TUGAS MATA KULIAH

ILMU PENYAKIT DALAM VETERINER II

“Gagal Jantung Kongestif Sisi Kanan pada Sapi Feedlot Amerika Utara”

1. Makrina Weni Misa 1609511125

2. Putu Teza Juliantari 1709511031
3. Nelci Elisabeth Bolla 1709511034
4. Made Bayu Putra 1709511036
5. Martina Tiodora Sitohang 1709511063

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

DENPASAR

2020
 Gagal Jantung Kongestif Sisi Kanan pada Sapi Feedlot Amerika Utara

J.M. Neary, C.W. Booker, B.K. Wildman, and P.S. Morley

Latar belakang: Laporan Anekdotal menunjukkan bahwa kejadian gagal jantung

kongestif sisi kanan (RHF) pada sapi feedlot meningkat; Namun, tingkat kejadian
dan faktor risiko sebagian besar tidak diketahui.

Tujuan: untuk mengevaluasi risiko RHF dari waktu ke waktu dan di antara
feedlot, untuk mengkarakterisasi beberapa faktor risiko untuk RHF, dan untuk
menyelidiki bagaimana faktor-faktor risiko dapat mempengaruhi waktu terjadinya
RHF.

Hewan: Populasi yang berisiko terdiri dari 1,56 juta sapi yang ditempatkan di 10
feedlot Kanada selama tahun 2000, 2004, 2008, dan 2012, dan 5 tempat
penggemukan AS selama tahun 2012.

Metode: Penelitian observasional retrospektif dilakukan. Variabel, termasuk

tahun masuknya ke feedlot, dievaluasi untuk hubungan dengan RHF
menggunakan model binomial negatif dan regresi regresi nol. Faktor-faktor yang
mempengaruhi waktu untuk RHF dievaluasi menggunakan analisis regresi hazard
proporsional Cox. Kematian akibat gangguan pencernaan berfungsi sebagai
kontrol.

Hasil: Risiko RHF di feedlot Kanada berlipat dua dari tahun 2000 ke tahun 2012
(P = 0,003). Untuk setiap 10.000 sapi yang memasuki feedlot AS pada tahun
2012, 11 sapi mati karena RHF dan 45 sapi mati akibat gangguan pencernaan.
Waktu rata-rata untuk RHF adalah 19 minggu. Sapi yang dirawat karena penyakit
pernafasan 3 kali lebih mungkin meninggal akibat RHF dan mati lebih awal pada
periode menyusui.

Kesimpulan: Menggandakan insiden RHF selama periode waktu singkat,

khususnya untuk feedlot AS yang terletak di ketinggian sedang di dataran tinggi.

Kata kunci: Gagal jantung kongestif; Lemak; Hipoksia; Hipertensi paru;

Penyakit pernapasan.
 Gagal jantung kongestif sisi kanan (RHF) dimulai oleh penyempitan
arteriol paru yang diinduksi hipoksia. Penyempitan pembuluh darah
meningkatkan resistensi terhadap aliran darah, yang berarti tekanan arteri paru dan
menimbulkan RHF. Sapi yang terkena hipoksia hipobarik di tempat tinggi
memiliki risiko yang lebih besar terhadap hipoksia alveolar dan berisiko lebih
besar mengalami RHF daripada sapi di ketinggian lebih rendah. Sebelum tahun
1970-an, RHF hanya dilaporkan pada sapi di ketinggian lebih dari 2.130 m3,4;
sejak itu telah dilaporkan di ketinggian yang lebih rendah. Pada tahun 1974,
sebuah studi dari 4 feedlot di AS yang terletak di ketinggian 1.600 m melaporkan
risiko serangan RHF menjadi 2,85 kasus per 10.000 sapi yang memasuki feedlot.
Baru-baru ini, sebuah penelitian yang dilakukan di ketinggian 1.600 m
melaporkan bahwa RHF adalah penyebab utama kematian kedua, setelah
pneumonia, di sapi perah Holstein usia <1,5 tahun. Lebih lanjut, laporan
anekdotal menunjukkan bahwa kejadian RHF pada sapi feedlot meningkat.
Laporan-laporan ini memprihatinkan karena mayoritas feedlot AS terletak pada
ketinggian sedang (800-1.600 m) di Dataran Tinggi. Pengobatan untuk penyakit
pernafasan sapi (BRD), tanggal masuk feedlot, risiko BRD / demam yang tidak
berkurang (UF), dan umur saat masuk feedllot, dievaluasi sebagai faktor risiko
potensial untuk RHF.

Singkatan :

RHF : Right Heart Failure

DD : Digestive Disorders

BRD : Bovine Respiratory Disease

UF : Undifferentiated Fever
 Bahan dan Metode

Tinjauan Studi

Data dari 10 feedlots Kanada diperoleh dari tahun 2000, 2004, 2008, dan
2012, dan dari 5 US feedlots dari tahun 2012. Sapi yang masuk feedlots
dikategorikan berdasarkan tanggal masuk tempat makan, umur, jenis kelamin, dan
risiko BRD / UF. Semua sapi yang mati di feedlot diperiksa postmortem oleh
dokter hewan dan penyebab utama kematian dicatat. Untuk keperluan penelitian
ini, hanya catatan individual ternak yang mati karena RHF atau gangguan
pencernaan dievaluasi. Dari data ini, risiko RHF dan gangguan pencernaan (DD)
ditentukan setiap 4 tahun dari tahun 2000 hingga tahun 2012. Efek penyakit
pernapasan, tanggal penempatan, risiko BRD / UF, jenis kelamin dan kesehatan
reproduksi selama periode penggemukan dievaluasi.

Populasi Studi

Populasi penelitian terdiri dari sapi yang ditempatkan di 10 feedlot yang

terletak di Kanada barat selama tahun 2000, 2004, 2008, dan 2012, dan ternak
ditempatkan di 5 feedlot di Amerika Serikat bagian barat selama tahun 2012.
Feedlot ini dipilih karena secara individual mengidentifikasi semua sapi yang di
kelola, mencatat informasi kesehatan terperinci untuk semua individu dan
necropsy dilakukan oleh dokter hewan pada semua hewan yang mati. Data ini
disediakan oleh perusahaan manajemen kesehatan hewan yang bertanggung jawab
atas pengawasan perawatan kesehatan dalam populasi ini.

Sebanyak 1,28 juta sapi memasuki feedlot Kanada selama bertahun-tahun,

dan 273.319 sapi memasuki feedlot AS pada tahun 2012. Feedlots Kanada
berlokasi di ketinggian mulai dari 657 hingga 1.145 m. Satu feedlot AS berada di
ketinggian 596 m; 4 feedlot lainnya terletak di ketinggian mulai dari 1.142 hingga
1.282 m. Hewan yang memasuki feedlot memiliki kisaran berat badan (225-400
kg). Berdasarkan pada faktor-faktor ini, dan pola historis penyakit pada sapi yang
sama, kelompok yang tiba diberi kategori ordinal risiko untuk mengembangkan
BRD / UF (risiko rendah hingga risiko sangat tinggi), yang digunakan untuk
menentukan pencegahan dan pengobatan.
 Prosedur standar kesehatan dan produksi yang sama digunakan di semua
feedlot. Pada saat kedatangan di feedlot, semua sapi diberi label telinga dengan
nomor identifikasi yang unik, implan pertumbuhan, antikanmintik avermectin
topical dan vaksin terhadap agen bakteri dan virus penyakit pernapasan. Sapi yang
dikategorikan berisiko tinggi mengalami BRD / UF diberikan antibiotik parenteral
sebagai pengobatan profilaksis, atau metafilaksis. Sapi diberi makan ransum yang
memenuhi atau melampaui persyaratan Dewan Riset Nasional untuk sapi potong.
Sapi biasanya disembelih dengan berat badan 550-650 kg, sekitar 120–250 hari
setelah masuk ke feedlot.

Pengumpulan Data dan Diagnosis Penyakit

Populasi yang berisiko adalah jumlah sapi yang memasuki feedlot selama
satu tahun : 2000, 2004, 2008, atau 2012. Populasi dikelompokkan untuk analisis
berdasarkan: feedlot, pakan, tahun penempatan, periode penempatan (1 Januari -
30 April; 1 Mei - 31 Agustus; dan, 1 September - 31 Desember), umur, jenis
kelamin dan risiko BRD / UF (tinggi atau rendah). Data yang dikumpulkan untuk
semua sapi dalam populasi penelitian termasuk identifikasi individu, bobot
individu pada saat kedatangan, bobot badan saat keluar dari feedlot, semua
perawatan preventif dan terapeutik (misalnya, vaksinasi, cacingan, obat-obatan
yang diberikan), dan diagnosa penyakit apa pun. Penyakit BRD diidentifikasi
ketika sapi menunjukkan tanda-tanda dispnea, kurangnya respons terhadap
stimulasi, keengganan untuk bergerak, pengangkutan abnormal atau postur kepala,
atau kombinasi dari tanda-tanda ini. Semua sapi yang mati di nekropsi, dan dokter
hewan menggunakan riwayat klinis dan temuan fisik untuk menentukan penyebab
kematian. Untuk keperluan penelitian ini, diagnosis postmortem yang dikaitkan
dengan gangguan percernaan termasuk ternak dengan radang kembung ruminal,
enteritis, gangguan usus, dan peritonitis. Peritonitis termasuk dalam gangguan
pencernaan karena dianggap sebagai penyebab utama.

Kriteria yang digunakan untuk diagnosis RHF dan gangguan pencernaan

(DD) disediakan pada Tabel 2. Untuk tujuan analisis, setiap hewan diberi satu
penyebab utama kematian. Selain informasi yang diperoleh dari semua sapi,
informasi yang diperoleh dari sapi yang mati karena RHF atau gangguan
pencernaan juga termasuk pengobatan sebelumnya untuk BRD (ya / tidak).

Pengumpulan Data dan Diagnosis Penyakit

Tabel. Lesi postmortem digunakan untuk identifikasi penyebab kematian.

PENYEBAB KEMATIAN LESI POST MORTEM

Gagal jantung kongesif Edema ventral, hydroperitoneum;

hydrothorax dan atelektasis sekunder;
hepatomegali dan kongesti, edema usus
dan mesenterika hidroperikardium;
ventrikel kanan hipertrofi dan dilatasi

Ruminal bloat Paru-paru yang kurang kembung;

kongesti pada karkas bagian cranial,
ekor pucat, edema jaringan subkutan,
rumen berisi gas, hati berukuran kecil
dan pucat

Enteritis Hiperemia dan edema pada mukosa

usus; mukosa fibrinous, pendarahan,
gelap, berisi cairan.

Gangguan usus Mesenterika rent,parasitisme usus,

penyempitan usus,torsi / volvulus

Peritonitis Hydroperitoneum, deposisi fibrin

Tidak semua lesi diperlukan untuk diagnosis. Peritonitis sebagai "penyebab"

kematian tetapi penyebab yang mendasari peritonitis tidak bisa diidentifikasi.
Model yang digunakan: binomial negatif nol-inflasi, regresi logistik, dan Cox
proportional hazard regression. Setiap model memberikan informasi unik.
 Model binomial negatif nol-inflasi mengungkapkan faktor risiko dikaitkan
dengan RHF, tetapi tidak dapat membedakan antara faktor-faktor risiko spesifik
dengan RHF dan faktor risiko tidak spesifik untuk kematian. Melalui analisis
regresi logistik, gangguan pencernaan merupakan faktor risiko khusus untuk RHF.
Analisis regresi hazard proporsional Cox mengungkapkan bagaimana berbagai
faktor risiko mempengaruhi tingkat terjadinya RHF melalui periode menyusui.
Temuan terakhir penting karena waktu berisiko atau durasi makan, mungkin telah
mengacaukan faktor risiko dalam model regresi logistik. Misalnya, ternak
memasuki feedlot karena anak sapi kemungkinan akan diberi makan lebih lama
dari sapi masuk sebagai anakan. Oleh karena itu, di risiko RHF selama lebih dari
satu tahun. Akibatnya, anak sapi memiliki peluang yang sama atau lebih besar
menderita RHF.

Dalam semua model, hewan secara individu digunakan untuk analisis.

Interaksi antara periode penempatan feedlot, risiko BRD / UF, jenis kelamin, dan
usia, dievaluasi. Faktor inflasi varians<2,0 untuk semua variabel yang
menunjukkan bahwa model tidak buruk dipengaruhi oleh multikolinieritas.
Clustering dengan feedlot tadinya dikontrol sebagai efek tetap di semua model,
memberikan feedlot-spesifik perkiraan dampak. Tes Wald ("tes") dilakukan di
semua model untuk menentukan signifikansi statistik dari variabel variabel multi-
level. Model binomial negatif nol-meningkat ("zinb") digunakan untuk
menghitung rasio risiko serangan untuk RHF dan DD sesuai dengan periode
penempatan, risiko BRD / UF, jenis kelamin, usia, tahun penempatan (hanya
feedlot Kanada).

Jumlah ternak dalam pola kovariat adalah satu-satunya variabel yang

dimasukkan di bagian logistik dari semua model nol-inflasi. Pola kovarian dengan
lebih sedikit ternak lebih mungkin untuk memiliki nol hitungan RHF dan DD.
Hasil bagian logistik dari model tidak berkaitan dengan tujuan penelitian sehingga
tidak disajikan. Risiko rata-rata yang disesuaikan dari RHF dan DD adalah
diperoleh untuk sapi AS pada 2012. Semua variabel tetap dalam model akhir
terlepas dari hubungan statistik dengan RHF. Ini memungkinkan perbandingan
faktor risiko antara populasi AS dan Kanada dan hubungan antara faktor-faktor
risiko dan hasil yang harus dipersiapkan di berbagai model. Risiko rata-rata yang
disesuaikan dari RHF juga diperoleh untuk masing-masing AS dan Kanada pada
tahun 2012, sambil mengontrol periode feedlot, risiko BRD / UF, jenis kelamin,
dan usia

Analisis kasus-kontrol, dikelompokkan berdasarkan negara, dilakukan

menggunakan model regresi logistik (“logistik”) untuk menyelidiki faktor risiko
yang lebih spesifik terkait dengan RHF. Kasus ternak yang kematiannya
disebabkan oleh RHF, dan kontrol adalah kucing yang mati karena DD. Peluang
RHF dihitung untuk periode penempatan feedlot, risiko BRD / UF, jenis kelamin,
umur, pengobatan untuk BRD, dan feedlot. Semua variabel tetap dalam model
akhir terlepas dari hubungan statistik dengan RHF. Tahun penempatan (hanya
model Kanada) dan feedlot masuk sebagai efek tetap untuk mengontrol
pengelompokan. Analisis regresi hazard proporsional Cox ("stcox") dilakukan
bertingkat di negara untuk menentukan faktor risiko mana yang berpengaruh
untuk RHF. Kasus sapi yang mati karena RHF dan kontrol adalah sapi yang mati
DD. Faktor-faktor risiko yang dievaluasi termasuk periode penempatan, jenis
kelamin, risiko BRD / UF, dan pengobatan untuk BRD. Para model
dikelompokkan berdasarkan tahun penempatan (hanya Kanada), dan feedlot.
Metode eliminasi digunakan sehingga dalam model akhir semua variabel
dianggap signifikan secara statistik jika P <0,05.

Hasil

Risiko yang disesuaikan dari RHF berlipat dua dari tahun 2000 hingga
tahun 2012, ketika mengendalikan periode penempatan feedlot, risiko, jenis
kelamin, umur, dan feedlot. Antara tahun 2000 dan 2012, risiko RHF, bloat, DD
nonbloat (enteritis, gangguan usus dan peritonitis), dan semua DD meningkat
sebesar 91, 70, 29, dan 61%. Sehubungan dengan tahun 2000, peluangnya RHF
pada tahun 2004, 2008, dan 2012 adalah 1,58 (95% CI = 1,11, 2,26), 2,69 (95%
CI = 1,95, 3,70), dan 1,51 (95% CI = 1,07, 2,13).
 Kemungkinan RHF Di antara Feedlots

Pada tahun 2012 Risiko yang disesuaikan dari RHF dan DD di tempat
pemberian makan di AS adalah 1,08 per 1.000 sapi (95% CI = 0,89, 1,28) dan
4,54 per 1.000 sapi (95% CI = 3,52,56), masing-masing.

Relatif terhadap sapi di feedlot AS, sapi di feedlot Kanada memiliki

sekitar setengah risiko RHF dan DD. Di AS dan Kanada, feedlot memiliki risiko
kematian akibat RHF adalah sekitar 5 kali lebih rendah dari risiko kematian akibat
DD. Ada perbedaan besar dalam risiko kesehatan reproduksi di antara tempat
pemberian AS dan Kanada (P <.001).

Risiko RHF Berdasarkan Waktu Penempatan, Risiko BRD /UF, Umur, dan
Jenis Kelamin

Periode penempatan, risiko BRD / UF, dan jenis kelamin, menunjukkan

kesamaan di AS dan Kanada. Sapi ditempatkan di feedlot dari 1 Mei hingga 31
Agustus, atau dari 1 September hingga 31 Desember, memiliki risiko yang
disesuaikan dengan RHF setidaknya 50% lebih besar dari sapi yang ditempatkan
di feedlot dari 1 Januari hingga 30 April. Di feedlot AS, sapi jantan dan ternak
diklasifikasikan pada penempatan memiliki risiko tinggi terhadap BRD / UF
sekitar 2 dan 3 kali mati akibat RHF daripada sapi betina dan kucing yang
diklasifikasikan pada penempatan memiliki risiko rendah BRD / UF.

Kemungkinan Terjadinya RHF

Sapi yang dirawat karena BRD 3 kali lebih mungkin mati akibat RHF
daripada sapi yang tidak dirawat karena BRD. Periode penempatan feedlot secara
signifikan terkait dengan kemungkinan RHF di AS dan Feedlots Kanada (P
<.001). Sapi memasuki feedlot dari 1 Mei hingga 31 Desember memiliki 51-127%
lebih besar risiko RHF dibandingkan sapi yang masuk sejak 1 Januari hingga 30
April. Peluang RHF adalah 39% lebih besar jantan terhadap betina di feedlot AS
(P = 0,04), tetapi tidak ada perbedaan jenis kelamin di feedlot Kanada. Umur pada
saat kedatangan di feedlot tidak dikaitkan dengan kemungkinan RHF di feedlot
AS atau Kanada.
 Waktu Tiba di Feedlot Sampai Mati karena RHF

Kematian akibat RHF terjadi selama periode menyusui tetapi cenderung

terjadi pada periode menyusui dari pada kematian akibat DD (Gbr 2). Kematian
akibat RHF tidak berubah secara signifikan dari waktu ke waktu, saat mengontrol
periode penempatan, feedlot ,Risiko BRD / UF, usia, jenis kelamin, dan
perawatan untuk BRD (P> .20). Ruminal bloat menjadi penyebab 72 dan 83% dari
kematian akibat DD di feedlots Kanada dan AS.

Diskusi

Hasil studi ini mendukung kekhawatiran produser bahwa kejadian RHF

pada sapi penggemukan memiliki peningkatan: risiko RHF di feedlot Kanada
sekitar dua kali lipat dari tahun 2000 ke tahun 2008 dan 2012. Meskipun
peningkatan 2 kali lipat angka kematian RHF, jumlah ternak yang mati dari RHF
di 2012 adalah relativitas kecil jika dibandingkan dengan DD: sekitar 4-5 kali
lebih banyak ternak meninggal karena DD dari RHF. Meskipun kerugian
kematian dari RHF relatif kecil, terjadinya RHF pada sapi penggemukan dicatat
untuk 2 alasan: Pertama, sebelum tahun 1970-an, RHF hanya dilaporkan pada
sapi pada ketinggian lebih 2.130 m; Oleh karena itu, peningkatan 2 kali lipat
dalam RHF selama 12 tahun di feedlot terletak di rendah (657 m) sampai sedang
(1.145 m) elevasi layak untuk mendapatkan perhatian. Kedua, meskipun RHF
terjadi sepanjang periode makan, setengah dari semua kasus terjadi setelah 19
minggu; ini membuat penurunan kematian akibat RHF terutama mahal. Orang
mungkin menduga bahwa karena sapi diberi makan lebih lama, dan lebih berat di
finishing bobot, periode risiko untuk RHF telah hanya meningkat dari waktu ke
waktu akibatnya lebih banyak RHF menyebabkan kematian, terutama pada
periode makan terlambat. Jika demikian, rata-rata waktu dari penggemukan
kedatangan mati dari RHF seharusnya meningkat dari waktu ke waktu, tetapi
dalam penelitian kami, ini tidak diamati. Sayangnya, karena kita tahu sedikit
tentang faktor risiko untuk penyakit ini, upaya untuk mengurangi kejadian RHF
telah frustasi untuk kedua produsen dan dokter hewan.

Pada sapi, hipoksia alveolar dianggap faktor risiko utama untuk renovasi
vaskular paru dan hipertensi, yang mungkin pada akhirnya menyebabkan RHF.
Faktor-faktor predisposisi ternak hipoksia alveolar bisa, oleh karena itu, telah
menjelaskan peningkatan mortalitas RHF diamati dari waktu ke waktu dalam
penelitian kami. Faktor-faktor yang dapat menyebabkan hipoksia alveolar
meliputi: hipoksia hypobaric, hipoventilasi, dan penyakit pernapasan.

Hipoksia hypobaric tidak dapat menjelaskan peningkatan RHF hilangnya

kematian diamati sejak feedlots Kanada yang sama dipelajari selama seluruh
periode. Itu bisa, bagaimanapun, menjelaskan mengapa sapi memiliki dua kali
risiko RHF di feedlot AS relatif terhadap feedlots Kanada. Feedlots AS yang
diteliti memiliki kisaran terbesar dari ketinggian dan umumnya terletak di
ketinggian tertinggi. Empat dari 5 feedlots AS yang diteliti berada di ketinggian
lebih dari 1.142 m; yang kelima penggemukan terletak hanya di 596 m.
Ketinggian selisih dari 686 m mungkin menjelaskan mengapa sapi feedlot terletak
pada ketinggian tertinggi (1.282 m) yang 9 kali lebih mungkin meninggal dari
RHF dari ternak di ketinggian terendah. Atau, risiko RHF mungkin telah lebih
besar dalam feedlot AS pada ketinggian ≥ 1.142 m karena mereka lebih mungkin
untuk memiliki ternak diperoleh dari daerah dataran tinggi (> 1600 m) dari
penggemukan di 596 m. Sebelum merumput gunung diduga meningkatkan risiko
RHF pada sapi penggemukan. 5 feedlots Kanada, di sisi lain, umumnya terletak di
ketinggian lebih rendah dari feedlots AS dan kemungkinan diperoleh ternak dari
ketinggian yang lebih rendah. Mereka juga memiliki ketinggian maksimum
selisihnya hanya 488 m, yang kemungkinan menjelaskan mengapa risiko RHF,
dan variasi risiko RHF antara penggemukan, itu relatif kecil dibandingkan dengan
penggemukan AS.
 Gambar Kurva Kaplan-Meier, dengan penduga varians yang kuat,
membandingkan waktu bertahan hidup di antara semua sapi yang mati karena
gagal jantung kanan (RHF) di tempat pemberian pakan Kanada.

Sayangnya, desain penelitian kami tidak memungkinkan kami untuk

menyelidiki hubungan antara risiko RHF dan ketinggian tempat pemberian pakan.
Ada terlalu banyak variabel pengganggu potensial yang terkait dengan ketinggian
tempat pemberian pakan, seperti ketinggian tempat pengadaan ternak, untuk
membuat kesimpulan. Namun, kita dapat menyimpulkan bahwa meskipun
hipoksia hipobarik, atau paparan hipoksia hipobarik sebelumnya, mungkin telah
menekankan risiko RHF pada sapi penggemukan, tidak ada penjelasan yang dapat
menjelaskan secara memadai peningkatan mortalitas RHF dari waktu ke waktu.
Ini meninggalkan BRD dan hipoventilasi sebagai penjelasan yang mungkin.

Hasil kami menunjukkan bahwa sapi yang dirawat karena BRD 2–3 kali
lebih mungkin meninggal akibat RHF daripada sapi yang tidak dirawat untuk
BRD. Meskipun secara biologis layak bahwa BRD merupakan predisposisi untuk
RHF, hubungan sebab akibat pada sapi belum didokumentasikan. Seseorang
mungkin menduga bahwa peningkatan risiko Kesehatan Reproduksi yang diamati
dari waktu ke waktu sebagian disebabkan oleh peningkatan risiko BRD selama
periode waktu yang sama. Hasil kami, bagaimanapun, menunjukkan bahwa
kemungkinan RHF meningkat dari waktu ke waktu bahkan ketika mengendalikan
untuk pengobatan BRD.

Penjelasan yang mungkin kedua, hipoventilasi, sebelumnya telah

disarankan sebagai faktor risiko untuk RHF. Ini bisa menjadi masalah pada sapi
penggemukan karena 2 alasan: Pertama, pembengkakan ruminal setelah makan
dapat menekan paru-paru dan, akibatnya, mengurangi ventilasi alveolar yang
efektif; dan kedua, sapi penggemukan mengumpulkan banyak lemak tubuh selama
periode menyusui. Akumulasi lemak di perut dan di atas dada dapat meningkatkan
kerja mekanik pernapasan.

Gambar Kurva Kaplan – Meier, dengan penduga varians yang kuat,

membandingkan waktu bertahan hidup di antara semua sapi yang mati karena
gagal jantung kanan
(RHF) di tempat pemberian AS.

Ada beberapa faktor yang menunjukkan akumulasi lemak tubuh sebagai

faktor risiko untuk RHF. Pertama, RHF dominan terjadi setelah 4 bulan menyusui,
suatu periode yang bertepatan dengan persentase lemak tubuh maksimal. Kedua,
anak-anak sapi memiliki dua kali lipat tingkat RHF relatif terhadap anak sapi
(anak sapi), tetapi selama periode pemberian makan masing-masing, mereka
sama-sama cenderung meninggal akibat RHF. Mungkin penjelasan yang paling
pelit untuk temuan ini adalah bahwa anak sapi dan anak sapi dikelola pada titik
akhir yang sama: sapi gemuk siap untuk disembelih. Namun, anakanak biasanya
lebih gemuk daripada anak sapi saat masuk ke tempat pemberian pakan; ini
mungkin telah membuat mereka memiliki risiko yang lebih besar untuk kesehatan
reproduksi pada awal periode menyusui. Terakhir, dan agak paradoksal, sapi
dengan risiko BRD / UF yang tinggi 50% lebih kecil kemungkinannya meninggal
akibat RHF daripada sapi yang dianggap berisiko rendah. Ini tampaknya tidak
masuk akal mengingat bahwa pengobatan untuk BRD meningkatkan risiko
kesehatan reproduksi sebanyak 2-3 kali; kecuali, bagaimanapun, risiko BRD / UF
dikacaukan oleh faktor risiko yang protektif terhadap RHF seperti genetika,
kondisi tubuh, atau perbedaan manajemen.

Keterbatasan penelitian kami adalah hanya 4 tahun data yang digunakan

untuk memperkirakan risiko RHF di tempat pemberian pakan Kanada. Namun,
kami yakin dengan ketepatan estimasi kami mengingat bahwa data kami terdiri
dari 1,56 juta sapi yang dikelola menggunakan protokol manajemen kesehatan
standar, dan disusun oleh spesialis dalam kesehatan tempat pemberian pakan.
Selain itu, meskipun kami tidak memperhitungkan potensi pengelompokan pada
tingkat pena, penggunaan kami penduga varian kuat di semua model memastikan
bahwa estimasi yang diperoleh konservatif. Namun, karena hanya 4 tahun data
yang dipilih, kami tidak dapat mengesampingkan kemungkinan bahwa variasi
iklim dalam tahun-ke-tahun atau faktor-faktor lain berkontribusi terhadap variasi
dalam risiko RHF. Sekalipun variasi iklim dari tahun ke tahun memengaruhi hasil
kami, bagaimanapun, bias dalam risiko RHF dari waktu ke waktu akan terjadi
terhadap nol. Sebaliknya, kami menemukan bahwa relatif terhadap tahun 2000,
kemungkinan RHF secara konsisten lebih besar di tahun-tahun berikutnya.

Keterbatasan lain adalah bahwa karena hanya tempat pemberian pakan

Kanada yang dipelajari selama beberapa tahun kami tidak dapat membuat
kesimpulan tentang bagaimana risiko RHF di tempat pemberian pakan AS
berubah selama periode waktu yang sama. Namun, bukti yang tersedia
menunjukkan bahwa kejadian RHF pada sapi penggemukan di AS telah
meningkat secara substansial. Pada tahun 1974, sebuah penelitian terhadap 4
tempat pemberian pakan di AS yang terletak di ketinggian 1.600 m melaporkan
risiko RHF menjadi 2,85 kasus per 10.000 sapi yang memasuki tempat pemberian
pakan. Dalam penelitian kami di tempat pemberian pakan di AS, risiko kesehatan
reproduksi sangat tinggi: mulai dari 4 hingga 17 kematian per 10.000 sapi yang
memasuki tempat pemberian pakan di ketinggian masing-masing mulai dari 596
hingga 1.282 m.

Kurva Kaplan-Meier, dengan penduga varians yang kuat, membandingkan

waktu bertahan hidup di antara semua sapi yang mati karena gagal jantung kanan
(RHF) di tempat pemberian pakan Kanada. (A) Sapi yang memasuki tempat
pemberian pakan mulai 1 Mei hingga 31 Agustus meninggal karena RHF lebih
awal daripada sapi yang masuk pada waktu lain (P ≤ 0,01). (B) Sapi dikategorikan
sebagai berisiko tinggi penyakit pernapasan (BRD) dan demam tidak
berdiferensiasi (UF) meninggal akibat RHF kemudian dalam periode pemberian
makan daripada sapi dengan risiko rendah (P <0,001). (C) Sapi masuk ke tempat
pemberian pakan saat anak-anak mati dari RHF lebih awal dari sapi masuk
sebagai anak sapi (P = 0,002). (D) Sapi yang dirawat karena BRD mati lebih awal
dari RHF daripada sapi yang tidak dirawat (P <.001).

Kurva Kaplan-Meier, dengan penduga varians yang kuat, membandingkan

waktu bertahan hidup di antara semua sapi yang mati karena gagal jantung kanan
(RHF) di tempat pemberian pakan di AS. (A) Sapi yang memasuki tempat
pemberian pakan mulai 1 Januari hingga 30 April meninggal karena RHF lebih
lambat daripada sapi yang masuk pada waktu lain (P ≤ 0,005). (B) Sapi
dikategorikan sebagai berisiko tinggi penyakit pernapasan (BRD) dan demam
tidak berdiferensiasi (UF) meninggal kemudian pada periode pemberian makanan
daripada sapi dengan risiko rendah (P <0,001). (C) Sapi yang memasuki tempat
pemberian pakan mati lebih awal dari sapi yang masuk sebagai anak sapi (P =
.001). (D) Sapi yang dirawat karena BRD mati lebih awal daripada sapi yang tidak
dirawat (P <.001).
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/283577230

Right-Sided Congestive Heart Failure in North American Feedlot Cattle

Article  in  Journal of Veterinary Internal Medicine · November 2015

DOI: 10.1111/jvim.13789

CITATIONS READS
11 178

4 authors, including:

Joseph M Neary Calvin W Booker

Texas Tech University Feedlot Health Management Services
35 PUBLICATIONS   85 CITATIONS    99 PUBLICATIONS   1,191 CITATIONS   

SEE PROFILE SEE PROFILE

Paul S Morley
Texas A&M University
323 PUBLICATIONS   4,892 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Characterizing the impact of endotoxicosis on the health of feedlot cattle View project

Effects of Ceftiofur and Chlortetracycline on the Resistome of Feedlot Cattle View project

All content following this page was uploaded by Paul S Morley on 10 November 2015.

The user has requested enhancement of the downloaded file.

J Vet Intern Med 2015

Right-Sided Congestive Heart Failure in North American Feedlot

Cattle
J.M. Neary, C.W. Booker, B.K. Wildman, and P.S. Morley
Background: Anecdotal reports suggest the incidence of right-sided congestive heart failure (RHF) in feedlot cattle is
increasing; however, the rate of occurrence and risk factors are largely unknown.
Objective: The purposes of this study were to evaluate the risk of RHF over time and among feedlots, to characterize
some of the risk factors for RHF, and to investigate how risk factors may affect the timing of RHF occurrence.
Animals: The population at risk consisted of 1.56 million cattle that were placed in 10 Canadian feedlots during the years
2000, 2004, 2008, and 2012, and 5 US feedlots during the year 2012.
Methods: A retrospective observational study was conducted. Variables, including year of feedlot entry, were evaluated
for association with RHF using zero-inflated negative binomial and logistic regression models. Factors affecting time to RHF
were evaluated using Cox proportional hazard regression analyzes. Death from digestive disorders (DD) served as a control.
Results: The risk of RHF in Canadian feedlots doubled from the year 2000 to the year 2012 (P = .003). For every 10,000
cattle entering US feedlots in 2012, 11 cattle died from RHF and 45 cattle died from DD. The median time to RHF was
19 weeks. Cattle treated for bovine respiratory disease were 3 times more likely to die from RHF, and they died earlier in
the feeding period.
Conclusions: A doubling of the incidence of RHF over a short time period is concerning, particularly for US feedlots situ-
ated at moderate altitudes in the High Plains.
Key words: Congestive heart failure; Fat; Hypoxia; Pulmonary hypertension; Respiratory disease.

ight-sided congestive heart failure (RHF), also

R known as high altitude disease or brisket disease, is
initiated by hypoxia-induced pulmonary arteriolar nar-
rowing.1,2 Vessel narrowing increases resistance to
blood flow, mean pulmonary arterial pressure and, ulti-
mately, the risk of RHF. Cattle exposed to the hypo-
baric hypoxia of high altitude have a greater baseline
risk of alveolar hypoxia and, consequently, are at
greater risk of RHF than cattle at lower altitudes.
Before the 1970s, RHF had only been reported in cattle
at altitudes over 2,130 m3,4; it has since been reported
at lower altitudes, however. In 1974, a study of 4 US
feedlots located at an altitude of 1,600 m reported the
attack risk of RHF to be 2.85 cases per 10,000 cattle
entering the feedlot.5 More recently, a study conducted
at an altitude of 1,600 m reported RHF to be the sec-
ond leading cause of death, behind pneumonia, in Hol-
stein dairy heifers aged <1.5 years.6 Furthermore,
anecdotal reports suggest that the incidence of RHF in
feedlot cattle is increasing. These reports are concerning
From the Department of Animal and Food Sciences, Texas Tech
University, Lubbock, TX (Neary); the Feedlot Health Management
Services Ltd, Okotoks, AB Canada (Wildman and Bookers); and
Department of Clinical Sciences, Colorado State University, Fort
Collins, CO (Morley).
Corresponding author: J.M. Neary, Department of Animal and
Food Sciences, Texas Tech University, Lubbock, TX 79409-2141;
e-mail: joe.neary@ttu.edu.
Submitted March 19, 2015; Revised September 18, 2015;
Accepted October 13, 2015.
Copyright © 2015 The Authors. Journal of Veterinary Internal
Medicine published by Wiley Periodicals, Inc. on behalf of the Ameri-
can College of Veterinary Internal Medicine.
This is an open access article under the terms of the Creative
Commons Attribution-NonCommercial License, which permits use,
distribution and reproduction in any medium, provided the original
work is properly cited and is not used for commercial purposes.
DOI: 10.1111/jvim.13789
Abbreviations:
RHF right heart failure
DD digestive disorders
BRD bovine respiratory disease
UF undifferentiated fever
because the majority of US feedlots are situated at
moderate altitudes (800–1,600 m) in the High Plains.7
The purposes of this study were 3-fold: to evaluate
the risk of RHF over time and among feedlots; to
investigate some of the risk factors for RHF; and, to
determine how these risk factors affect the time to RHF
occurrence. Treatment for bovine respiratory disease
(BRD), date of feedlot entry, risk of BRD/undifferenti-
ated fever (UF), and age on feedlot entry, were evalu-
ated as potential risk factors for RHF.
Materials and Methods
Study Overview
Data from 10 Canadian feedlots were obtained from the years
2000, 2004, 2008, and 2012, and from 5 US feedlots from the year
2012. Cattle entering the feedlots were categorized by date of feed-
lot entry, age, sex, and risk of BRD/UF. All cattle that died in the
feedlots were examined postmortem by a veterinarian and a pri-
mary cause of death recorded. For the purposes of this study, only
the individual records of cattle that died from RHF or a digestive
disorder were evaluated. From these data, the risks of RHF and
digestive disorders (DD) were determined every 4 years from the
year 2000 to the year 2012. The effects of respiratory disease,
placement date, risk of BRD/UF, and sex, on the risk, and distri-
bution, of RHF through the feeding period were evaluated. Death
from DD served as a competing cause.
Study Population
The study population consisted of cattle placed in 10 feedlots
located in western Canada during the years 2000, 2004, 2008, and
2 Neary et al

2012, and cattle placed in 5 feedlots in the western United States
during the year 2012. These feedlots were chosen because they
individually identified all cattle they managed, recorded detailed
health information for all individuals in a specially designed com-
puter information system (iFHMS), and a gross necropsy was per-
formed by a licensed veterinarian on all animals that died.a These
data were provided by the veterinary health management company
responsible for oversight of health care in these populations.a
A total of 1.28 million cattle entered the participating Canadian
feedlots over the years studied, and 273,319 cattle entered the par-
ticipating US feedlots in 2012 (Table 1). The Canadian feedlots
were located at altitudes ranging from 657 to 1,145 m. One US
feedlot was located at an altitude of 596 m; the other 4 feedlots
were located at altitudes ranging from 1,142 to 1,282 m (Table 1).
The procurement and management of cattle within the feedlots
studied was typical of those practices used at large commercial cat-
tle feedlots. Pens of animals entering the feedlots had a range of
body weights (225–400 kg), ages, frame sizes, and sexes. Based
upon these factors, and historical patterns of illness in similar cat-
tle, arriving groups were assigned an ordinal category of perceived
risk for developing BRD/UF (low risk to very high risk), which
was used to determine prevention and treatment protocols. For
this study, these categories were dichotomized (low versus high
risk).
The same standardized health and production procedures were
used across all feedlots, as per the protocols developed by special-
ist feedlot veterinarians.a On arrival at the feedlot, all cattle
received an ear tag with a unique identification number, a growth
implant, a topical avermectin anthelmintic, and vaccines against
bacterial and viral agents of respiratory disease. Cattle categorized
as being at high risk of BRD/UF were administered a parenteral
antibiotic as a prophylactic, or metaphylactic, treatment. Cattle
were fed a ration that met or exceeded the National Research
Council requirements for beef cattle.8 Cattle were typically slaugh-
tered at a body weight of 550–650 kg, approximately 120–250 days
after feedlot arrival.
Data Collection and Disease Diagnosis
The population at risk was the number of cattle entering a feed-
lot during a calendar year: 2000, 2004, 2008, or 2012. All cattle
that entered a feedlot within 1 of these years were followed until
the day of slaughter, which might have been in the calendar year
after their arrival at the feedlot. The population was grouped for
analyses by: feedlot, placement year, placement period (January
1–April 30; May 1–August 31; and, September 1–December 31),
age on feedlot placement (calf or yearling), sex (male or female),
and risk of BRD/UF (high or low). Information that was collected
for all cattle in the study population included individual identifica-
tion, individual weights on feedlot arrival, group weights on
feedlot exit, all preventive and therapeutic treatments (eg, vaccina-
tions, deworming, medications administered), and any disease
diagnoses. Trained feedlot personnel evaluated cattle for signs of
illness at arrival and daily thereafter. Animals that were considered
to be ill or injured were moved to a chute for closer examination.
The primary illness was diagnosed and recorded in the health
information system using standardized diagnosis categories. Illness
consistent with BRD was identified when cattle exhibited signs of
dyspnea, lack of response to stimulation, reluctance to move,
abnormal carriage or posture of the head, or some combination of
these signs. All cattle that died underwent necropsy examination,
and a veterinarian used clinical history and physical findings to
assign the cause of death using a standardized set of diagnosis
codes. For the purposes of this study, postmortem diagnoses
attributed to DD included cattle with ruminal bloat, enteritis,
intestinal disorders, and peritonitis. Peritonitis was included in the
DD as it was deemed that a digestive disorder was the most likely
underlying cause of the peritonitis.
To minimize confounding associated with a common pathogen-
esis, cattle that died of DD served as a control group for the anal-
ysis of risk factors associated with RHF. The criteria used for the
diagnoses of RHF and DD are provided in Table 2. For analysis
purposes, each animal was assigned a single, primary cause of
death. In addition to the information that was obtained from all
cattle, the information obtained from cattle that died of RHF or a
digestive disorder also included prior treatment for BRD (yes/no)
and the number of days from feedlot entry to death.
Statistical Analyses
Analyses were performed using commercially available statisti-
cal software.b Data were summarized descriptively, including cal-
culations of frequencies, and means for quantitative variables with
associated 95% confidence intervals (95% CI). Three statistical

Table 1. The number of cattle that entered each feedlot according to year of feedlot entry.
Year
Total
Country Feedlot Altitude, m 2000 2004 2008 2012
Canada 1 1,006 30,933 29,107 64,926 44,740 169,706
2 837 3,453 3,045 1,738 2,646 10,882
3 1,018 20,933 23,682 25,538 13,368 83,521
4 934 63,817 60,212 104,364 57,247 285,640
5 917 23,281 34,761 51,394 23,597 133,033
6 657 55,489 53,865 60,071 27,735 197,160
7 1,145 9,858 9,716 6,464 5,252 31,290
8 887 2,779 1,529 2,234 1,984 8,526
9 1,102 65,582 60,148 86,947 49,380 262,057
10 1,005 10,941 25,613 48,016 17,809 102,379
Total 287,066 301,678 451,692 243,758 1,284,194
United States 11 1,161 – – – 91,088 –
12 1,242 – – – 34,736 –
13 1,282 – – – 44,164 –
14 1,142 – – – 28,590 –
15 596 – – – 74,741 –
Total 273,319 273,319
Combined total 1,557,513
 Right Heart Failure in Feedlot Cattle
Table 2. The postmortem lesions used for establishing
the cause of death.
Cause of Death Postmortem Lesions
Congestive heart failure Brisket and ventral edema;
hydroperitoneum; hydrothorax and
secondary atelectasis; hepatomegaly
and chronic passive congestion;
intestinal and mesenteric edema;
hydropericardium; right-ventricular
hypertrophy and dilatation
Ruminal bloat Underinflated lungs; cranial carcass
congestion; caudal carcass pallor;
edema of subcutaneous tissue and
facial planes of hind limbs; rumen
distended with gas; small, pale liver;
small, pale heart
Enteritis Hyperemia and edema of intestinal
mucosa; fibrinous mucosa; luminal
hemorrhage; dark, fluid-filled
intestine; diffuse or segmented
Intestinal disorder Intussusception; mesenteric rent;
intestinal parasitism; lodged
trichobezoar; stricture; intestinal
torsion/volvulus
Peritonitis Hydroperitoneum; fibrin deposition;
adhesions; local or diffuse
Not all of the lesions listed were required for a diagnosis. Peri-
tonitis was recorded as the “cause” of death when peritonitis was
present, but an underlying cause of the peritonitis could not be
identified.
models were used: zero-inflated negative binomial, logistic regres-
sion, and Cox proportional hazard regression. Each model pro-
vided unique information.
The zero-inflated negative binomial models revealed which risk
factors were associated with RHF, but could not distinguish
between risk factors specific to RHF and nonspecific risk factors
for death loss. By using DD as a competing cause, we determined,
through logistic regression analyses, which of the risk factors were
specific to RHF. Finally, Cox proportional hazard regression anal-
yses divulged how the various risk factors affected the rate of
RHF occurrence through the feeding period. The latter findings
were important because time at risk, or feeding duration, might
have confounded risk factors in the logistic regression models. For
example, cattle entering feedlots as calves were likely fed for
longer than cattle entering as yearlings. Calves were, therefore, at
risk of RHF for longer than yearlings. Consequently, calves and
yearlings might have had the same odds of RHF even if the rate
of RHF occurrence was greater in yearlings. Cox proportional
hazard regression was necessary to disclose such information.
In all models, the individual animal was the unit of analysis.
Two-way interactions between period of feedlot placement, risk of
BRD/UF, sex, and age, were evaluated. Variance inflation factors
were <2.0 for all variables indicating that the models were not
adversely affected by multicollinearity. Clustering by feedlot was
controlled as a fixed-effect in all models, providing feedlot-specific
estimates of effect. Pen-level information was not available; there-
fore, robust variance estimators were used in all models to account
for potential clustering at the pen-level and assure that interpreta-
tions are conservative. Wald tests (“test”) were performed in all
models to determine the statistical significance of multi-level cate-
gorical variables.
Zero-inflated negative binomial models (“zinb”) were used to
calculate attack risk ratios for RHF and DD according to per-
iod of feedlot placement, risk of BRD/UF, sex, age, year of
3
placement (Canadian feedlots only), and feedlot. The number of
cattle within a covariate pattern was the only variable included
in the logistic part of all zero-inflated models. Covariate pat-
terns with fewer cattle were more likely to have a zero count of
RHF and DD. The results of the logistic part of the model
were not pertinent to the study objectives; they are, therefore,
not presented. Adjusted mean risks of RHF and DD were
obtained for US cattle in 2012 and, for Canadian cattle for
each year studied, while controlling for period of feedlot place-
ment, risk of BRD/UF, sex, age, and feedlot. All variables
remained in the final model irrespective of their statistical asso-
ciation with RHF. This allowed the comparison of risk factors
between US and Canadian populations, and also allowed the
relationship between the risk factors and outcome to be com-
pared across the various models. Adjusted mean risks (“mar-
gins”) of RHF were also obtained for each US and Canadian
feedlot in 2012, while controlling for period of feedlot place-
ment, risk of BRD/UF, sex, and age.
Case–control analyses, stratified by country, were performed
using logistic regression models (“logistic”) to investigate risk fac-
tors that were more specifically associated with RHF. Cases were
cattle whose death was attributed to RHF, and controls were cat-
tle that died from DD. The odds of RHF were calculated for per-
iod of feedlot placement, risk of BRD/UF, sex, age, treatment for
BRD, and feedlot. All variables remained in the final model irre-
spective of their statistical association with RHF. Year of place-
ment (Canadian model only) and feedlot were forced into the
models as fixed effects to control for clustering.
Cox proportional hazard regression analyses (“stcox”) were per-
formed, stratifying on country, to determine which risk factors
affected time to RHF. A case–control design was used; cases were
cattle that died of RHF, and controls were cattle that died from
DD. The risk factors evaluated included period of feedlot place-
ment, sex, risk of BRD/UF, and treatment for BRD. The models
were grouped by year of placement (Canada only), and feedlot. A
backward elimination method was used so that in the final model
all variables were considered statistically significant if P < .05.
The proportional hazards assumption was validated by graphical
assessment of the log-cumulative hazard plot.
Results
Risk of RHF Over Time
The adjusted risk of RHF doubled from the year
2000 to the year 2012, when controlling for period of
feedlot placement, risk category, sex, age, and feedlot
(Table 3). Between the years 2000 and 2012, the risk of
RHF, bloat, nonbloat DD (enteritis, intestinal disorders
and peritonitis), and all DD increased by 91, 70, 29,
and 61%, respectively. The odds of RHF increased over
time relative to the year 2000, when controlling for
death loss from DD. Relative to the year 2000, the odds
of RHF in the years 2004, 2008, and 2012 were 1.58
(95% CI = 1.11, 2,26), 2.69 (95% CI = 1.95, 3.70), and
1.51 (95% CI = 1.07, 2.13), respectively, when control-
ling for the likelihood of DD, feedlot, age, risk of
BRD/UF, sex, period of feedlot placement, and treat-
ment for respiratory disease.
Likelihood of RHF Among Feedlots in 2012
The adjusted risks of RHF and DD in US feedlots
were 1.08 per 1,000 cattle (95% CI = 0.89, 1.28) and
4.54 per 1,000 cattle (95% CI = 3.52, 5.56), respectively.
4 Neary et al
Table 3. The adjusteda risk and robust 95% CI of RHF, bloat, nonbloatb DD and all DD determined using multi-
variable zero-inflated negative binomial regression for cattle in Canadian feedlots.
Mean Attack Risk Per 1,000 Cattle (95% CI)
Cause of Death 2000 2004
RHF 0.21 (0.11, 0.31) 0.28 (0.17,
Bloat 1.05 (0.79, 1.31) 0.81 (0.65,
Nonbloat DD 0.42 (0.27, 0.57) 0.65 (0.49,
DD 1.37 (1.03, 1.71) 1.39 (1.12,
DD, digestive disorders; CI, confidence intervals; RHF, right heart failure.
a
Controlling for feedlot, age, risk of respiratory disease and undifferentiated fever, sex, and period of feedlot entry.
b
Nonbloat DD included enteritis, intestinal disorders, and peritonitis.
Relative to cattle in US feedlots, cattle in Canadian
feedlots had approximately half the risk of RHF and
DD (Table 3). In both US and Canadian feedlots, the
risk of death from RHF was approximately 5 times
lower than the risk of death from DD.
There were substantial differences in the risk of RHF
among US and Canadian feedlots (P < .001; Fig 1).
Among the Canadian feedlots in 2012, Feedlot 4 had
the greatest risk of RHF (adjusted risk = 0.99 per 1,000
cattle; 95% CI = 0.57, 1.42), and Feedlot 8 had the
least risk (adjusted risk = 0.09 per 1,000 cattle; 95%
CI = 0, 0.30). Canadian feedlots with an increased risk
of RHF relative Feedlot 8 did not have significantly
greater likelihood of death from RHF, when controlling
for the likelihood of death from DD (Fig 1).
Among US feedlots, Feedlot 13 had the greatest
adjusted risk of RHF (adjusted risk = 1.75 per 1,000
cattle; 95% CI = 1.29, 2.20), and Feedlot 15 had the
least risk (adjusted risk = 0.42 per 1,000 cattle; 95%
CI = 0.26, 0.58). Relative to Feedlot 15, cattle in the
other 4 US feedlots were more likely to die of RHF,
when controlling for death loss from DD (P < .001;
Fig 1). This indicates that in US feedlots, the risk of
RHF did not parallel the risk of DD.
Risk of RHF by Season of Placement, Risk of BRD/
UF, Age, and Sex
Period of placement, BRD/UF risk category, and
sex, showed the same direction of effect in US and
Canadian feedlots (Table 4). Cattle placed in feedlots
from May 1 to August 31, or from September 1 to
December 31, had an adjusted risk of RHF that was
at least 50% greater than cattle placed in feedlots from
January 1 to April 30. In US feedlots, male cattle and
cattle classified at placement as having a high risk of
developing BRD/UF were approximately 2 and 3 times
more likely to die of RHF than female cattle and cat-
tle classified at placement as having a low risk of
BRD/UF, respectively. In Canadian feedlots, sex and
BRD/UF risk had the same direction of effect as US
feedlots, but they had a reduced magnitude of effect
(Table 4). The adjusted risk of RHF in cattle entering
the feedlots as yearlings was 60% lower than calves in
Canadian feedlots, but 138% greater than calves in US
feedlots (Table 4).
2008 2012
0.39) 0.47 (0.27, 0.66) 0.40 (0.24, 0.56)
0.98) 1.30 (0.95, 1.64) 1.78 (1.23, 2.45)
0.82) 0.64 (0.44, 0.84) 0.54 (0.31, 0.78)
1.65) 1.81 (1.34, 2.28) 2.20 (1.52, 2.88)
Likelihood of RHF Occurrence
Cattle treated for BRD were approximately 3 times
more likely to die from RHF than cattle that were not
treated for BRD, when controlling for the likelihood
of death from DD, year of placement, risk of BRD/
UF, age, sex, period of feedlot placement, and feedlot
(Table 5). Period of feedlot placement was significantly
associated with the odds of RHF in both US and
Canadian feedlots (P < .001). Cattle entering feedlots
from May 1 to December 31 had a 51–127% greater
risk of RHF than cattle that entered from January 1
to April 30. Cattle categorized as low risk of BRD/UF
on feedlot arrival were twice as likely to die from
RHF when compared to cattle categorized as high risk
(Table 5). The odds of RHF were 39% greater in
males relative to females in US feedlots (P = .04), but
there was no sex difference in Canadian feedlots. Age
on arrival at the feedlot was not associated with the
likelihood of RHF in either US or Canadian feedlots
(Table 5).
Time From Feedlot Arrival to Death From RHF
Death from RHF occurred throughout the feeding
period but tended to occur later in the feeding period
than death from DD (Fig 2). The median days to death
from RHF and bloat were 132 and 129 in Canadian
feedlots, and 133 and 107 days in US feedlots, respec-
tively. Relative to the year 2000, the mean days to
death from RHF did not significantly change over time,
when controlling for period of placement, feedlot,
BRD/UF risk, age, sex, and treatment for BRD
(P > .20). Ruminal bloat accounted for 72 and 83% of
deaths from DD in Canadian and US feedlots, respec-
tively.
Although age on feedlot entry did not affect the like-
lihood of RHF (Table 5), the rate of RHF in yearlings
was double that of calves (Table 6). Except for period
of feedlot placement, all other factors associated with
time to RHF showed a similar pattern in US and Cana-
dian feedlots (Figs 3, 4).
Discussion
The results of this study support producer concerns
that the incidence of RHF in feedlot cattle has
 Right Heart Failure in Feedlot Cattle 5

Fig 1. Adjusted mean estimate and robust 95% confidence intervals of the attack risk of right heart failure (RHF) per 1,000 cattle (Con-
trolling for country, season of placement, bovine respiratory disease/undifferentiated fever [BRD/UF] risk category, sex and age.) entering
(A) Canadian feedlots in 2012 and (B) US feedlots in 2012; and, the odds of RHF (Controlling for the likelihood of death from digestive
disorders, period of feedlot placement, risk of BRD/UF, sex, age and treatment for BRD.) in, (C) Canadian feedlots, and (D) US feedlots,
relative to the feedlot in each respective country with the lowest risk of RHF in 2012. Feedlots arranged in descending order of risk.

Table 4. The adjusted risk ratio and robust 95% CI for RHF in US and Canadian feedlots determined using multi-
variable zero-inflated negative binomial regression.
Canadaa United Statesb

Variable Category Risk Ratio (95% CI) P-Value Risk Ratio (95% CI) P-Value
Placement period January 1–April 30 Reference .006 Reference .03
May 1–August 31 1.62 (1.00, 2.59) 1.58 (1.00, 2.50)
September 1–December 31 2.10 (1.33, 3.32) 1.62 (1.11, 2.36)
Risk of BRD/UF Low Reference Reference
High 1.20 (0.77, 1.87) .42 2.89 (1.61, 5.18) <.001
Age Calf Reference Reference
Yearling 0.40 (0.26, 0.60) <.001 2.38 (1.38, 4.09) .002
Sex Female Reference Reference
Male 1.19 (0.89, 1.58) .23 2.21 (1.58, 3.08) <.001

The number of cattle within a covariate pattern was significantly associated with the probability of a nonzero count of RHF.
BRD, bovine respiratory disease; CI, confidence intervals; RHF, right heart failure; UF, undifferentiated fever.
a
All years; b2012 only.

increased: the risk of RHF in Canadian feedlots
approximately doubled from the year 2000 to the years
2008 and 2012. Despite a 2-fold increase in RHF mor-
tality, the number of cattle that died of RHF in 2012
was relativity minor when compared to DD: approxi-
mately 4-5 times more cattle died of DD than RHF.
Although death loss from RHF was relatively minor,
the occurrence of RHF in feedlot cattle is noteworthy
for 2 reasons: First, before the 1970s, RHF was only
reported in cattle at altitudes over 2,130 m;3,4,9 there-
fore, a 2-fold increase in RHF over a 12 year period in
feedlots located at low (657 m) to moderate (1,145 m)
elevations deserves attention. Second, although RHF
occurred throughout the feeding period, half of all cases
occurred after 19 weeks; this makes death loss from
RHF particularly costly. One might suspect that
because cattle are being fed for longer, and to heavier
finishing weights, the risk period for RHF has merely
increased over time and, consequently, led to more
RHF fatalities, particularly in the late feeding period. If
so, the average time from feedlot arrival to death from
RHF should have increased over time, but in our study,
this was not observed. Unfortunately, because we know
so little about the risk factors for this disease, attempts
to reduce the incidence of RHF have been frustrating
for both producers and veterinarians.
6 Neary et al

Table 5. The adjusted odds and robust 95% CI of RHF controlling for the likelihood of death from digestive dis-
orders in 10 Canadian and 5 US feedlots determined using multivariable logistic regression, controlling for year of
placement.
Canadaa United Statesb

Variable Category OR (95% CI) P-Value OR (95% CI) P-Value

Placement period January 1–April 30 Reference <.001 Reference <.001
May 1–August 31 2.02 (1.38, 2.95) 1.51 (1.01, 2.26)
September 1–December 31 1.73 (1.26, 2.39) 2.27 (1.56, 3.30)
Risk of BRD/UF Low Reference Reference
High 0.45 (0.32, 0.64) <.001 0.62 (0.37, 1.02) .06
Age Calf Reference Reference
Yearling 0.85 (0.61, 1.18) .25 1.29 (0.80, 2.09) .31
Sex Female Reference Reference
Male 0.98 (0.79, 1.20) .83 1.39 (1.01, 1.93) .04
Treated for BRD No Reference Reference
Yes 2.52 (2.05, 3.10) <.001 3.14 (2.29, 4.30) <.001

BRD, bovine respiratory disease; CI, confidence intervals; OR, odds ratio; RHF, right heart failure; UF, undifferentiated fever.
a
All years; b2012 only.

Fig 2. Box and whisker plot of days on feed to death from right heart failure (RHF), bloat, enteritis, intestinal disorder, and peritonitis
in 10 Canadian feedlots over the years 2000, 2004, 2008, and 2012 and 5 US feedlots in 2012.

In cattle, alveolar hypoxia is considered to be the pri-
mary risk factor for pulmonary vascular remodeling
and hypertension, which may ultimately cause RHF.
Any factors predisposing cattle to alveolar hypoxia
could, therefore, have explained the increase in RHF
mortality observed over time in our study. Factors that
may cause alveolar hypoxia include: hypobaric hypoxia,
hypoventilation, and respiratory disease.
Hypobaric hypoxia cannot explain the increase in
RHF death loss observed since the same Canadian feed-
lots were studied over the entire period. It could, how-
ever, explain why cattle had twice the risk of RHF in
the US feedlots relative to Canadian feedlots. The US
feedlots studied had the greatest range of altitudes and
were generally located at the highest altitudes. Four of
the 5 US feedlots studied were located at altitudes over
1,142 m; the fifth feedlot was located at just 596 m. An
altitude difference of 686 m may explain why cattle in
the feedlot located at the highest altitude (1,282 m)
were 9 times more likely to die of RHF than cattle at
the lowest altitude. Alternatively, the risk of RHF may
have been greater in US feedlots at altitudes ≥1,142 m
because they were more likely to have procured cattle
from high altitude regions (>1,600 m) than the feedlot
at 596 m. Prior mountain grazing is thought to increase
the risk of RHF in feedlot cattle.5 Canadian feedlots,
on the other hand, were generally located at lower alti-
tudes than the US feedlots and likely procured cattle
from lower altitudes. They also had a maximum alti-
tude difference of only 488 m, which likely explains why
the risk of RHF, and the variation in RHF risk among
feedlots, was small relative to the US feedlots.
 Right Heart Failure in Feedlot Cattle 7

Table 6. Adjusted hazard ratios and robust 95% CI for death from RHF for cattle that entered into 10 Canadian
feedlots and 5 US feedlots determined using multivariable Cox proportional hazards modeling.
Canadaa United Statesb

Variable Category HR (95% CI) P-Value HR (95% CI) P-Value

Placement period January 1–April 30 Reference .02 Reference <.001
May 1–August 31 1.66 (1.15, 2.39) 1.67 (1.18, 2.37)
September 1–December 31 1.12 (0.82, 1.55) 2.11 (1.55, 2.89)
Risk of BRD/UF Low Reference Reference
High 0.48 (0.35, 0.66) <.001 0.42 (0.27, 0.64) <.001
Age Calf Reference Reference
Yearling 1.75 (1.24, 2.46) .001 2.09 (1.41, 3.10) <.001
Treated for BRD No Reference Reference
Yes 2.32 (1.91, 2.82) <.001 2.58 (2.00, 3.33) <.001

BRD, bovine respiratory disease; CI, confidence intervals; HR, hazard ratio; RHF, right heart failure; UF, Undifferentiated fever.
a
All years; b2012 only.

Fig 3. Kaplan–Meier curves, with robust variance estimators, comparing survival times among all cattle that died of right heart failure
(RHF) in Canadian feedlots. (A) Cattle entering feedlots from May 1 to August 31 died from RHF earlier than cattle entering at any other
time (P ≤ .01). (B) Cattle categorized as being at high risk of respiratory disease (BRD) and undifferentiated fever (UF) died from RHF
later in the feeding period than cattle at low risk (P < .001). (C) Cattle entering feedlots as yearlings died from RHF earlier than cattle
entering as calves (P = .002). (D) Cattle treated for BRD died earlier from RHF than cattle not treated (P < .001).

Unfortunately, our study design did not allow us to
investigate the relationship between RHF risk and
feedlot altitude. There were too many potentially
confounding variables associated with feedlot altitude,
such as altitude from which cattle were procured, to
make any conclusions. We can conclude, however, that
although hypobaric hypoxia, or prior exposure to
hypobaric hypoxia, might have accentuated the risk of
RHF in feedlot cattle, neither explanation can
adequately explain the increase in RHF mortality over
time. This leaves BRD and hypoventilation as possible
explanations.
Our results show that cattle treated for BRD were
2–3 times more likely to die of RHF than cattle that
were not treated for BRD. Although it is biologically
feasible that BRD predisposes to RHF,10 a causal rela-
tionship in cattle has yet to be documented. One may
suspect that the increase in RHF risk observed over
time was partly attributable to an increase in the risk of
BRD over the same time period. Our results, however,
show that the likelihood of RHF increased over time
even when controlling for BRD treatment.
The second possible explanation, hypoventilation, has
been previously suggested as a risk factor for RHF.5 It
could be problematic in feedlot cattle for 2 reasons:
First, ruminal engorgement after feeding could com-
press the lungs and, consequently, reduce effective alve-
olar ventilation; and second, feedlot cattle accumulate
large amounts of body fat through the feeding period.11
The accumulation of fat in the abdomen and over the
8 Neary et al

Fig 4. Kaplan–Meier curves, with robust variance estimators, comparing survival times among all cattle that died of right heart failure
(RHF) in US feedlots. (A) Cattle entering feedlots from January 1 to April 30 died from RHF later than cattle entering at any other time
(P ≤ .005). (B) Cattle categorized as being at high risk of respiratory disease (BRD) and undifferentiated fever (UF) died later in the feed-
ing period than cattle at low risk (P < .001). (C) Cattle entering feedlots died earlier than cattle entering as calves (P = .001). (D) Cattle
treated for BRD died earlier that cattle not treated (P < .001).

thorax could increase the mechanical work of breath-
ing.
There are several factors that point to body fat accu-
mulation as a risk factor for RHF. First, RHF pre-
dominantly occurred after 4 months on feed, a period
coinciding with maximal body fat percentages.12 Sec-
ond, yearlings had twice the rate of RHF relative to
calves (calf-feds), but over their respective feeding peri-
ods, they were equally likely to die from RHF. Perhaps
the most parsimonious explanation for these findings is
that calves and yearlings are managed to a similar end
point: fat cattle ready for slaughter. Yearlings, how-
ever, are typically fatter than calves on feedlot entry;
this may have predisposed them to a greater risk of
RHF earlier in the feeding period. Lastly, and rather
paradoxically, cattle with a high risk of BRD/UF were
50% less likely to die of RHF than cattle considered
to be a low risk. This seems nonsensical given that
treatment for BRD increased the risk of RHF by 2–3
times; unless, however, the risk of BRD/UF was con-
founded by a risk factor that was protective against
RHF such as genetics, body condition, or management
differences.
A limitation of our study is that only 4 years of data
were used to estimate the risk of RHF in Canadian
feedlots. However, we are confident in the precision of
our estimates given that our data consisted of 1.56 mil-
lion cattle that were managed using standardized health
management protocols, and were compiled by specialists
in feedlot health.a Furthermore, although we did not
account for potential clustering at the pen-level, our use
of robust variance estimators in all models assure that
the estimations obtained are conservative. Because,
however, only 4 years of data were selected, we cannot
rule out the possibility that year-to-year variation in cli-
mate or other factors contributed to variation in the
risk of RHF. Even if year-to-year variation in climate
affected our results, however, any bias in the risk of
RHF over time would have occurred toward the null.
Instead, we found that relative to the year 2000, the
likelihood of RHF was consistently greater in subse-
quent years.
Another limitation is that because only Canadian
feedlots were studied over multiple years we cannot
make inferences regarding how the risk of RHF in US
feedlots changed over the same time period. However,
the available evidence suggests that the incidence of
RHF in US feedlot cattle has increased substantially.
In 1974, a study of 4 US feedlots located at an altitude
of 1,600 m reported the risk of RHF to be 2.85 cases
per 10,000 cattle entering the feedlot.5 In our study of
US feedlots, the risk of RHF was notably higher: rang-
ing from 4 to 17 deaths per 10,000 cattle entering feed-
lots at altitudes ranging from 596 to 1,282 m,
respectively.
Footnotes
a
Feedlot Health Management Services Ltd, Okotoks, Alberta,
Canada
b
STATA version 12, Stata Corporation, College Station, TX
 Right Heart Failure in Feedlot Cattle
Acknowledgments
Conflict of Interest Declaration: Authors disclose no
conflict of interest.
Off-label Antimicrobial Declaration: Authors declare
no off-label use of antimicrobials.
References
1. Alexander AF, Jensen R. Pulmonary vascular pathology of
high altitude induced pulmonary hypertension in cattle. Am J Vet
Res 1963;24:1112–1122.
2. Alexander AF, Jensen R. Pulmonary arteriographic studies
of bovine high mountain disease. Am J Vet Res 1963;24:1094–
1097.
3. Glover GH, Newsom IE. Brisket Disease (Dropsy of High Alti-
tude). Colorado Agricultural Experiment Station; Fort Collins, CO,
USA. 1915:3–24.
4. Hecht HH, Kuida H, Lange RL, et al. Brisket disease. II.
Clinical features and hemodynamic observations in altitude-depen-
dent right heart failure of cattle. Am J Med 1962;32:171–183.
5. Jensen R, Pierson RE, Braddy PM, et al. Brisket disease in
yearling feedlot cattle. J Am Vet Med Assoc 1976;169:515–517.
View publication stats
9
6. Malherbe CR, Marquard J, Legg DE, et al. Right ventricu-
lar hypertrophy with heart failure in Holstein heifers at elevation
of 1,600 meters. J Vet Diagn Invest 2012;24:867–877.
7. USDA. Cattle Fattened on Grain and Concentrates and
Sold, 1997. Available at: http://www.agcensus.usda.gov/Publica-
tions/1997/Ag_Atlas_Maps/Livestock_and_Animals/map193.gif.
Accessed March 5, 2015.
8. NRC. Nutrient Requirements of Beef Cattle: Seventh
Revised Edition: Update 2000. Washington DC: The National
Academies Press; 2000.
9. Blake JT. Occurrence and Distribution of Brisket Disease in
Utah. Logan, UT: Utah State University Utah Agricultural Exper-
iment Station Circular; 1968:2–15.
10. Holt T, Callan R. Pulmonary arterial pressure testing for
high mountain disease in cattle. Vet Clin North Am Food Anim
Pract 2007;23:575–596.
11. Rathmann RJ, Bernhard BC, Swingle RS, et al. Effects of
zilpaterol hydrochloride and days on the finishing diet on feedlot
performance, carcass characteristics, and tenderness in beef heifers.
J Anim Sci 2012;90:3301–3311.
12. Owens FN, Gill DR, Secrist DS, et al. Review of some
aspects of growth and development of feedlot cattle. J Anim Sci
1995;73:3152–3172.