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Background and Aims The presence of CKD impacts short term survival of heart failure patients however impact on long term survival is not well known. The aim of this study was to investigate the impact of CKD on long term survival. Method Data were collected on long term survival of 845 patients (1029 admissions) admitted with diagnosis with acute heart failure. Data on mortality was collected by electronic patient records. Data were analysed using IBM SPSS 25. Results The baseline characteristics were: age 76 (13) mean (SD); Haemoglobin 11.8 (2), urea 37.2 (26.8), eGFR 63.3 (30.4), potassium 4.34 (0.70) and 36% diabetics, 567 patients (67%) died during follow up of median 916 days (IQR 188-1936 days). Patients who died were older, with higher urea, creatinine, potassium and NT proBNP. In a survival analysis adjusted for diabetes and haemoglobin; age, urea, NT-proBNP baseline eGFR and potassium predicted mortality (see table). CKD patients with eGFR 60 (log rank p=0.000) (see figure 1) Conclusion Long term mortality in patients with CKD was higher which was an independent predictor of survival

Aims Inpatients with heart failure and renal impairment have poor outcomes and variable quality of care. We investigate treatment practice and outcomes in an unselected real-world cohort using historical creatinine measurements. Methods and results Admissions between 1/4/2013 and 30/4/2015 diagnosed at discharge with heart failure were retrospectively analysed. Stages of chronic kidney disease (CKD) and acute kidney injury (AKI) were calculated from creatinine at discharge and 3–12 months before admission. We identified 1056 admissions of 851 patients (mean age 76 years, 56% Caucasian, 36% with diabetes mellitus, 54% with ischaemic heart disease, and 57% with valvular heart disease). CKD was common; 36%—Stage 3a/b, 11%—Stage 4/5; patients were older, more often diabetic, with higher potassium, lower haemoglobin, and more oedema but similar prevalence of left ventricular systolic dysfunction (LVSD) compared patients with Stages 0–2. AKI was present in 17.0% (10.4%—Stage 1, 3.7%—Stage 2, and 2.9%—Stage 3); these had higher potassium and lower haemoglobin than patients with no AKI. Length of stay was longer in Stage 4/5 CKD [11 days; P = 0.008] and AKI [13 days; P = 0.006]. Mortality was higher with Stage 4/5 CKD (13.8% compared with 7.7% for Stages 0–2 CKD (P = 0.036)] and increased with AKI (5%—no AKI, 20.9%—Stage 1, 35.9%—Stage 2, and 48.4%—Stage 3; P

Aims Inpatients with heart failure and renal impairment have poor outcomes and variable quality of care. We investigate treatment practice and outcomes in an unselected real‐world cohort using historical creatinine measurements. Methods and results Admissions between 1/4/2013 and 30/4/2015 diagnosed at discharge with heart failure were retrospectively analysed. Stages of chronic kidney disease (CKD) and acute kidney injury (AKI) were calculated from creatinine at discharge and 3–12 months before admission. We identified 1056 admissions of 851 patients (mean age 76 years, 56% Caucasian, 36% with diabetes mellitus, 54% with ischaemic heart disease, and 57% with valvular heart disease). CKD was common; 36%—Stage 3a/b, 11%—Stage 4/5; patients were older, more often diabetic, with higher potassium, lower haemoglobin, and more oedema but similar prevalence of left ventricular systolic dysfunction (LVSD) compared patients with Stages 0–2. AKI was present in 17.0% (10.4%—Stage 1, 3.7%—Stage 2, and 2.9%—Stage 3); these had higher potassium and lower haemoglobin than patients with no AKI. Length of stay was longer in Stage 4/5 CKD [11 days; P = 0.008] and AKI [13 days; P = 0.006]. Mortality was higher with Stage 4/5 CKD (13.8% compared with 7.7% for Stages 0–2 CKD (P = 0.036)] and increased with AKI (5%—no AKI, 20.9%—Stage 1, 35.9%—Stage 2, and 48.4%—Stage 3; P

Background How advances in knowledge lead via behaviour change to better health is not well understood. Here we report two case studies: a rapid reduction in HIV transmission in homosexual men and a decline in Sudden Infant Death Syndrome (SIDS) that took place in the period before the relevant national education programmes commenced, respectively, in 1986 and 1991. The role of newspapers in transferring knowledge relevant to reducing the risk of AIDS and SIDS is assessed. Methods HIV Searches were made of The Times (1981–1985), Gay News (1981–1984) and, for the key period of April to June 1983, of eight newspapers with the highest readership. Information on transmission route and educational messages were abstracted and analysed. SIDS Searches were made of The Times and the Guardian (1985–1991), The Sun (selected periods only, 1988–1991) and selected nursing journals published in England and Wales. Information on sleeping position and educational messages were abstracted and analysed. Results HIV Forty-five out of 50 articles identified in newspapers described homosexuals as an at risk group. Sexual transmission of AIDS was, however, covered poorly, with only 7 (14%) articles referring explicitly to sexual transmission. Only seven articles (14%) associated risk with promiscuity. None of the articles were specific about changes in behaviour that could be expected to reduce risk. Gay periodicals did not include specific advice on reducing the number of partners until early 1984. SIDS Out of 165 relevant articles in The Times and 84 in the Guardian, 7 were published before 1991 and associated risk with sleeping position. The reviewed nursing journals reflected a pervasive sense of uncertainty about the link between SIDS and sleeping position. Conclusion Presumptively receptive audiences responded rapidly to new knowledge on how changes in personal behaviour might reduce risk, even though the 'signals' were not strong and were transmitted, at least partly, through informal and 'horizontal' channels. Advances in knowledge with the potential to prevent disease by behaviour change may thus yield substantial health benefits even without the mediation of formal education campaigns ('interventions'). Formal campaigns, when they came, did make important additional contributions, especially in the case of SIDS.