Plication Of A High-flow Arteriovenous Fistula Resulting In Improvement Of High-output Heart Failure
HFSA ePoster Library. Wong J. 09/10/21; 343653; 93
Joseph Isaac Wong
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Abstract
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Introduction: The initiation of sacubitril/valsartan (S/V) after hemodynamic stabilization in patients hospitalized for acute decompensated heart failure has been shown to be safe and effective. There are limited data suggesting that S/V is safe in patients in cardiogenic shock. The optimal timing of initiation or resumption of therapy remains uncertain.
Hypothesis: S/V is safe and tolerable for patients in cardiogenic shock requiring inotropic support.
Methods: We identified patients with an ICD 9/10 code diagnosis of heart failure with reduced ejection fraction who had been admitted to the cardiac intensive care unit of a quaternary care medical center between January 1, 2017 and December 31, 2020. Within this cohort, we identified 19 patients who were treated with S/V while receiving inotropic support. Demographics and clinical characteristics (laboratory results and invasive hemodynamics) were collected. Opening hemodynamics were obtained within 24 hours of admission and closing hemodynamics were obtained after weaning off or selecting a stable discharge dose of inotrope. Differences between clinical characteristics were compared using paired Wilcoxon signed rank tests.
Results: 19 patients (100%) received milrinone and 3 patients (15.8%) additionally received dobutamine during their hospitalization. Cardiac index increased from 1.70 L/min/m2 [interquartile range [IQR], 1.50-2.20 L/min/m2] to 2.50 L/min/m2 ([IQR, 2.20-2.70 L/min/m2]; p<0.001) and systemic vascular resistance decreased from 1490 dynes/sec/cm5 [IQR, 1340-1741 dynes/sec/cm5] to 945 dynes/sec/cm5 ([IQR, 864-1102 dynes/sec/cm5]; p<0.001). Serum creatinine and potassium remained stable from admission to discharge (p for both > 0.05). At discharge, 14 patients (73.7%) were prescribed S/V. Of the patients discharged on S/V, 5 (35.7%) were also discharged on milrinone. S/V was discontinued prior to discharge due to hypotension in 4 patients (21.1%) and acute kidney injury in 1 patient (5.3%). At 3 months post-discharge, a majority of patients (68.4%) remained on S/V.
Conclusions: Patients in cardiogenic shock requiring inotropic support can safely receive S/V without a significant increase in serum creatinine or potassium. Further analyses of larger cohorts should explore the ideal timing for initiating or resuming S/V in patients receiving inotropic support. Establishing the safety and tolerability of this practice may lead to earlier adoption and/or decreased interruption of guideline directed medical therapy.
Hypothesis: S/V is safe and tolerable for patients in cardiogenic shock requiring inotropic support.
Methods: We identified patients with an ICD 9/10 code diagnosis of heart failure with reduced ejection fraction who had been admitted to the cardiac intensive care unit of a quaternary care medical center between January 1, 2017 and December 31, 2020. Within this cohort, we identified 19 patients who were treated with S/V while receiving inotropic support. Demographics and clinical characteristics (laboratory results and invasive hemodynamics) were collected. Opening hemodynamics were obtained within 24 hours of admission and closing hemodynamics were obtained after weaning off or selecting a stable discharge dose of inotrope. Differences between clinical characteristics were compared using paired Wilcoxon signed rank tests.
Results: 19 patients (100%) received milrinone and 3 patients (15.8%) additionally received dobutamine during their hospitalization. Cardiac index increased from 1.70 L/min/m2 [interquartile range [IQR], 1.50-2.20 L/min/m2] to 2.50 L/min/m2 ([IQR, 2.20-2.70 L/min/m2]; p<0.001) and systemic vascular resistance decreased from 1490 dynes/sec/cm5 [IQR, 1340-1741 dynes/sec/cm5] to 945 dynes/sec/cm5 ([IQR, 864-1102 dynes/sec/cm5]; p<0.001). Serum creatinine and potassium remained stable from admission to discharge (p for both > 0.05). At discharge, 14 patients (73.7%) were prescribed S/V. Of the patients discharged on S/V, 5 (35.7%) were also discharged on milrinone. S/V was discontinued prior to discharge due to hypotension in 4 patients (21.1%) and acute kidney injury in 1 patient (5.3%). At 3 months post-discharge, a majority of patients (68.4%) remained on S/V.
Conclusions: Patients in cardiogenic shock requiring inotropic support can safely receive S/V without a significant increase in serum creatinine or potassium. Further analyses of larger cohorts should explore the ideal timing for initiating or resuming S/V in patients receiving inotropic support. Establishing the safety and tolerability of this practice may lead to earlier adoption and/or decreased interruption of guideline directed medical therapy.
Introduction: The initiation of sacubitril/valsartan (S/V) after hemodynamic stabilization in patients hospitalized for acute decompensated heart failure has been shown to be safe and effective. There are limited data suggesting that S/V is safe in patients in cardiogenic shock. The optimal timing of initiation or resumption of therapy remains uncertain.
Hypothesis: S/V is safe and tolerable for patients in cardiogenic shock requiring inotropic support.
Methods: We identified patients with an ICD 9/10 code diagnosis of heart failure with reduced ejection fraction who had been admitted to the cardiac intensive care unit of a quaternary care medical center between January 1, 2017 and December 31, 2020. Within this cohort, we identified 19 patients who were treated with S/V while receiving inotropic support. Demographics and clinical characteristics (laboratory results and invasive hemodynamics) were collected. Opening hemodynamics were obtained within 24 hours of admission and closing hemodynamics were obtained after weaning off or selecting a stable discharge dose of inotrope. Differences between clinical characteristics were compared using paired Wilcoxon signed rank tests.
Results: 19 patients (100%) received milrinone and 3 patients (15.8%) additionally received dobutamine during their hospitalization. Cardiac index increased from 1.70 L/min/m2 [interquartile range [IQR], 1.50-2.20 L/min/m2] to 2.50 L/min/m2 ([IQR, 2.20-2.70 L/min/m2]; p<0.001) and systemic vascular resistance decreased from 1490 dynes/sec/cm5 [IQR, 1340-1741 dynes/sec/cm5] to 945 dynes/sec/cm5 ([IQR, 864-1102 dynes/sec/cm5]; p<0.001). Serum creatinine and potassium remained stable from admission to discharge (p for both > 0.05). At discharge, 14 patients (73.7%) were prescribed S/V. Of the patients discharged on S/V, 5 (35.7%) were also discharged on milrinone. S/V was discontinued prior to discharge due to hypotension in 4 patients (21.1%) and acute kidney injury in 1 patient (5.3%). At 3 months post-discharge, a majority of patients (68.4%) remained on S/V.
Conclusions: Patients in cardiogenic shock requiring inotropic support can safely receive S/V without a significant increase in serum creatinine or potassium. Further analyses of larger cohorts should explore the ideal timing for initiating or resuming S/V in patients receiving inotropic support. Establishing the safety and tolerability of this practice may lead to earlier adoption and/or decreased interruption of guideline directed medical therapy.
Hypothesis: S/V is safe and tolerable for patients in cardiogenic shock requiring inotropic support.
Methods: We identified patients with an ICD 9/10 code diagnosis of heart failure with reduced ejection fraction who had been admitted to the cardiac intensive care unit of a quaternary care medical center between January 1, 2017 and December 31, 2020. Within this cohort, we identified 19 patients who were treated with S/V while receiving inotropic support. Demographics and clinical characteristics (laboratory results and invasive hemodynamics) were collected. Opening hemodynamics were obtained within 24 hours of admission and closing hemodynamics were obtained after weaning off or selecting a stable discharge dose of inotrope. Differences between clinical characteristics were compared using paired Wilcoxon signed rank tests.
Results: 19 patients (100%) received milrinone and 3 patients (15.8%) additionally received dobutamine during their hospitalization. Cardiac index increased from 1.70 L/min/m2 [interquartile range [IQR], 1.50-2.20 L/min/m2] to 2.50 L/min/m2 ([IQR, 2.20-2.70 L/min/m2]; p<0.001) and systemic vascular resistance decreased from 1490 dynes/sec/cm5 [IQR, 1340-1741 dynes/sec/cm5] to 945 dynes/sec/cm5 ([IQR, 864-1102 dynes/sec/cm5]; p<0.001). Serum creatinine and potassium remained stable from admission to discharge (p for both > 0.05). At discharge, 14 patients (73.7%) were prescribed S/V. Of the patients discharged on S/V, 5 (35.7%) were also discharged on milrinone. S/V was discontinued prior to discharge due to hypotension in 4 patients (21.1%) and acute kidney injury in 1 patient (5.3%). At 3 months post-discharge, a majority of patients (68.4%) remained on S/V.
Conclusions: Patients in cardiogenic shock requiring inotropic support can safely receive S/V without a significant increase in serum creatinine or potassium. Further analyses of larger cohorts should explore the ideal timing for initiating or resuming S/V in patients receiving inotropic support. Establishing the safety and tolerability of this practice may lead to earlier adoption and/or decreased interruption of guideline directed medical therapy.
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