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D’Amato A, Severino P, Mancone M, Mariani MV, Prosperi S, Colombo L, Myftari V, Cestiè C, Labbro Francia A, Germanò R, Pierucci N, Fanisio F, Marek-Iannucci S, De Prisco A, Scoccia G, Birtolo LI, Manzi G, Lavalle C, Sardella G, Badagliacca R, Fedele F, Vizza CD. Prognostic Assessment of HLM Score in Heart Failure Due to Ischemic Heart Disease: A Pilot Study. J Clin Med 2024; 13:3322. [PMID: 38893033 PMCID: PMC11172826 DOI: 10.3390/jcm13113322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Ischemic heart disease (IHD) represents the main cause of heart failure (HF). A prognostic stratification of HF patients with ischemic etiology, particularly those with acute coronary syndrome (ACS), may be challenging due the variability in clinical and hemodynamic status. The aim of this study is to assess the prognostic power of the HLM score in a population of patients with ischemic HF and in a subgroup who developed HF following ACS. Methods: This is an observational, prospective, single-center study, enrolling consecutive patients with a diagnosis of ischemic HF. Patients were stratified according to the four different HLM stages of severity, and the occurrence of CV death, HFH, and worsening HF events were evaluated at 6-month follow-up. A sub-analysis was performed on patients who developed HF following ACS at admission. Results: The study included 146 patients. HLM stage predicts the occurrence of CV death (p = 0.01) and CV death/HFH (p = 0.003). Cox regression analysis confirmed HLM stage as an independent predictor of CV death (OR: 3.07; 95% IC: 1.54-6.12; p = 0.001) and CV death/HFH (OR: 2.45; 95% IC: 1.43-4.21; p = 0.001) in the total population of patients with HF due to IHD. HLM stage potentially predicts the occurrence of CV death (p < 0.001) and CV death/HFH (p < 0.001) in patients with HF following ACS at admission. Conclusions: Pathophysiological-based prognostic assessment through HLM score is a potentially promising tool for the prediction of the occurrence of CV death and CV death/HFH in ischemic HF patients and in subgroups of patients with HF following ACS at admission.
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Affiliation(s)
- Andrea D’Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Silvia Prosperi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Lorenzo Colombo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Claudia Cestiè
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Aurora Labbro Francia
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Rosanna Germanò
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Nicola Pierucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | | | - Stefanie Marek-Iannucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Andrea De Prisco
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Gianmarco Scoccia
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Giovanna Manzi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Gennaro Sardella
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | | | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
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Docherty KF, Simpson J, Jhund PS, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, Ponikowski P, Sabatine MS, Bengtsson O, Sjöstrand M, Lindholm D, Langkilde AM, Solomon SD, McMurray JJV. Effect of Dapagliflozin, Compared With Placebo, According to Baseline Risk in DAPA-HF. JACC. HEART FAILURE 2022; 10:104-118. [PMID: 35115084 DOI: 10.1016/j.jchf.2021.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The authors sought to examine the effect of dapagliflozin across the spectrum of risk in patients enrolled in DAPA-HF. BACKGROUND In the DAPA-HF (Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure) trial, the sodium-glucose cotransporter 2 inhibitor dapagliflozin decreased the risk of worsening HF events and cardiovascular death in patients with HF and reduced ejection fraction. METHODS The MAGGIC (Meta-analysis Global Group in Chronic Heart Failure) and the PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure) PREDICT-HF (Risk of Events and Death in the Contemporary Treatment of Heart Failure) risk models were used to categorize patients according to risk score quintiles. The authors analyzed rates of the primary composite outcome of a worsening HF event or cardiovascular death, its components, and all-cause mortality according to risk quintile and whether risk modified the effect of dapagliflozin. RESULTS The MAGGIC score was available for 4,740 of 4,744 patients in DAPA-HF (median score 22 [IQR: 18-25]). A1-point increase was associated with an 8.2% (95% CI: 6.9%-9.4%) higher relative risk of the primary endpoint (P < 0.001). The benefit of dapagliflozin over placebo for the primary endpoint was similar across the spectrum of MAGGIC risk score (interaction P = 0.71). Applying the overall relative risk reduction (26%) with dapagliflozin added to standard therapy resulted in 7 fewer patients in the highest MAGGIC risk quintile experiencing a primary outcome, compared with 2 in the lowest quintile, per 100 person-years of treatment. The findings with PREDICT-HF were similar, although this model led to better risk discrimination. CONCLUSIONS The benefits of dapagliflozin were consistent across the broad spectrum of baseline risk in DAPA-HF.
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Affiliation(s)
- Kieran F Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Joanne Simpson
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lars Køber
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | | | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
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Remawi BN, Gadoud A, Murphy IMJ, Preston N. Palliative care needs-assessment and measurement tools used in patients with heart failure: a systematic mixed-studies review with narrative synthesis. Heart Fail Rev 2020; 26:137-155. [PMID: 32748015 PMCID: PMC7769784 DOI: 10.1007/s10741-020-10011-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patients with heart failure have comparable illness burden and palliative care needs to those with cancer. However, few of them are offered timely palliative care. One main barrier is the difficulty in identifying those who require palliative care. Several palliative care needs-assessment/measurement tools were used to help identify these patients and assess/measure their needs, but it is not known which one is the most appropriate for this population. This review aimed to identify the most appropriate palliative care needs-assessment/measurement tools for patients with heart failure. Cochrane Library, MEDLINE Complete, AMED, PsycINFO, CINAHL Complete, EMBASE, EThOS, websites of the identified tools, and references and citations of the included studies were searched from inception to 25 June 2020. Studies were included if they evaluated palliative care needs-assessment/measurement tools for heart failure populations in terms of development, psychometrics, or palliative care patient/needs identification. Twenty-seven papers were included regarding nineteen studies, most of which were quantitative and observational. Six tools were identified and compared according to their content and context of use, development, psychometrics, and clinical applications in identifying patients with palliative care needs. Despite limited evidence, the Needs Assessment Tool: Progressive Disease - Heart Failure (NAT:PD-HF) is the most appropriate palliative care needs-assessment tool for use in heart failure populations. It covers most of the patient needs and has the best psychometric properties and evidence of identification ability and appropriateness. Psychometric testing of the tools in patients with heart failure and evaluating the tools to identify those with palliative care needs require more investigation.
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Affiliation(s)
- Bader Nael Remawi
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Amy Gadoud
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.,International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
| | - Iain Malcolm James Murphy
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.,Trinity Hospice and Palliative Care Services, Low Moor Road, Blackpool, FY2 0BG, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
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