11/28/2023 0 Comments Yu chen![]() ![]() Validation in a multicenter cohort is warranted. The score has excellent IRR across provider levels and is associated with major hospital outcomes supporting its clinical validity. Among the 28 patients hospitalized during a 3-months period (N = 28), quartiles of peak score were associated with LOS (p < 0.01) and in-hospital mortality (p < 0.01): HFS 0 to 3 (median LOS of 5 days and mortality of 0%), HFS 4 to 6 (median LOS of 18 days and mortality of 0%), HFS 5 to 9 (median LOS of 29 days and mortality of 23%), and HFS 10 to 12 (median LOS of 121 days and mortality of 50%).CONCLUSION: This simple acute HFS may be a useful tool to quantify and monitor day-to-day HF symptoms in children hospitalized with ADHF regardless of etiology or age group. Score trajectory reflected our clinical impression of patient response to HF therapies across a range of HF syndromes including 1- and 2-ventricle heart disease and reduced or preserved ejection fraction. Among clinicians who scored 12 inpatients with ADHF simultaneously, the intraclass correlation (ICC) was 0.94 (respiratory ICC=0.89, feeding ICC=0.85, and activity ICC=0.80). Peak HFSs were analyzed against mortality and length of stay (LOS) for all pediatric HF discharges between July and October 2019.RESULTS: The final HFS was a 4-point ordinal severity score for each of the 3 symptom domains (total score 0-12). The inter-rater reliability (IRR) across a range of providers was assessed using the final version. The score was iteratively improved over a 3-year pilot phase until no further changes were made. To address these, we developed an acute HFS corresponding to the 3 cardinal symptoms of HF: difficulty with breathing, feeding, and activity. We sought to develop an inpatient HF score (HFS) that could be used as a clinical tool and for clinical trials.METHODS: Pediatric HF clinicians at Stanford reviewed the limitations of existing HFSs, which include lack of calibration to the inpatient setting, omission of gastrointestinal symptoms, need for multiple age-based tools, and scores that prioritize treatment intensity over patient symptoms. View details for DOI 10.1097/MAT.0000000000001460īACKGROUND: Currently, there are no simple tools to evaluate the acute heart failure (HF) symptom severity in children hospitalized with acute decompensated HF (ADHF). Better methods for evaluating right heart function and volume status are needed to improve our understanding of how hemodynamics impact renal function in this population. Additionally, they highlight the challenge of using CVP to guide management of renal dysfunction in pediatric heart failure. Our results illustrate a complex relationship between ventricular function, volume status, and renal function. In patients with preexisting renal dysfunction, higher absolute CVP values 48 and 72 hours after implantation predicted better renal outcome (p = 0.005). In subgroup analysis, these associations were significant only for those with normal pre-ventricular assist device renal function (p = 0.026). However, 48 hours postimplantation, an increase in CVP from baseline was associated with eGFR decline over time (p = 0.01). Among 54 patients, higher preoperative central venous pressure (CVP) was associated with eGFR improvement after implantation (p = 0.012). The relationship between hemodynamic parameters and estimated glomerular filtration rate (eGFR) was assessed using univariate and multivariate modeling. A single-center retrospective cohort study was conducted in patients less than 21 years who underwent LVAD placement between June 2004 and December 2015. We aimed to identify hemodynamic parameters associated with improved renal function after pediatric LVAD placement. Although renal function often improves after pediatric left ventricular assist device (LVAD) implantation, recovery is inconsistent. ![]()
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