Introduction: Hospital readmissions due to worsening heart failure have been associated with adverse prognosis in chronic heart failure patients.
Hypothesis: We sought to investigate the effects of transendocardial CD34+ cell therapy on hospital readmission rates in patients with chronic heart failure and reduced left ventricular ejection fraction (HFrEF).
Methods: We performed registry data analysis of patients with HFrEF treated with transendocardial CD 34+ cell therapy at our center between years 2006 and 2016. All patients received bone marow stimulation with G-CSF, cells were collected via apheresis, and injected transendocardially in the areas of hibernating myocardium as defined by NOGA electromechanical mapping. All patients received 20 injections of stem cell suspension. Hospital admissions one year prior to and one year after cell therapy were adjudicated and admissions due to worsening heart failure were included in the analysis.
Results: We enrolled 148 HFrEF patients with a mean age of 53±10 years; 87% were male. Nonischemic and ischemic cardiomyopathy were present in 62% and 38% of patients, respectively. The average serum creatinine was 88±24μmol/L, serum bilirubine 18±10μmol/L, NT-proBNP 2061±2891 pg/mL, LVEF 30±8% and 6' walk test 456±110 m. Within 1 year after cell therapy, 5 (3%) patients died, and 13 (9%) patients underwent heart transplantation. During this time frame we have observed a significant decrease in heart-failure related hospital readmissions when compared to the 1-year interval before cell therapy (0,8±0,8 admissions/year before cell therapy and 0,5±0,9 admissions/year after cell therapy; P=0.007). The decrease in admission rates was comparable in patients with nonischemic and ischemic heart failure etiology (-0.28±0.77 vs. -0.32±1,22; P=0.81 respectively).
Conclusions: In patients with chronic heart failure with reduced ejection fraction CD34+ cell therapy appears to be associated with reduced hospital readmission rates. Further prospective studies are needed to confirm this registry data and to investigate a possible long-term survival benefit of cell therapy in this patient population.