The Effect of Emergency Department Visits and Inflammatory Markers on One-Year Mortality in Patients with Heart Failure
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The Effect of Emergency Department Visits and Inflammatory Markers on One‑Year Mortality in Patients with Heart Failure Ataman Köse1 · Ahmet Çelik2 · Ersin Altınsoy1 · Seyran Bozkurt Babus1 · Semra Erdoğan3 Received: 17 April 2020 / Accepted: 21 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The neurohumoral and inflammatory pathways proposed for the development and progression of heart failure (HF) remain up-to-date. We aimed to investigate the effect of emergency department (ED) visits and inflammatory markers on mortality in HF patients. Two-hundred patients with stable chronic HF followed by the cardiology clinic were included in this study. The patients were divided into two groups as patients who had visited the ED due to worsening HF symptoms within the last 6 months (ED visit Group) and who had not (No ED visit Group). The demographical properties, clinical characteristics, and laboratory values including inflammatory markers of the patients were recorded. During the follow-up period, 38 patients (19%) died. In HF patients with previous ED visits, the mortality risk was 2.091 times higher (relative risk, RR). It was identified that the HF patients who died during the follow-up had higher initial NLR (p = 0.004), IG% (p = 0.029), hs-CRP (p = 0.001), and NT-proBNP (p = 0.004) values. It was observed that the area under the curve (AUC) values, NLR (AUC: 0.705, p 0.4 (95% CI 1.16–4.957), and 4,2 times higher when hs-CRP > 9.9 mg/ dl (95% CI 2.16–8.16) (p 9.9 mg/dL, and 3.839 times higher in patients with NT-proBNP > 3270 (p 3.7, IG% > 0.4, and hsCRP > 9.9 mg/L. According to these cut-off values, inflammatory markers are associated with the one-year mortality risk of HF patients. In these patients, it was identified that the mortality risk was 3.39 times higher in patients with NLR > 3.7, 2.39 times higher in patients with IG% > 0.4, and 4.2 times higher in patients with hs-CRP > 9.9 mg/L. In general, it is predicted that HF patients who present to the ED are acute, more severe, and have more negative outcomes. Between 2008 and 2014, 41% of HF patients presented to the outpatient clinics, 11% to EDs, and 47% directly to hospitals. However, data from this study show
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Cardiovascular Toxicology
Table 1 The Baseline characteristics of the patients according to emergency department visit Variables Clinical features Sex n (%) Male Female Ischemic etiology (%) NYHA Class, n (%) I/II III/IV HF type, n (%) HfrEF HfpEF Age (mean, SD) Systolic blood pressure (mm Hg), (Mean, SD) Diastolic blood pressure (mm Hg), (Mean, SD) Heart rate (beats/min), (Mean, SD) Medical history n (%) CABG Diabetes mellitus Hypertension Cerebrovascular disease Chronic kidney disease Chronic lung disease Smoke ICD CRT Pacemaker Medications, n (%) RAASi Beta-blockers Loop diuretic MRAs Digoxin Aspirin Ivabradine Nitrates ECG rhythm, n (%) Sinus rhythm Atrial fibrillation Pace rhythm Echocardiography datas (Mean, SD) LVEF (%) LVEDD (cm) LVESD (cm) L
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