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Poor medication adherence is associated with increased hospitalization and mortality rates in patients with heart failure with reduced ejection fraction (HFrEF), but its association with health status is unknown. CHAMP-HF is a multicenter observational study of outpatients with HFrEF (EF ≤40%). Medication adherence was assessed using the Morisky Medication Adherence Scale 4-Item © (MMAS-4) and any "yes" response was taken as a positive screen for non-adherence at enrollment. Health status was assessed by the Kansas City Cardiomyopathy Questionnaire Overall Summary score (KCCQ-OS) at baseline and 12-months. Robust linear regression was used to assess differences in health status at baseline, as well as change from baseline to 12 months. Models were serially adjusted for sociodemographic characteristics and comorbidities (Model 2), and HF medications (Model 3). Of 4,780 patients, 3,245 (67.9%) were classified as adherent and were more likely to be older (69 vs 65 years), white (75.1% vs 71.1%), more educated, and on fewer HF medications (3[2-4] vs 3[3-4]). They were also less likely to smoke (18.4% vs 23%) and have depression (24.9% vs 29%). Non-adherence to HF medications was associated with lower mean baseline KCCQ-OS (60.2 vs 66.8, p<0.001) that persisted after adjusting for baseline characteristics, comorbidities, and HF medications (Table 1A). Non-adherent patients also had a lower mean KCCQ-OS 12-months later (71.4 vs 77.1, p<0.001), with less improvement over 12-months in fully-adjusted analyses (Table 1B). Poor medication adherence was associated with both worse baseline health status and less health status improvement over 12-months. Interventions that improve medication adherence should be tested to improve patients' health status. [ABSTRACT FROM AUTHOR]

Obesity paradox has been described in heart failure but data on in-hospital outcomes and readmission rates in Heart Failure with Preserved Ejection Fraction (HFpEF) in relation to body mass index (BMI) is limited. We hypothesized that mortality and readmissions would be lower in an obese population. National Readmission Database 2016 was queried for adult patients with principal discharge diagnosis of HFpEF (I50.30-I50.33) and also had ICD 10 codes for BMI listed. Patients who died during index hospitalization were excluded from readmission analysis. 87041 patients met inclusion criteria and were divided in 3 groups: Non-Obese (BMI<30), obese (BMI30-39) and morbidly obese (BMI≥40). Patients in the obese and morbidly obese group were significantly younger, African-Americans and had more co-morbidities. Acute on chronic diastolic heart failure was the most common cause of readmission in all groups but was significantly high in morbidly obese group accounting for 21.3% of all readmissions. In the non-obese and obese group, it accounted for 16.3% and 19.3% of all readmissions respectively. Sepsis was the second most common readmission diagnosis in all three groups. Acute Kidney Injury (AKI) was the third most common readmission diagnosis in obese and morbidly obese groups accounting for 5.1% and 5.7% of readmissions respectively. AKI accounted for only 3.1% of readmissions in non-obese group. HFpEF related readmissions were significantly higher in the morbidly obese group and obesity paradox was not observed for readmission rate in this cohort. In-hospital mortality was significantly high in non-obese group but length of stay (LOS) and total hospitalization charges were similar in non-obese and morbidly obese groups. In-hospital complications of AKI and readmissions due to AKI were significantly high in the obese and morbidly obese groups and needs further investigation. [ABSTRACT FROM AUTHOR]

The national data on trends, patient characteristics, utilization of therapies and outcomes in patients with sudden cardiac arrest (SCA) are lacking. Using the National Inpatient Sample (NIS) database we identified yearly trends, patient characteristics, utilization of therapies and differences of in-hospital outcomes among patients with in-hospital vs out-of-hospital CA between years 2007-2015 A total of 1018541 patients (87% in-hospital) were identified with SCA between 2007 and 2015 with an increasing yearly trend. Of those, 201231 (20%) had AMI and 112104 (11%) cardiogenic shock and 64886 (7%) of patients underwent revascularization during same hospitalization (Table 1). Overall, 37590 (3.5%), 38489 (0.3%) and 2969 (0.3%) of patients underwent IABP, percutaneous LVAD (pLVAD) and ECMO placements respectively. While pLVAD and ECMO use has been increasing steadily in recent years, IABP use is consistently decreasing. 190 (0.05%) of patients underwent durable LVAD implantation and 225 (0.02%) underwent orthotropic heart transplant (OHT) during same hospitalization (Table 2). The length of stay (LOS) for entire cohort was 8.1(±12.4) days and the mortality for entire cohort was 68% with decreasing trend over the study period (Figure 1). The mortality in patients who underwent ECMO, durable LVAD and OHT was lower than the overall cohort (p<0.001). There has been an increase in the number of SCA patients with a concomitant decreasing mortality trend in the recent era. The mortality in patients who underwent ECMO, durable LVAD and OHT was lower than the overall cohort. [ABSTRACT FROM AUTHOR]