Jun 19, 2015
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Content uploaded by Ercole Vellone
Author content
All content in this area was uploaded by Ercole Vellone on Jun 19, 2015
Content may be subject to copyright.
Content uploaded by Ercole Vellone
Author content
All content in this area was uploaded by Ercole Vellone on Jun 19, 2015
Content may be subject to copyright.
Poster Session 3 301
Methods: We evaluated ID in patients with CHF at entry to a heart failure unit
of 3 university hospitals. ID was dened as a ferritin <100 ug/L or a Transferrin
Saturation <20% if ferritin between 100 and 299 ug/L. We retrospectively assessed
treatment with IV Iron at any point after entry. Time to rst hospitalization due to
decompensated CHF or any cause was evaluated using Kaplan Meier survival
curves.
Results: We included 2172 patients, 65% males, median age of 72 years and
median left ventricular ejection fraction of 36%. Median glomerular ltration rate
was 53 ml/min, NT-proBNP of 1484 pg/mL, haemoglobin of 12.7 g/dL and 37%
in NYHA functional class III-IV. ID was present in 55% and 461 patients (21%)
received IV Iron and 6% EPO. Median follow-up was 19 months. Figure 1 shows
how patients with ID had more re-hospitalizations due to CHF than those without
ID, however IV iron was associated with more re-hospitalizations due to CHF. A
similar picture was seen with re-hospitalizations due to any cause.
Conclusions: Patients with CHF and ID had more re-hospitalizations due to
decompensated CHF or to any cause. Paradoxically, treatment with IV Iron was
associated with more re-hospitalizations. We do not think IV Iron caused more
re-hospitalizations. Because IV Iron was assessed at any point in time during
follow-up, this nding probably reects the current pattern of use of IV Iron, where
it is more often used if the patient decompensates and not up-front.
Re-hospitalizations in CHF
P1437
How comorbidity, self-care confidence and self-care behaviors interact to
predict hospitalization in heart failure patients
E Vellone1;HG Buck
2;VV Dickson
3;R Fida
4; F D’agostino1; R Alvaro1;B
Riegel5
1University of Rome Tor Vergata, Rome, Italy;2Pennsylvania State University,
University Park, PA, United States of America;3New York University, New York,
United States of America;4Sapienza University of Rome, Rome, Italy;5University of
Pennsylvania, School of Nursing, Philadelphia, United States of America
Purpose: As many as 70% of heart failure (HF) patients suffer from at least one
other chronic condition. Comorbidity in HF is associated with frequent hospitaliza-
tions. Self-care can mitigate poor outcomes. Yet, lack of condence is known to
interfere with self-care when more than one chronic condition exists. The mecha-
nism by which comorbidity, self-care condence and self-care behaviors interact
to predict hospitalization in HF patients is unclear. The aim of this study was test
an explanatory model of predictors of hospitalization by: 1) identifying the contri-
bution of comorbidity to HF self-care behaviors and hospitalization, and 2) testing
comorbidity as a moderator of the relationship between self-care condence and
HF self-care behaviors.
Methods: We conducted a secondary analysis of data from a cross sectional study
of 628 HF patients enrolled across Italy. All participants: 1) had a conrmed diag-
nosis of HF; 2) were stable in the preceding month; 3) were age >18 years; and 4)
had symptoms in the last month so that we could analyze their symptom manage-
ment behaviors. Both comorbidity, as measured by the 12 item Charlson Comor-
bidity Index total score, and hospitalization were evaluated from medical record
review. Self-care was measured with the Self-Care of HF Index v.6.2. All three scales
(maintenance, management, condence) yield standardized scores ranging 0-100
with higher scores indicating higher HF self-care. Structural equation modeling and
post-hoc simple slope analysis were used to analyze the data.
Results: Participants were primarily male (58%), older (73 years old, SD =11) and
NYHA class II or III (75%). In model testing, higher numbers of hospitalization were
associated with lower self-care maintenance (i.e. treatment adherence and symptom
monitoring) and higher comorbidity. Higher self-care maintenance was associated
with higher self-care condence. Higher self-care management (i.e. symptom man-
agement behaviors) was associated with lower comorbidity and higher self-care
condence. Slope analysis showed that comorbidity moderated the relationship
between self-care condence and self-care maintenance. As the level of comorbidity
increased, the effect of self-care condence on self-care maintenance decreased.
The nal model t the data well (t indices: CFI =0.99, RMSEA =0.03).
Conclusion: Self-care condence plays a key role in the relationship between
comorbidity and self-care in inuencing hospitalization. When patients have comor-
bid conditions, interventions designed to improve self-care condence may help to
decrease hospitalizations.
HEART FAILURE DIAGNOSIS
P1438
First HF admission: doppler echocardiographic differences based on left
ventricular ejection fraction
P Paula Martinez Santos1; I Vilacosta2; E Batlle Lopez3; B Sanchez Sauce3;
E Espana Barrio3; J Jimenez Valtierra3; A De La Rosa Riestra3;J AlonsoBello
3;
F Perez Gonzalez3; MD Martin Rios4
1Hospital de Fuenlabrada, Cardiology, Madrid, Spain;2Hospital Clinic San Carlos,
Cardiology, Madrid, Spain;3University Hospital Alcorcon Foundation, Cardiology,
Madrid, Spain;4Foundation Jimenez Diaz, Madrid, Spain
Purpose: The heart failure (HF) syndrome has been divided according to the left
ventricle ejection fraction (LVEF) into two different entities: HF with reduced ejection
fraction (HF REF, LVEF<50%) and HF with preserved ejection fraction (HF PEF,
LVEF≥50%). Nevertheless, diastole and systole are part of a continuum process
which makes this classication somewhat articial. The aim of this study was to
compare the Doppler diastolic echocardiographic parameters among HF patients
hospitalized for the rst time. METHODS We prospectively collected data from 116
patients admitted to the Cardiology or Internal Medicine Units during 3 months.
We only included patients whom LVEF was not previously known. Patients with
advanced chronic renal disease, high output HF, congenital heart disease, mitral
or aortic prosthesis or severe mitral or aortic native valve disease. RESULTS Out
of the 116 patients, 82 had PEF and 34 REF. Average age (SD) was 79.7 years
(8.4) among HF PEF patients and 76 (12.9) in the REF group (p=0.064). HF PEF
was found predominantly in women (87.5% vs 12.5%, p <0.0001). Patients with HF
REF were more frequently admitted to Cardiology (p=0.007). The median (IQR) of
the NT proBNP was higher in the HF REF group, 6474 (14463) ng/l vs 1831 (3969)
ng/l, p =0.003. The main baseline echocardiographic characteristics of both cohorts
are summarized in Table 1. HF REF had worse LV diastolic dysfunction: the early
diastolic velocity of mitral annulus obtained by DTI (e’) was lower and the E/e’ ratio
of the mitral inow E wave to the tissue Doppler e’ wave was higher among patients
with LVEF <50%. The E wave deceleration time was also lower among HF REF
patients.CONCLUSIONS Hospitalized HF patients with HF REF had worse diastolic
function than patients with HF PEF.
Table 1. Echocardiographic differences
LVEF <50% X (SD) LVEF ≥50% X (SD) p
LVEDVI ml/m265,76 (28,06) 38,47 (15,74) <0,0001
LVEF Simpson % 29,85 (12,70) 65,73 (7,87) <0,0001
émitral annulus
wave cm/s
4,8 (1,6) 6,6 (2,1) <0,0001
E/e ́septal ratio 19,5 (6,9) 15,6 (6,6) 0,005
E/e ́lateral ratio 15,0 (6,1) 12,9 (6.1) 0,126
E wave deceleration
time ms
177 (87) 214 (86) 0,039
Left ventricular
dp/dt mmHg/s
757 (440) 1515 (1136) <0,0001
LVEDVI: Left ventricle end-diastolic volume index
P1439
Ultrasound diagnosis of pulmonary edema in congestive heart failure;
simplified approach
M Mikheil Tsverava1
1Tbilisi Medical Academy, Tbilisi, Georgia, Republic of
Pulmonary edema (PE), due to uid retention and redistribution is the cardinal
manifestations of heart failure (HF). The aim of this investigation was to study the
effectiveness of simplied thoracic sonography in diagnosis of PE
Material and methods: 400 patients with II-IV NYHA functional class HF were
evaluated (105 patients with diastolic and 295 with systolic HF). The control group
consisted of 160 patients with different heart diseases (CHD, Hypertension, Aortic
valve diseases), but without HF. Sonographic examination of a lung was done with
3,0-4,0 MgHz convex or sector probe, from 10 points on thoracic wall (cross points
of midclavicular line with II, IV and V intercostal spaces and anterior axilar line with
IV and V intercostal spaces), which corresponded to the projection of lower, middle
and upper lobes of right lung and upper and lower lobes of left lung.
Results: During ultrasound examination 94.5% of patients with HF had "Comet
tail phenomenon" (CTPh), which was registered only in 35,5% patients without HF
(p >0,001). In DHF group CTPh was registered in 90,5% and in systolic HF group in
95,9% patients. In 91% of patients with HF CTPh was registered from 3 and more
registration points. In control group CTPh was registered from more than 3 points
© 2015 The Authors
European Journal of Heart Failure © 2015 European Society of Cardiology, 17 (Suppl. 1), 5– 441
