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Tan YJ, Ong SC, Yong VS, Khor WW, Pang LJ, Choong YY, Zameram AM, Tan LY, Voo JYH, Lam KK, Yen CH, Wahab MJA, Abdulla ZB. Examining health-related quality of life in ambulatory adult patients with chronic heart failure: insights from Malaysia using EQ-5D-5L. Qual Life Res 2024; 33:2181-2195. [PMID: 38839679 DOI: 10.1007/s11136-024-03674-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Health-related quality-of-life (HRQoL) data for the chronic heart failure (HF) population in Malaysia are lacking. Using EQ-5D-5L, this study intended to describe their HRQoL, identify predictors of worse HRQoL, and derive EQ-5D-5L index scores for use in economic evaluations. METHODS A cross-sectional survey was conducted between April and September 2023 to collect EQ-5D-5L, sociodemographic, and clinical data from outpatients with HF across seven public specialist hospitals in Malaysia. Multivariable logistic and linear regression models were used to identify independent predictors of reported problems in the EQ-5D-5L dimensions, and predictors of index scores and EQ-VAS, respectively. RESULTS EQ-5D-5L data from 424 outpatients of multi-ethnic background (mean age: 57.1 years, 23.8% female, mean left ventricular ejection fraction: 35.7%, 89.7% NYHA class I-II) were collected using either Malay, English, or Chinese, achieving a 99.8% completion rate. Nearly half of the respondents reported issues in the Mobility, Usual Activities, and Pain/Discomfort dimensions. Mean EQ-5D-5L index was 0.820, lower than the general population, and significantly lower with NYHA class III-IV (0.747) versus NYHA class I (0.846) and NYHA class II (0.805). Besides NYHA class, independent predictors of worse HRQoL included Indian ethnicity, living alone, lower education, unemployment due to ill-health, and proxy-reported HRQoL, largely aligning with existing literature. CONCLUSION Community-dwelling Malaysians with HF reported poorer HRQoL compared to the general population. The observed disparities in HRQoL among HF patients may be linked to specific patient characteristics, suggesting potential areas for targeted interventions. HRQoL assessment using EQ-5D-5L proves feasible and should be considered for routine implementation in local clinics.
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Affiliation(s)
- Yi Jing Tan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia
- Seri Manjung Hospital, Ministry of Health Malaysia, 32040 Seri Manjung, Perak, Malaysia
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia.
| | - Vee Sim Yong
- Clinical Research Centre, Institute for Clinical Research, Hospital Queen Elizabeth II, National Institute of Health, Ministry of Health Malaysia, 88300, Kota Kinabalu, Sabah, Malaysia
| | - Wei Wern Khor
- Sarawak General Hospital, Ministry of Health Malaysia, 93586, Kuching, Sarawak, Malaysia
| | - Lie Jin Pang
- Sarawak General Hospital, Ministry of Health Malaysia, 93586, Kuching, Sarawak, Malaysia
| | - Yong Ying Choong
- Seri Manjung Hospital, Ministry of Health Malaysia, 32040 Seri Manjung, Perak, Malaysia
| | | | - Lin Yuing Tan
- Teluk Intan Hospital, Ministry of Health Malaysia, 36000, Teluk Intan, Perak, Malaysia
| | - James Yau Hon Voo
- Duchess of Kent Hospital, Ministry of Health Malaysia, 90000, Sandakan, Sabah, Malaysia
| | - Kar Kei Lam
- Duchess of Kent Hospital, Ministry of Health Malaysia, 90000, Sandakan, Sabah, Malaysia
| | - Chia How Yen
- Clinical Research Centre, Institute for Clinical Research, Hospital Queen Elizabeth II, National Institute of Health, Ministry of Health Malaysia, 88300, Kota Kinabalu, Sabah, Malaysia
| | | | - Zarina Banu Abdulla
- Penang General Hospital, Ministry of Health Malaysia, 10990, Georgetown, Penang, Malaysia
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Walters GWM, Yeo JL, Bilak JM, Pepper C, Gulsin GS, Freeman SC, Gray LJ, McCANN GP, Brady EM. The Effectiveness of Lifestyle Interventions in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Network Meta-Analysis. J Card Fail 2024; 30:994-1009. [PMID: 38428727 DOI: 10.1016/j.cardfail.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/30/2023] [Accepted: 01/17/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES To perform a network meta-analysis to determine the effectiveness of lifestyle interventions in exercise tolerance and quality of life (QoL) in people with HFpEF. METHODS Ten databases were searched for randomized controlled trials that evaluated a diet and/or exercise intervention in people with heart failure with preserved ejection fraction until May 2022. The co-primary outcomes were peak oxygen uptake (V̇O2peak) and Quality of Life as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). We synthesized data using network meta-analysis. RESULTS We identified 13 trials, including a total of 869 participants, and we incorporated 6 different interventions. Improvements in V̇O2peak compared to controls were seen for all exercise interventions (2.88 [95% CI: 1.36; 4.39] mL/kg/min) for high-intensity interval training (HIIT); 2.37 [95% CI: 1.02; 3.71] mL/kg/min for low-intensity exercise (LIT) combined with a hypocaloric diet; 2.05 [95% CI: 0.81; 3.29] mL/kg/min for moderate-intensity continuous training (MICT); 1.94 [95% CI: 0.59; 3.29] mL/kg/min for LIT; 1.85 [95% CI: 0.27; 3.44] mL/kg/min for MICT combined with resistance training) but not a hypocaloric diet alone (1.26 [95%CI: -0.08; 2.61] mL/kg/min). Only HIIT (-14.45 [95%CI: -24.81; -4.10] points) and LIT (95% CI: -11.05 [-20.55; -1.54] mL/kg/min) significantly improved MLHFQ scores. Network meta-analysis indicated that HIIT was the most effective intervention for improving both V̇O2peak (mean improvement 2.88 [95% CI: 1.36; 4.39] mL/kg/min, follow-up range, 4 weeks-3 years) and QoL (-14.45 [95% CI: -24.81; -4.10] points, follow-up range, 12-26 weeks) compared to usual care. CONCLUSIONS This network meta-analysis indicates that HIIT is the most effective lifestyle intervention studied to improve exercise capacity and QoL, with mean improvements exceeding the minimum clinically meaningful thresholds. HIIT is likely to be an underused management strategy in HFpEF, but further studies are needed to confirm long-term improvements in symptoms and clinical outcomes.
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Affiliation(s)
- Grace W M Walters
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK.
| | - Jian L Yeo
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Joanna M Bilak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Coral Pepper
- University Hospitals Leicester, Headquarters Level 3, Balmoral Building Leicester Royal Infirmary, Infirmary Square Leicester, Leicestershire, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Suzanne C Freeman
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Gerry P McCANN
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
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Dardas LA, Al-Ammouri I, Sweis S, Eid A, Abid M, Pan W. Beyond the heart: Cognitive and verbal outcomes in Arab children with congenital heart diseases. Birth Defects Res 2024; 116:e2374. [PMID: 38923365 DOI: 10.1002/bdr2.2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/12/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND This study investigates how congenital heart diseases (CHD) characteristics and interventions affect cognitive and verbal skills in Arab children, while also uncovering previously unexplored connections between these skills and the quality of life (QoL) scores as perceived by both children and parents. METHODS A cross-sectional study was conducted in Jordan, involving 62 children with CHD aged 6-16. Data were collected through standardized intelligence tests (namely The Raven's Progressive Matrices Test and The Wechsler Intelligence Scale for Children) and QoL assessments. RESULTS Sex, disease severity, cyanosis, CHD defect status, conducted operations, and types of interventions did not significantly influence cognitive scores. However, a significant difference was observed in Wechsler's scores between cyanotic and non-cyanotic children (p < .01) and between severe and moderate cases (p = .01). Further, a significant positive correlation was identified between Wechsler's Scores and QoL reported by parents (r = 0.33, p < .01). This correlation was particularly pronounced in the social and school functioning dimensions of QoL. CONCLUSIONS This study highlights the need for personalized care approaches for children with CHDs based on their individual characteristics. While cognitive abilities did not directly correlate with children's QoL reports, a significant positive correlation between verbal skills and QoL reported by parents underscores the importance of effective communication in assessing a child's overall well-being. Future research should further examine the cognitive development in this population, employing neurocognitive investigations and longitudinal studies to gain a deeper understanding of their cognitive profiles and trajectories.
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Affiliation(s)
| | | | - Sami Sweis
- The University of Jordan, Aljubeiha, Amman, Jordan
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Ventoulis I, Kamperidis V, Abraham MR, Abraham T, Boultadakis A, Tsioukras E, Katsiana A, Georgiou K, Parissis J, Polyzogopoulou E. Differences in Health-Related Quality of Life among Patients with Heart Failure. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:109. [PMID: 38256370 PMCID: PMC10818915 DOI: 10.3390/medicina60010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Heart failure (HF) is characterized by a progressive clinical course marked by frequent exacerbations and repeated hospitalizations, leading to considerably high morbidity and mortality rates. Patients with HF present with a constellation of bothersome symptoms, which range from physical to psychological and mental manifestations. With the transition to more advanced HF stages, symptoms become increasingly more debilitating, interfere with activities of daily living and disrupt multiple domains of life, including physical functioning, psychological status, emotional state, cognitive function, intimate relationships, lifestyle status, usual role activities, social contact and support. By inflicting profuse limitations in numerous aspects of life, HF exerts a profoundly negative impact on health-related quality of life (HRQOL). It is therefore not surprising that patients with HF display lower levels of HRQOL compared not only to the general healthy population but also to patients suffering from other chronic diseases. On top of this, poor HRQOL in patients with HF becomes an even greater concern considering that it has been associated with unfavorable long-term outcomes and poor prognosis. Nevertheless, HRQOL may differ significantly among patients with HF. Indeed, it has consistently been reported that women with HF display poorer HRQOL compared to men, while younger patients with HF tend to exhibit lower levels of HRQOL than their older counterparts. Moreover, patients presenting with higher New York Heart Association (NYHA) functional class (III-IV) have significantly more impaired HRQOL than those in a better NYHA class (I-II). Furthermore, most studies report worse levels of HRQOL in patients suffering from HF with preserved ejection fraction (HFpEF) compared to patients with HF with reduced ejection fraction (HFrEF) or HF with mildly reduced ejection fraction (HFmrEF). Last, but not least, differences in HRQOL have been noted depending on geographic location, with lower HRQOL levels having been recorded in Africa and Eastern Europe and higher in Western Europe in a recent large global study. Based on the observed disparities that have been invariably reported in the literature, this review article aims to provide insight into the underlying differences in HRQOL among patients with HF. Through an overview of currently existing evidence, fundamental differences in HRQOL among patients with HF are analyzed based on sex, age, NYHA functional class, ejection fraction and geographic location or ethnicity.
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Affiliation(s)
- Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St Kiriakidi 1, 54636 Thessaloniki, Greece;
| | - Maria Roselle Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, USA; (M.R.A.); (T.A.)
| | - Theodore Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, USA; (M.R.A.); (T.A.)
| | - Antonios Boultadakis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
| | - Efthymios Tsioukras
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Aikaterini Katsiana
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Konstantinos Georgiou
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
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Mamasoula C, Pennington L, Adesanya AM, Rankin J. A systematic review and meta-analysis of school and cognitive function domains of health-related quality of life measures for children and young adults with congenital heart disease. Birth Defects Res 2024; 116:e2275. [PMID: 38014517 DOI: 10.1002/bdr2.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/31/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Research on cognitive and school functioning domains of health-related quality of life (HRQOL) for children and adolescents with congenital heart disease (CHD) presents inconsistencies. OBJECTIVES To summarize and synthesize data on school and cognitive function domains of HRQOL for children and young people (CYP) with CHD. METHODS Five electronic databases MEDLINE, Scopus, PsycINFO, EMBASE, ERI, and citations were systematically searched. We included original-research articles reporting the cognitive and school function domains of HRQOL for children and young people with CHD (child and parent reports included). Both fixed and random-effects meta-analyses were performed to estimate pooled mean test scores for cognitive and school function. A total of 34 studies met our inclusion criteria and were synthesized narratively, 17 studies were included in formal meta-analyses. RESULTS Self-reported cognitive function was lower for children and young people with CHD than healthy controls (SMD -0.28 (-0.42, -0.15)). Parental reports demonstrated similar results to self-reports (SMD -0.54 (-0.91, -0.18)). School function was lower in children and young people with CHD compared with healthy controls in self-reported (SMD -0.30 (-0.48, -0.13)) and parent reported HRQOL (SMD -0.49 (0.64, -0.36)). Self-reported school function domain scores were lower for young (<8 years) (SMD -0.65 (-1.32, 0.03)) and older children (8-18 years) (SMD -0.25 (-0.47, -0.03)) with CHD than their peers. Similarly, parents reported lower school function domain scores for young (<8 years) (SMD -0.68 (-1.29, -0.07)) and older (8-18 years) (SMD -0.46 (-068, -0.25)) children with CHD than typically developing peers. CONCLUSION Children born with CHD may experience lower cognitive and school function HRQOL scores than healthy controls (self and proxy-report). This is consistent with a subgroup meta-analysis of young (<8 years) and older (8 years old or more) children with CHD reporting lower school function scores compared to controls.
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Affiliation(s)
| | - Lindsay Pennington
- Population Health Science Institute, Newcastle University, Newcastle, UK
| | | | - Judith Rankin
- Population Health Science Institute, Newcastle University, Newcastle, UK
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Lawson CA, Tay WT, Richards M, Zaccardi F, Tromp J, Teng THK, Hung CL, Chandramouli C, Wander GS, Ouwerkerk W, Teramoto K, Ali M, Kadam U, Hand S, Harrison M, Anand I, Naik A, Squire I, Khunti K, Stromberg A, Lam CS. Patient-Reported Status and Heart Failure Outcomes in Asia by Sex, Ethnicity, and Socioeconomic Status. JACC. ASIA 2023; 3:349-362. [PMID: 37323861 PMCID: PMC10261894 DOI: 10.1016/j.jacasi.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 06/17/2023]
Abstract
Background In heart failure (HF), symptoms and health-related quality of life (HRQoL) are known to vary among different HF subgroups, but evidence on the association between changing HRQoL and outcomes has not been evaluated. Objectives The authors sought to investigate the relationship between changing symptoms, signs, and HRQoL and outcomes by sex, ethnicity, and socioeconomic status (SES). Methods Using the ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) Registry, we investigated associations between the 6-month change in a "global" symptoms and signs score (GSSS), Kansas City Cardiomyopathy Questionnaire overall score (KCCQ-OS), and visual analogue scale (VAS) and 1-year mortality or HF hospitalization. Results In 6,549 patients (mean age: 62 ± 13 years], 29% female, 27% HF with preserved ejection fraction), women and those in low SES groups had higher symptom burden but lower signs and similar KCCQ-OS to their respective counterparts. Malay patients had the highest GSSS (3.9) and lowest KCCQ-OS (58.5), and Thai/Filipino/others (2.6) and Chinese patients (2.7) had the lowest GSSS scores and the highest KCCQ-OS (73.1 and 74.6, respectively). Compared to no change, worsening of GSSS (>1-point increase), KCCQ-OS (≥10-point decrease) and VAS (>1-point decrease) were associated with higher risk of HF admission/death (adjusted HR: 2.95 [95% CI: 2.14-4.06], 1.93 [95% CI: 1.26-2.94], and 2.30 [95% CI: 1.51-3.52], respectively). Conversely, the same degrees of improvement in GSSS, KCCQ-OS, and VAS were associated with reduced rates (HR: 0.35 [95% CI: 0.25-0.49], 0.25 [95% CI: 0.16-0.40], and 0.64 [95% CI: 0.40-1.00], respectively). Results were consistent across all sex, ethnicity, and SES groups (interaction P > 0.05). Conclusions Serial measures of patient-reported symptoms and HRQoL are significant and consistent predictors of outcomes among different groups with HF and provide the potential for a patient-centered and pragmatic approach to risk stratification.
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Affiliation(s)
- Claire A. Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
| | | | - Mark Richards
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
- National University Heart Centre, Singapore
| | - Francesco Zaccardi
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
- Diabetes Research Centre, Leicester, United Kingdom
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- School of Allied Health, University of Western Australia, Australia
| | - Chung-Lieh Hung
- Department of Cardiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chanchal Chandramouli
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Gurpreet S. Wander
- Department of Cardiology, Hero Dayanand Medical College Heart Institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore
- Department of Dermatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | | | - Mohammad Ali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Umesh Kadam
- Diabetes Research Centre, Leicester, United Kingdom
- Department of Health Sciences, University of Leicester, Leicestershire, United Kingdom
| | - Simon Hand
- Department of Health Sciences, University of Leicester, Leicestershire, United Kingdom
| | - Mary Harrison
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Inder Anand
- Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ajay Naik
- Care Institute of Medical Sciences, Ahmedabad, India
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
- Diabetes Research Centre, Leicester, United Kingdom
| | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, and Department of Cardiology, Linkoping University, Sweden
| | - Carolyn S.P. Lam
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- George Institute for Global Health, Sydney, Australia
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
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Angélico-Gonçalves A, Leite AR, Neves JS, Saraiva F, Brochado L, Oliveira AC, Butler J, Packer M, Zannad F, Vasques-Nóvoa F, Leite-Moreira A, Ferreira JP. Changes in health-related quality of life and treatment effects in chronic heart failure: A meta-analysis. Int J Cardiol 2023:S0167-5273(23)00726-X. [PMID: 37211049 DOI: 10.1016/j.ijcard.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Heart failure (HF) is associated with poor health status, and high morbi-mortality. However, it is not well established how health status changes correlate with treatment effects on clinical outcomes. Our aim was to study the association between treatment-induced changes in health-status, assessed by Kansas City Cardiomyopathy Questionnaire 23 (KCCQ-23) and clinical outcomes in chronic HF. METHODS Systematic search of phase III-IV pharmacological RCTs in chronic HF that assessed KCCQ-23 changes and clinical outcomes throughout follow-up. We studied the association between treatment induced changes in KCCQ-23 and treatment effects on clinical outcomes (HF hospitalization or cardiovascular death, HF hospitalization, cardiovascular death, and all-cause death) using weighted random-effects meta-regression. RESULTS Sixteen trials were included, enrolling a total of 65,664 participants. Treatment induced KCCQ-23 changes were moderately correlated with treatment effects on the combined outcome of HF hospitalization or cardiovascular mortality (regression coefficient (RC) = -0.047, 95%CI: -0.085 to -0.009; R2 = 49%), a correlation that was mainly driven by HF hospitalization (RC = -0.076, 95%CI: -0.124 to -0.029; R2 = 56%). Correlations of treatment induced KCCQ-23 changes with cardiovascular death (RC = -0.029, 95%CI: -0.073 to 0.015; R2 = 10%) and all-cause death (RC = -0.019, 95%CI: -0.057 to 0.019; R2 = 0%) were weak and non-significant. CONCLUSIONS Treatment-induced changes in KCCQ-23 were moderately correlated with treatment-effects on HF hospitalizations but were not correlated with the effects on cardiovascular and all-cause mortality. Treatment-induced changes in patient-centered outcomes (i.e., KCCQ-23) may reflect non-fatal symptomatic changes in the clinical course of HF leading to hospitalization.
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Affiliation(s)
- António Angélico-Gonçalves
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Rita Leite
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Endocrinology and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - João Sérgio Neves
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Endocrinology and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Liliana Brochado
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ana Cristina Oliveira
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, United States of America; Department of Medicine, University of Mississippi, Jackson, MS, United States of America
| | - Milton Packer
- Baylor University Medical Center, Dallas, TX, United States of America; Imperial College, London, United Kingdom
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques, - Plurithématique 14-33 and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Francisco Vasques-Nóvoa
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Pedro Ferreira
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Functional and Symptomatic Clinical Trial Endpoints: The HFC-ARC Scientific Expert Panel. JACC. HEART FAILURE 2022; 10:889-901. [PMID: 36456063 DOI: 10.1016/j.jchf.2022.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/09/2022] [Accepted: 09/18/2022] [Indexed: 11/11/2022]
Abstract
The Heart Failure Academic Research Consortium is a partnership between the Heart Failure Collaboratory (HFC) and the Academic Research Consortium (ARC) composed of patients, academic investigators from the United States and Europe, the U.S. Food and Drug Administration, the National Institutes of Health, payers, and industry. Members discussed the measure, remote capture, and clinical utility of functional and quality-of-life endpoints for use in clinical trials of heart failure and cardiovascular therapeutics, with the goal of improving the efficiency of heart failure and cardiovascular clinical research, evidence generation, and thereby patient quality of life, functional status, and survival. Assessments of patient-reported outcomes and maximal and submaximal exercise tolerance are standardized and validated, but actigraphy remains inconsistent as a potential endpoint. This paper details those discussions and consensus recommendations.
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9
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Quality of Life in Older Patients after a Heart Failure Hospitalization: Results from the SENECOR Study. J Clin Med 2022; 11:jcm11113035. [PMID: 35683423 PMCID: PMC9181457 DOI: 10.3390/jcm11113035] [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: 04/25/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Information about health-related quality of life (HRQoL) in heart failure (HF) in older adults is scarce. Methods: We aimed to describe the HRQoL of the SENECOR study cohort, a single-center, randomized trial comparing the effects of multidisciplinary intervention by a geriatrician and a cardiologist (intervention group) to that of a cardiologist alone (control group) in older patients with a recent HF hospitalization. Results: HRQoL was assessed by the short version of the disease-specific Kansas Cardiomyopathy Questionnaire (KCCQ-12) in 141 patients at baseline and was impaired (KCCQ-12 < 75) in almost half of the cohort. Women comprised 50% of the population, the mean age was 82.2 years, and two-thirds of patients had preserved ejection fraction. Comorbidities were highly prevalent. Patients with impaired HRQoL had a worse NYHA functional class, a lower NT-proBNP, a lower Barthel index, and a higher Clinical Frailty Scale. One-year all-cause mortality was 22.7%, significantly lower in the group with good-to-excellent HRQoL (14.5% vs. 30.6%; hazard ratio 0.28; 95% confidence interval 0.10−0.78; p = 0.014). In the group with better HRQoL, all-cause hospitalization was lower, and there was a trend towards lower HF hospitalization. Conclusions: The KCCQ-12 questionnaire can provide inexpensive prognostic information even in older patients with HF. (Funded by grant Primitivo de la Vega, Fundación MAPFRE. ClinicalTrials number, NCT03555318).
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10
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Johansson I, Balasubramanian K, Bangdiwala S, Mielniczuk L, Hage C, Sharma SK, Branch K, Zhu J, Kragholm K, Sliwa K, Alla F, Yonga G, Roy A, Orlandini A, Grinvalds A, McCready T, Pogosova N, Störk S, McMurray JJ, Conen D, Yusuf S. Factors associated with health‐related quality of life in heart failure in 23,000 patients from 40 countries: Results of the
G‐CHF
Research Program. Eur J Heart Fail 2022; 24:1478-1490. [DOI: 10.1002/ejhf.2535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Isabelle Johansson
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
| | | | - Shrikant Bangdiwala
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
| | - Lisa Mielniczuk
- Division of Cardiology University of Ottawa Heart Institute, Ottawa Ontario
| | - Camilla Hage
- Karolinska University Hospital Heart, Vascular and Neuro Theme Heart Failure Section
- Karolinska Institutet Department of Medicine Cardiology Unit
| | | | - Kelly Branch
- Division of Cardiology University of Washington School of Medicine Seattle
| | - Jun Zhu
- 3 Fuwai Hospital, CAMS & PUMC China
| | | | - Karen Sliwa
- Cape Heart Institute, Department of Medicine and Cardiology, Faculty of Health Sciences University of Cape Town
| | - Francois Alla
- Bordeaux Population Health Research Center. Inserm Université de Bordeaux Bordeaux France
- Prevention department, CHU, Bordeaux, France. Bordeaux Population Health Research Center. Inserm Université de Bordeaux Bordeaux France
| | | | - Ambuj Roy
- Department of Cardiology All India Institute of Medical Sciences, New Delhi Delhi India
| | | | - Alex Grinvalds
- Population Health Research Institute McMaster University Hamilton Canada
| | - Tara McCready
- Population Health Research Institute McMaster University Hamilton Canada
| | - Nana Pogosova
- National Medical Research Center of Cardiology Moscow Russia
| | - Stefan Störk
- Comprehensive Heart Failure Center University and University Hospital Würzburg Würzburg Germany
| | | | - David Conen
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
| | - Salim Yusuf
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
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11
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Influence of Health Education Based on IMB on Prognosis and Self-Management Behavior of Patients with Chronic Heart Failure. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8517802. [PMID: 35432589 PMCID: PMC9012616 DOI: 10.1155/2022/8517802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/22/2022] [Accepted: 03/05/2022] [Indexed: 01/30/2023]
Abstract
As the contemporary society is increasingly entering an aging society, heart failure, as a common disease in the elderly population, has an increasing impact on people. The common one is mainly chronic heart failure. Coupled with the influence of various complications, such as hypostatic pneumonia and venous thrombosis, the mortality and hospital admission rates of patients are very high. Moreover, the current technology is not very effective for the prevention and treatment of chronic heart failure. The per capita consumption level of ordinary people in China is low, and it is not suitable to promote high-cost treatment programs. Based on this, this paper proposes the intervention management of mental failure patients under the intervention of health education based on IMB, in order to explore the impact of the intervention of health education on patients. The research in this paper selected 112 patients with chronic heart failure who were admitted to the cardiovascular ward of a city public hospital in 2017 and divided the patients into two groups. One group received health education intervention, which was the intervention group. The other group was the control group. The control group was given routine education and nursing. The experimental results of this paper show that the satisfaction of the intervention group is higher, accounting for 85.3%, and the satisfaction of the control group is lower than that of the intervention group, about 67.9%. Dissatisfaction with health education and the probability of short-term readmission were higher than those in the intervention group.
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12
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Primary Disease, Sex, and Racial Differences in Health-Related Quality of Life in Adolescents and Young Adults with Heart Failure. Pediatr Cardiol 2022; 43:1568-1577. [PMID: 35378609 PMCID: PMC8979480 DOI: 10.1007/s00246-022-02884-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022]
Abstract
Health-related quality of life (HRQOL) is an important clinical and research trial endpoint in adult heart failure and has been shown to predict mortality and hospitalizations in adult heart failure populations. HRQOL has not been adequately studied in the growing pediatric and young adult heart failure population. This study described HRQOL in adolescents and young adults (AYAs) with heart failure and examined primary disease, sex, race, and other correlates of HRQOL in this sample. Participants in this cross-sectional, single-center study included adolescent and young adults with heart failure and a parent/guardian. Patients and their parent/proxies completed the PedsQL, a well-established measure of HRQOL in pediatric chronic illness populations. HRQOL is impaired in AYAs with heart failure resulting from dilated, hypertrophic, or other cardiomyopathy, congenital heart disease, or post-transplant with rejection/complications. Patients identifying as white endorsed poorer total HRQOL than non-white patients (p = 0.002). Subscale analysis revealed significant correlations between female sex (p = 0.01) and white race (p = 0.01) with poorer self-reported physical functioning. Family income was unrelated to HRQOL. Functional status was strongly associated with total (p = 0.0003) and physical HRQOL (p < 0.0001). Sociodemographic and disease-specific risk and resilience factors specific to HRQOL in AYAs with heart failure include primary cardiac disease, race, sex, and functional status. Building upon extensive work in adult heart failure, utilization, and study of HRQOL as a clinical and research trial outcome is necessary in pediatric heart failure. Developing targeted interventions for those at greatest risk of impaired HRQOL is an important next step.
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13
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Aung T, Qin Y, Tay WT, Binte Salahudin Bamadhaj NS, Chandramouli C, Ouwerkerk W, Tromp J, Anand I, Richards AM, Hung CL, Teramoto K, Katherine Teng TH, Lam CS. Prevalence and Prognostic Significance of Frailty in Asian Patients With Heart Failure. JACC: ASIA 2021; 1:303-313. [PMID: 36341220 PMCID: PMC9627805 DOI: 10.1016/j.jacasi.2021.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022]
Abstract
Background Frailty is common in patients with heart failure (HF) and can adversely impact outcomes. Objectives This study examined the prevalence of frailty among Asian patients with HF, its association with 1-year outcomes, and if race-ethnicity, HF subtypes, and sex modify this relationship. Methods In the multinational ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) registry, a baseline frailty index (FI) was constructed using a cumulative deficits approach with 48 baseline variables, and patients were followed for the 1-year primary outcome of all-cause death or HF hospitalization. Results Among 3,881 participants (age 61 ± 13 years, 27% female), the mean FI was 0.28 ± 0.11, and 69% were frail (FI >0.21). Higher FI was associated with older age, Malay ethnicity, and Southeast Asian residency. While comorbidities were more frequent in frail patients (by definition), body mass index was not different across frailty classes. Compared with FI class 1 (<0.21, nonfrail), FI class 2 (0.21-0.31) and FI class 3 (>0.31) had increased risk of the 1-year composite outcome (hazard ratios of 1.84 [95% confidence interval (CI): 1.42-2.38] and 4.51 [95% CI: 3.59-5.67], respectively), even after multivariable adjustment (adjusted hazard ratios of 1.49 [95% CI: 1.13-1.97] and 2.69 [95% CI: 2.06-3.50], respectively). Race-ethnicity modified the association of frailty with the composite outcome (Pinteraction = 0.0097), wherein the impact of frailty was strongest among Chinese patients. The association between frailty and outcomes did not differ between men and women (Pinteraction = 0.186) or for HF with reduced ejection fraction versus HF with preserved ejection fraction (Pinteraction = 0.094). Conclusions Most Asian patients with HF are frail despite relatively young age. Our results reveal specific ethnic (Malay) and regional (Southeast Asia) predisposition to frailty and highlight its prognostic importance, especially in Chinese individuals. (ASIAN HF Registry, A Prospective Observational Study [ASIANHF]; NCT01633398)
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Affiliation(s)
- Than Aung
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Yan Qin
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | | | | | | | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore
- Department of Dermatology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
- Duke-National University of Singapore Medical School, Singapore
| | - Inder Anand
- Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| | - A. Mark Richards
- National University Heart Centre, Singapore
- University of Otago, Dunedin, New Zealand
| | | | | | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
- Dr Tiew-Hwa Katherine Teng, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609.
| | - Carolyn S.P. Lam
- National Heart Centre Singapore, Singapore
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
- Duke-National University of Singapore Medical School, Singapore
- Address for correspondence: Dr Carolyn S.P. Lam, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609. @lamcardio
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14
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Johansson I, Joseph P, Balasubramanian K, McMurray JJV, Lund LH, Ezekowitz JA, Kamath D, Alhabib K, Bayes-Genis A, Budaj A, Dans ALL, Dzudie A, Probstfield JL, Fox KAA, Karaye KM, Makubi A, Fukakusa B, Teo K, Temizhan A, Wittlinger T, Maggioni AP, Lanas F, Lopez-Jaramillo P, Silva-Cardoso J, Sliwa K, Dokainish H, Grinvalds A, McCready T, Yusuf S. Health-Related Quality of Life and Mortality in Heart Failure: The Global Congestive Heart Failure Study of 23 000 Patients From 40 Countries. Circulation 2021; 143:2129-2142. [PMID: 33906372 DOI: 10.1161/circulationaha.120.050850] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries. METHODS We used the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) to record HRQL in 23 291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years. RESULTS The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction ≥40%. Average HRQL differed between regions (lowest in Africa [mean± SE, 39.5±0.3], highest in Western Europe [62.5±0.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17-1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03-1.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21-1.42]; interaction P<0.0001). Lower HRQL predicted death in patients with New York Heart Association class I or II and III or IV symptoms (HR, 1.17 [95% CI, 1.14-1.19] and HR, 1.14 [95% CI, 1.12-1.17]; interaction P=0.13) and was a stronger predictor for the composite outcome in New York Heart Association class I or II versus class III or IV (HR 1.15 [95% CI, 1.13-1.17] versus 1.09 [95% CI, [1.07-1.11]; interaction P<0.0001). HR for death was greater in ejection fraction ≥40 versus <40% (HR, 1.23 [95% CI, 1.20-1.26] and HR, 1.15 [95% CI, 1.13-1.17]; interaction P<0.0001). CONCLUSION HRQL is a strong and independent predictor of all-cause death and HF hospitalization across all geographic regions, in mildly and severe symptomatic HF, and among patients with preserved and reduced ejection fraction. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03078166.
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Affiliation(s)
- Isabelle Johansson
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.).,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Canada (S.Y., I.J.)
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Kumar Balasubramanian
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Scotland (J.J.V.M.)
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (L.H.L.).,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Justin A Ezekowitz
- Faculty of Medicine and Dentistry, University of Alberta Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E.)
| | - Deepak Kamath
- Division of Clinical Research and Training, St John's Research Institute, India (D.K.)
| | - Khalid Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia (K.A.)
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.B.-G.).,Department of Medicine, Universitat Autonoma Barcelona, CIBERCV, Spain (A.B.-G.)
| | - Andrzej Budaj
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland (A.B.)
| | - Antonio L L Dans
- Department of Cardiac Sciences, University of Philippines, Manila, Philippines (A.L.L.D.)
| | - Anastase Dzudie
- Douala General Hospital, Cameroon (A.D.).,Clinical Research Education, Networking and Consultancy, Douala, Cameroon (A.D.).,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon (A.D.)
| | | | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.)
| | - Kamilu M Karaye
- Department of Medicine, Aminu Kano Teaching Hospital and Bayero University Kano, Nigeria (K.M.K.)
| | - Abel Makubi
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania (A.M.)
| | - Bianca Fukakusa
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Koon Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Ahmet Temizhan
- Ankara City Hospital, Department of Cardiology, University of Health Sciences, Turkey (A.T.)
| | | | - Aldo P Maggioni
- ANMCO Research Center, Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy (A.P.M.)
| | | | - Patricio Lopez-Jaramillo
- Masira Research Institute, UDES, Bucaramanga, Colombia (P.L.-J.).,Facultad de Ciencias de la Salud, UTE, Quito, Ecuador (P.L.-J.)
| | - José Silva-Cardoso
- Faculty of Medicine, University of Porto, Sao Joao University Hospital Centre, Porto, Portugal (J.S.-C.)
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.)
| | - Hisham Dokainish
- Echocardiography Laboratory, Circulate Cardiac and Vascular Centre, Burlington, Canada (H.D.)
| | - Alex Grinvalds
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Tara McCready
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.).,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Canada (S.Y., I.J.)
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15
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Tromp J, Claggett BL, Liu J, Jackson AM, Jhund PS, Køber L, Widimský J, Boytsov SA, Chopra VK, Anand IS, Ge J, Chen CH, Maggioni AP, Martinez F, Packer M, Pfeffer MA, Pieske B, Redfield MM, Rouleau JL, Van Veldhuisen DJ, Zannad F, Zile MR, Rizkala AR, Inubushi-Molessa A, Lefkowitz MP, Shi VC, McMurray JJV, Solomon SD, Lam CSP. Global Differences in Heart Failure With Preserved Ejection Fraction: The PARAGON-HF Trial. Circ Heart Fail 2021; 14:e007901. [PMID: 33866828 DOI: 10.1161/circheartfailure.120.007901] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a global public health problem with important regional differences. We investigated these differences in the PARAGON-HF trial (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in HFpEF), the largest and most inclusive global HFpEF trial. METHODS We studied differences in clinical characteristics, outcomes, and treatment effects of sacubitril/valsartan in 4796 patients with HFpEF from the PARAGON-HF trial, grouped according to geographic region. RESULTS Regional differences in patient characteristics and comorbidities were observed: patients from Western Europe were oldest (mean 75±7 years) with the highest prevalence of atrial fibrillation/flutter (36%); Central/Eastern European patients were youngest (mean 71±8 years) with the highest prevalence of coronary artery disease (50%); North American patients had the highest prevalence of obesity (65%) and diabetes (49%); Latin American patients were younger (73±9 years) and had a high prevalence of obesity (53%); and Asia-Pacific patients had a high prevalence of diabetes (44%), despite a low prevalence of obesity (26%). Rates of the primary composite end point of total hospitalizations for HF and death from cardiovascular causes were lower in patients from Central Europe (9 per 100 patient-years) and highest in patients from North America (28 per 100 patient-years), which was primarily driven by a greater number of total hospitalizations for HF. The effect of treatment with sacubitril-valsartan was not modified by region (interaction P>0.05). CONCLUSIONS Among patients with HFpEF recruited worldwide in PARAGON-HF, there were important regional differences in clinical characteristics and outcomes, which may have implications for the design of future clinical trials. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.
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Affiliation(s)
- Jasper Tromp
- National Heart Centre Singapore (J.T., C.S.P.L.).,Duke-NUS Medical School, Singapore (J.T., C.S.P.L.).,Department of Cardiology, University Medical Centre Groningen, University of Groningen, the Netherlands (J.T., D.J.V.V., C.S.P.L.).,Saw Swee Hock School of Public Health, National University of Singapore, Singapore (J.T.)
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.L.C., J.L., M.A.P., S.D.S.)
| | - Jiankang Liu
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.L.C., J.L., M.A.P., S.D.S.)
| | - Alice M Jackson
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.M.J., P.S.J., J.J.V.M.)
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.M.J., P.S.J., J.J.V.M.)
| | - Lars Køber
- Department of Cardiology, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.)
| | - Jiří Widimský
- First Faculty of Medicine, Charles University Prague, Czech Republic (J.W.)
| | - Sergey A Boytsov
- National Research Center for Cardiology of the Ministry of Health of the Russian Federation, Moscow (S.B.)
| | - Vijay K Chopra
- Heart Failure and Research Max Super Specialty Hospital Saket, New Delhi, India (V.C.)
| | - Inder S Anand
- Department of Medicine, VA Medical Center and University of Minnesota, Minneapolis (I.S.A.)
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, China (J.G.)
| | - Chen-Huan Chen
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China (C.-H.C.)
| | - Aldo P Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy (A.P.M.)
| | | | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.)
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.L.C., J.L., M.A.P., S.D.S.)
| | - Burkert Pieske
- Department of Internal Medicine, Cardiology Charité, Universitaetsmedizin Berlin, Campus Virchow Klinikum Berlin, Germany (B.P.)
| | | | - Jean L Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, QC, Canada (J.L.R.)
| | - Dirk J Van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, the Netherlands (J.T., D.J.V.V., C.S.P.L.)
| | - Faiez Zannad
- Inserm CIC 1433 and Université de Lorraine, Centre Hospitalier Régional Universitaire, Nancy, France (F.Z.)
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.)
| | - Adel R Rizkala
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (A.R.R., A.I.-M., M.P.L., V.C.S.)
| | - Akiko Inubushi-Molessa
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (A.R.R., A.I.-M., M.P.L., V.C.S.)
| | - Martin P Lefkowitz
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (A.R.R., A.I.-M., M.P.L., V.C.S.)
| | - Victor C Shi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (A.R.R., A.I.-M., M.P.L., V.C.S.)
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.M.J., P.S.J., J.J.V.M.)
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.L.C., J.L., M.A.P., S.D.S.)
| | - Carolyn S P Lam
- National Heart Centre Singapore (J.T., C.S.P.L.).,Duke-NUS Medical School, Singapore (J.T., C.S.P.L.).,Department of Cardiology, University Medical Centre Groningen, University of Groningen, the Netherlands (J.T., D.J.V.V., C.S.P.L.)
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16
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Teng THK, Tay WT, Richards AM, Chew TSM, Anand I, Ouwerkerk W, Chandramouli C, Huang W, Lawson CA, Kadam UT, Yap J, Lim S, Hung CL, MacDonald MR, Loh SY, Shimizu W, Tromp J, Lam CSP. Socioeconomic Status and Outcomes in Heart Failure With Reduced Ejection Fraction From Asia. Circ Cardiovasc Qual Outcomes 2021; 14:e006962. [PMID: 33757307 DOI: 10.1161/circoutcomes.120.006962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. METHODS We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). RESULTS Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (<US$1000); and 29.5% had no/only primary education. The largest disparity in treatment across regional income levels pertained to β-blocker and device therapies, with patients from low-income regions being less likely to receive these treatments compared with those from high-income regions and even greater disparity among patients with lower education status and lower household income within each regional income strata. Higher country- and patient-level socioeconomic indicators related to higher quality of life scores and lower risk of the primary composite outcome. Notably, we found a significant interaction between regional income level and both household income and education status (Pinteraction <0.001 for both), where the association of low household income and low education status with poor outcomes was more pronounced in high-income compared with lower income regions. CONCLUSIONS These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov; Unique Identifier: NCT01633398.
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Affiliation(s)
- Tiew-Hwa K Teng
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Duke-National University of Singapore Medical School (T.-H.K.T., J.T., C.S.P.L.).,School of Population & Global Health, University of Western Australia (T.-H.K.T.)
| | - Wan Ting Tay
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | - Arthur Mark Richards
- National University Heart Centre, Singapore (A.M.R., S.L.).,University of Otago, New Zealand (A.M.R.)
| | | | - Inder Anand
- Veterans Affairs Medical Center, University of Minnesota, Minneapolis (I.A.)
| | - Wouter Ouwerkerk
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Department of Dermatology, Amsterdam Medical Center, the Netherlands (W.O.)
| | - Chanchal Chandramouli
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | - Weiting Huang
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | | | - Umesh T Kadam
- University of Leicester, United Kingdom (C.A.L., U.T.K.)
| | - Jonathan Yap
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | - Shirlynn Lim
- National University Heart Centre, Singapore (A.M.R., S.L.)
| | | | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.)
| | - Jasper Tromp
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Duke-National University of Singapore Medical School (T.-H.K.T., J.T., C.S.P.L.).,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands (J.T., C.S.P.L.)
| | - Carolyn Su Ping Lam
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Duke-National University of Singapore Medical School (T.-H.K.T., J.T., C.S.P.L.).,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands (J.T., C.S.P.L.)
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17
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Greene SJ, Tan X, Yeh YC, Bernauer M, Zaidi O, Yang M, Butler J. Factors associated with non-use and sub-target dosing of medical therapy for heart failure with reduced ejection fraction. Heart Fail Rev 2021; 27:741-753. [PMID: 33471236 DOI: 10.1007/s10741-021-10077-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 01/06/2023]
Abstract
In clinical practice, many patients with heart failure with reduced ejection fraction (HFrEF) are either not prescribed guideline-directed medical therapies for which they are eligible or are prescribed therapies at sub-target doses. The objective of this study was to examine the factors associated with not receiving guideline-directed medical therapies or receiving sub-target doses. We conducted a systematic review of articles published between January 2014 and May 2019 that described dosing patterns and factors associated with non-use and sub-target dosing of HFrEF therapies in clinical practice. Thirty-seven studies were included. The percentages of patients reaching target doses for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, sacubitril/valsartan, beta-blockers, and mineralocorticoid receptor antagonists ranged from 4 to 55%, 11 to 87%, 4 to 60%, and 22 to 80%, respectively. Older age and worsening renal function were associated with non-use and sub-target dosing, lower body mass index was commonly associated with non-use, and hyperkalemia and hypotension were commonly associated with sub-target dosing. In conclusion, several common patient characteristics are associated with non-use and sub-target dosing of medical therapy for HFrEF. These high-risk groups are in particular need of further studies to improve implementation of available medications and to define the role of novel therapies.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, NC, USA.,Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Xi Tan
- Merck & Co., Inc, Kenilworth, NJ, USA
| | - Yu-Chen Yeh
- Pharmerit - an OPEN Health Company, Newton, MA, USA
| | | | - Omer Zaidi
- Pharmerit - an OPEN Health Company, Newton, MA, USA
| | - Mei Yang
- Merck & Co., Inc, Kenilworth, NJ, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA.
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18
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Huang W, Teng TK, Tay WT, Richards AM, Kadam U, Lawson CA, Shimizu W, Loh SY, Anand I, Lam CSP. Patient-reported outcomes in heart failure with preserved vs. reduced ejection fraction: focus on physical independence. ESC Heart Fail 2020; 7:2051-2062. [PMID: 32862518 PMCID: PMC7524068 DOI: 10.1002/ehf2.12950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/19/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a widely used patient-reported outcome measure in heart failure (HF). The KCCQ was validated in patients with HF with reduced ejection fraction (HFrEF), leaving knowledge gaps regarding its applicability in HF with preserved ejection fraction (HFpEF). This study addresses the psychometric properties of internal consistency and reliability, construct, and known-group validity of KCCQ in both HFrEF and HFpEF. We aimed to evaluate the psychometric properties of the KCCQ and their prognostic significance in HFpEF and HFrEF, within a large prospective multinational HF cohort. METHODS AND RESULTS We examined the 23-item KCCQ in the prospective multinational ASIAN-HF study [4470 HFrEF (ejection fraction <40%); 921 HFpEF (ejection fraction ≥50%)]. Internal consistency (using Cronbach's alpha) showed high reliability in HFrEF and HFpeF: functional status score: 0.89 and 0.91 and clinical summary score: 0.89 and 0.90, respectively. Confirmatory factor analysis in HFrEF validated the five original domains of KCCQ (physical function, symptoms, self-efficacy, social limitation, and quality of life); in HFpEF, questions measuring physical function and social limitation had strong correlation (r = 0.66) and different domains emerged. We proposed an additional physical independence summary score, especially in HFpEF (comprising the original physical function and social limitation domains), which showed good internal consistency (α = 0.89) and has comparable receiver operating characteristic curve 0.766 ± 0.037 with the clinical summary score (receiver operating characteristic curve 0.774 ± 0.037), in predicting 1 year death and/or HF hospitalization. CONCLUSIONS Our results confirmed the robustness of the KCCQ clinical summary score in HF regardless of ejection fraction group. In the assessment of physical capacity in HFpEF, our results suggest strong interaction with social limitation, and we propose a summary score comprising both components be used.
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Affiliation(s)
- Weiting Huang
- National Heart Centre Singapore5 Hospital DriveSingapore169609Singapore
| | - Tiew‐Hwa Katherine Teng
- National Heart Centre Singapore5 Hospital DriveSingapore169609Singapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- School of Population & Global HealthThe University of Western AustraliaCrawleyWAAustralia
- The George Institute for Global HealthSydneyNSWAustralia
| | - Wan Ting Tay
- National Heart Centre Singapore5 Hospital DriveSingapore169609Singapore
| | - Arthur Mark Richards
- Cardiovascular Research InstituteNational University of SingaporeSingaporeSingapore
- Christchurch Heart InstituteUniversity of OtagoDunedinNew Zealand
| | - Umesh Kadam
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | | | | | | | - Inder Anand
- Veterans Affairs Medical CenterUniversity of MinnesotaMinneapolisMNUSA
| | - Carolyn Su Ping Lam
- National Heart Centre Singapore5 Hospital DriveSingapore169609Singapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- Department of CardiologyGroningen University Medical CenterGroningenThe Netherlands
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19
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Ong ASE, Chan AKW, Sultana R, Koh MS. Impact of psychological impairment on quality of life and work impairment in severe asthma. J Asthma 2020; 58:1544-1553. [PMID: 32777181 DOI: 10.1080/02770903.2020.1808989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Psychological impairment, such as anxiety and depression, is common in severe asthma. However, the impact of psychological impairment on asthma-specific quality of life (ASQOL) and work impairment has not been assessed within Southeast-Asia. Furthermore, previous ASQOL questionnaires contained items overlapping with asthma control, making it challenging to isolate the relationship between psychological impairment with ASQOL and asthma control, respectively. OBJECTIVE To evaluate the relationship between psychological impairment with ASQOL and work impairment in severe asthma. METHODS This is a cross-sectional study of severe asthma at Singapore General Hospital. We assessed ASQOL, psychological impairment, work impairment and asthma control using validated questionnaires. An ASQOL questionnaire not containing items evaluating asthma symptoms was selected to reduce overlap with asthma control. Medical records were used to obtain other asthma characteristics and healthcare utilization patterns. RESULTS Amongst 111 patients, 37% had psychological impairment based on Hospital Anxiety and Depression Scale. Poorer ASQOL was associated with anxiety (p = .013) after controlling for demographic characteristics, asthma control and comorbidities. Anxiety symptoms were associated with greater health concerns while depression symptoms were associated with sleep difficulty and physical limitations. Having depressive symptoms was associated with an additional 16% impairment of total work hours (p = .038). Psychological impairment was not associated with spirometry results or healthcare utilization. Ethnicity significantly predicted both ASQOL and work impairment. CONCLUSIONS In severe asthma, patients with psychological impairment have poorer ASQOL and greater work impairment than those without psychological impairment. There is an urgent need to mitigate this problem.
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Affiliation(s)
| | - Adrian Kwok Wai Chan
- Duke-NUS Medical School, Singapore, Singapore.,Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | | | - Mariko Siyue Koh
- Duke-NUS Medical School, Singapore, Singapore.,Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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20
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Tromp J, Shen L, Jhund PS, Anand IS, Carson PE, Desai AS, Granger CB, Komajda M, McKelvie RS, Pfeffer MA, Solomon SD, Køber L, Swedberg K, Zile MR, Pitt B, Lam CSP, McMurray JJV. Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol 2020; 74:601-612. [PMID: 31370950 DOI: 10.1016/j.jacc.2019.05.052] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/13/2019] [Accepted: 05/21/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although heart failure with preserved ejection fraction (HFpEF) is considered a disease of the elderly, younger patients are not spared from this syndrome. OBJECTIVES This study therefore investigated the associations among age, clinical characteristics, and outcomes in patients with HFpEF. METHODS Using data on patients with left ventricular ejection fraction ≥45% from 3 large HFpEF trials (TOPCAT [Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function], I-PRESERVE [Irbesartan in Heart Failure With Preserved Systolic Function], and CHARM Preserved [Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity]), patients were categorized according to age: ≤55 years (n = 522), 56 to 64 years (n = 1,679), 65 to 74 years (n = 3,405), 75 to 84 years (n = 2,464), and ≥85 years (n = 398). This study compared clinical and echocardiographic characteristics, as well as mortality and hospitalization rates, mode of death, and quality of life across age categories. RESULTS Younger patients (age ≤55 years) with HFpEF were more often obese, nonwhite men, whereas older patients with HFpEF were more often white women with a higher prevalence of atrial fibrillation, hypertension, and chronic kidney disease (eGFR <60 ml/min/1.73 m2). Despite fewer comorbidities, younger patients had worse quality of life compared with older patients (age ≥85 years). Compared with patients age ≤55 years, patients age ≥85 years had higher mortality (hazard ratio: 6.9; 95% confidence interval: 4.2 to 11.4). However, among patients who died, sudden death was, proportionally, the most common mode of death (p < 0.001) in patients age ≤55 years. In contrast, older patients (age ≥85 years) died more often from noncardiovascular causes (34% vs. 20% in patients age ≤55 years; p < 0.001). CONCLUSIONS Compared with the elderly, younger patients with HFpEF were less likely to be white, were more frequently obese men, and died more often of cardiovascular causes, particularly sudden death. In contrast, elderly patients with HFpEF had more comorbidities and died more often from noncardiovascular causes. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302; Irbesartan in Heart Failure With Preserved Systolic Function [I-PRESERVE]; NCT00095238; Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity [CHARM Preserved]; NCT00634712).
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Affiliation(s)
- Jasper Tromp
- National Heart Centre Singapore and Duke-NUS Medical School, Singapore; Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Li Shen
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Inder S Anand
- Department of Medicine, University of Minnesota Medical School and VA Medical Center, Minneapolis, Minnesota
| | - Peter E Carson
- Department of Cardiology, Washington VA Medical Center, Washington, DC
| | - Akshay S Desai
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Michel Komajda
- Department of Cardiology, Hospital Saint Joseph, Paris, France
| | | | - Marc A Pfeffer
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott D Solomon
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnston Veterans Administration Medical Center, Charleston, South Carolina
| | - Bertram Pitt
- Department of Internal Medicine-Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-NUS Medical School, Singapore; Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
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21
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Factors limiting habitual exercise in patients with chronic heart failure: a multicenter prospective cohort study. Heart Vessels 2019; 35:655-664. [PMID: 31686125 DOI: 10.1007/s00380-019-01529-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/18/2019] [Indexed: 01/06/2023]
Abstract
Physical activity (PA) in the daily life is strongly related to prognosis in patients with or at high risk of heart failure (HF). However, factors limiting habitual exercise and their prognostic impacts remain unknown in HF patients. We sent questionnaires asking factors limiting habitual exercise in the daily life to 8370 patients with Stage A/B/C/D HF in our nationwide registry and received valid responses from 4935 patients (mean age 71.8 years, 71.0% male). Among the 5 components consisting of "busyness", "weak will", "dislike, "socioeconomic reasons" and "diseases" in the questionnaires, "busyness" (34.5%) and "diseases" (34.7%) were the most frequently reported factors limiting habitual exercise, while "socioeconomic reasons" were the least (15.3%). Multiple Cox proportional hazard models indicated that "busyness"and "diseases" were associated with better (hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.39-0.72, P < 0.001) and worse prognosis (HR 1.57, 95% CI 1.21-1.98, P < 0.001), respectively, while other components were not. Furthermore, it was noted that, while prognostic relevance of "busyness" limiting exercise did not differ by age or sex, negative impact of "diseases" was particularly evident in patients with age < 75 years (P for interaction < 0.01). Factors limiting habitual exercise were associated with "busyness" and "diseases", but not with "weak will", "dislike, or "socioeconomic reasons". While "busyness" was associated with better prognosis regardless of age and sex, "diseases" was associated with worse prognosis in younger populations. Thus, physicians may pay more attentions to the reasons that limit exercise in the daily lives of HF patients rather than the low amount of exercise itself.
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22
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Chandra A, Vaduganathan M, Lewis EF, Claggett BL, Rizkala AR, Wang W, Lefkowitz MP, Shi VC, Anand IS, Ge J, Lam CS, Maggioni AP, Martinez F, Packer M, Pfeffer MA, Pieske B, Redfield MM, Rouleau JL, Van Veldhuisen DJ, Zannad F, Zile MR, McMurray JJ, Solomon SD. Health-Related Quality of Life in Heart Failure With Preserved Ejection Fraction. JACC-HEART FAILURE 2019; 7:862-874. [DOI: 10.1016/j.jchf.2019.05.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 11/30/2022]
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23
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Tromp J, MacDonald MR, Tay WT, Teng THK, Hung CL, Narasimhan C, Shimizu W, Ling LH, Ng TP, Yap J, McMurray JJV, Zile MR, Richards AM, Anand IS, Lam CSP. Heart Failure With Preserved Ejection Fraction in the Young. Circulation 2019; 138:2763-2773. [PMID: 30565987 DOI: 10.1161/circulationaha.118.034720] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF), traditionally considered a disease of the elderly, may also affect younger patients. However, little is known about HFpEF in the young. METHODS We prospectively enrolled 1203 patients with HFpEF (left ventricular ejection fraction ≥50%) from 11 Asian regions. We grouped HFpEF patients into very young (<55 years of age; n=157), young (55-64 years of age; n=284), older (65-74 years of age; n=355), and elderly (≥75 years of age; n=407) and compared clinical and echocardiographic characteristics, quality of life, and outcomes across age groups and between very young individuals with HFpEF and age- and sex-matched control subjects without heart failure. RESULTS Thirty-seven percent of our HFpEF population was <65 years of age. Younger age was associated with male preponderance and a higher prevalence of obesity (body mass index ≥30 kg/m2; 36% in very young HFpEF versus 16% in elderly) together with less renal impairment, atrial fibrillation, and hypertension (all P<0.001). Left ventricular filling pressures and prevalence of left ventricular hypertrophy were similar in very young and elderly HFpEF. Quality of life was better and death and heart failure hospitalization at 1 year occurred less frequently ( P<0.001) in the very young (7%) compared with elderly (21%) HFpEF. Compared with control subjects, very young HFpEF had a 3-fold higher death rate and twice the prevalence of hypertrophy. CONCLUSIONS Young and very young patients with HFpEF display similar adverse cardiac remodeling compared with their older counterparts and very poor outcomes compared with control subjects without heart failure. Obesity may be a major driver of HFpEF in a high proportion of HFpEF in the young and very young.
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Affiliation(s)
- Jasper Tromp
- University Medical Center Groningen, Department of Cardiology, the Netherlands (J.T., C.S.P.L.).,National Heart Centre Singapore (J.T., W.T.T., T.-H.K.T., J.Y., C.S.P.L.).,Duke-National University Singapore Medical School (J.T., C.S.P.L.)
| | | | - Wan Ting Tay
- National Heart Centre Singapore (J.T., W.T.T., T.-H.K.T., J.Y., C.S.P.L.)
| | - Tiew-Hwa K Teng
- National Heart Centre Singapore (J.T., W.T.T., T.-H.K.T., J.Y., C.S.P.L.).,School of Population and Global Health, University of Western Australia, Perth (T.-H.K.T.)
| | | | | | - Wataru Shimizu
- Nippon Medical School, Tokyo, Japan (W.S.).,National Cerebral and Cardiovascular Centre, Osaka, Japan (W.S.)
| | - Lieng Hsi Ling
- Yong Loo Lin School of Medicine, National University Singapore and Cardiac Department, National University Health System (L.H.L., T.P.N.)
| | - Tze Pin Ng
- Yong Loo Lin School of Medicine, National University Singapore and Cardiac Department, National University Health System (L.H.L., T.P.N.)
| | - Jonathan Yap
- National Heart Centre Singapore (J.T., W.T.T., T.-H.K.T., J.Y., C.S.P.L.)
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences and School of Medicine, Dentistry and Nursing, University of Glasgow, UK (J.J.V.M.)
| | - Michael R Zile
- Medical University of South Carolina, Charleston (M.R.Z.).,Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z.)
| | - A Mark Richards
- National University Heart Centre, Singapore (A.M.R., C.S.P.L.).,Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.)
| | - Inder S Anand
- Veterans Affairs Medical Center, Minneapolis, MN (I.S.A.)
| | - Carolyn S P Lam
- University Medical Center Groningen, Department of Cardiology, the Netherlands (J.T., C.S.P.L.).,National Heart Centre Singapore (J.T., W.T.T., T.-H.K.T., J.Y., C.S.P.L.).,Duke-National University Singapore Medical School (J.T., C.S.P.L.).,National University Heart Centre, Singapore (A.M.R., C.S.P.L.)
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24
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Tromp J, Lim SL, Tay WT, Teng THK, Chandramouli C, Ouwerkerk W, Wander GS, Sawhney JPS, Yap J, MacDonald MR, Ling LH, Sattar N, McMurray JJV, Richards AM, Anand I, Lam CSP. Microvascular Disease in Patients With Diabetes With Heart Failure and Reduced Ejection Versus Preserved Ejection Fraction. Diabetes Care 2019; 42:1792-1799. [PMID: 31292141 DOI: 10.2337/dc18-2515] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/27/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Microvascular complications are common among patients with diabetes mellitus (DM). The presence of heart failure (HF) is presumed to be due to macrovascular disease (typically HF with reduced ejection fraction [HFrEF] following myocardial infarction). We hypothesized that HF with preserved ejection fraction (HFpEF) in patients with DM may be a manifestation of microvascular disease compared with HFrEF. The objective of this study was to examine the prevalence and association with clinical outcome of microvascular complications in patients with HF and DM. RESEARCH DESIGN AND METHODS We investigated the prevalence, association with clinical outcome, and cardiac structure and function of microvascular (neuropathy, nephropathy, and retinopathy) complications of DM in 2,800 prospectively enrolled participants with HF and DM (561 with HFpEF) from the Asian Sudden Cardiac Death In Heart Failure (ASIAN-HF) registry. RESULTS A total of 601 (21.5%) participants with DM had microvascular complications. Participants with DM and any (one or more) microvascular complications were more likely to have HFpEF (odds ratio 1.70 [95% CI 1.15-2.50]; P = 0.008). Furthermore, the likelihood of having HFpEF increased with an increasing number of microvascular complications (P trend < 0.001). Microvascular complications were associated with more left ventricular (LV) hypertrophy and a greater reduction in quality of life in HFpEF than HFrEF (P interaction < 0.001 for all). Compared with participants with DM and without microvascular complications, the adjusted hazard ratio for the composite outcome of all-cause death or HF hospitalization was 1.35 (95% CI 1.04-1.76) for participants with DM and microvascular complications regardless of HF type (P interaction = 0.112). CONCLUSIONS Diabetic microvascular disease is more common, and related to greater LV remodeling, more impairment of quality in life, and similar adverse outcomes, in participants with HFpEF compared with HFrEF. HFpEF may be a clinical manifestation of microvascular disease in DM.
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Affiliation(s)
- Jasper Tromp
- National Heart Centre Singapore, Singapore.,University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.,Duke-NUS Medical School, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore
| | | | | | | | | | | | | | | | | | - Lieng Hsi Ling
- Department of Cardiology, National University Heart Centre, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences and School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, U.K
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences and School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, U.K
| | - A Mark Richards
- Department of Cardiology, National University Heart Centre, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore.,Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Inder Anand
- Veterans Affairs Medical Center, Minneapolis, MN
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Association of obesity with heart failure outcomes in 11 Asian regions: A cohort study. PLoS Med 2019; 16:e1002916. [PMID: 31550265 PMCID: PMC6759142 DOI: 10.1371/journal.pmed.1002916] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/23/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Asians are predisposed to a lean heart failure (HF) phenotype. Data on the 'obesity paradox', reported in Western populations, are scarce in Asia and have only utilised the traditional classification of body mass index (BMI). We aimed to investigate the association between obesity (defined by BMI and abdominal measures) and HF outcomes in Asia. METHODS AND FINDINGS Utilising the Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) registry (11 Asian regions including Taiwan, Hong Kong, China, India, Malaysia, Thailand, Singapore, Indonesia, Philippines, Japan, and Korea; 46 centres with enrolment between 1 October 2012 and 6 October 2016), we prospectively examined 5,964 patients with symptomatic HF (mean age 61.3 ± 13.3 years, 26% women, mean BMI 25.3 ± 5.3 kg/m2, 16% with HF with preserved ejection fraction [HFpEF; ejection fraction ≥ 50%]), among whom 2,051 also had waist-to-height ratio (WHtR) measurements (mean age 60.8 ± 12.9 years, 24% women, mean BMI 25.0 ± 5.2 kg/m2, 7% HFpEF). Patients were categorised by BMI quartiles or WHtR quartiles or 4 combined groups of BMI (low, <24.5 kg/m2 [lean], or high, ≥24.5 kg/m2 [obese]) and WHtR (low, <0.55 [thin], or high, ≥0.55 [fat]). Cox proportional hazards models were used to examine a 1-year composite outcome (HF hospitalisation or mortality). Across BMI quartiles, higher BMI was associated with lower risk of the composite outcome (ptrend < 0.001). Contrastingly, higher WHtR was associated with higher risk of the composite outcome. Individuals in the lean-fat group, with low BMI and high WHtR (13.9%), were more likely to be women (35.4%) and to be from low-income countries (47.7%) (predominantly in South/Southeast Asia), and had higher prevalence of diabetes (46%), worse quality of life scores (63.3 ± 24.2), and a higher rate of the composite outcome (51/232; 22%), compared to the other groups (p < 0.05 for all). Following multivariable adjustment, the lean-fat group had higher adjusted risk of the composite outcome (hazard ratio 1.93, 95% CI 1.17-3.18, p = 0.01), compared to the obese-thin group, with high BMI and low WHtR. Results were consistent across both HF subtypes (HFpEF and HF with reduced ejection fraction [HFrEF]; pinteraction = 0.355). Selection bias and residual confounding are potential limitations of such multinational observational registries. CONCLUSIONS In this cohort of Asian patients with HF, the 'obesity paradox' is observed only when defined using BMI, with WHtR showing the opposite association with the composite outcome. Lean-fat patients, with high WHtR and low BMI, have the worst outcomes. A direct correlation between high WHtR and the composite outcome is apparent in both HFpEF and HFrEF. TRIAL REGISTRATION Asian Sudden Cardiac Death in HF (ASIAN-HF) Registry ClinicalTrials.gov Identifier: NCT01633398.
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26
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Chandramouli C, Teng THK, Tay WT, Yap J, MacDonald MR, Tromp J, Yan L, Siswanto B, Reyes EB, Ngarmukos T, Yu CM, Hung CL, Anand I, Richards AM, Ling LH, Regensteiner JG, Lam CSP. Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN-HF registry. Eur J Heart Fail 2018; 21:297-307. [PMID: 30548089 DOI: 10.1002/ejhf.1358] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/24/2018] [Accepted: 10/14/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS To examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1-year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM). METHODS AND RESULTS Utilizing the Asian Sudden Cardiac Death in HF (ASIAN-HF) registry, 5255 patients (mean age 59.6 ± 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body mass index in women vs. men (≥ 23 vs. ≥ 27.5 kg/m2 , Pinteraction = 0.014). DM was more strongly related to chronic kidney disease in women vs. men [adjusted odds ratio (OR) 1.85, 95% confidence interval (CI) 1.33-2.57 vs. OR 1.32, 95% CI 1.11-1.56, Pinteraction = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (Pinteraction = 0.003), whereby DM was associated with a more concentric left ventricular geometry in women than men. Women had lower quality of life than men (P < 0.001), in both DM and non-DM groups. DM was associated with worse composite outcomes at 1 year in women vs. men [hazard ratio (HR) 1.79, 95% CI 1.24-2.60 vs. HR 1.32, 95% CI 1.12-1.56; Pinteraction = 0.005). CONCLUSIONS Asian women with HFrEF were more likely to have DM despite a lean body mass index, a greater burden of chronic kidney disease and more concentric left ventricular geometry, compared to men. Furthermore, DM confers worse quality of life, irrespective of sex, and a greater risk of adverse outcomes in women than men. These data underscore the need for sex-specific approaches to diabetes in patients with HF.
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Affiliation(s)
| | | | | | | | | | - Jasper Tromp
- National Heart Centre Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Limin Yan
- National Heart Centre Singapore, Singapore
| | - Bambang Siswanto
- National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Cheuk-Man Yu
- Hong Kong Baptist Hospital, The Chinese University of Hong Kong, Hong Kong, The People's Republic of China
| | | | - Inder Anand
- Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - A Mark Richards
- Cardiovascular Research Institute, Singapore.,National University of Singapore, Singapore.,Christchurch Heart Institute, University of Otago, Otago, New Zealand
| | | | | | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands.,Duke-National University of Singapore, Singapore
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27
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Dewan P, Jhund PS, Shen L, Petrie MC, Abraham WT, Atif Ali M, Chen CH, Desai AS, Dickstein K, Huang J, Kiatchoosakun S, Kim KS, Køber L, Lai WT, Liao Y, Mogensen UM, Oh BH, Packer M, Rouleau JL, Shi V, Sibulo AS, Solomon SD, Sritara P, Swedberg K, Tsutsui H, Zile MR, McMurray JJV. Heart failure with reduced ejection fraction: comparison of patient characteristics and clinical outcomes within Asia and between Asia, Europe and the Americas. Eur J Heart Fail 2018; 21:577-587. [PMID: 30536678 PMCID: PMC6607486 DOI: 10.1002/ejhf.1347] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/23/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022] Open
Abstract
Aims Nearly 60% of the world's population lives in Asia but little is known about the characteristics and outcomes of Asian patients with heart failure with reduced ejection fraction (HFrEF) compared to other areas of the world. Methods and results We pooled two, large, global trials, with similar design, in 13 174 patients with HFrEF (patient distribution: China 833, India 1390, Japan 209, Korea 223, Philippines 223, Taiwan 199 and Thailand 95, Western Europe 3521, Eastern Europe 4758, North America 613, and Latin America 1110). Asian patients were younger (55.0–63.9 years) than in Western Europe (67.9 years) and North America (66.6 years). Diuretics and devices were used less, and digoxin used more, in Asia. Mineralocorticoid receptor antagonist use was higher in China (66.3%), the Philippines (64.1%) and Latin America (62.8%) compared to Europe and North America (range 32.8% to 49.6%). The rate of cardiovascular death/heart failure hospitalization was higher in Asia (e.g. Taiwan 17.2, China 14.9 per 100 patient‐years) than in Western Europe (10.4) and North America (12.8). However, the adjusted risk of cardiovascular death was higher in many Asian countries than in Western Europe (except Japan) and the risk of heart failure hospitalization was lower in India and in the Philippines than in Western Europe, but significantly higher in China, Japan, and Taiwan. Conclusion Patient characteristics and outcomes vary between Asia and other regions and between Asian countries. These variations may reflect several factors, including geography, climate and environment, diet and lifestyle, health care systems, genetics and socioeconomic influences.
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Affiliation(s)
- Pooja Dewan
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Li Shen
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - William T Abraham
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, USA
| | - M Atif Ali
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University School of Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Akshay S Desai
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kenneth Dickstein
- University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | - Jun Huang
- Department of Cardiology, First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | | | - Kee-Sik Kim
- Daegu Catholic University Medical Centre, Daegu, South Korea
| | - Lars Køber
- Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Wen-Ter Lai
- Division of Cardiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yuhua Liao
- Institute of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ulrik M Mogensen
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Byung-Hee Oh
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Centre, Dallas, TX, USA
| | - Jean L Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada
| | - Victor Shi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Scott D Solomon
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Piyamitr Sritara
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.,National Heart and Lung Institute, Imperial College, London, UK
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Centre, Charleston, SC, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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28
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Cooper LB, Yap J, Tay WT, Teng THK, MacDonald M, Anand IS, Sharma A, O'Connor CM, Kraus WE, Mentz RJ, Lam CS. Multi-ethnic comparisons of diabetes in heart failure with reduced ejection fraction: insights from the HF-ACTION trial and the ASIAN-HF registry. Eur J Heart Fail 2018; 20:1281-1289. [PMID: 29943890 DOI: 10.1002/ejhf.1223] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/25/2022] Open
Abstract
AIM To describe differences in patient characteristics and outcomes by ethnicity in patients with diabetes mellitus (DM) and heart failure (HF) with reduced ejection fraction (HFrEF, ejection fraction ≤35%) in a multi-ethnic cohort. METHODS AND RESULTS Patient level data from two cohorts (HF-ACTION and ASIAN-HF) were combined, and patients grouped by self-reported ethnicity. DM was defined as the presence of a clinical diagnosis and/or receiving anti-diabetic therapy. A total of 6214 (1324 whites, 674 blacks, 1297 Chinese, 1510 Indians, 717 Malays, 692 Japanese/Koreans) patients were included. The overall prevalence of DM was 39.5% (n = 2454). The prevalence of DM was lowest in whites (29.3%), followed by Japanese/Koreans (34.1%), blacks (35.9%), Chinese (42.3%), Indians (44.2%), and highest in Malays (51.9%). The correlation between age, sex, body mass index, coronary artery disease, hypertension, atrial fibrillation, peripheral vascular disease and chronic kidney disease with DM differed significantly by ethnicity (P for interaction <0.05). The strongest correlations were seen in Malay women, whites with obesity, Indians with coronary artery disease and hypertension, and blacks with chronic kidney disease. On multivariable analyses, DM was significantly associated with the composite of 1-year overall mortality/HF hospitalization (hazard ratio 1.37, 95% confidence interval 1.19-1.57; P < 0.001), with no interaction by ethnicity (P for interaction =0.31). CONCLUSIONS There is marked heterogeneity in the prevalence and correlates of DM among different ethnic groups with HF worldwide. Subgroups particularly predisposed to DM warrant special attention, since DM increases the combined risk of morbidity and mortality in all ethnicities with HF.
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Affiliation(s)
- Lauren B Cooper
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Duke University Medical Center, Durham, NC, USA
| | | | | | | | | | | | - Abhinav Sharma
- Stanford University, Palo Alto, CA, USA.,University of Alberta, Edmonton, Alberta, Canada
| | - Christopher M O'Connor
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Duke University Medical Center, Durham, NC, USA
| | | | | | - Carolyn S Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
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The Utility of 5 Hypothetical Health States in Heart Failure Using Time Trade-Off (TTO) and EQ-5D-5L in Korea. Clin Drug Investig 2018; 38:727-736. [PMID: 29804184 DOI: 10.1007/s40261-018-0659-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Utility provides a preference for specific health state in economic evaluation, and they obtained from general population could be useful in respect of societal resource allocation. We aimed to investigate the utilities of health states for heart failure (HF), a major and growing public health problem, related to hospitalization and adverse drug effects by interrogating the general Korean population. METHODS Five health states for patients with HF were developed based on literature reviews: stable chronic heart failure (SCHF), hospitalization, SCHF + cough, SCHF + hypotension, and SCHF + hyperkalemia. We selected 100 individuals from the general population through quota sampling by age, sex, and region, and conducted face-to-face interviews. We measured utilities for 5 hypothetical health states of HF using both time trade-off (TTO) and EuroQol-5 dimensions-5 levels (EQ-5D-5L). Repeated-measures analysis of variance compared the utilities between all health states for each instrument. To identify the factors affecting the utility, a linear mixed model (LMM) analysis was performed. RESULTS The mean utility value for SCHF, SCHF + cough, SCHF + hypotension, SCHF + hyperkalemia, and hospitalization was calculated as 0.815, 0.732, 0.646, 0.548, and 0.360, respectively, by using TTO. The respective values using EQ-5D-5L were 0.871, 0.793, 0.710, 0.589, and 0.215. The utilities for HF significantly differed between all health states in each instrument (p < 0.001). In LMM analysis, hospitalization had a significantly negative effect on the utilities of both instruments. CONCLUSIONS The utilities decreased in order of SCHF, SCHF + cough, SCHF + hypotension, SCHF + hyperkalemia, and hospitalization. These results can be useful for decision making in resource allocation for HF interventions.
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30
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Goh VJ, Tromp J, Teng THK, Tay WT, Van Der Meer P, Ling LH, Siswanto BB, Hung CL, Shimizu W, Zhang S, Narasimhan C, Yu CM, Park SW, Ngarmukos T, Liew HB, Reyes E, Yap J, MacDonald M, Richards MA, Anand I, Lam CSP. Prevalence, clinical correlates, and outcomes of anaemia in multi-ethnic Asian patients with heart failure with reduced ejection fraction. ESC Heart Fail 2018; 5:570-578. [PMID: 29604185 PMCID: PMC6073031 DOI: 10.1002/ehf2.12279] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 12/14/2022] Open
Abstract
Aims Recent international heart failure (HF) guidelines recognize anaemia as an important comorbidity contributing to poor outcomes in HF, based on data mainly from Western populations. We sought to determine the prevalence, clinical correlates, and prognostic impact of anaemia in patients with HF with reduced ejection fraction across Asia. Methods and results We prospectively studied 3886 Asian patients (60 ± 13 years, 21% women) with HF (ejection fraction ≤40%) from 11 regions in the Asian Sudden Cardiac Death in Heart Failure study. Anaemia was defined as haemoglobin <13 g/dL (men) and <12 g/dL (women). Ethnic groups included Chinese (33.0%), Indian (26.2%), Malay (15.1%), Japanese/Korean (20.2%), and others (5.6%). Overall, anaemia was present in 41%, with a wide range across ethnicities (33–54%). Indian ethnicity, older age, diabetes, and chronic kidney disease were independently associated with higher odds of anaemia (all P < 0.001). Ethnicity modified the association of chronic kidney disease with anaemia (Pinteraction = 0.045), with the highest adjusted odds among Japanese/Koreans [2.86; 95% confidence interval (CI) 1.96–4.20]. Anaemic patients had lower Kansas City Cardiomyopathy Questionnaire scores (P < 0.001) and higher risk of all‐cause mortality and HF hospitalization at 1 year (hazard ratio = 1.28, 95% CI 1.08–1.50) compared with non‐anaemic patients. The prognostic impact of anaemia was modified by ethnicity (Pinteraction = 0.02), with the greatest hazard ratio in Japanese/Koreans (1.82; 95% CI 1.14–2.91). Conclusions Anaemia is present in a third to more than half of Asian patients with HF and adversely impacts quality of life and survival. Ethnic differences exist wherein prevalence is highest among Indians, and survival is most severely impacted by anaemia in Japanese/Koreans.
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Affiliation(s)
| | - Jasper Tromp
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Peter Van Der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Bambang B Siswanto
- National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia
| | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shu Zhang
- Fuwai Cardiovascular Hospital, Beijing, China
| | | | | | | | | | - Houng Bang Liew
- Queen Elizabeth II Hospital, Clinical Research Center, Sabah, Malaysia
| | | | | | | | - Mark A Richards
- National University Heart Centre, Singapore.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Inder Anand
- Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Carolyn S P Lam
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.,National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
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31
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Tromp J, Tay WT, Ouwerkerk W, Teng THK, Yap J, MacDonald MR, Leineweber K, McMurray JJV, Zile MR, Anand IS, Lam CSP. Multimorbidity in patients with heart failure from 11 Asian regions: A prospective cohort study using the ASIAN-HF registry. PLoS Med 2018; 15:e1002541. [PMID: 29584721 PMCID: PMC5870945 DOI: 10.1371/journal.pmed.1002541] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/21/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Comorbidities are common in patients with heart failure (HF) and complicate treatment and outcomes. We identified patterns of multimorbidity in Asian patients with HF and their association with patients' quality of life (QoL) and health outcomes. METHODS AND FINDINGS We used data on 6,480 patients with chronic HF (1,204 with preserved ejection fraction) enrolled between 1 October 2012 and 6 October 2016 in the Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) registry. The ASIAN-HF registry is a prospective cohort study, with patients prospectively enrolled from in- and outpatient clinics from 11 Asian regions (Hong Kong, Taiwan, China, Japan, Korea, India, Malaysia, Thailand, Singapore, Indonesia, and Philippines). Latent class analysis was used to identify patterns of multimorbidity. The primary outcome was defined as a composite of all-cause mortality or HF hospitalization within 1 year. To assess differences in QoL, we used the Kansas City Cardiomyopathy Questionnaire. We identified 5 distinct multimorbidity groups: elderly/atrial fibrillation (AF) (N = 1,048; oldest, more AF), metabolic (N = 1,129; obesity, diabetes, hypertension), young (N = 1,759; youngest, low comorbidity rates, non-ischemic etiology), ischemic (N = 1,261; ischemic etiology), and lean diabetic (N = 1,283; diabetic, hypertensive, low prevalence of obesity, high prevalence of chronic kidney disease). Patients in the lean diabetic group had the worst QoL, more severe signs and symptoms of HF, and the highest rate of the primary combined outcome within 1 year (29% versus 11% in the young group) (p for all <0.001). Adjusting for confounders (demographics, New York Heart Association class, and medication) the lean diabetic (hazard ratio [HR] 1.79, 95% CI 1.46-2.22), elderly/AF (HR 1.57, 95% CI 1.26-1.96), ischemic (HR 1.51, 95% CI 1.22-1.88), and metabolic (HR 1.28, 95% CI 1.02-1.60) groups had higher rates of the primary combined outcome compared to the young group. Potential limitations include site selection and participation bias. CONCLUSIONS Among Asian patients with HF, comorbidities naturally clustered in 5 distinct patterns, each differentially impacting patients' QoL and health outcomes. These data underscore the importance of studying multimorbidity in HF and the need for more comprehensive approaches in phenotyping patients with HF and multimorbidity. TRIAL REGISTRATION ClinicalTrials.gov NCT01633398.
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Affiliation(s)
- Jasper Tromp
- National Heart Centre Singapore, Singapore, Singapore
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Wan Ting Tay
- National Heart Centre Singapore, Singapore, Singapore
| | - Wouter Ouwerkerk
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, Netherlands
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore, Singapore
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jonathan Yap
- National Heart Centre Singapore, Singapore, Singapore
| | | | | | - John J. V. McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Michael R. Zile
- Medical University of South Carolina, Charleston, South Carolina, United States of America
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, United States of America
| | - Inder S. Anand
- Minneapolis VA Medical Center, Minneapolis, Minnesota, United States of America
| | - Carolyn S. P. Lam
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
- National University Heart Centre, Singapore, Singapore
- Duke–NUS Medical School, Singapore, Singapore
- * E-mail:
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