ABSTRACT
Background/Aims@#The Heart Failure Association (HFA)-PEFF score is recognized as a simple method to diagnose heart failure (HF) with preserved ejection fraction (HFpEF). This study aimed to evaluate the relationship between HFA-PEFF scores and cardiovascular outcomes in HFpEF patients. @*Methods@#A total of 502 consecutive HFpEF patients were prospectively observed for up to 1,500 days. Cardiovascular outcomes were compared between two groups of patients, defined by their HFA-PEFF scores: those who scored 2–4 (the intermediate-score group) and those who scored 5–6 group (the high-score group). Overall, 236 cardiovascular events were observed during the follow-up period (median, 1,159 days). @*Results@#Kaplan-Meier analysis showed that there were significant differences in composite cardiovascular events and HF-related events between the intermediate-score group and the high-score group (p = 0.003 and p < 0.001, respectively). Multivariate Cox proportional hazards analysis showed that the HFA-PEFF scores significantly predicted future HF-related events (hazard ratio, 1.66; 95% confidence interval [CI], 1.11 to 2.50; p = 0.014); receiver operating characteristic analysis confirmed this relationship (area under the curve, 0.633; 95% CI, 0.574 to 0.692; p < 0.001). The cutoff HFA-PEFF score for the identification of HF-related events was 4.5. Decision curve analysis revealed that combining the HFA-PEFF score with conventional prognostic factors improved the prediction of HF-related events. @*Conclusions@#HFA-PEFF scores may be useful for predicting HF-related events in HFpEF patients.
ABSTRACT
Introduction: We report two cases of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients treated by the palliative care team during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. These patients were receiving interventions for pain control, but subsequently contracted COVID-19, leading to their deaths. Cases: Two patients with hematopoietic tumors had been taking hydromorphone tablets for pain control. Both patients contracted COVID-19 during their clinical course, and displayed happy hypoxia, a typical complication of SARS-CoV-2 infection. Although the rapid systemic deterioration of the patients' conditions were recognized, there were no complaints of breathing difficulties. We attempted to alleviate the symptoms by adjusting the medications, including changes to the administration route. Discussion: When a patient receiving palliative care is infected with SARS-CoV-2, the presence of an underlying condition may cause a rapid deterioration, and opioid titration may be required depending on the characteristics of the symptoms.
