Table. Multivariate Logistic Regression Analysis of factors significantlyCorrelated to all-cause mortality in bivariate analyses.

The 18th Annual Scientific Meeting � HFSA S107

1. Evaluate an algorithm used to identify high-risk heart failure patients (highLOS, high readmission risk or both) early in their hospital stay to reduce inpa-tient LOS and to reduce the likelihood of subsequent readmission by workingwith our LTAC partner.

2. Evaluate the benefits of an LTAC model in managing high risk heart failureadmissions

3. Identify barriers associated with LTAC placement

Methods: Data was prospectively collected for the entire 14 months of our affiliation.The algorithm utilized to identify high-risk heart failure patients was applied to allhospitalized heart failure patients on their third hospital day and all patients thatwere identified as eligible for LTAC referral were evaluated. Outcomes for patientswho were identified and transferred to LTAC were compared to those who weredeemed eligible but a discharge to LTAC could not be made due to a system barrier.Barriers that precluded their placement in LTAC were identified. Results: Seventy-five referrals to LTAC were made, out of which 18 (24%) patients were transferredto our partner LTAC. There was a difference in readmission rates among patientsplaced at LTAC versus those unable to be placed that acted as control (23% vs28%). Denial by LTAC 16 (28%), patient refusal 12 (21%), denial by insurance 11(19.3%) were leading factors precluding their placement to LTAC. Conclusion:Our algorithm can play a pivotal role in identifying and placing high-risk heart failurepatients in LTAC to improve quality of care with cost effectiveness. Patient educa-tion, insurance policy changes and readdressing LTAC’s placement criteria may over-come these barriers. Further studies are needed to validate this tool.

VariableNumber/Mean/Percentage

Oddsratio

p-value

Left Ventricular GlobalLongitudinal Strain $-7.95

N5 109 3.43 0.038

Left ventricular Ejection fraction 34613% 1.58 0.834Age 57614 years 1.02 0.194NYHA II 30% 0.91 0.861NYHA III 43% 1.14 0.778Chronic Kidney Disease 25% 1.69 0.185

Figure.

270Post-Exercise Heart Rate Recovery Independently Predicts Clinical Outcome inPatients with Acute Decompensated Heart FailureJong-Chan Youn, Namki Hong, Jaewon Oh, Sungha Park, Sang-Hak Lee, DonghoonChoi, Seok-Min Kang; Severance Cardiovascular Hospital, Yonsei UniversityCollege of Medicine, Seoul, Republic of Korea

Background: Post-exercise heart rate recovery (HRR) is an index of parasympatheticfunction associated with clinical outcomes in patients with chronic heart failure.However, its prognostic value in patients with acute decompensated heart failure(ADHF) is not well investigated.Methods: We measured HRR (calculated as the dif-ference between heart rate at peak exercise and after 2 minute of recovery) in 98 pro-spectively and consecutively enrolled ADHF patients (65 male, 60 6 15 years, meanejection fraction 28.46 13.9%) at predischarge period. Primary endpoint was cardio-vascular (CV) events defined as CV mortality, cardiac transplantation or rehospital-ization. Results: The primary outcome occurred in 26 (26.5%) patients (5cardiovascular deaths and 7 cardiac transplantations) during follow up period (me-dian 158 days, 5-646 days). When the patients with ADHF were divided by HRR ac-cording to Youden index, low HRR (! 22.5) was shown to be associated with poorclinical outcome (p50.009). Multivariate Cox regression analysis revealed that HRRwas found to be an independent predictor of CV events (p50.029) when controlledfor age, hemoglobin, creatinine, NT-proBNP and beta-blocker use. Conclusion:Post-exercise HRR is an independent prognostic marker in patients with ADHF.These findings may explain the novel relationship between autonomic dysfunctionand clinical outcome in these patients.

Figure.

271Left Ventricular Global Longitudinal Strain Predicts Mortality in AfricanAmericans with Heart FailureIbrahim N. Mansour1, Mayank Kansal1, Sahar J. Ismail1, Omer Mirza1, Adam Bress2,Grace Wu1, Rahul Marpadga1, Yien Li1, Larisa Cavallari2, Thomas D. Stamos1;

1University of Illinois at Chicago, Chicago, IL; 2University of Illinois at Chicago,Chicago, IL

Background: Left ventricular global longitudinal strain (LV GLS) is a sensitive mea-sure of LV mechanics that has been correlated with adverse events in patients withheart failure. Previous studies have included few African American (AA) patients.Methods: We enrolled 219 AA adults, age 576 14 years, with heart failure (HF)on optimal guideline-directed medical therapy from the University of Illinois HFclinic between November 2001 and February 2014. LV GLS was assessed by velocityvector imaging using 2, 3 and 4-chamber views. Patients were followed up for all-cause mortality for 3.462.7 years. LV GLS value of -7.95 was used as the optimalcutoff point that maximizes sensitivity + specificity. Results: In bivariate analyses,worse LV GLS, as a continuous variable and a categorical variable of $-7.95, wassignificantly associated with higher all-cause mortality (B52.30, p50.002 andOdds ratio5 3.8, p!0.001, respectively). After adjusting for age, LV ejection frac-tion, chronic kidney disease and NYHA class, worse LV GLS ($-7.95) was the stron-gest predictor of all-cause mortality (OR 3.4, 95% CI 1.1-11, p50.038) in amultivariate logistic regression model. Kaplan-Meier survival curves showed signif-icantly higher mortality in patients with LV GLS value $-7.95 (log-rank p!0.001)(Figure). Conclusion: LV GLS is a strong independent predictor of all-cause mortal-ity in chronic stable AA patients with HF.

272PIIINP Predicts Mortality in African American Patients with Heart FailureIbrahim N. Mansour1, Sahar J. Ismail2, Adam Bress3, Vicki Groo3, Shital Patel3,Hana Gheith2, Thomas D. Stamos2, Larisa Cavallari3; 1University of Illinois atChicago, Oak Lawn, IL; 2University of Illinois at Chicago, Chicago, IL;3University of Illinois at Chicago, Chicago, IL

Background: Elevated serum N-terminal procollagen III propeptide (PIIINP) is abiomarker used to indicate cardiac fibrosis in heart failure (HF) patients. Wesought to determine if PIIINP would predict all-cause mortality in African Amer-ican (AA) patients with HF. Methods: We prospectively enrolled 183 (55%female) self-reported AA adults with a diagnosis of HF on optimal guideline-directed medical therapy from the University of Illinois (UIC) HF clinic betweenJanuary 2002 and February 2014. All patients had blood drawn for analysis ofPIIINP, and mortality status was obtained from the electronic medical recordand the Social Security Death Index database. Results: Twenty-two percent of

Table.

Total number of patients age $65yrs(n5278)

Pvalue

No readmission(n5216)

Readmission(62)

S108 Journal of Cardiac Failure Vol. 20 No. 8S August 2014

patients died over a mean follow up of 2.962.9 years. On bivariate analyses, higherPIIINP levels, as a continuous variable and a categorical variable of $ 4.88 ng/ml,were significantly associated with higher all-cause mortality (B51.777, p#0.001and Odds Ratio5 3.9, 95% CI 1.8-8.8, p!0.001, respectively). After adjusting forage, LV ejection fraction, NYHA class, chronic kidney disease and history of atrialfibrillation/flutter, PIIINP $ 4.88 ng/ml was the strongest predictor of all-causemortality (OR 3.6, 95% CI 1.4-9.0, p50.008) in a multivariate logistic regressionmodel. Kaplan-Meier survival curves showed significantly higher mortality in patientswith PIIINP $ 4.88 ng/ml (log-rank p!0.001) (Figure). Conclusion: PIIINP is astrong independent predictor of all-cause mortality in chronic stable AA patientswith HF.

Table. Multivariate Logistic Regression Analysis of factors significantlycorrelated to all-cause mortality in bivariate analysis.

VariableNumber/Mean/Percentage

Oddsratio

p-value

PIIINP level $4.88 ng/ml N577 3.56 0.008Left ventricular Ejection

fraction36613% 0.02 0.033

Age 55615 years 1.63 0.063NYHA II 28% 1.38 0.632NYHA III 45% 1.16 0.819Atrial fibrillation/Flutter 19% 2.02 0.07Chronic Kidney Disease 18% 1.63 0.362

Figure.

Age, in years 75.369 78.768.7 0.008Male Gender 140 (65%) 34 (55%) NSCAD 99 (45%) 20 (32%) 0.05Hypertension 172 (79%) 36 (58%) 0.006Diabetes Mellitus 99 (45%) 44 (71%) 0.005Atrial fibrillation 98 (45%) 28 (45%) NSBody Mass Index 30.967.1 23.564.3 !0.001Weight Loss O 10 lbs 5 (0.02%) 32 (51%) !0.001Dyslipidemia 141 (65%) 36 (58%) NSACE/ARB 173 (80%) 54 (87%) NSBeta Blockers 189 (87.5%) 58 (95%) NSStatins 132 (61%) 36 (58%) NSSpironolactone

inhibitors78 (36%) 22 (35%) NS

Diuretics 170 (79%) 54 (87%) NSLVEF, in% 2969 2969 NSLA diameter, in cm 5.161 5.161 NSLVESV, in ml 78.8644 80.5655 NSTAPSE, in mm 17.562 12.863.1 !0.001PASP, in mmHg 38.669.2 65.2 6 17 !0.001Mortality in 5 years 91 (42%) 32 (52%) !0.001eGFR, in ml/min 54625 48616 0.005

Predictors of early readmission (!30days) of index hospitalization

NoReadmission(n5216)

EarlyReadmission

(n562)P

value

Age, in years 75.3+9 78.7+9 0.008EF,in% 28.9+8.8 29+9.2 0.955CAD 99 (45%) 20 (32) 0.056OM 99 (46%) 44 (71%) 0.005HTN 172 (80%) 36 (58%) 0.006Pulmonary Hypertension

(PASPO50mmHg)27 (12%) 48 (77%) !0.001

RV failure (TASPE !16) 37 (17%) 46 (74%) !0.001BMI !25 177 (82%) 20 (32%) !0.001

Predictors of 5 Year Mortality

Alive, at 5 years(155)

Died, at 5years(123)

Pvalue

Age, in years 74.5 6 9.4 7868.1 0.001EF,in% 28.7 6 8.8 29.269 0.617CAD 71 (46%) 48 (39%) 0.256DM 87 (56%) 56 (45%) 0.079HTN 113 (73%) 95 (77%) 0.408Pulmonary Hypertension

(PASPO50mmHg)32 (21%) 43 (35%) 0.007

RV failure (TASPE !16) 37 (24%) 46 (37%) 0.014BMI !25 121 (78%) 76 (62%) 0.003

273Poor Right Ventricular Systolic Function (Lower TAPSE) and HigherPulmonary Artery Systolic Pressure (PASP) Predicts Early Readmissions andAll Cause Mortality in Elderly Patients with Heart FailureGunjan Choudhary, Umashankar Lakshmanadoss, Hari Prasad, Ashok Shah, ZaruhiBabayan, Dwight Stapleton; Guthrie/Robert Packer Hospital, Sayre, PA

Background: Heart failure(HF) related early readmission (!30days) and mortality re-mains high in elderly patients. Right ventricular (RV) dysfunction is associated withworse prognosis in patients with HF with reduced ejection fraction (HFrEF). We eval-uated effect of RV function (as measured by TAPSE - Tricuspid annular plane systolicexcursion) and Pulmonary artery systolic pressure (PASP) on early HF readmission andmortality in elderly HF patients. Methods: This is single center observational study ofelderly ($65 years )patients with HFrEF. Patients with principal discharge diagnosis ofHFrEF are included (n5 278, age 77 6 9 years, 38% female, LVEF 29% 6 9%). De-mographic and echocardiographic data are collected. TAPSE (as a marker of RV sys-tolic dysfunction) and PASP are measured as per ASE guidelines. Prediction modelsare performed using univariate and multivariable logistic regression analysis. Results:Among 278 patients, 62 patients (22.3%) had HF related early readmission and 123patients (44%) died at the end of 5 year. On univariate analysis, older age, Hyperten-sion, Diabetes, higher PASP , RV systolic dysfunction (TAPSE !16mm) and BMI!25 are predictors of early readmission and mortality (P value!0.05). On multivariablelogistic regression analysis, early HF readmission was predicted by TAPSE !16 mm(OR523.6; p ! 0.001; CI 10.23-54.60) and PASP O50 mmHg ( OR 5 34; p !0.001; 95 CI 14.08-82.81); five year all cause mortality was predicted by TAPSE !16mm (OR 5 1.85; p 0.023; 95 CI 1.08-3.16) and PASP O50 mmHg (OR 5 2.11;p 0.009; 95 CI 1.19-3.72). Conclusion: TAPSE !16 mm and PASP O50 mmHg

are strong predictors of early readmission and five year all cause mortality in elderlyHF patients. The assessment of RV function through TAPSE and PASP , helps torisk-stratify elderly patients with HFrEF.

274The Role of Spironolactone in Real World Patients Hospitalized with AcuteDecompensated Heart FailureMin-Seok Kim1, Sang-Eun Lee2, Hyun-Jai Cho2, Hae-Young Lee2, Hyun-YoungPark3, Myeong-Chan Cho4, Byung-Hee Oh2, Jae-Joong Kim1; 1Asan MedicalCenter Heart Institute, Seoul, Republic of Korea; 2Seoul National UniversityHospital, Seoul, Republic of Korea; 3National Institute of Health (NIH), Osong-eup, Republic of Korea; 4Chungbuk National University College of Medicine,Cheongju, Republic of Korea

Background: Mineralocorticoid receptor antagonists reduced morbidity and mortal-ity in chronic heart failure (HF) with reduced ejection fraction (EF) and post-myocar-dial infarction. However, there are few data about their role in patients hospitalized