Clinicians’ Practices In Pain Assessment And Management For Elderly With Heart Failure
HFSA ePoster Library. Kang Y. 09/10/21; 343351; 129
Dr. Youjeong Kang
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Abstract
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Introduction: Heart failure with preserved ejection fraction (HFpEF) is on pace to become the most common type of heart failure in the population with a prevalence that is increasing by 1% annually. Despite this, there remains no gold standard in diagnosing HFpEF. In addition to clinical exam and history, scoring criteria including H2FPEF score and HFA-PEFF score have been validated to assist in diagnosis. Guidelines and algorithms to determine echocardiographic diastolic dysfunction have also been described.
Purpose: Our study aimed to compare the sensitivities of various clinical, biochemical and echocardiographic criteria used to diagnosis HFpEF on a cohort of admitted HFpEF patients. Methods: This was a single-center retrospective review of inpatients with a primary diagnosis of HFpEF over a 2-year period. Electronic medical records were reviewed to analyze patient demographics, medical comorbidities and laboratory results. Echocardiograms were reviewed to analyze left ventricular mass, left atrial volume index and tricuspid regurgitation jet velocity as well as parameters of diastology to determine H2FPEF, HFA-PEFF scores, and American Society of Echocardiography diastolic dysfunction (ASE-DD) grading. Sensitivities for various diagnostic criteria were compared. A subgroup analysis was performed for different cut-offs of E/e’ septal velocities. Student’s T test was performed for continuous data and statistical significant was defined as p<0.05.
Results: Over a 2 year period, 325 patients admitted with a primary diagnosis of HFpEF were analyzed. The average patient age was 80.2 years and 197 patients were female (60.6%). Brain natriuretic peptide (BNP) great than 100 pg/ml had the highest sensitivity of 94%. ASE-DD criteria for diastolic dysfunction had a sensitivity of 58%. H2FPEF risk percentage of ≥90% had sensitivity of 63%. Septal E/e’ of ≥15 had a sensitivity of 57% which increased to 90% when cut-off was lowered to ≥10. In a subgroup analysis of E/e’ <12 or ≥12, patients with E/e' ≥12 had significantly higher H2FPEF score, HFA-PEFF score and length of stay (p<0.05). Average E/e’ also had a positive correlation to percent change in BNP from baseline (R=0.83) and admission BNP (R=0.62).
Conclusion: Our study shows that current diagnostic criteria for HFpEF have relatively low sensitivity. Specifically, echocardiographic criteria may be too strict and a lower E/e’ cutoff may improve diagnostic sensitivity. The correlation of E/e’ and BNP suggests a relationship between the functional and biochemical entities of HFpEF. Further studies to optimize HFpEF diagnostic criteria are desired.
Purpose: Our study aimed to compare the sensitivities of various clinical, biochemical and echocardiographic criteria used to diagnosis HFpEF on a cohort of admitted HFpEF patients. Methods: This was a single-center retrospective review of inpatients with a primary diagnosis of HFpEF over a 2-year period. Electronic medical records were reviewed to analyze patient demographics, medical comorbidities and laboratory results. Echocardiograms were reviewed to analyze left ventricular mass, left atrial volume index and tricuspid regurgitation jet velocity as well as parameters of diastology to determine H2FPEF, HFA-PEFF scores, and American Society of Echocardiography diastolic dysfunction (ASE-DD) grading. Sensitivities for various diagnostic criteria were compared. A subgroup analysis was performed for different cut-offs of E/e’ septal velocities. Student’s T test was performed for continuous data and statistical significant was defined as p<0.05.
Results: Over a 2 year period, 325 patients admitted with a primary diagnosis of HFpEF were analyzed. The average patient age was 80.2 years and 197 patients were female (60.6%). Brain natriuretic peptide (BNP) great than 100 pg/ml had the highest sensitivity of 94%. ASE-DD criteria for diastolic dysfunction had a sensitivity of 58%. H2FPEF risk percentage of ≥90% had sensitivity of 63%. Septal E/e’ of ≥15 had a sensitivity of 57% which increased to 90% when cut-off was lowered to ≥10. In a subgroup analysis of E/e’ <12 or ≥12, patients with E/e' ≥12 had significantly higher H2FPEF score, HFA-PEFF score and length of stay (p<0.05). Average E/e’ also had a positive correlation to percent change in BNP from baseline (R=0.83) and admission BNP (R=0.62).
Conclusion: Our study shows that current diagnostic criteria for HFpEF have relatively low sensitivity. Specifically, echocardiographic criteria may be too strict and a lower E/e’ cutoff may improve diagnostic sensitivity. The correlation of E/e’ and BNP suggests a relationship between the functional and biochemical entities of HFpEF. Further studies to optimize HFpEF diagnostic criteria are desired.
Introduction: Heart failure with preserved ejection fraction (HFpEF) is on pace to become the most common type of heart failure in the population with a prevalence that is increasing by 1% annually. Despite this, there remains no gold standard in diagnosing HFpEF. In addition to clinical exam and history, scoring criteria including H2FPEF score and HFA-PEFF score have been validated to assist in diagnosis. Guidelines and algorithms to determine echocardiographic diastolic dysfunction have also been described.
Purpose: Our study aimed to compare the sensitivities of various clinical, biochemical and echocardiographic criteria used to diagnosis HFpEF on a cohort of admitted HFpEF patients. Methods: This was a single-center retrospective review of inpatients with a primary diagnosis of HFpEF over a 2-year period. Electronic medical records were reviewed to analyze patient demographics, medical comorbidities and laboratory results. Echocardiograms were reviewed to analyze left ventricular mass, left atrial volume index and tricuspid regurgitation jet velocity as well as parameters of diastology to determine H2FPEF, HFA-PEFF scores, and American Society of Echocardiography diastolic dysfunction (ASE-DD) grading. Sensitivities for various diagnostic criteria were compared. A subgroup analysis was performed for different cut-offs of E/e’ septal velocities. Student’s T test was performed for continuous data and statistical significant was defined as p<0.05.
Results: Over a 2 year period, 325 patients admitted with a primary diagnosis of HFpEF were analyzed. The average patient age was 80.2 years and 197 patients were female (60.6%). Brain natriuretic peptide (BNP) great than 100 pg/ml had the highest sensitivity of 94%. ASE-DD criteria for diastolic dysfunction had a sensitivity of 58%. H2FPEF risk percentage of ≥90% had sensitivity of 63%. Septal E/e’ of ≥15 had a sensitivity of 57% which increased to 90% when cut-off was lowered to ≥10. In a subgroup analysis of E/e’ <12 or ≥12, patients with E/e' ≥12 had significantly higher H2FPEF score, HFA-PEFF score and length of stay (p<0.05). Average E/e’ also had a positive correlation to percent change in BNP from baseline (R=0.83) and admission BNP (R=0.62).
Conclusion: Our study shows that current diagnostic criteria for HFpEF have relatively low sensitivity. Specifically, echocardiographic criteria may be too strict and a lower E/e’ cutoff may improve diagnostic sensitivity. The correlation of E/e’ and BNP suggests a relationship between the functional and biochemical entities of HFpEF. Further studies to optimize HFpEF diagnostic criteria are desired.
Purpose: Our study aimed to compare the sensitivities of various clinical, biochemical and echocardiographic criteria used to diagnosis HFpEF on a cohort of admitted HFpEF patients. Methods: This was a single-center retrospective review of inpatients with a primary diagnosis of HFpEF over a 2-year period. Electronic medical records were reviewed to analyze patient demographics, medical comorbidities and laboratory results. Echocardiograms were reviewed to analyze left ventricular mass, left atrial volume index and tricuspid regurgitation jet velocity as well as parameters of diastology to determine H2FPEF, HFA-PEFF scores, and American Society of Echocardiography diastolic dysfunction (ASE-DD) grading. Sensitivities for various diagnostic criteria were compared. A subgroup analysis was performed for different cut-offs of E/e’ septal velocities. Student’s T test was performed for continuous data and statistical significant was defined as p<0.05.
Results: Over a 2 year period, 325 patients admitted with a primary diagnosis of HFpEF were analyzed. The average patient age was 80.2 years and 197 patients were female (60.6%). Brain natriuretic peptide (BNP) great than 100 pg/ml had the highest sensitivity of 94%. ASE-DD criteria for diastolic dysfunction had a sensitivity of 58%. H2FPEF risk percentage of ≥90% had sensitivity of 63%. Septal E/e’ of ≥15 had a sensitivity of 57% which increased to 90% when cut-off was lowered to ≥10. In a subgroup analysis of E/e’ <12 or ≥12, patients with E/e' ≥12 had significantly higher H2FPEF score, HFA-PEFF score and length of stay (p<0.05). Average E/e’ also had a positive correlation to percent change in BNP from baseline (R=0.83) and admission BNP (R=0.62).
Conclusion: Our study shows that current diagnostic criteria for HFpEF have relatively low sensitivity. Specifically, echocardiographic criteria may be too strict and a lower E/e’ cutoff may improve diagnostic sensitivity. The correlation of E/e’ and BNP suggests a relationship between the functional and biochemical entities of HFpEF. Further studies to optimize HFpEF diagnostic criteria are desired.
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