10 Cases (10%), Hypertensive Push in 6 Cases (6%), Anemia in 4 Cases (4%) and A

390 Poster Session 4

10 cases (10%), hypertensive push in 6 cases (6%), anemia in 4 cases (4%) and a

lung infection in 4 cases (4%).

Conclusion: Heart Failure rehospitalization within 6 months’ follow-up occurred

in 11% of our cohort. The highest rates of readmission were noted in those with

a diet gap and patients who discontinued maintenance therapy. Education and

improvement of living conditions are the main objectives to address this public health

problem.

P1782

Co-morbidities and age differences in patients hospitalized for acute

decompensated chronic heart failure - does it really matter?

T Teodora Zaninovic Jurjevic1; G Brumini2; Z Matana Kastelan3; N Jurjevic4;

L Skorup5; A Ruzic1; L Zaputovic1

1Clinical Hospital Center Rijeka , Rijeka, Croatia; 2Rijeka University School of

Medicine, Department of Medical Informatics, Rijeka, Croatia; 3Clinical Hospital

Center Rijeka, Department of Radiology, Rijeka, Croatia; 4Rijeka University School

of Medicine, Rijeka, Croatia; 5Primorsko Goranska County, Department of

Emergency Medicine, Rijeka, Croatia

Purpose: To analyse co-morbidities in two age groups of patients, hospitalized with

acute decompensated chronic heart failure (ADCHF).

Methods:We performed single-centre retrospective study of patients consecutively

hospitalized for ADCHF. The study was approved by the institution’s Ethics Committee.

The retrospective analysis included 1534 patients older than 18 years, enrolled

in a Department of Cardiovascular Diseases, from June 2006 to June 2012. Only

patients discharged alive were included in further analysis. The patients were divided

in two groups according to their age (134085 and 194 ≥ 85 years old). We have

considered the following comorbidities: arterial hypertension (AH), diabetes mellitus

(DM), peripheral arterial disease (PAD), cerebrovascular disease (CVD), ischemic

heart disease (IHD) and anaemia. The difference between two groups according to

their co-morbidities and possible impact of co-morbidities on the length of hospitalization

was analyzed. In all tests P value of 0,05 was considered statisticaly

significant.

Results: The mean patients age in both groups was 74.7 ±10.1 years, in those85

was 72.8±9.3 years and in ≥ 85 was 88.0±2.7 years (P0.001). There were 917

(68.4%) patients with AH85 years versus 152 (78.3%) ≥ 85 years (P=0.005).

Likewise, 535 (39.9%) patients85 years had DM versus 60 (30.9%) ≥ 85 years

(P=0.016). In patients85 years there were 75 (5.6%)with PAD versus 4 (2.1%) ≥ 85

years (P=0.037). In patients85 years 315 (23.5%) had one, 410 (30.6%) had two,

334 (24.9%) had three, 140 (10.4%) had four and 29 (2.2%) had five co-morbidities,

while in patients ≥ 85 years, 39 (20.1%) had one, 71 (36.6%) had two, 64 (33.0%)

had three and 11 (5.7%) had four co-morbidities. (P=0.003). The length of hospital

stay was 10.8±6.1 days for patients85 years and 10.2±9.1 for those ≥ 85 years

old, (P=0.293).

Conclusion: There was statistically significant difference according to AH, DM and

PAD between the analyzed groups, but there was no statistical difference between

groups according to CVD, IHD and anaemia. The difference, considering the number

of co-morbidities between age groups, was found to be statistically significant.

Data from the literature show that co-morbidities could extend the length of hospitalization

in patients with heart failure. However, in the analyzed groups of patients

co-morbidities did not affect the length of stay (P0.005).

P1784

Cardio-hepatic syndrome and its influence on acute decompensated heart

failure patients in a single tertiary cardiology center

I Ilir Sharka1; S Myftiu1; A Quka2; A Shkoza3; E Dado4; L Gjyli1; G Knuti4;

J Diamandi4

1University Hospital Center Mother Theresa, Department of Cardiology & Cardiac

Surgery, Tirana, Albania; 2University Hospital Center Mother Theresa, Tirana,

Albania; 3University Hospital Center Mother Theresa, Department of Biomedical

and Experimental Sciences, Tirana, Albania; 4Hygeia Hospital of Tirana,

Department of Cardiology, Tirana, Albania

Purpose: cardio-hepatic syndrome (CHS) is a newly emerging definition for acute

liver injury in acutely decompensated heart failure (ADHF) patients (pts); it may be

associated with cardio-renal syndrome (CRS); recent data have demonstrated the

implication of CHS in HF management and prognosis; the aim of the study was to

evaluate the presence of CHS in ADHF patients in a tertiary cardiology center; main

predictors of CHS occurrence and the influence of CHS during in-hospital management

of ADHF patients.

Methods: we prospectively analyzes clinical and laboratory records on 365 consecutive

ADHF patients from 2012 to September 2014; liver function tests were used

for the screening of CRS (a ratio of ALT/LDH 1.5 was considered a cardiogenic

injury), a MELD score evaluation was performed on a daily basis; ADHF patients

were stratified into three levels: I (CHS absent), II (CHS present), III (CHS & CRS

present); a composite endpoint (use of intravenous inotropes, diuretic resistance, a

prolonged in-hospital treatment a week, cardiac death) was defined a complicated

clinical course; a Cox proportional hazards model was used to define the relation of

CRS presence to the complicated in-hospital clinical course.

Results: CHS was present in 237 (64.9%) pts; between CHS and non CHS patients

there were no significant differences in age (67.4 ±0.3 vs 62.3±0.7, p>.05), sex

(males) (57.3% vs 53%, p>.05), diabetes (32.4% vs 29.2%, p>.05); but there

were significant differences in MELD score (39.4±7.7 vs 16.2±8.5, p.0001);

re-hospitalizations for AHF 4 (2 to 6) vs 2 (0 to 3), p.05; cardiac index 1.5

l/min/m2 (61.5% vs 17.6%, p.0001); PASP (53±18 vs 38±12 mmHg, p.001);

use of inotropes (61.1% vs 19.7%, p.0001);); Charlson Comorbidity index (CCI)

≥4 (67.4% vs 46.2%, p.001); diuretic resistance (26,8% vs 8.6%, p.0001). main

predictors of CHS occurrence in Cox regression were: low cardiac index; high PASP;

re-hospitalization for AHF; diuretic resistance; HR (95%CI) of level II to I of ADH

patients was 1.86 (1.24 - 2.67, p=.0025) and level III to I was 3.69 (2.14 - 6.87,

p.0001).

Conclusions: cardio-hepatic syndrome seems to be a clinically important member

of the constellation of end-organ involvements in ADHF patients, which presence

offers significant clinical and prognostic implications in our daily cardiology practice;

identifying patientsmore susceptible to CHS would help to reduce clinical complications

in HF management and thus lower costs of treatment imposed by a prolonged

hospitalization; further studies are needed to help clinicians in CHS treatment guidelines.

CHRONIC HEART FAILURE

P1785

Survival analysis of adult patients with congenital heart disease and heart

failure

K Kristina Andjelkovic1; D Kalimanovska Ostric1; V Karadzic1; D Vasic1; S

Matic1; I Andjelkovic2

1School of Medicine, University of Belgrade, Cardiology Clinic, CCS, Belgrade,

Serbia; 2University of Belgrade, School of Electrical Engineering, Belgrade, Serbia

Purpose: Adult patients with congenital heart disease (ACHD) are commonly faced

with various complications due to residual defects, interventions and disease

course. The most frequent are heart failure (HF), arrhythmias, pulmonary hypertension,

and infective endocarditis which contribute to significant increase in morbidity

and mortality of these patients. The aim of this study is survival analysis and identification

of mortality predictors in ACHD patients and HF.

Methods: We retrospectively reviewed 173 adult patients with CHD (40% males

and 60% females), followed-up for 36 months since their admission at the Department

for congenital heart disease in adults of the Clinical center of Serbia, due to

complications such as heart failure, arrhythmias, infective endocarditis, pulmonary

hypertension, or until death as end-point. They were classified into 3 groups according

to CHD complexity (simple, moderate and severe). NYHA functional class at

admission, medical history data, physical and echocardiography findings were analyzed

variables. Kaplan-Meier techniques were used to assess all-cause mortality.

Log-rank testing was used to identify association between heart failure and major

events, and multivariate Cox proportional-hazards regression model was used to

identify predictors of the worst outcome.

Results: According to CHD type, 45% pts had simple, 28% moderate, and 27%

severe CHD complexity. Heart failure was diagnosed in 28% (n=48) patients. Overall

mortality rate was 8.1% (n=14), and mortality rate among those with heart failure

was 22% (n=11) of patients. Mean survival time in our group of patients with congenital

heart disease was 33.8 months, SE 0.635, 95% CI 32.6 to 35.0. Log rank

test showed that the survival time is higher in group of patients without HF. Median

survival time in group of patients without HF was 35.6 months, SE 0.32, 95% CI

35.0 to 36.2 and in group with HF was 29.0 months, SE 2.0, 95% CI 25.0 to 33.1;

p0.001. In a multivariate Cox proportional-hazards regression model, NYHA functional

class was highlighted as significant predictor of the worst outcome in ACHD

patients with heart failure (hazard ratio [HR]=6.1, 95% CI 1.5 to 25.4, p=0.013),

among others analyzed variables. Higher NYHA class is associate with higher risk of

mortality.

Conclusions: Survival analysis showed that adult patients with congenital heart

disease and heart failure have higher mortality risk. NYHA functional class is an

independent predictor of mortality rate in these patients.