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Peters AE, Clare RM, Chiswell K, Harrington J, Kelsey A, Hernandez A, Felker GM, Mentz RJ, DeVore AD. Implications of trial eligibility in patients with heart failure with mildly reduced or preserved ejection fraction. ESC Heart Fail 2024. [PMID: 38757437 DOI: 10.1002/ehf2.14777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/27/2024] [Accepted: 03/16/2024] [Indexed: 05/18/2024] Open
Abstract
AIMS Clinical trials in heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) commonly have detailed eligibility criteria. This may contribute to challenges with efficient enrolment and questions regarding the generalizability of trial findings. METHODS AND RESULTS Patients with HFmrEF/HFpEF from a large US healthcare system were identified through a computable phenotype applied in linked imaging and electronic health record databases. We evaluated shared eligibility criteria from five recent/ongoing HFmrEF/HFpEF trials (PARAGON-HF, EMPEROR-Preserved, DELIVER, FINE-ARTS, and SPIRRIT-HFpEF) and compared clinical and echocardiographic features as well as outcomes between trial-eligible and trial-ineligible patients. Among 5552 patients with HFpEF/HFmrEF, 792 (14%) were eligible for trial consideration, having met all criteria assessed. Causes of ineligibility included lack of recent loop diuretics (37%), significant pulmonary disease (24%), reduced estimated glomerular filtration rate (17%), recent stroke/transient ischaemic attack (13%), or low natriuretic peptides (12%); 53% of ineligible patients had >1 reason for exclusion. Compared with eligible patients, ineligible patients were younger (age 71 vs. 75 years, P < 0.001) with higher rates of coronary artery disease (66% vs. 59%, P < 0.001) and peripheral vascular disease (40% vs. 33%, P < 0.001), but less mitral regurgitation, lower E/e' ratio, and smaller left atrial sizes. Both eligible and ineligible patients demonstrated high rates of structural heart disease consistent with HFpEF [elevated left atrial size or left ventricular (LV) hypertrophy/increased LV mass], although this was slightly higher among eligible patients (95% vs. 92%, P = 0.001). The two cohorts demonstrated similar LV global longitudinal strain along with a similar prevalence of atrial fibrillation/flutter, hypertension, and obesity. Ineligible patients had similar all-cause mortality (33% vs. 33% at 3 years) to those eligible but lower rates of heart failure hospitalization (20% vs. 28% at 3 years, P < 0.001). CONCLUSIONS Among patients with HFmrEF/HFpEF from a large health system, approximately one in seven were eligible for major trials based on key criteria applied through a clinical computable phenotype. These findings highlight the large proportion of patients with HFmrEF/HFpEF ineligible for contemporary trials for whom the generalizability of trial findings may be questioned and further investigation would be beneficial.
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Affiliation(s)
- Anthony E Peters
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Josephine Harrington
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Anita Kelsey
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Adrian Hernandez
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Gary Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Adam D DeVore
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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2
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Wolsk E. Is it worth tying the knot? The lifelong commitment between heart failure patients and pulmonary artery pressure monitoring. Eur J Heart Fail 2024; 26:1199-1200. [PMID: 38700447 DOI: 10.1002/ejhf.3275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Affiliation(s)
- Emil Wolsk
- The Heart Failure Unit, Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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3
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Nazari I, Feinstein MJ. Evolving mechanisms and presentations of cardiovascular disease in people with HIV: implications for management. Clin Microbiol Rev 2024; 37:e0009822. [PMID: 38299802 PMCID: PMC10938901 DOI: 10.1128/cmr.00098-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
People with HIV (PWH) are at elevated risk for cardiovascular diseases (CVDs), including myocardial infarction, heart failure, and sudden cardiac death, among other CVD manifestations. Chronic immune dysregulation resulting in persistent inflammation is common among PWH, particularly those with sustained viremia and impaired CD4+ T cell recovery. This inflammatory milieu is a major contributor to CVDs among PWH, in concert with common comorbidities (such as dyslipidemia and smoking) and, to a lesser extent, off-target effects of antiretroviral therapy. In this review, we discuss the clinical and mechanistic evidence surrounding heightened CVD risks among PWH, implications for specific CVD manifestations, and practical guidance for management in the setting of evolving data.
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Affiliation(s)
- Ilana Nazari
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J. Feinstein
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology in the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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4
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Han Y, Lu J, Chen B, Li X, Dai H, Zhang L, Yan X, Liu J, Zhang H, Fu X, Yu Q, Ren J, Cui H, Gao Y, Li J. A novel polygenic risk score improves prognostic prediction of heart failure with preserved ejection fraction in the Chinese Han population. Eur J Prev Cardiol 2023; 30:1382-1390. [PMID: 37343143 DOI: 10.1093/eurjpc/zwad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 06/23/2023]
Abstract
AIMS Mortality risk assessment in patients with heart failure (HF) with preserved ejection fraction (HFpEF) presents a major challenge. We sought to construct a polygenic risk score (PRS) to accurately predict the mortality risk of HFpEF. METHODS AND RESULTS We first carried out a microarray analysis of 50 HFpEF patients who died and 50 matched controls who survived during 1-year follow-up for candidate gene selection. The HF-PRS was developed using the independent common (MAF > 0.05) genetic variants that showed significant associations with 1-year all-cause death (P < 0.05) in 1442 HFpEF patients. Internal cross-validation and subgroup analyses were performed to evaluate the discrimination ability of the HF-PRS. In 209 genes identified by microarray analysis, 69 independent variants (r < 0.1) were selected to develop the HF-PRS model. This model yielded the best discrimination capability for 1-year all-cause mortality with an area under the curve (AUC) of 0.852 (95% CI 0.827-0.877), which outperformed the clinical risk score consisting of 10 significant traditional risk factors for 1-year all-cause mortality (AUC 0.696, 95% CI 0.658-0.734, P = 4 × 10-11), with net reclassification improvement (NRI) of 0.741 (95% CI 0.605-0.877; P < 0.001) and integrated discrimination improvement (IDI) of 0.181 (95% CI 0.145-0.218; P < 0.001). Individuals in the medium and the highest tertile of the HF-PRS had nearly a five-fold (HR = 5.3, 95% CI 2.4-11.9; P = 5.6 × 10-5) and 30-fold (HR = 29.8, 95% CI 14.0-63.5; P = 1.4 × 10-18) increased risk of mortality compared to those in the lowest tertile, respectively. The discrimination ability of the HF-PRS was excellent in cross validation and throughout the subgroups regardless of comorbidities, gender, and patients with or without a history of heart failure. CONCLUSION The HF-PRS comprising 69 genetic variants provided an improvement of prognostic power over the contemporary risk scores and NT-proBNP in HFpEF patients.
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Affiliation(s)
- Yi Han
- National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China
| | - Jiapeng Lu
- National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China
| | - Bowang Chen
- National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China
| | - Xi Li
- National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China
| | - Hao Dai
- National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China
| | - Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China
| | - Xiaofang Yan
- National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China
| | - Haibo Zhang
- National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China
| | - Xin Fu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, China
| | - Qin Yu
- Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Zhongshan District, Dalian, China
| | - Jie Ren
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Yanta District, Xian, China
| | - Hanbin Cui
- Department of Cardiology, Ningbo First Hospital, Ningbo University, 59 Liuting Street, Haishu District, Ningbo, China
| | - Yan Gao
- National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China
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Zecchin M, Trevisan B, Baggio C, Bessi R, Saitta M, Salvatore L, Cappelletto C, Gregorio C, Bianco E, Longaro F, Carriere C, Zorzin-Fantasia A, Piccinin F, Dal Monte G, Sinagra G. Short- and long-term survival in patients over 90 years old undergoing pacemaker implantation. J Cardiovasc Med (Hagerstown) 2023; 24:625-630. [PMID: 37605954 DOI: 10.2459/jcm.0000000000001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
AIMS In Italy, 12-month survival in the general population between 90 and 94 years old is 26%. In very old patients, the benefit of pacemaker implantation in terms of quality and duration of life is unclear. The aim of our study was to analyse clinical characteristics, outcome and factors associated with survival in patients at least 90 years old at the time of the first pacemaker implant. METHODS Clinical parameters, device characteristics, survival and predictors of outcome in patients at least 90 years old treated with a pacemaker in our centre in 2019-2020 were evaluated. RESULTS Among the 554 patients undergoing pacemaker implantation in our centre during the study interval, 69 (12%) were at least 90 years old; a complete/advanced atrioventricular block was present in 65%. A cardiological comorbidity (excluding atrial fibrillation) was present in 22 patients (32%). Oncological, pulmonary and neurological comorbidities were present in 12 (17%), 19 (28%) and 32 (46%), respectively. Renal impairment was present in 25 patients (36%). After pacemaker implantation, a pneumothorax developed in two patients and lead dislodgment in one. During follow-up (median 17 months, interquartile range: 13-24), 32 patients died (46%), with a 12-month mortality probability of 24.6%. At multivariate analysis, the presence of oncological (hazard ratio (HR) 5.31; P < 0.001) and neurological (HR 6.44; P < 0.001) comorbidities was associated with mortality. Truncating the outcome at 6 months, renal impairment (HR 8.01; P = 0.003), anticoagulant therapy (HR 8.14; P = 0.003), oncological comorbidities (HR 14.1; P < 0.001) and left ventricular function (5% increase of left ventricular ejection fraction: HR 0.66; P < 0.001) were significantly associated with outcome. CONCLUSION At our centre, patients at least 90 years old underwent pacemaker implantation mainly for advanced atrioventricular block. One-year survival was excellent, even better than expected in the general population.
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Affiliation(s)
- Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, University of Trieste, Trieste, Italy
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6
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Chuzi S, Lindenauer PK, Faridi K, Priya A, Pekow PS, D'Aunno T, Mazor KM, Stefan MS, Spatz ES, Gilstrap L, Werner RM, Lagu T. Variation in Risk-Standardized Acute Admission Rates Among Patients With Heart Failure in Accountable Care Organizations: Implications for Quality Measurement. J Am Heart Assoc 2023; 12:e029758. [PMID: 37345796 PMCID: PMC10356066 DOI: 10.1161/jaha.122.029758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023]
Abstract
Background Accountable care organizations (ACOs) aim to improve health care quality and reduce costs, including among patients with heart failure (HF). However, variation across ACOs in admission rates for patients with HF and associated factors are not well described. Methods and Results We identified Medicare fee-for-service beneficiaries with HF who were assigned to a Medicare Shared Savings Program ACO in 2017 and survived ≥30 days into 2018. We calculated risk-standardized acute admission rates across ACOs, assigned ACOs to 1 of 3 performance categories, and examined associations between ACO characteristics and performance categories. Among 1 232 222 beneficiaries with HF, 283 795 (mean age, 81 years; 54% women; 86% White; 78% urban) were assigned to 1 of 467 Medicare Shared Savings Program ACOs. Across ACOs, the median risk-standardized acute admission rate was 87 admissions per 100 people, ranging from 61 (minimum) to 109 (maximum) admissions per 100 beneficiaries. Compared to the overall average, 13% of ACOs performed better on risk-standardized acute admission rates, 72% were no different, and 14% performed worse. Most ACOs with better performance had fewer Black beneficiaries and were not hospital affiliated. Most ACOs that performed worse than average were large, located in the Northeast, had a hospital affiliation, and had a lower proportion of primary care providers. Conclusions Admissions are common among beneficiaries with HF in ACOs, and there is variation in risk-standardized acute admission rates across ACOs. ACO performance was associated with certain ACO characteristics. Future studies should attempt to elucidate the relationship between ACO structure and characteristics and admission risk.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population SciencesUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMAUSA
| | - Kamal Faridi
- Department of Healthcare Delivery and Population SciencesUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMAUSA
| | - Aruna Priya
- Department of Healthcare Delivery and Population SciencesUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMAUSA
| | - Penelope S. Pekow
- Department of Healthcare Delivery and Population SciencesUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMAUSA
| | - Thomas D'Aunno
- Wagner Graduate School of Public Service at New York UniversityNew YorkNYUSA
| | - Kathleen M. Mazor
- Division of Health Systems Science, Department of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMAUSA
| | - Mihaela S. Stefan
- Department of MedicineUniversity of Massachusetts Chan Medical SchoolSpringfieldMAUSA
| | - Erica S. Spatz
- Section of Cardiovascular MedicineYale School of MedicineNew HavenCTUSA
- Department of EpidemiologyYale School of Public HealthNew HavenCTUSA
- Yale Center for Outcomes Research and EvaluationNew HavenCTUSA
| | - Lauren Gilstrap
- Heart and Vascular Center, Dartmouth Hitchcock Medical CenterThe Dartmouth Institute, Geisel School of Medicine at DartmouthLebanonNHUSA
| | - Rachel M. Werner
- Leonard Davis Institute of Health Economics and Perelman School of MedicineUniversity of Pennsylvania; Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaPAUSA
| | - Tara Lagu
- Institute for Public Health and Medicine, Northwestern University Feinberg School of MedicineChicagoILUSA
- Division of Hospital Medicine, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
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7
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Does the Measurement of Ejection Fraction Still Make Sense in the HFpEF Framework? What Recent Trials Suggest. J Clin Med 2023; 12:jcm12020693. [PMID: 36675622 PMCID: PMC9867046 DOI: 10.3390/jcm12020693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/17/2023] Open
Abstract
Left ventricular ejection fraction (LVEF) is universally accepted as a cardiac systolic function index and it provides intuitive interpretation of cardiac performance. Over the last two decades, it has erroneously become the leading feature used by clinicians to characterize the left ventricular function in heart failure (HF). Notably, LVEF sets the basis for structural and functional HF phenotype classification in current guidelines. However, its diagnostic and prognostic role in patients with preserved or mildly reduced contractile function is less clear. This is related to several concerns due to intrinsic technical, methodological and hemodynamic limitations entailed in LVEF measurement that do not describe the chamber's real contractile performance as expressed by pressure volume loop relationship. In patients with HF and preserved ejection fraction (HFpEF), it does not reflect the effective systolic function because it is prone to preload and afterload variability and it does not account for both longitudinal and torsional contraction. Moreover, a repetitive measurement could be assessed over time to better identify HF progression related to natural evolution of disease and to the treatment response. Current gaps may partially explain the causes of negative or neutral effects of traditional medical agents observed in HFpEF. Nevertheless, recent pooled analysis has evidenced the positive effects of new therapies across the LVEF range, suggesting a potential role irrespective of functional status. Additionally, a more detailed analysis of randomized trials suggests that patients with higher LVEF show a risk reduction strictly related to overall cardiovascular (CV) events; on the other hand, patients experiencing lower LVEF values have a decrease in HF-related events. The current paper reports the main limitations and shortcomings in LVEF assessment, with specific focus on patients affected by HFpEF, and it suggests alternative measurements better reflecting the real hemodynamic status. Future investigations may elucidate whether the development of non-invasive stroke volume and longitudinal function measurements could be extensively applied in clinical trials for better phenotyping and screening of HFpEF patients.
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8
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Mild and moderate to severe early acute kidney injury following cardiac surgery among patients with heart failure and preserved vs. mid-range vs. reduced ejection fraction. Eur J Anaesthesiol 2022; 39:673-684. [DOI: 10.1097/eja.0000000000001713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Cittadini A, Bossone E, Ventura HO. Emerging Comorbidities in Heart Failure. Cardiol Clin 2022; 40:xi-xiv. [DOI: 10.1016/j.ccl.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Association between early detected heart failure stages and future cardiovascular and non-cardiovascular events in the elderly (Copenhagen Heart Failure Risk Study). BMC Geriatr 2022; 22:230. [PMID: 35313808 PMCID: PMC8935831 DOI: 10.1186/s12877-022-02875-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/24/2022] [Indexed: 12/11/2022] Open
Abstract
Background Early stages of heart failure (HF) are associated with an increased risk of hospitalization and increased mortality, however the course of progression and the impact of non-cardiovascular comorbidities on adverse events in elderly high-risk patients are unknown. Aim To examine the risk of future cardiovascular (CV) and non-CV events in early stages of HF in a cohort of elderly patients (age ≥ 60 with ≥ 1 risk factor for HF and without known or clinically suspected HF). Methods A total of 400 patients (American Heart Association HF stage A: N = 177; stage B: N = 150; stage C: N = 73) from the Copenhagen Heart Failure Risk Study were identified and followed for the main composite outcome of a HF hospitalization (HFH), ischemic heart disease (IHD), stroke, and all-cause death, recorded within the Danish nationwide registries. Non-CV hospitalization was a secondary outcome. Absolute risk was calculated by the Aalen-Johansen estimator. Results The median follow-up time was 3.3 years, total number of events were 83, and the 3-year risk (95% confidence interval) of the main outcome was 12.8% (7.8–17.9), 22.8% (16.1–29.6) and 31.8% (21.0–42.6) for patients with stage A, B, and C, respectively. 1.1% (0.0–2.7), 3.4% (1.0–6.3) and 10.0% (2.8–16.3) experienced HFH as their first event, whereas 37.3% (30.2–44.4), 49.7% (41.6–57.8) and 54.8% (43.4–66.2) were admitted for non-CV causes as their first event. Conclusion The risk of HFH, IHD, stroke and all-cause death increased with severity of HF stage, and 10% of patients with undiagnosed HF stage C were admitted for HF within 3 years. However, the risk of non-CV hospitalizations was greater compared to the risk of experiencing HFH. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02875-1.
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11
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Ferreira JP, Shah AM, Claggett BL, Pitt B, Lewis EF, Solomon SD, Zannad F. Cardiac structure and function and quality of life associations in HFpEF: An analysis from TOPCAT-Americas. Int J Cardiol 2022; 352:78-83. [DOI: 10.1016/j.ijcard.2022.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/05/2022]
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12
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Tini G, Sessarego E, Benenati S, Vianello PF, Musumeci B, Autore C, Canepa M. Yield of bone scintigraphy screening for transthyretin-related cardiac amyloidosis in different conditions: Methodological issues and clinical implications. Eur J Clin Invest 2021; 51:e13665. [PMID: 34390490 PMCID: PMC9286629 DOI: 10.1111/eci.13665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Transthyretin-related cardiac amyloidosis (TTR-CA) is thought to be particularly common in specific at-risk conditions, including aortic stenosis (AS), heart failure with preserved ejection fraction (HFpEF), carpal tunnel syndrome (CTS) and left ventricular hypertrophy or hypertrophic cardiomyopathy (LVH/HCM). METHODS We performed a systematic revision of the literature, including only prospective studies performing TTR-CA screening with bone scintigraphy in the above-mentioned conditions. Assessment of other forms of CA was also evaluated. For selected items, pooled estimates of proportions or means were obtained using a meta-analytic approach. RESULTS Nine studies (3 AS, 2 HFpEF, 2 CTS and 2 LVH/HCM) accounting for 1375 screened patients were included. One hundred fifty-six (11.3%) TTR-CA patients were identified (11.4% in AS, 14.8% in HFpEF, 2.6% in CTS and 12.9% in LVH/HCM). Exclusion of other forms of CA and use of genetic testing was overall puzzled. Age at TTR-CA recognition was significantly older than that of the overall screened population in AS (86 vs. 83 years, p = .04), LVH/HCM (75 vs. 63, p < .01) and CTS (82 vs. 71), but not in HFpEF (83 vs. 79, p = .35). In terms of comorbidities, hypertension, diabetes and atrial fibrillation were highly prevalent in TTR-CA-diagnosed patients, as well as in those with an implanted pacemaker. CONCLUSIONS Screening with bone scintigraphy found an 11-15% TTR-CA prevalence in patients with AS, HFpEF and LVH/HCM. AS and HFpEF patients were typically older than 80 years at TTR-CA diagnosis and frequently accompanied by comorbidities. Several studies showed limitations in the application of recommended TTR-CA diagnostic algorithm, which should be addressed in future prospective studies.
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Affiliation(s)
- Giacomo Tini
- Cardiology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Division of Cardiology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Eugenio Sessarego
- Cardiology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Stefano Benenati
- Cardiology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Beatrice Musumeci
- Division of Cardiology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Camillo Autore
- Division of Cardiology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Marco Canepa
- Cardiology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Cardiology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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Fayol A, Wack M, Livrozet M, Carves JB, Domengé O, Vermersch E, Mirabel M, Karras A, Le Guen J, Blanchard A, Azizi M, Amar L, Bories MC, Mousseaux E, Carette C, Puymirat E, Hagège A, Jannot AS, Hulot JS. Aetiological classification and prognosis in patients with heart failure with preserved ejection fraction. ESC Heart Fail 2021; 9:519-530. [PMID: 34841727 PMCID: PMC8788026 DOI: 10.1002/ehf2.13717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/31/2021] [Indexed: 12/18/2022] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with various causes that may influence prognosis. METHODS AND RESULTS We extracted the electronic medical records for 2180 consecutive patients hospitalized between 2016 and 2019 for decompensated heart failure. Using a text mining algorithm looking for a left ventricular ejection fraction ≥50% and plasma brain natriuretic peptide level >100 pg/mL, we identified 928 HFpEF patients. We screened for a prevailing cause of HFpEF according to European guidelines and found that 418 (45.0%) patients had secondary HFpEF due to either myocardial (n = 125, 13.5%) or loading condition abnormalities (n = 293, 31.5%), while the remaining 510 (55.0%) patients had idiopathic HFpEF. We assessed the association between the causes of HFpEF and survival collected up to 31 December 2020 using Cox proportional hazards analysis. Even though patients with idiopathic HFpEF were older, frequently female, and had frequent co-morbidities and a higher crude mortality rate compared with secondary HFpEF patients, their prognosis was similar after adjustment for age and sex. Unsupervised clustering analysis revealed three main phenogroups with different distribution of idiopathic vs. secondary HFpEF. The phenogroup with the highest proportion of idiopathic HFpEF (69%) had (i) an excess rate of non-cardiac co-morbidities including chronic obstructive pulmonary disease (31%) or obesity (41%) and (ii) a better prognosis compared with the two other phenogroups enriched with secondary HFpEF. CONCLUSIONS Aetiological classification provides clinical and prognostic information and may be useful to better decipher the clinical heterogeneity of HFpEF.
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Affiliation(s)
- Antoine Fayol
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Maxime Wack
- Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Inserm, Paris, France.,Departement d'Informatique Hospitalière, DMU PRIME, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Marine Livrozet
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Jean-Baptiste Carves
- CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | | | - Eva Vermersch
- Université de Paris, INSERM, PARCC, Paris, F-75006, France
| | | | - Alexandre Karras
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Department of Nephrology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Julien Le Guen
- Department of Geriatry, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Anne Blanchard
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Michel Azizi
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Hypertension Department and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Laurence Amar
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Hypertension Department and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Marie-Cécile Bories
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Department of Cardiology and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, F-75015, France
| | - Elie Mousseaux
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Claire Carette
- CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France.,Department of Nutrition, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Etienne Puymirat
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Department of Cardiology and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, F-75015, France
| | - Albert Hagège
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,Department of Cardiology and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, F-75015, France
| | - Anne-Sophie Jannot
- Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Inserm, Paris, France.,Departement d'Informatique Hospitalière, DMU PRIME, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Jean-Sébastien Hulot
- Université de Paris, INSERM, PARCC, Paris, F-75006, France.,CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
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14
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Deaton C. The Emperor-Preserved trial: what will change for patients with heart failure with preserved ejection fraction? Eur J Cardiovasc Nurs 2021; 21:293-294. [PMID: 34718524 DOI: 10.1093/eurjcn/zvab093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Christi Deaton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK
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15
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Lavine SJ, Murtaza G, Rahman ZU, Kelvas D, Paul TK. Diastolic function grading by American Society of Echocardiography guidelines and prediction of heart failure readmission and all-cause mortality in a community-based cohort. Echocardiography 2021; 38:1988-1998. [PMID: 34555216 DOI: 10.1111/echo.15206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 06/25/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Diastolic function (DF) guidelines have been simplified but lack extensive outcome data. Using a rural university heart failure (HF) database, we assessed whether DF grading could predict HF, HF readmission, and all-cause mortality (ACM). METHODS In this single-center retrospective study that included 613 patients in sinus rhythm hospitalized for HF (HF with preserved-254 patients, with mid-range-216 patients, and reduced ejection fraction-143 patients), we recorded demographics, Doppler-echo, Framingham HF score, laboratories, HF readmission, and ACM with follow-up to 2167 days. RESULTS Diastolic dysfunction (Ddys) parameters (left atrial volume index [LAVI] > 34 ml/m2 , tricuspid regurgitation [TR] velocity > 2.8 m/sec, and E/e' > 14) had moderate sensitivity (46.2%-65.0%) for predicting HF among all phenotypes combined with DF grading having moderate predictability and additive to a clinical composite for HF prediction (AUC = .677, P < 0.0001; difference = .043, P < 0.001) for combined phenotypes. Ddys parameters and Ddys severity (2016 ASE criteria: grade II and III) were significantly associated with HF readmission for decompensated HF within 60-2167 days of follow-up (LAVI > 34 ml/m2 : HR 1.56 [1.26-2.19]; E/e' > 14: HR 1.44 [1.21-1.99]; TR > 2.8 m/sec: H1.43 [1.19-1.88]; LV Dys grade II: HR 2.12 [1.42-2.96]; LV Ddys grade III: HR 2.39 [1.57-4.82]). CONCLUSION The findings of this study highlight the clinical and prognostic relevance of determining the severity of LV Ddys in patients with HF with regard to HF verification and HF readmission.
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Affiliation(s)
- Steven J Lavine
- Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA.,Department of Medicine/Cardiology, Washington University of St. Louis, St. Louis, Missouri, USA
| | - Ghulam Murtaza
- Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Zia Ur Rahman
- Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Danielle Kelvas
- Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Timir K Paul
- Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
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16
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Abdel-Qadir H, Tai F, Croxford R, Austin PC, Amir E, Calvillo-Argüelles O, Ross H, Lee DS, Thavendiranathan P. Characteristics and Outcomes of Women Developing Heart Failure After Early Stage Breast Cancer Chemotherapy: A Population-Based Matched Cohort Study. Circ Heart Fail 2021; 14:e008110. [PMID: 34187164 PMCID: PMC8288484 DOI: 10.1161/circheartfailure.120.008110] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/22/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The prognosis of heart failure (HF) after early stage breast cancer (EBC) treatment with anthracyclines or trastuzumab is not well-characterized. METHODS Using administrative databases, women diagnosed with HF after receiving anthracyclines or trastuzumab for EBC in Ontario during 2007 to 2017 (the EBC-HF cohort) were categorized by cardiotoxic exposure (anthracycline alone, trastuzumab alone, sequential therapy with both agents) and matched on age with ≤3 cancer-free HF controls to compare baseline characteristics. To study prognosis after HF onset, we conducted a second match on age plus important HF prognostic factors. The cumulative incidence function was used to describe risk of hospitalization or emergency department visits (hospital presentations) for HF and cardiovascular death. RESULTS A total of 804 women with EBC developed HF after anthracyclines (n=312), trastuzumab (n=112), or sequential therapy (n=380); they had significantly fewer comorbidities than 2411 age-matched HF controls. After the second match, the anthracycline-HF cohort had a similar 5-year incidence of HF hospital presentations (16.5% [95% CI, 12.0%-21.7%]) as controls (17.1% [95% CI, 14.4%-20.1%]); the 5-year incidence was lower than matched controls for the trastuzumab-HF (9.7% [95% CI, 4.7%-16.9%]; controls 16.4% [95% CI, 12.1%-21.3%]; P=0.03) and sequential-HF cohorts (2.7% [95% CI, 1.4%-4.8%]; controls 10.8% [95% CI, 8.9%-13.0%]; P<0.001). At 5 years, the incidence of cardiovascular death was 2.9% (95% CI, 1.2%-5.9%) in the anthracycline-HF cohort vs. 9.5% (95% CI, 6.9%-12.6%) in controls, and 1.7% (0.6%-3.7%) for women developing HF after trastuzumab vs. 4.3% (95% CI, 3.1-5.8%) for controls. CONCLUSIONS Women developing HF after cardiotoxic EBC chemotherapy have fewer comorbidities than cancer-free women with HF; trastuzumab-treated women who develop HF have better prognosis than matched HF controls.
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Affiliation(s)
- Husam Abdel-Qadir
- Women’s College Hospital (H.A.-Q., F.T.), University of Toronto, ON, Canada
- Ted Rogers Program in Cardiotoxicity Prevention (H.A.-Q., O.C.-A., P.T.), University of Toronto, ON, Canada
- Division of Cardiology, Peter Munk Cardiac Center (H.A.-Q., O.C.-A., H.R., D.S.L., P.T.), University of Toronto, ON, Canada
- University Health Network, Institute of Health Policy Management and Evaluation (H.A.-Q., P.C.A., E.A., D.S.L.), University of Toronto, ON, Canada
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., R.C., P.C.A., D.S.L.)
| | - Felicia Tai
- Women’s College Hospital (H.A.-Q., F.T.), University of Toronto, ON, Canada
| | - Ruth Croxford
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., R.C., P.C.A., D.S.L.)
| | - Peter C. Austin
- University Health Network, Institute of Health Policy Management and Evaluation (H.A.-Q., P.C.A., E.A., D.S.L.), University of Toronto, ON, Canada
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., R.C., P.C.A., D.S.L.)
| | - Eitan Amir
- University Health Network, Institute of Health Policy Management and Evaluation (H.A.-Q., P.C.A., E.A., D.S.L.), University of Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center (E.A.), University of Toronto, ON, Canada
| | - Oscar Calvillo-Argüelles
- Ted Rogers Program in Cardiotoxicity Prevention (H.A.-Q., O.C.-A., P.T.), University of Toronto, ON, Canada
- Division of Cardiology, Peter Munk Cardiac Center (H.A.-Q., O.C.-A., H.R., D.S.L., P.T.), University of Toronto, ON, Canada
| | - Heather Ross
- Division of Cardiology, Peter Munk Cardiac Center (H.A.-Q., O.C.-A., H.R., D.S.L., P.T.), University of Toronto, ON, Canada
| | - Douglas S. Lee
- Division of Cardiology, Peter Munk Cardiac Center (H.A.-Q., O.C.-A., H.R., D.S.L., P.T.), University of Toronto, ON, Canada
- Joint Department of Medical Imaging (D.S.L., P.T.), University of Toronto, ON, Canada
- University Health Network, Institute of Health Policy Management and Evaluation (H.A.-Q., P.C.A., E.A., D.S.L.), University of Toronto, ON, Canada
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., R.C., P.C.A., D.S.L.)
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention (H.A.-Q., O.C.-A., P.T.), University of Toronto, ON, Canada
- Division of Cardiology, Peter Munk Cardiac Center (H.A.-Q., O.C.-A., H.R., D.S.L., P.T.), University of Toronto, ON, Canada
- Joint Department of Medical Imaging (D.S.L., P.T.), University of Toronto, ON, Canada
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17
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Roderburg C, Loosen SH, Jahn JK, Gänsbacher J, Luedde T, Kostev K, Luedde M. Heart failure is associated with an increased incidence of cancer diagnoses. ESC Heart Fail 2021; 8:3628-3633. [PMID: 34180146 PMCID: PMC8497216 DOI: 10.1002/ehf2.13421] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/18/2021] [Accepted: 05/02/2021] [Indexed: 02/05/2023] Open
Abstract
AIMS The prognosis and quality of life of heart failure patients is determined to a significant extent by co-morbidities. New data suggest that heart failure may be associated with an increased incidence of cancer. The present retrospective study investigates this association in a large collective of outpatients with heart failure. METHODS AND RESULTS This retrospective cohort study assessed the incidence of cancer in patients with an initial diagnosis of heart failure and a matched non-heart failure cohort in 1274 general practices in Germany between January 2000 and December 2018. The study is based on the Disease Analyser database (IQVIA), which contains drug prescriptions, diagnoses, and basic medical and demographic data. Hazard regression models were used to study the association between heart failure and the incidences of different cancers. A total of 100 124 patients with heart failure and 100 124 patients without heart failure were included in the analysis. Patients were matched individually by sex, age, diabetes, obesity, and yearly consultation frequency. Within the 10 year observation period, 25.7% of patients with heart failure and 16.2% of patients without heart failure had been diagnosed with cancer (log-rank P < 0.001). These proportions were 28.6% vs. 18.8% in female and 23.2% vs. 13.8% in male patients. Heart failure was significantly associated with the incidence of cancer [hazard ratio (HR), 95% confidence interval: 1.76, 1.71-1.81; P < 0.001 in total; HR: 1.85, 1.77-1.92, P < 0.001 in women; HR: 1.69, 1.63-1.76, P < 0.001 in men]. A significant association was found between heart failure and all cancer sites assessed. The strongest association was observed for cancer of lip, oral cavity, and pharynx (HR: 2.10, 95% confidence interval: 1.66-2.17; P < 0.001), followed by respiratory organs (HR: 1.91, 1.74-2.10; P < 0.001) and genital organs of female patients (HR: 1.86, 1.56-2.17; P < 0.001). The association for skin tumours was 1.83 (1.72-1.94; P < 0.001), for cancer of lymphoid and haematopoietic tissue 1.77 (1.63-1.91; P < 0.001), for cancer of the digestive tract 1.75 (1.64-1. 87; P < 0.001), for breast cancer 1.67 (1.52-1.84; P < 0.001), for cancer of the genitourinary tract 1.64 (1.48-1.81; P < 0.001), and for male genital organ cancer 1.52 (1.40-1.66; P < 0.001). CONCLUSIONS Our study indicates that heart failure patients experience a significantly higher incidence of cancer during the course of the disease.
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Affiliation(s)
- Christoph Roderburg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Julia K Jahn
- Internal Medicine I, Central Hospital Bremerhaven, Bremerhaven, Germany
| | - Julia Gänsbacher
- Internal Medicine III, University Hospital of Kiel, Kiel, Germany
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | | | - Mark Luedde
- KGP Bremerhaven, Postbrookstr. 105, Bremerhaven, 27574, Germany.,Christian-Albrechts-University Kiel, Kiel, Germany
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18
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Palazzuoli A, Beltrami M. Are HFpEF and HFmrEF So Different? The Need to Understand Distinct Phenotypes. Front Cardiovasc Med 2021; 8:676658. [PMID: 34095263 PMCID: PMC8175976 DOI: 10.3389/fcvm.2021.676658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022] Open
Abstract
Traditionally, patients with heart failure (HF) are divided according to ejection fraction (EF) threshold more or <50%. In 2016, the ESC guidelines introduced a new subgroup of HF patients including those subjects with EF ranging between 40 and 49% called heart failure with midrange EF (HFmrEF). This group is poorly represented in clinical trials, and it includes both patients with previous HFrEF having a good response to therapy and subjects with initial preserved EF appearance in which systolic function has been impaired. The categorization according to EF has recently been questioned because this variable is not really a representative of the myocardial contractile function and it could vary in relation to different hemodynamic conditions. Therefore, EF could significantly change over a short-term period and its measurement depends on the scan time course. Finally, although EF is widely recognized and measured worldwide, it has significant interobserver variability even in the most accredited echo laboratories. These assumptions imply that the same patient evaluated in different periods or by different physicians could be classified as HFmrEF or HFpEF. Thus, the two HF subtypes probably subtend different responses to the underlying pathophysiological mechanisms. Similarly, the adaptation to hemodynamic stimuli and to metabolic alterations could be different for different HF stages and periods. In this review, we analyze similarities and dissimilarities and we hypothesize that clinical and morphological characteristics of the two syndromes are not so discordant.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital University of Siena, Siena, Italy
| | - Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Florence, Italy
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19
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Rohde LE, Claggett BL, Wolsk E, Packer M, Zile M, Swedberg K, Rouleau J, Pfeffer MA, Desai AS, Lund LH, Kober L, Anand I, Merkely B, Senni M, Shi V, Rizkala A, Lefkowitz M, McMurray JJV, Solomon SD. Cardiac and Noncardiac Disease Burden and Treatment Effect of Sacubitril/Valsartan: Insights From a Combined PARAGON-HF and PARADIGM-HF Analysis. Circ Heart Fail 2021; 14:e008052. [PMID: 33706551 DOI: 10.1161/circheartfailure.120.008052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The net clinical benefit of cardiac disease-modifying drugs might be influenced by the interaction of different domains of disease burden. We assessed the relative contribution of cardiac, comorbid, and demographic factors in heart failure (HF) and how their interplay might influence HF prognosis and efficacy of sacubitril/valsartan across the spectrum of left ventricular ejection fraction. METHODS We combined data from 2 global trials that evaluated the efficacy of sacubitril/valsartan compared with a renin-angiotensin antagonist in symptomatic HF patients (PARADIGM-HF [Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With an Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure; n=8399] and PARAGON-HF [Prospective Comparison of Angiotensin-Converting Enzyme Inhibitor With Angiotensin Receptors Blockers Global Outcomes in Heart Failure With Preserved Ejection Fraction; n=4796]). We decomposed the previously validated Meta-Analysis Global Group in Chronic Heart Failure risk score into cardiac (left ventricular ejection fraction, New York Heart Association class, blood pressure, time since HF diagnosis, HF medications), noncardiac comorbid (body mass index, creatinine, diabetes, chronic obstructive pulmonary disease, smoking), and demographic (age, gender) categories. Based on these domains, an index representing the balance of cardiac to noncardiac comorbid burden was created (cardiac-comorbid index). Clinical outcomes were time to first HF hospitalization or cardiovascular deaths and all-cause mortality. RESULTS Higher scores of the cardiac domain were observed in PARADIGM-HF (10 [7-13] versus 5 [3-6], P<0.001) and higher scores of the demographic domain in PARAGON-HF (10 [8-13] versus 5 [2-9], P<0.001). In PARADIGM-HF, the contribution of the cardiac domain to clinical outcomes was greater than the noncardiac domain (P<0.001), while in PARAGON-HF the attributable risk of the comorbid and demographic categories predominated. Individual scores from each sub-domain were linearly associated with the risk of clinical outcomes (P<0.001). Beneficial effects of sacubitril/valsartan were observed in patients with preponderance of cardiac over noncardiac comorbid burden (cardiac-comorbid index >5 points), suggesting a significant treatment effect modification (interaction P<0.05 for both outcomes). CONCLUSIONS Domains of disease burden are clinically relevant features that influence the prognosis and treatment of patients with HF. The therapeutic benefits of sacubitril/valsartan vary according to the balance of components of disease burden, across different ranges of left ventricular ejection fraction.
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Affiliation(s)
- Luis E Rohde
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA (L.E.R., B.L.C., M.A.P., A.S.D., S.D.S.).,Hospital de Clínicas de Porto Alegre and UFRGS Medical School, Brazil (L.E.R.)
| | - Brian L Claggett
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA (L.E.R., B.L.C., M.A.P., A.S.D., S.D.S.)
| | - Emil Wolsk
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark (E.W.)
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.).,Imperial College, London, United Kingdom (M.P.)
| | - Michael Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.Z.)
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.)
| | - Jean Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.R.)
| | - Marc A Pfeffer
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA (L.E.R., B.L.C., M.A.P., A.S.D., S.D.S.)
| | - Akshay S Desai
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA (L.E.R., B.L.C., M.A.P., A.S.D., S.D.S.)
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Lars Kober
- Department of Cardiology, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.)
| | - Inder Anand
- Department of Medicine, VA Medical Center and University of Minnesota, Minneapolis (I.A.)
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.)
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy (M.S.)
| | - Victor Shi
- Novartis, East Hanover, New Jersey (V.S., A.R., M.L.)
| | - Adel Rizkala
- Novartis, East Hanover, New Jersey (V.S., A.R., M.L.)
| | | | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.)
| | - Scott D Solomon
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA (L.E.R., B.L.C., M.A.P., A.S.D., S.D.S.)
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20
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Feldman SF, Lesuffleur T, Olié V, Gastaldi-Ménager C, Juillière Y, Tuppin P. French annual national observational study of 2015 outpatient and inpatient healthcare utilization by approximately half a million patients with previous heart failure diagnosis. Arch Cardiovasc Dis 2021; 114:17-32. [DOI: 10.1016/j.acvd.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
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21
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Tomasoni D, Adamo M, Anker MS, von Haehling S, Coats AJS, Metra M. Heart failure in the last year: progress and perspective. ESC Heart Fail 2020; 7:3505-3530. [PMID: 33277825 PMCID: PMC7754751 DOI: 10.1002/ehf2.13124] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
Research about heart failure (HF) has made major progress in the last years. We give here an update on the most recent findings. Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM‐HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA‐HF and EMPEROR‐Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65–0.85; P < 0.001 and HR 0.75; 95% CI 0.65–0.86; P < 0.001, respectively]. Second, vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo (HR 0.90; 95% CI 0.82–0.98; P = 0.02). On the other hand, both the diagnosis and treatment of HF with preserved ejection fraction, as well as management of advanced HF and acute HF, remain challenging. A better phenotyping of patients with HF would be helpful for prognostic stratification and treatment selection. Further aspects, such as the use of devices, treatment of arrhythmias, and percutaneous treatment of valvular heart disease in patients with HF, are also discussed and reviewed in this article.
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Affiliation(s)
- Daniela Tomasoni
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Cardiology and Cardiac Catheterization Laboratory, Cardio-thoracic Department, Civil Hospitals, Brescia, Italy
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Cardiology and Cardiac Catheterization Laboratory, Cardio-thoracic Department, Civil Hospitals, Brescia, Italy
| | - Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité-University Medicine Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Cardiology (CBF), Charité-University Medicine Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Andrew J S Coats
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Cardiology and Cardiac Catheterization Laboratory, Cardio-thoracic Department, Civil Hospitals, Brescia, Italy
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22
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Kvasnička J, Havlíček A, Bělohlávek J, Večeřa J, Čermáková E. Why is the clinical response to cardiac resynchronization better in LBBB patients? ESC Heart Fail 2020; 7:3667-3675. [PMID: 32945621 PMCID: PMC7754895 DOI: 10.1002/ehf2.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022] Open
Abstract
Aims The improved clinical response in patients with left bundle branch block (LBBB) over LBBB‐free patients treated with cardiac resynchronization therapy with a defibrillator (CRT‐D) is commonly attributed to an LBBB abnormality. We aimed to find an alternative explanation. Methods and results We analysed an immediate effect of selecting the LBBB group of patients in a cohort of 63 non‐ischaemic cardiomyopathy (non‐ICM) and 83 ischaemic cardiomyopathy (ICM) patients treated with CRT‐D; 75% of non‐ICM and 51% of ICM patients had an LBBB abnormality on the electrocardiogram, with a significant difference (P = 0.0032 by χ2). As a result of this difference, the proportion of non‐ICM patients increased from 43% in the primary cohort to 53% in LBBB selection and decreased to 28% in non‐LBBB group. By nonparametric survival analysis, the hazard ratio in non‐ICM patients in the LBBB selection decreased from 0.48 (P = 0.0488) to 0.36 (P = 0.0251) and increased in the non‐LBBB group to 0.75 (P = 0.6496). Any comparison of LBBB and non‐LBBB groups must compare sets with a significantly altered proportion of patients of different aetiologies. Most publications on LBBB patients are erroneous because they compare LBBB with non‐LBBB groups, not taking into account that the groups have been substantially changed by the selection process. Conclusions The declared outcome of the LBBB groups reflects inevitably the survival outcome of their non‐ICM patients and not the intended outcome of patients with LBBB. CRT‐D in patients with different aetiologies of cardiomyopathy calls for separate evaluation.
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Affiliation(s)
- Jiří Kvasnička
- Department of Invasive Arrhythmology, Cardiac Center AGEL AGEL AS Pardubice Czech Republic
- Cardiology Department Internal Medicine Clinic, Pardubice Hospital Pardubice Czech Republic
- 1st Department of Internal Medicine ‐ Cardioangiology Charles University Medical Faculty and Teaching Hospital Hradec Králové Czech Republic
| | - Aleš Havlíček
- Department of Invasive Arrhythmology, Cardiac Center AGEL AGEL AS Pardubice Czech Republic
- Cardiology Department Internal Medicine Clinic, Pardubice Hospital Pardubice Czech Republic
| | - Jan Bělohlávek
- Department of Invasive Arrhythmology, Cardiac Center AGEL AGEL AS Pardubice Czech Republic
- Cardiology Department Internal Medicine Clinic, Pardubice Hospital Pardubice Czech Republic
| | - Jan Večeřa
- Department of Invasive Arrhythmology, Cardiac Center AGEL AGEL AS Pardubice Czech Republic
- Cardiology Department Internal Medicine Clinic, Pardubice Hospital Pardubice Czech Republic
| | - Eva Čermáková
- Department of Medical Biophysics Charles University, Medical Faculty Hradec Králové Czech Republic
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23
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Adamo M, Lombardi CM, Metra M. June 2020 at a glance: focus on COVID-19, quality of life and comorbidities. Eur J Heart Fail 2020; 22:917-918. [PMID: 32731308 DOI: 10.1002/ejhf.1515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Carlo Mario Lombardi
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
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24
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The role of pulmonary function in patients with heart failure and preserved ejection fraction: Looking beyond chronic obstructive pulmonary disease. PLoS One 2020; 15:e0235152. [PMID: 32634145 PMCID: PMC7340281 DOI: 10.1371/journal.pone.0235152] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/09/2020] [Indexed: 12/30/2022] Open
Abstract
Background The prognostic value of chronic obstructive pulmonary disease (COPD) as a comorbidity in heart failure has been well documented. However, the role of pulmonary function indices in patients with heart failure and preserved ejection fraction (HFpEF) remains to be elucidated. Methods Subjects with HFpEF received pulmonary function tests and echocardiogram. Total lung capacity (TLC), residual volume (RV), forced expiratory flow rate between 25% and 75% of vital capacity (FEF25-75), forced expiratory volume in the 1st second (FEV1), forced vital capacity (FVC), and vital capacity (VC) were measured. Echocardiographic indices, including pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e’), and left ventricular mass (LVM), were recorded. National Death Registry was linked for the identification of mortality. Results A total of 1194 patients (72.4±13.2 years, 59% men) were enrolled. PASP, E/e’ and LVM were associated with either obstructive (RV/TLC, FEV1 and FEF25-75) or restrictive (VC and TLC) ventilatory indices. During a mean follow-up of 23.0±12.8 months, 182 patients died. Subjects with COPD had a lower survival rate than those without COPD. While VC, FVC, RV/TLC, and FEV1 were all independently associated with all-cause mortality in patients without COPD, only FEF25-75 was predictive of outcomes in those with COPD. Conclusions The abnormalities of pulmonary function were related to the cardiac hemodynamics in patients with HFpEF. In addition, these ventilatory indices were independently associated with long-term mortality, especially in those without COPD.
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25
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Kintscher U, Foryst-Ludwig A, Haemmerle G, Zechner R. The Role of Adipose Triglyceride Lipase and Cytosolic Lipolysis in Cardiac Function and Heart Failure. CELL REPORTS MEDICINE 2020; 1:100001. [PMID: 33205054 PMCID: PMC7659492 DOI: 10.1016/j.xcrm.2020.100001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure is one of the leading causes of death worldwide. New therapeutic concepts are urgently required to lower the burden of heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), the two major forms of heart failure. Lipolytic processes are induced during the development of heart failure and occur in adipose tissue and multiple organs, including the heart. Increasing evidence suggests that cellular lipolysis, in particular, adipose triglyceride lipase (ATGL) activity, has an important function in cardiac (patho)physiology. This review summarizes the crucial role of cellular lipolysis for normal cardiac function and for the development of HFrEF and HFpEF. We discuss the most relevant pre-clinical studies and elaborate on the cardiac consequences of non-myocardial and myocardial lipolysis modulation. Finally, we critically analyze the therapeutic importance of pharmacological ATGL inhibition as a potential treatment option for HFrEF and/or HFpEF in the future.
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Affiliation(s)
- Ulrich Kintscher
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Corresponding author
| | - Anna Foryst-Ludwig
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Guenter Haemmerle
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria
- BioTechMed-Graz, 8010 Graz, Austria
| | - Rudolf Zechner
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria
- BioTechMed-Graz, 8010 Graz, Austria
- Einstein BIH Visiting Fellow, Berlin Institute of Health, and Charité - Universitätsmedizin Berlin, Berlin, Germany
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26
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The impact of worsening renal function with elevated B-type natriuretic peptide at discharge on 1-year prognosis in heart failure patients. Sci Rep 2020; 10:4451. [PMID: 32157134 PMCID: PMC7064501 DOI: 10.1038/s41598-020-61404-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 02/25/2020] [Indexed: 01/01/2023] Open
Abstract
There are a few studies about the clinical impacts of plasma B-type natriuretic peptide (BNP) at discharge with the occurrence of worsening renal function (WRF) on mortality in patients with heart failure (HF). We divided total 301 patients with acute decompensated HF into four groups by the median value (278.7 pg/mL) of BNP level at discharge and by the occurrence of WRF. WRF developed in 100 patients (33.2%). Cardiovascular mortality was significantly different between the four groups (P = 0.0002). Patients with WRF and elevated BNP had a higher cardiovascular mortality than patients without WRF and elevated BNP in Cox proportional hazard models (hazard ratio [HR], 10.48; 95% confident interval [95% CI], 1.27–225.53; P = 0.03). Patients with either WRF or elevated BNP did not have an increased risk of cardiovascular mortality compared to patients without WRF and elevated BNP. Regarding HF readmission and cardiovascular mortality, patients with WRF and elevated BNP had the highest risk (HR, 5.17; 95% CI, 2.07–14.30, P = 0.0003) and patients with either WRF or elevated BNP had a higher risk than patients without WRF and elevated BNP. The occurrence of WRF combined with elevated BNP at discharge was associated with increased 1-year cardiovascular mortality and HF readmission.
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27
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Prognostic value of hemodynamics and comorbidities in pulmonary hypertension due to advanced heart failure. Heart Lung 2020; 49:158-164. [DOI: 10.1016/j.hrtlng.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 01/03/2023]
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28
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Kalogirou F, Forsyth F, Kyriakou M, Mantle R, Deaton C. Heart failure disease management: a systematic review of effectiveness in heart failure with preserved ejection fraction. ESC Heart Fail 2020; 7:194-212. [PMID: 31978280 PMCID: PMC7083420 DOI: 10.1002/ehf2.12559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/25/2022] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) poses a substantial challenge for clinicians, but there is little guidance for effective management. The aim of this systematic review was to determine if there was evidence that disease management programmes (DMPs) improved outcomes for patients with HFpEF. METHODS AND RESULTS A systematic review of controlled studies in English or Greek of DMPs including patients with HFpEF from 2008 to 2018 was conducted using CINAHL, Cochrane, MEDLINE, and Embase. Interventions were assessed using a DMP taxonomy and scored for complexity and intensity. Bias was assessed using the Cochrane Collaboration tool. Initial and updated searches found 6089 titles once duplicates were removed. The final analysis included 18 studies with 5435 HF patients: 1866 patients (34%, study ranges 18-100%) had potential HFpEF (limited by variable definitions). Significant heterogeneity in terms of the population, intervention, comparisons, and outcomes prohibited meta-analysis. Statistically significant or positive trends were found in mortality, hospitalization rates, self-care ability, quality of life, anxiety, depression, and sleep, but findings were not robust or consistent. Four studies reported results separately for study-defined HFpEF, with two finding less positive effect on outcomes. CONCLUSIONS Varying definitions of HFpEF used in studies are a substantial limitation in interpretation of findings. The reduced efficacy noted in contemporary HF DMP studies may not only be due to improvements in usual care but may also reflect inclusion of heterogeneous patients with HFpEF or HF with mid-range EF who may not respond in the same way as HFrEF to individual components. Given that patients with HFpEF are older and multi-morbid, DMPs targeting HFpEF should not rely on a single-disease focus but provide care that addresses predisposing and presentation phenotypes and draws on the principles of comprehensive geriatric assessment. Other components could also be more targeted to HFpEF such as modification of lifestyle factors for which there is emerging evidence, rather than simply continuing the model of care used in HFrEF. Based on current evidence, HF DMPs may improve mortality, hospitalization rates, self-care, and quality of life in patients with HFpEF; however, further research specifically tailored to appropriately defined HFpEF is required.
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Affiliation(s)
| | - Faye Forsyth
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
- Department of Public Health and Primary Care, Forvie SiteUniversity of Cambridge School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUK
| | - Martha Kyriakou
- Cyprus University of TechnologyLimassolCyprus
- American Medical CenterNicosiaCyprus
| | - Rhys Mantle
- University of Cambridge School of Clinical MedicineCambridgeUK
| | - Christi Deaton
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
- Department of Public Health and Primary Care, Forvie SiteUniversity of Cambridge School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUK
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29
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Rosano GMC, Seferović PM. Physiological monitoring in the complex multi-morbid heart failure patient - Introduction. Eur Heart J Suppl 2020; 21:M1-M4. [PMID: 31908606 PMCID: PMC6937512 DOI: 10.1093/eurheartj/suz229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Repeated physiological monitoring of comorbidities in heart failure (HF) is pivotal. This document introduces the main challenges related to physiological monitoring in the complex multimorbid HF patient, arising during an ESC consensus meeting on this topic.
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Affiliation(s)
- Giuseppe M C Rosano
- Department of Medical Sciences, IRCCS San Raffaele IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Roma, Italy
| | - Petar M Seferović
- Faculty of Medicine, Belgrade University, Studentski trg 1, 11000 Belgrade, Serbia
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31
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Böhm M, Coats AJS, Kindermann I, Spoletini I, Rosano G. Physiological monitoring in the complex multimorbid heart failure patient - Conclusions. Eur Heart J Suppl 2019; 21:M68-M71. [PMID: 31908622 PMCID: PMC6937511 DOI: 10.1093/eurheartj/suz232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Comorbidities are increasingly recognized as crucial components of the heart failure syndrome. Main specific challenges are polypharmacy, poor adherence to treatments, psychological aspects, and the need of monitoring after discharge. The chronic multimorbid patient therefore represents a specific heart failure phenotype that needs an appropriate and continuous management over time. This supplement issue covers the key points of a series of meeting coordinated by the Heart Failure Association of the European Society of Cardiology (ESC), that have discussed the issues surrounding the effective monitoring of our ever more complex and multimorbid heart failure patients. Here, we present an overview of the complex issues from a healthcare delivery perspective.
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Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, 66421 Homburg/Saar, Germany
| | - Andrew J S Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Via della Pisana 235, 00163 Rome, Italy
| | - Ingrid Kindermann
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, 66421 Homburg/Saar, Germany
| | - Ilaria Spoletini
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Via della Pisana 235, 00163 Rome, Italy
| | - Giuseppe Rosano
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Via della Pisana 235, 00163 Rome, Italy
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32
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Anker MS, von Haehling S, Papp Z, Anker SD. ESC Heart Failure receives its first impact factor. Eur J Heart Fail 2019; 21:1490-e8. [PMID: 31883221 DOI: 10.1002/ejhf.1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research), partner site Berlin and Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center Göttingen, University of Göttingen Medical Center, George August University, Göttingen, Germany and German Center for Cardiovascular Medicine (DZHK), partner site Göttingen, Göttingen, Germany
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany, DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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Abstract
Heart failure (HF) is a complex clinical syndrome resulting from structural or functional cardiac disorders. In the developed world, HF is primarily a disorder of the elderly. It is one that is accompanied by many non-cardiac comorbidities that affect treatments given, the patient's response and treatment tolerance and outcomes. Even the pathophysiological mechanisms of HF change as we look at older patient populations. Younger HF patients typically have ischaemic heart disease and HF with reduced ejection fraction (HFrEF), whereas older patients have more hypertension HF with preserved ejection fraction (HFpEF). The prevalence of HF has progressively increased for many years and rises even more steeply with age. The outcomes of older especially HFpEF patients have not progressed as much younger HFrEF cohorts. We need more studies specifically recruiting older HF patients with more comorbidities, to guide real-world practice, and we need more assessment of patient-reported outcomes and quality of life rather than just mortality effects. The management of elderly patients with HF requires a more holistic approach recognizing individual needs and necessary support mechanisms and our future trials need to guide us more in achieving these gains.
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Affiliation(s)
- Andrew J Stewart Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Roma, Italy
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Abstract
The assessment of frailty in heart failure patients can help clinicians to build a tailored care plan, aimed at improving the selection of patients likely to benefit from one treatment vs. another, thereby improving outcomes. Although progress has been made in the ‘operationalization’ of frailty assessment, there is still the need to provide an improved instrument to assess frailty that is easy, quick and at the same time predictive within the setting of a busy clinical practice. Using such an ideal instrument, clinicians would be able to optimize the use of limited health care resources and avoid what has been termed ‘frailtyism’. This term, similar to ageism, can be defined as prejudice or discrimination based on the presence of frailty.
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Affiliation(s)
- Cristiana Vitale
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, University Rd, Belfast BT7 1NN, Northern Ireland
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35
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Seferović PM. Introduction to the special issue entitled 'Heart failure management of the elderly patient: focus on frailty, sarcopenia, cachexia, and dementia'. Eur Heart J Suppl 2019; 21:L1-L3. [PMID: 31885503 PMCID: PMC6926411 DOI: 10.1093/eurheartj/suz234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is a special issue focused on heart failure management of the elderly patient with a focus on frailty, sarcopaenia, cachexia, and dementia, all common problems in the contemporary older heart failure (HF) patient. The Heart Failure Association (HFA) of the European Society of Cardiology (ESC) has brought together experts to discuss these topical and clinically difficult areas. There are papers on ageing, demographics, and heart failure, drug treatment of the older patient, the frail heart failure patient and how to recognize frailty and screen for it without the risk segmenting these patients in a form of discrimination of them as less worthy of treatment through ‘frailtyism’. This is also discussion of the common problems affecting skeletal muscle, both sarcopaenia and cachexia, as well as dementia and cognitive decline and the crucial issue of planning health care for the older patient with HF most effectively by the use of care plans.
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Affiliation(s)
- Petar M Seferović
- Faculty of Medicine, University of Belgrade, 8 Dr Subotića, 11000 Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
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36
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Clarke SJ, Giblett JP, Yang LL, Hubsch A, Zhao T, Aetesam-Ur-Rahman M, West NEJ, O'Sullivan M, Figg N, Bennett M, Wewer Albrechtsen NJ, Deacon CF, Cheriyan J, Hoole SP. GLP-1 Is a Coronary Artery Vasodilator in Humans. J Am Heart Assoc 2019; 7:e010321. [PMID: 30571482 PMCID: PMC6404441 DOI: 10.1161/jaha.118.010321] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The mechanism underlying the beneficial cardiovascular effects of the incretin GLP‐1 (glucagon‐like peptide 1) and its analogues in humans is elusive. We hypothesized that activating receptors located on vascular smooth muscle cells to induce either peripheral or coronary vasodilatation mediates the cardiovascular effect of GLP‐1. Methods and Results Ten stable patients with angina awaiting left anterior descending artery stenting underwent forearm blood flow measurement using forearm plethysmography and post–percutaneous coronary intervention coronary blood flow measurement using a pressure‐flow wire before and after peripheral GLP‐1 administration. Coronary sinus and artery bloods were sampled for GLP‐1 levels. A further 11 control patients received saline rather than GLP‐1 in the coronary blood flow protocol. GLP‐1 receptor (GLP‐1R) expression was assessed by immunohistochemistry using a specific GLP‐1R monoclonal antibody in human tissue to inform the physiological studies. There was no effect of GLP‐1 on absolute forearm blood flow or forearm blood flow ratio after GLP‐1, systemic hemodynamics were not affected, and no binding of GLP‐1R monoclonal antibody was detected in vascular tissue. GLP‐1 reduced resting coronary transit time (mean [SD], 0.87 [0.39] versus 0.63 [0.27] seconds; P=0.02) and basal microcirculatory resistance (mean [SD], 76.3 [37.9] versus 55.4 [30.4] mm Hg/s; P=0.02), whereas in controls, there was an increase in transit time (mean [SD], 0.48 [0.24] versus 0.83 [0.41] seconds; P<0.001) and basal microcirculatory resistance (mean [SD], 45.9 [34.7] versus 66.7 [37.2] mm Hg/s; P=0.02). GLP‐1R monoclonal antibody binding was confirmed in ventricular tissue but not in vascular tissue, and transmyocardial GLP‐1 extraction was observed. Conclusions GLP‐1 causes coronary microvascular dilation and increased flow but does not influence peripheral tone. GLP‐1R immunohistochemistry suggests that GLP‐1 coronary vasodilatation is indirectly mediated by ventricular‐coronary cross talk.
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Affiliation(s)
- Sophie J Clarke
- 1 Division of Cardiovascular Medicine University of Cambridge United Kingdom
| | - Joel P Giblett
- 3 Department of Interventional Cardiology Royal Papworth Hospital NHS Foundation Trust Cambridge United Kingdom
| | - Lucy L Yang
- 2 Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
| | - Annette Hubsch
- 2 Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
| | - Tian Zhao
- 3 Department of Interventional Cardiology Royal Papworth Hospital NHS Foundation Trust Cambridge United Kingdom
| | - Muhammad Aetesam-Ur-Rahman
- 3 Department of Interventional Cardiology Royal Papworth Hospital NHS Foundation Trust Cambridge United Kingdom
| | - Nick E J West
- 3 Department of Interventional Cardiology Royal Papworth Hospital NHS Foundation Trust Cambridge United Kingdom
| | - Michael O'Sullivan
- 3 Department of Interventional Cardiology Royal Papworth Hospital NHS Foundation Trust Cambridge United Kingdom
| | - Nichola Figg
- 1 Division of Cardiovascular Medicine University of Cambridge United Kingdom
| | - Martin Bennett
- 1 Division of Cardiovascular Medicine University of Cambridge United Kingdom
| | - Nicolai J Wewer Albrechtsen
- 4 Department of Biomedical Sciences NNF Centre for Basic Metabolic Research University of Copenhagen Denmark.,5 Department of Clinical Biochemistry, Rigshospitalet University of Copenhagen Denmark
| | - Carolyn F Deacon
- 4 Department of Biomedical Sciences NNF Centre for Basic Metabolic Research University of Copenhagen Denmark
| | - Joseph Cheriyan
- 2 Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
| | - Stephen P Hoole
- 3 Department of Interventional Cardiology Royal Papworth Hospital NHS Foundation Trust Cambridge United Kingdom
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37
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Tomasoni D, Adamo M, Lombardi CM, Metra M. Highlights in heart failure. ESC Heart Fail 2019; 6:1105-1127. [PMID: 31997538 PMCID: PMC6989277 DOI: 10.1002/ehf2.12555] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in recent studies in patients hospitalized for acute HF. More recently, dapagliflozin and prevention of adverse-outcomes in DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HF research are summarized and reviewed in this article.
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Affiliation(s)
- Daniela Tomasoni
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Marianna Adamo
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Carlo Mario Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
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38
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Canepa M, Franssen FME, Olschewski H, Lainscak M, Böhm M, Tavazzi L, Rosenkranz S. Diagnostic and Therapeutic Gaps in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease. JACC-HEART FAILURE 2019; 7:823-833. [PMID: 31521680 DOI: 10.1016/j.jchf.2019.05.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/26/2019] [Accepted: 05/11/2019] [Indexed: 12/31/2022]
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) coincide in a significant number of patients. Recent population-based registries suggest that spirometry is largely underused in patients with HF to diagnose comorbid COPD and that patients with COPD frequently do not receive the recommended beta-blocker (BB) treatment. This state-of-the-art review summarizes: 1) current challenges in the implementation of recommended spirometry for COPD diagnosis in patients with HF; and 2) current underuse and underdosing of BBs in patients with HF and COPD despite guideline recommendations. Open issues in the therapeutic management of patients with HF and COPD are discussed in the third section, including the use of the nonselective BB carvedilol, target BB doses in patients with HF and COPD, BB and bronchodilator management during HF hospitalization with and without COPD exacerbation, and the use of BBs in patients with COPD with right HF or free from cardiovascular disease. The whole scenario described herein advocates for a bipartisan initiative to drive immediate attention to the translation of guideline recommendations into clinical practice for patients with HF with co-occurring COPD.
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Affiliation(s)
- Marco Canepa
- Cardiovascular Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Frits M E Franssen
- CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Horst Olschewski
- Medical University of Graz, Department of Internal Medicine, Division of Pulmonology, Graz, Austria
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana and Department of Internal Medicine, General Hospital Murska Sobota, Ljubljana, Slovenia
| | - Michael Böhm
- Saarland University Medical Center, Homburg, Germany
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine (Cardiology) and Center for Molecular Medicine, University of Cologne, Cologne, Germany; Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
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39
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Komuro J, Nagatomo Y, Mahara K, Isobe M, Goda A, Sujino Y, Mizuno A, Shiraishi Y, Kohno T, Kohsaka S, Yoshikawa T. Clinical Scenario Classification for Characterization and Outcome Prediction of Acute Decompensated Heart Failure Under Contemporary Phenotyping. Circ Rep 2019; 1:162-170. [PMID: 33693133 PMCID: PMC7889455 DOI: 10.1253/circrep.cr-18-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The concept of Clinical Scenario (CS) classification has been widely utilized to aid in choosing appropriate management strategies for acute decompensated heart failure (ADHF). Methods and Results: The West Tokyo-Heart Failure (WET-HF) Registry is a multicenter, prospective cohort registry enrolling consecutive hospitalized ADHF patients. Based on systolic blood pressure (SBP) at admission, 4,000 patients enrolled between 2006 and 2017 were classified into 3 groups: CS1, SBP ≥140 mmHg; CS2, 100≤SBP<140 mmHg; and CS3, SBP <100 mmHg. The CS1 group had a high rate of fluid retention such as leg edema, and the largest reduction in body weight at discharge. In-hospital diuretics use was the most frequent in CS1. Although the primary endpoint of long-term all-cause death and/or ADHF re-hospitalization was more common in more advanced CS, there was no significant difference between the 3 CS groups in patients with HF with preserved ejection fraction (HFpEF; P=0.10). Although more advanced CS was associated with larger left ventricular (LV) chamber size in HF with reduced EF (HFrEF), it was associated with smaller LV size in HFpEF. Conclusions: The long-term prognostic value of CS classification was limited in HFpEF. Whereas CS was closely associated with degree of LV remodeling in HFrEF, a smaller LV chamber might be associated with a lower cardiovascular functional reserve in HFpEF.
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Affiliation(s)
- Jin Komuro
- Department of Cardiology, Sakakibara Heart Institute Fuchu Japan.,Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Yuji Nagatomo
- Department of Cardiology, Sakakibara Heart Institute Fuchu Japan.,Department of Cardiology, National Defense Medical College Tokorozawa Japan
| | - Keitaro Mahara
- Department of Cardiology, Sakakibara Heart Institute Fuchu Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute Fuchu Japan
| | - Ayumi Goda
- Division of Cardiology, Kyorin University School of Medicine Tokyo Japan
| | - Yasumori Sujino
- Department of Cardiology, Saitama Medical University, International Medical Center Hidaka Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital Tokyo Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
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Metra M. March 2019 at a glance: epidemiology and clinical trials. Eur J Heart Fail 2019; 21:259-260. [PMID: 30883999 DOI: 10.1002/ejhf.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 12/02/2016] [Accepted: 12/13/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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41
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Rossignol P, Hernandez AF, Solomon SD, Zannad F. Heart failure drug treatment. Lancet 2019; 393:1034-1044. [PMID: 30860029 DOI: 10.1016/s0140-6736(18)31808-7] [Citation(s) in RCA: 207] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022]
Abstract
Heart failure is the most common cardiovascular reason for hospital admission for people older than 60 years of age. Few areas in medicine have progressed as remarkably as heart failure treatment over the past three decades. However, progress has been consistent only for chronic heart failure with reduced ejection fraction. In acutely decompensated heart failure and heart failure with preserved ejection fraction, none of the treatments tested to date have been definitively proven to improve survival. Delaying or preventing heart failure has become increasingly important in patients who are prone to heart failure. The prevention of worsening chronic heart failure and hospitalisations for acute decompensation is also of great importance. The objective of this Series paper is to provide a concise and practical summary of the available drug treatments for heart failure. We support the implementation of the international guidelines. We offer views on the basis of our personal experience in research areas that have insufficient evidence. The best possible evidence-based drug treatment (including inhibitors of the renin-angiotensin-aldosterone system and β blockers) is useful only when optimally implemented. However, implementation might be challenging. We believe that disease management programmes can be helpful in providing a multidisciplinary, holistic approach to the delivery of optimal medical care.
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Affiliation(s)
- Patrick Rossignol
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut National de la Santé et de la Recherche Médicale (Inserm), Centre Hospitalier Régional Universitaire (CHRU) de Nancy, Inserm U1116, and French Clinical Research Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France.
| | - Adrian F Hernandez
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, NC, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, MA, USA
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut National de la Santé et de la Recherche Médicale (Inserm), Centre Hospitalier Régional Universitaire (CHRU) de Nancy, Inserm U1116, and French Clinical Research Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
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42
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Canepa M, Ameri P, Lucci D, Nicolosi GL, Marchioli R, Porcu M, Tognoni G, Franzosi MG, Latini R, Maseri A, Tavazzi L, Maggioni AP. Modes of death and prognostic outliers in chronic heart failure. Am Heart J 2019; 208:100-109. [PMID: 30580128 DOI: 10.1016/j.ahj.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/18/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of incident sudden cardiac death (SCD) on the predictive accuracy of prognostic risk scores for patients with chronic heart failure (HF) has rarely been examined. We assessed the relationship between estimated probability of death and modes of death in this population, as well as the predictors of death and survival in prognostic outliers. METHODS AND RESULTS The MAGGIC 3-year probability of death was estimated in 6,859 participants of the GISSI-HF trial (mean age 67±11 years, 78% men, 91% with ejection fraction <40%, mean follow-up 3.5±1.3 years, observed mortality 28.4%). The incidence of SCD progressively decreased with increased probability of death, and occurred in 52.5% of patients estimated at low-risk (N = 61 with probability <14%) vs. in 23.5% of the high-risk ones (N = 375 with probability >56%, P < .0001). On the contrary, death from worsening HF was significantly more frequent in the latter group (19.7% vs. 46.1%, P < .0001). The overall predictive accuracy of the MAGGIC model improved after excluding deaths from SCD (AUC from 0.731 to 0.760, P = .0034). Among patients estimated at low-risk (N = 61 dead, 743 alive), independent predictors of death were older age, longer history of HF, higher serum uric acid and chronic obstructive pulmonary disease. The only predictor of survival in patients estimated at high-risk (N = 210 alive, 375 dead) was higher systolic blood pressure. CONCLUSIONS The MAGGIC risk score demonstrated its scarce ability to capture SCD, particularly in chronic HF patients estimated at low risk of death. Newer and better prognostic tools in the evolving horizon of HF are needed.
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Affiliation(s)
- Marco Canepa
- Cardiovascular Disease Unit, Policlinic Hospital San Martino IRCCS & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, Policlinic Hospital San Martino IRCCS & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Donata Lucci
- ANMCO Research Centre, Florence, Fondazione per il Tuo cuore - HCF onluse, Florence, Italy
| | - Gian Luigi Nicolosi
- Department of Cardiology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | | | - Maurizio Porcu
- Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy
| | - Gianni Tognoni
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Maria Grazia Franzosi
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Roberto Latini
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Attilio Maseri
- Fondazione per il Tuo cuore - HCF onlus, Florence, Italy
| | - Luigi Tavazzi
- Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy
| | - Aldo Pietro Maggioni
- ANMCO Research Centre, Florence, Fondazione per il Tuo cuore - HCF onluse, Florence, Italy.
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Ageev FT, Ovchinnikov AG. Heart failure with mid-range ejection fraction: are there clinical reasons in introduction of this new group as a distinct entity? ACTA ACUST UNITED AC 2018; 58:4-10. [PMID: 30625103 DOI: 10.18087/cardio.2609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 12/25/2018] [Indexed: 11/18/2022]
Abstract
The article discusses the clinical expedience of isolating into a separate classification subgroup of patients with heart failure and a mid‑range ejection fraction (EF) of 40-49 %. Analysis of studies 2017-2018 focusing on the issue of patients with mid‑range LV EF showed that this subgroup is highly heterogenous and by some clinical and demographic parameters takes an intermediate position between heart failure (HF) patients with reduced (<40 %) and preserved (>50 %) LV EF. However, patients with mid‑range LV EF positively respond to beta‑blocker and RAAS inhibitor therapy, and their response is close to that of patients with reduced LV EF. This is a principal difference between patients with mid‑range and preserved LV EF who generally do not display any beneficial effect of such therapy. One of the major causes for such difference is a dissimilarity of HF etiology and, hence, pathogenesis in patients with reduced and mid‑range LV EF: primarily IHD (so‑called "ischemic" phenotype) in patients with reduced and mid‑range LV EF and non‑cardiac causes ("non‑ischemic" phenotype) in patients with preserved LV EF. Since the nonischemic phenotype is also rather common among patients with mid‑range LV EF a new HF classification should definitely indicate, in addition to LV EF, the clinical phenotype of disease, which is particularly important for patients with mid‑range LV EF of 40-49 %. Further studies should focus on variants of HF clinical phenotypes.
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Affiliation(s)
- F T Ageev
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation.
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44
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Heart failure with preserved ejection fraction: A systemic disease linked to multiple comorbidities, targeting new therapeutic options. Arch Cardiovasc Dis 2018; 111:766-781. [DOI: 10.1016/j.acvd.2018.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 12/13/2022]
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The tip of the iceberg: finding patients with heart failure with preserved ejection fraction in primary care. An observational study. BJGP Open 2018; 2:bjgpopen18X101606. [PMID: 30564739 PMCID: PMC6189778 DOI: 10.3399/bjgpopen18x101606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/25/2018] [Indexed: 12/24/2022] Open
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) is under-identified in primary care. Aim The aim of this study was to determine what information is available in patients' primary care practice records that would identify patients with HFpEF. Design & setting Record review in two practices in east of England. Method Practices completed a case report form on each patient on the heart failure register and sent anonymised echocardiography reports on patients with an ejection fraction (EF) >50%. Reports were reviewed and data analysed using SPSS (version 25). Results One hundred and forty-eight patients on the heart failure registers with mean age 77 +12 years were reviewed. Fifty-three patients (36%) had possible HFpEF based on available information. These patients were older and multimorbid, with a high prevalence of overweight and obesity. Confirmation of diagnosis was not possible as recommended HFpEF diagnostic information (natriuretic peptides, echocardiogram parameters of structural heart disease and diastolic function) was widely inconsistent or absent in these patients. Conclusion Without correct identification of HFpEF, patient management may be suboptimal or inappropriate, and lack the needed focus on comorbidities and lifestyle that can improve patient outcomes. This study describes in detail the characteristics of many of the patients who probably have HFpEF in a real-world sample, and the improvements and diagnostic information required to better identify them. Identifying more than the tip of the iceberg that is the HFpEF population will allow the improvement of the quality of their management, the prevention of ineffective health care, and the recruitment of patients into research.
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HF progression among outpatients with HF in a community setting. Int J Cardiol 2018; 277:140-146. [PMID: 30131230 DOI: 10.1016/j.ijcard.2018.08.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/28/2018] [Accepted: 08/14/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Incidence and prognostic impact of heart failure (HF) progression has been not well addressed. METHODS From 2009 until 2015, consecutive ambulatory HF patients were recruited. HF progression was defined by the presence of at least two of the following criteria: step up of ≥1 New York Heart Association (NYHA) class; decrease LVEF ≥ 10 points; association of diuretics or increase ≥ 50% of furosemide dosage, or HF hospitalization. RESULTS 2528 met study criteria (mean age 76; 42% women). Of these, 48% had ischemic heart disease, 18% patients with LVEF ≤ 35%. During a median follow-up of 2.4 years, overall mortality was 31% (95% CI: 29%-33%), whereas rate of HF progression or death was 57% (95% CI: 55%-59%). The 4-year incidence of HF progression was 39% (95% CI: 37%-41%) whereas the competing mortality rate was 18% (95% CI: 16%-19%). Rates of HF progression and death were higher in HF patients with LVEF ≤ 35% vs >35% (HF progression: 42% vs 38%, p = 0.012; death as a competing risk: 22% vs 17%, p = 0.002). HF progression identified HF patients with a worse survival (HR = 3.16, 95% CI: 2.75-3.72). In cause-specific Cox models, age, previous HF hospitalization, chronic obstructive pulmonary disease, chronic kidney disease, anemia, sex, LVEF ≤ 35% emerged as prognostic factors of HF progression. CONCLUSIONS Among outpatients with HF, at 4 years 39% presented a HF progression, while 18% died before any sign of HF progression. This trend was higher in patients with LVEF ≤ 35%. These findings may have implications for healthcare planning and resource allocation.
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Wolsk E. Heart failure and co-morbidity revisited; the elephant in the room. Eur J Heart Fail 2018; 20:1267-1268. [DOI: 10.1002/ejhf.1225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/28/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Emil Wolsk
- Rigshospitalet; Department of Cardiology, Copenhagen University Hospital; Copenhagen Denmark
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48
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Iorio A, Senni M, Barbati G, Greene SJ, Poli S, Zambon E, Di Nora C, Cioffi G, Tarantini L, Gavazzi A, Sinagra G, Di Lenarda A. Prevalence and prognostic impact of non-cardiac co-morbidities in heart failure outpatients with preserved and reduced ejection fraction: a community-based study. Eur J Heart Fail 2018; 20:1257-1266. [PMID: 29917301 DOI: 10.1002/ejhf.1202] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 02/26/2018] [Accepted: 03/26/2018] [Indexed: 12/22/2022] Open
Abstract
AIM To assess adverse outcomes attributable to non-cardiac co-morbidities and to compare their effects by left ventricular ejection fraction (LVEF) group [LVEF <50% (heart failure with reduced ejection fraction, HFrEF), LVEF ≥50% (heart failure with preserved ejection fraction, HFpEF)] in a contemporary, unselected chronic heart failure population. METHODS AND RESULTS This community-based cohort enrolled patients from October 2009 to December 2013. Adjusted hazard ratio (HR) and the population attributable fraction (PAF) were used to compare the contribution of 15 non-cardiac co-morbidities to adverse outcome. Overall, 2314 patients (mean age 77 ±10 years, 57% men) were recruited [n = 941 (41%) HFrEF, n = 1373 (59%) HFpEF]. Non-cardiac co-morbidity rates were similarly high, except for obesity and hypertension which were more prevalent in HFpEF. At a median follow-up of 31 (interquartile range 16-41) months, 472 (20%) patients died. Adjusted mortality rates were not significantly different between the HFrEF and HFpEF groups. After adjustment, an increasing number of non-cardiac co-morbidities was associated with a higher risk for all-cause mortality [HR 1.25; 95% confidence interval (CI) 1.10-1.26; P < 0.001], all-cause hospitalization (HR 1.17; 95% CI 1.12-1.23; P < 0.001), heart failure hospitalization (HR 1.28; 95% CI 1.19-1.38; P < 0.001), non-cardiovascular hospitalization (HR 1.16; 95% CI 1.11-1.22; P < 0.001). The co-morbidities contributing to high PAF were: anaemia, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, and peripheral artery disease. These findings were similar for HFrEF and HFpEF. Interaction analysis yielded similar results. CONCLUSIONS In a contemporary community population with chronic heart failure, non-cardiac co-morbidities confer a similar contribution to outcomes in HFrEF and HFpEF. These observations suggest that quality improvement initiatives aimed at optimizing co-morbidities may be similarly effective in HFrEF and HFpEF.
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Affiliation(s)
- Annamaria Iorio
- Cardiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.,Cardiovascular Department, University of Trieste, Italy
| | - Michele Senni
- Cardiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Stephen J Greene
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Stefano Poli
- Cardiovascular Department, University of Trieste, Italy
| | - Elena Zambon
- Cardiovascular Department, University of Trieste, Italy
| | | | | | - Luigi Tarantini
- Heart Failure Clinic, Division of Cardiology, San Martino Hospital, Belluno, Italy
| | - Antonello Gavazzi
- FROM - Clinical Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
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50
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Metra M. March 2018 at a glance: clinical trials, co-morbidities and treatment of mitral regurgitation. Eur J Heart Fail 2018; 20:411-412. [PMID: 29575434 DOI: 10.1002/ejhf.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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