Feasibility of including patients with migration background in a structured heart failure management programme: A prospective case-control study exemplarily on Turkish migrants.

AIMS: Structured management programmes deliver optimized care in heart failure patients and improve outcome. We examined the feasibility of including patients with migration background speaking little or no German in a heart failure management programme. METHODS AND RESULTS: After adaption of script material and staff to Turkish language we aimed to recruit 300 Turkish and 300 German (control group) patients within 18 months using the operational basis of a local heart failure management programme for screening, contact and inclusion. Of 488 and 1,055 eligible Turkish and German patients identified through screening, 165 Turkish (34%) and 335 German (32%) patients consented on participation (p = 0.46). General practitioners contributed significantly more of the Turkish (84%) than of the German patients (16%, p<0.001). Contact attempts by programme staff were significantly less successful in Turkish (52%) than in German patients (60%, p = 0.005) due to significantly higher rate of missing phone numbers (36% vs 25%), invalid address data (28% vs 7%) and being unreachable by phone more frequently (39% vs 26%, all p<0.001). Consent rate was significantly higher in successfully contacted Turkish (63%) compared to German patients (50%, p<0.001). CONCLUSION: The inclusion of Turkish minority patients into a heart failure management programme is feasible with higher consent rate than in Germans. However, effort is high due to inherent logistic adaptions and barriers in identification and contacting of patients. TRIAL REGISTRATION: DRKS00007780.

Association and prognostic impact of heart rate and micro- albuminuria in patients with type 2 diabetes and cardiovascular disease: results from the PROactive trial.

AIM: Microalbuminuria (MAU) and heart rate are established predictors of an adverse cardiovascular outcome. Recently, heart rate was described as an independent predictor of MAU in hypertensive patients, raising the question of a causal link. METHODS: In post-hoc analysis of the PROactive trial we examined the association of the baseline heart rate and MAU in diabetic patients with cardiovascular disease (n = 5,110, mean age 62 ± 8, 66% male) using logistic regression. Cox regression analysis was used to examine the independent impact of heart rate and MAU on the composite endpoint of all-cause mortality, myocardial infarction and stroke. RESULTS: Baseline heart rate was not associated with a significantly increased risk for MAU at baseline (OR 1.01 per 10 bpm, 95% CI 0.97-1.06, p = 0.48) or MAU at the final visit (OR per 10 bpm 1.04, 95% CI 0.98-1.11, p = 0.20). Similar results were observed in subgroups of patients with hypertensive blood pressure at baseline (OR 0.98 per 10 bpm, 95% CI 0.93-1.03, p = 0.42) or patients with a history of hypertension (OR 1.02 per 10 bpm, 95% CI 0.98-1.07, p = 0.31), respectively. Stratification by use of an ACE inhibitor/AT1-receptor blocker did also not change the results. In multivariate analysis, both heart rate and MAU were significantly predictive of a cardiovascular outcome. CONCLUSION: There was no evidence of an association between heart rate and MAU in diabetic patients with cardiovascular disease, independently of whether hypertension was present or not, but both markers were independently predictive of a cardiovascular outcome. These results do not support a causal link between heart rate and MAU.

Prognostic impact of NT-proBNP and renal function in comparison to contemporary multi-marker risk scores in heart failure patients.

BACKGROUND: Multi-marker risk scores accurately predict prognosis in heart failure patients but calculation is complex. AIMS: To compare the prognostic accuracy of the Seattle Heart Failure Survival Score (SHFS) and a model derived from the CHARM programme, with laboratory parameters NT-proBNP and glomerular filtration rate (GFR). METHODS AND RESULTS: In a sample of 290 heart failure patients, 39 patients died, 22 were hospitalised with acute heart failure and 4 underwent urgent cardiac transplantation during a median follow-up of 498 days. NT-proBNP, GFR, CHARM and SHFS showed an AUC for an endpoint during 1-year of 0.80, 0.72, 0.79 and 0.69, respectively. The hazard ratio for an endpoint during follow-up was 2.1, 2.6, 1.9 and 2.1 per 1 SD increase of log NT-proBNP and CHARM and per 1 SD decrease of GFR and SHFS, respectively. In multivariate analysis, log NT-proBNP and GFR added independent prognostic information to CHARM and SHFS, respectively. CONCLUSION: NT-proBNP and GFR independently predicted endpoint-free survival in systolic heart failure patients, with NT-proBNP being superior and equally predictive to the SHFS and CHARM score, respectively. Assessment of both laboratory markers can simplify prognostic stratification, addition to multi-marker scores should be evaluated.

NT-pro-BNP is associated with long-term outcome in a heterogeneous sample of cardiac inpatients.

BACKGROUND: B-type natriuretic peptides (NP) are excellent predictors of mortality in selected patients with heart failure and coronary heart disease. Up to now, the association of NPs with cardiovascular outcome has not been evaluated in multi-morbid populations with a broad spectrum of cardiovascular disease. METHODS: NT-pro-BNP was measured at discharge in 615 inpatients from a cardiology department of a university hospital. The association of discharge NT-pro-BNP with long-term outcome was examined during a median follow-up time of 1130 days. RESULTS: NT-pro-BNP was significantly elevated in patients who died, developed ischemic stroke, or were hospitalized due to acute heart failure, but not in patients who developed myocardial infarction or underwent coronary angioplasty compared to patients without any endpoint. Patients with supramedian NT-pro-BNP values (>339 pg/ml) had significantly worse outcomes with respect to the combined endpoint (CE) of death, heart failure hospitalization, and stroke than patients with inframedian NT-pro-BNP values. After adjusting for age, gender, renal function, NYHA class, presence of diabetes, coronary 3-vessel disease, systolic and valvular dysfunction, NT-pro-BNP was a significant predictor of the CE. The AUC for NT-pro-BNP to predict the CE was 0.79 in the total population, 0.81 in patients with coronary heart disease or acute heart failure, and 0.74 in patients with other diagnoses. A NT-pro-BNP cut-off value of 240 pg/ml revealed a negative predictive value of more than 93% in all three groups. CONCLUSION: In a heterogeneous population of hospitalized cardiac patients, NT-pro-BNP measured at discharge predicts a poor cardiovascular outcome, independently of the cardiologic diagnosis and traditional risk factors.