Dipeptidyl Peptidase-4 Inhibitors Do Not Exacerbate Heart Failure
Descrição do Produto
The 18th Annual Scientific Meeting
HFSA
S47
Outcomes I 112 Ischemic Cardiomyopathy Patients on Coumadin for Atrial Fibrillation Experience More Adverse Events with Clopidogrel or Percutaneous Coronary Intervention Abiodun Ishola, Montoya Taylor, Ayesha Hasan, Sakima Smith; Ohio State University Medical Center, Columbus, OH Background: Heart failure (HF) patients who develop Atrial Fibrillation (AF) are at an increased risk for adverse events. When these patients also have coronary disease (CAD), dual antiplatelet therapy may increase the risk of bleeding. We hypothesized that HF patients with CAD who develop AF will have worse outcomes when antiplatelet therapy is added to warfarin or if these patients have percutaneous coronary intervention (PCI), which also requires antiplatelet therapy. Method: This was a retrospective review of 255 HF patients with CAD and AF who were placed on warfarin. Our primary outcomes were time to death and time to first adverse event (myocardial infraction, stroke, pulmonary embolism or death) after the development of AF. Results: Cox analysis demonstrated that a history of PCI was associated with a higher hazard of death and clopidogrel use was associated with a higher hazard of an adverse event (Figure 1). Multivariable models identified that sotalol use increased the risk of death (HR 1.85, CI 1.1-3.1) and that end-stage renal disease (HR 1.8, CI 1.04-2.46) and chronic obstructive pulmonary disease (HR 1.5, CI 1.16-2.8) were predictors for an adverse event. Conclusion: HF patients with CAD complicated by AF who had PCI or used clopidogrel were more likely to experience death or to have an adverse event, respectively. These outcomes were likely related to an increased risk of bleeding.
Figure 1. Table. Demographics table: N 5255 patients (HF and known CAD diagnosis on Coumadin for AF)
Variables Gender (%Male) HTN DM ASA Plavix/Clopidogrel Race Sotalol COPD NYHA class (3-4) Age O75 Age O65 Stroke MI PE
164/255 (64.3%) 213/255 (83.5%) 169/255 (66.3%) 239/255 (93.7%) Plavix 41/255(16%), clopidogrel 116/255(45.4%) 189/255 74.1%White, 57/255(22.3%) AA 21/255(8.2%) 116/255(45) 133+35/255(65.8%) 40/255(15.7%) 98/255(38.4%) 78/255(30.5%) 79/255(30.9%) 17/255(6.6%)
included all key ACCF/AHA guideline topics (professionals inter-rater reliability O 90%) as well as supportive interactions where patients identified and resolved HF self -management problems with professionals. At 12 months, a significantly greater percentage of patients in the group clinics had improved HF self-care skills of reducing salt intake, medications, and exercise than standard care patients (c25 4.99, p5.026). Costs of all the intervention components were itemized and tallied including: a) the cost per hour for each multidisciplinary professional; b) the costs for all items provided to each patient; and c) the administrative costs associated with the printing of patient handouts and clinic packets. These costs were added together then averaged to calculate the total cost per patient for each group appointment. The cost for the five group appointments is $243.58. Conclusions: NP led, multidisciplinary group appointments are feasible, highly evaluated by HF patients and professional observations ratings. The data indicates those in the intervention group use HF self-management strategies of daily weighting, monitored symptoms for fluid retention, used low sodium diet, limited their fluids and took prescribed medications. The cost of the program is less than the current Medicare reimbursement for group education. This is certainly less than the cost of one HF emergency room visit or a HF hospitalization.
114 Dipeptidyl Peptidase-4 Inhibitors Do Not Exacerbate Heart Failure Arun Kanmanthareddy1, Sandeep Koripalli1, Avanija R. Buddam1, Madhu Reddy1, Ajay Vallakati2, Sudharani Bommana1, Donita Atkins1, Dhanunjaya Lakkireddy1; 1 The University of Kansas Medical Center, Kansas City, KS; 2Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH Introduction: Dipetidyl peptidase-4 (DPP-4) inhibitors are used for the treatment of diabetes mellitus and are supposedly known to have cardio-protective effects. However, a recent randomized controlled trial has shown that DPP-4 inhibitor use is associated with an increased risk for heart failure. In the light of this evidence, we performed a meta-analysis to review the risk of heart failure risk with the use of DPP-4 inhibitor use. Methods: We performed an electronic search for published studies on DPP-4 inhibitors. PubMed, Embase, Cochrane and Google Scholar databases were searched for the studies. Studies were then screened for reporting on heart failure incidence with the use of DPP-4 inhibitors. Revman 5.2 software was then used for carrying out the meta-analysis using Mantel-Haenszel random effects model. Results: A total of 5 studies met our inclusion and exclusion criteria of which, 4 were randomized control studies and 1 was a pooled analysis. Total number of subjects included in the meta-analysis was 33,642 patients out of which 18,480 patients were taking DPP-4 inhibitors and 15,162 patients were in the control group. The control group comprised of patients who were given either placebo (13,753 patients) or other anti-diabetic medications as a comparator (1409 patients). The final analysis showed no significant increase in the incidence of heart failure (Odds ratio 1.06, 95% CI 0.84 - 1.33) in patients taking DPP-4 inhibitors. Of all the 5 studies that were included, significant increase in the incidence of heart failure with DPP-4 inhibitors was evident in only one randomized control study (SAVOR-TIMI 53 trial). The baseline characteristics of the SVAOR TIMI 53 patients, which included patients with significant cardiovascular disease or multiple risk factors for vascular disease may have significantly increased the risk of heart failure among SAVOR TIMI 53 patients taking DPP-4 inhibitors. Conclusion: The results of cumulative meta-analysis suggest that use of DPP-4 inhibitors is not associated with increased risk for heart failure. However given the results observed in SAVOR TIMI 53 study, caution with DPP-4 inhibitor use needs to be exercised in patients with significant pre-existing cardiovascular disease. Further studies are recommended to evaluate this risk.
113 To Improve Heart Failure (HF) Self-Management through Patients Group Clinic Appointments Carol E. Smith; University of Kansas Shcool of Nursing, Frisco, TX Objectives: To improve heart failure (HF) self-management through patients group clinic appointments. Background: Over 70% of HF readmissions are preventable if patient had better self-management skills. Group Clinics Trial evaluated the effects of multi-disciplinary group clinic appointments on the development of self-care skills in the higher risk HF patient. Methods: Data were collected from the 72 group clinic appointments via: 1) patient evaluations; 2) group discussion content analysis. Results: Overall, patients rated group appointments as 4.8 out of 5 on the “helpfulness” score; group dynamics observations score was 4.1 (out of 5) reflecting active participation by group members. Content analysis revealed group discussions
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115 Self-Reported Sleep Dysfunction is Associated with Worse Cardiac Event-Free Survival in Patients with Heart Failure Kyoung Suk Lee1, Terry A. Lennie2, Sandra B. Dunbar3, Susan J. Pressler4, Seongkum Heo5, Debra K. Moser2; 1University of Wisconsin-Madison, Madison, WI; 2University of Kentucky, Lexington, KY; 3Emory University, Atlanta, GA;
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