ABSTRACT
BACKGROUND: Arrhythmias are common in chronic heart failure and affect outcomes. The incidence and significance of new arrhythmias in acute heart failure, however, are largely unknown. METHODS AND RESULTS: The Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations study randomized 949 patients with decompensated heart failure to receive intravenous milrinone or placebo. In the study, patients were divided into 2 groups based on the occurrence of a new arrhythmic event during their index hospitalization and analyzed for outcome. There were 59 new arrhythmic events occurring in 6% of the population. Of these, 49% were atrial fibrillation/flutter. The primary endpoint of days hospitalized for cardiovascular causes within 60 days after randomization was 30.9+/-22.7 for those in the arrhythmia group and 11.3+/-12.7 days for those with no arrhythmias (P=.0001). Mortality during index hospitalization was 26% in the arrhythmia group and 1.8% in the no arrhythmia group (P=.001). Death or hospitalization at 60 days was also worse in the arrhythmia group (35 versus 8.2%, P=.0001; 57 versus 34%, P=.001, respectively). Cox proportional hazard analysis identified new arrhythmias as an independent risk factor for the primary endpoint and death at 60 days. CONCLUSION: New arrhythmia during an exacerbation of heart failure identifies a high-risk group with higher intrahospital and 60-day morbidity and mortality.
Subject(s)
Arrhythmias, Cardiac/epidemiology , Heart Failure/epidemiology , Acute Disease , Aged , Arrhythmias, Cardiac/drug therapy , Atrial Fibrillation/drug therapy , Atrial Fibrillation/epidemiology , Cardiotonic Agents/therapeutic use , Endpoint Determination , Female , Follow-Up Studies , Heart Failure/drug therapy , Hospital Mortality , Hospitalization , Humans , Incidence , Male , Middle Aged , Predictive Value of Tests , Proportional Hazards Models , Prospective Studies , Risk Factors , Survival Analysis , Tachycardia, Ventricular/drug therapy , Tachycardia, Ventricular/epidemiology , Ventricular Fibrillation/drug therapy , Ventricular Fibrillation/epidemiologyABSTRACT
The authors examined the prevalence, characteristics, and correlates of depressive disorder among medical inpatients age 60 or over at a private teaching hospital. Seventy-six of 129 patients admitted to the general medicine and cardiology services at Duke University Hospital were screened for depressive disorder using DSM-III-R criteria. Depressive disorders were diagnosed in 34.2% of patients: major depression in 13.2%, adjustment disorder in 11.8%, depression not otherwise specified in 5.3%, organic mood disorder in 1.3%, and uncomplicated bereavement in 2.6%. Of patients with major depression, all had symptoms of mild-to-moderate severity. The most common presenting symptoms were insomnia, psychomotor agitation, difficulty concentrating, and loss of energy. Depression was more prevalent among women, general medicine patients, staff (vs. private) patients, and those who were functionally disabled or had multiple serious medical conditions. When other patient characteristics were controlled, however, only health factors were independently associated with depression.
