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The 30-day readmission rates, predictors, and outcomes for acute heart failure (AHF) patients are well published, but data beyond 30 days and the association between readmission-free period (RFP) and in-hospital readmission-related mortality remain unknown. We queried the National Readmission Database to analyze comparative outcomes of AHF. Patients were divided into three groups based on their RFP: group 1 (1-30 days), group 2 (31-90 days), and group 3 (91-275 days). AHF cases and clinical variables were identified using ICD-9 codes. The primary outcome was in-hospital mortality at the time of readmission. A total of 39,237 unplanned readmissions occurred within 275 days; 15,181 within group 1, 11,925 within group 2, and 12,131 within group 3. In-hospital mortality in groups 1, 2, and 3 were 7.4%, 5.1%, and 4.1% (p 0.001). Group 1 had higher percentages of patients with cardiogenic shock (1.3% vs. 0.9% vs. 0.9%; p 0.001), acute kidney injury (30.2% vs. 25.9% vs. 24.0%; p 0.001), dialysis use (8.6% vs. 7.5% vs. 6.9%; p 0.001), and non-ST elevation myocardial infarction (4.4% vs. 3.8% vs. 3.6%; p 0.001), but there was no statistical difference among the three groups for ST-elevation myocardial infarction, percutaneous coronary intervention (PCI), or ventricular assist device use at the time of index admission. However, group 3 had higher PCI (1.7%) compared with groups 1 and 2 (p 0.001). In multivariable logistic regression, groups 2 and 3 had odd ratio of 0.70 and 0.55, respectively, for in-hospital mortality compared with group 1. Longer RFP is associated with decreased risk of in-hospital mortality at the time of first readmission.

Introduction: Hereditary Hemorrhagic Telangiectasia (HHT) is a genetic disorder with vascular anomalies of various organ systems including the skin, brain, heart, lungs, and liver. While the most commonly recognized disease burden of HHT are epistaxis and mucocutaneous telangiectasia, the development of vascular malformations can result in more severe symptoms such as cerebral hemorrhage, liver cirrhosis, and stroke. Various case reports/series have reported high output cardiac failure, secondary to presence of a single large AVM or multi organ AVMs, as a major cause of morbidity and mortality in HHT population. To the best of our knowledge, this is the first study analyzing the cardiovascular disease burden in HHT patients from a large national database. Methodology: All HHT patients were identified using ICD-9 code 448.0 using the 2014 National Inpatient Sample (NIS) database. Comorbidities - intracerebral hemorrhage (431), cerebrovascular anomaly (747.81), congestive heart failure (428.0), anemia (285.9) were also identified using the ICD-9 coding system. Descriptive and inferential statistical analysis were performed using SAS 2015. Results: A total of 842 HHT patients were identified with relatively older patients having increased prevalence of anemia (29% vs 15%), congestive heart failure (16% vs 8%), intra-cerebral hemorrhage (0.5% vs 0.3%), hypertension (47% vs 42%) compared to general population, respectively. We report HHT to be linked with having higher odds (p < 0.05) of congestive heart failure (1.6 times), chronic pulmonary lung disease (1.7 times), liver disease (3 times), anemia (1.6 times), cerebrovascular anomaly including cerebral AVMs (26 times), and other neurological disorders than patients without HHT, after adjusting for confounders. Conclusion: This is the first database study confirming higher prevalence of CHF in HHT. We infer that chronic anemia and AVM/AVF can cumulatively cause high output congestive heart failure causing increased morbidity and mortality in HHT population especially in advanced ages.

Introduction TAVR is indicated in patients with severe symptomatic aortic stenosis in whom surgery is considered intermediate risk. In a retrospective study (2010-2014), 24% of patients were rehospitalized for heart failure (HF) one year after TAVI. We aimed to assess the incidence, prognostic impact, and predictive factors of readmission for congestive heart failure (CHF) one year after TAVR in an intermediate risk population. Methods All patients who underwent transfemoral TAVR from March 2018 to October 2018 were included. Prospective follow-up was achieved at 1 year and included, MACCE, readmission for CHF, clinical and echocardiographic data. Results This study included 102 patients. Medial aging, sex ratio and medial logistic euroSCORE were respectively 85 [81-87] years, 50% and 13%[9-19,1]. One year after TAVR, 39 patients (39%) had been readmitted at least once, and 9 (9%) for CHF, one patient was readmitted twice. On multivariate analysis, a previous episode of CHF was the only factor close to be associated with CHF readmission at 1 year (hazard ratio: 10,52 (0,74–149,35), P = 0.06). Conclusion The incidence of readmission for CHF decrease between 2014 and 2018. A previous episode of CHF is the only factor associated with CHF readmission in our study.

702 Objective daily measurements of patient activity confirm the role of cardiac resynchronization therapy in improving functional status of patients with advanced heart failure M. Bocchiardo1, M. Lunati2, M. Gasparini3, L. Padeletti4, G. Boriani5, M. Sassara6, A. Achilli6, M. Scaglione1, A. Grammatico7, A. Denaro7 1Ospedale Civile, Asti, Italy; 2Ospedale Niguarda, Milano, Italy; 3Ospedale Humanitas, Milano, Italy; 4Ospedale Careggi, Firenze, Italy; 5Ospedale S. Orsola, Bologna, Italy; 6Ospedale Belcolle, Viterbo, Italy; 7Medtronic, Roma, Italy