Why This Simple Heart Failure Symptom Is So Easy To Ignore

Why This Simple Heart Failure Symptom Is So Easy To Ignore

LISBON — Patients with decompensation heart failure Those who have bendopnea upon discharge from the hospital appear to have a significantly increased risk of all-cause mortality within two years, researchers reported.

The research, presented here at the Heart Failure Association of the European Society of Cardiology (HFA-ESC) 2024 and published in it European Journal of Preventive Cardiologyfound that in two study cohorts, the risk of all-cause mortality at least doubled among patients with difficulty breathing when leaning forward.

“Bendopnea can be assessed by a simple, non-invasive examination,” said lead researcher Dr. Taisuke Nakade, of the Department of Cardiovascular Biology and Medicine at Juntendo University School of Medicine in Tokyo, noting that the association with mortality is “independent.” of other known prognostic factors.

The current analysis continues A study published in He New England Journal of Medicine by Texas cardiologists who found that nearly one-third of patients with advanced heart failure who were referred to their cardiac catheterization laboratory had bendopnea.

He the researchers found that these patients were sicker, suggesting that they may require adjustments to their medications or further evaluation for advanced heart failure therapy.

High risk, low prevalence

Nakade and colleagues investigated the prevalence, clinical characteristics, and prognostic value of bendopnea in older patients hospitalized for heart failure using two recently completed prospective studies. FRAGILE-HF and SONIC-HF.

They included a total of 2,034 Japanese patients aged 65 years or older hospitalized for heart failure decompensation according to the Framingham criteria. All patients underwent a bendopnea assessment before discharge, which involved sitting them in a chair and asking them to lean forward to touch their ankles and hold the position for as long as possible.

Those who were unable to hold the position for 30 seconds due to difficulty breathing were diagnosed with bendopnea, Nakade said, while those who stopped doing so for other reasons were not defined as having the condition.

In the FRAGILE-HF cohort, bendopnea was diagnosed in 2.5% of people and 4.4% of those in the SONIC-HF cohort. Nakade said the prevalence of bendopnea in the two cohorts is lower than might be expected from previous analyses, which have found a prevalence of between 18% and 49%, but that may be due to differences in how and when it was assessed or bendopnea was evaluated. the profile of the included patients. Previous studies included much smaller numbers of patients with a variety of different heart failure conditions, Nakade noted.

Patients with bendopnea were more likely to be female, have a higher body mass index, and be diagnosed with New York Heart Association Class III or IV heart disease. They were also more likely to have a left ventricular ejection fraction of 50% or greater and less likely to have been treated with a angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.

During 2 years of follow-up, 38.7% of patients with bendopnea in the FRAGILE-HF cohort died compared with 20.7% of those without bendopnea. In the SONIC-HF cohort, half of those with bendopnea died compared with 20.6% of those without bendopnea. Cox proportional hazards analysis of all-cause mortality revealed that after adjustment for potentially confounding factors, bendopnea was associated with a significantly increased risk of death, with a hazard ratio of 2.11 in FRAGILE-HF and 4.20 on SONIC-HF.

An easy test

Bettina Heidecker, MD, chief of Heart Failure and Cardiomyopathy at Charité University Hospital in Berlin, Germany, and chair of the session where Nakade’s data were presented, said she had heard about bendopnea recently.

However, the mechanism underlying the link between leaning forward and shortness of breath is still unclear. Of the possibility, he said, “It seems like it could be a volume challenge, because when you bend over, you’re changing the volumes of your body,” he said, similar to the Valsalva maneuver or passive leg raises performed in the clinic. . .

“So this appears to be a similar mechanism,” Heidecker said during an interview.

Heidecker said the bendopnea test is an attractive proposition because it is “very simple and very practical.” It costs nothing and has no side effects, and could be especially valuable for cardiologists working in places without much healthcare infrastructure.

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