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Nielsen RR, Pryds K, Olesen KKW, Mortensen MB, Gyldenkerne C, Nielsen JC, Hindricks G, Dagres N, Maeng M. Coronary Artery Disease Is A Stronger Predictor of All-Cause Mortality Than Left Ventricular Ejection Fraction Among Patients With Newly Diagnosed Heart Failure: Insights From the WDHR. J Am Heart Assoc 2024; 13:e9771. [PMID: 38958148 PMCID: PMC11292771 DOI: 10.1161/jaha.123.033938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/14/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND In patients with newly diagnosed heart failure (HF) and left ventricular ejection fraction (LVEF) <50%, little is known whether LVEF per se or presence of coronary artery disease (CAD) provides independent prognostic information on all-cause mortality. METHODS AND RESULTS Using the WDHR (Western Denmark Heart Registry), we identified 3620 patients with newly diagnosed HF and LVEF 10% to 49% referred for first-time coronary angiography as part of general workup of HF. Patients were stratified by LVEF (10%-35% versus 36%-49%) and presence of CAD. We estimated 10-year all-cause mortality risk and calculated hazard ratios adjusted for relevant comorbidities and risk factors (aHRs). CAD was present in 1592 (44%) patients. Lower LVEF was associated with a relative 15% increased 10-year mortality: 37% for LVEF 36% to 49% versus 42% for LVEF 10% to 35% (aHR, 1.15 [95% CI, 0.99-1.34]). This result did not change when stratified into those with CAD (52% versus 56%; aHR, 1.11 [95% CI, 0.91-1.35]) and those without CAD (27% versus 33%; aHR, 1.24 [95% CI, 0.97-1.57]). In comparison, presence and extent of CAD were associated with a relative 43% increased 10-year mortality (CAD versus no CAD, 55.0% versus 31.5%; aHR, 1.43 [95% CI, 1.25-1.64]). Compared with a matched general population, excess mortality risk was higher for patients with HF and CAD (54.7% versus 26.3%; aHR, 2.10 [95% CI, 1.85-2.39]) versus those with HF and no CAD (31.4% versus 17.2%; aHR, 1.76 [95% CI, 1.52-2.02]). CONCLUSIONS Among newly diagnosed patients with HF and LVEF <50%, presence and extent of CAD are associated with substantial higher all-cause mortality risk than lower LVEF.
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Affiliation(s)
- Roni Ranghoej Nielsen
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus University, HealthAarhusDenmark
| | - Kasper Pryds
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | | | - Martin Bødtker Mortensen
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus University, HealthAarhusDenmark
- Department of CardiologyJohns HopkinsBaltimoreMD
| | | | - Jens Cosedis Nielsen
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus University, HealthAarhusDenmark
| | | | | | - Michael Maeng
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus University, HealthAarhusDenmark
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Xingmeng W, Guohua D, Hui G, Wulin G, Huiwen Q, Maoxia F, Runmin L, Lili R. Clinical efficacy and safety of adjunctive treatment of chronic ischemic heart failure with Qishen Yiqi dropping pills: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1271608. [PMID: 38179501 PMCID: PMC10765592 DOI: 10.3389/fcvm.2023.1271608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives Our study was to evaluate the effect of Qishen Yiqi Dropping Pills(QSYQ) on the prognosis of chronic ischemic heart failure(CIHF) and its safety. Methods Databases including CNKI, Wanfang, VIP, CBM, PubMed, Web of Science, The Cochrane Library and EMbase were searched from their inception to April 2023 to screen relevant randomized controlled trials (RCTs). Primary indicators included readmission rates, rates of major adverse cardiovascular events (MACE), and all-cause mortality rates. The quality of the literature was assessed according to the Cochrane Reviewers' Handbook 5.0 and the Modified Jadad Scale (with a score of 4-7 rated as high quality). Meta-analysis was performed using the meta-package created by R software version 4.2.3, continuous data were compared using SMDs, and dichotomous and ordered data were compared using ORs; and the I2 test was used to assess the heterogeneity. Results Fifty-nine studies out of 1,745 publications were finally included, totalling 6,248 patients. Most studies were poorly designed and had some publication bias, with only 26 high-quality papers (Jadad score ≥4). Meta-analysis showed that the combined application of QSYQ was able to reduce the readmission rate [OR = 0.42, 95% CI (0.33, 0.53), P < 0.001], all-cause mortality rate [OR = 0.43, 95% CI (0.27, 0.68), P < 0.001], and the incidence of MACE [OR = 0.42, 95% CI (0.31, 0.56), P < 0.001]. Also, the treatment method can improve clinical effectiveness [OR = 2.25, 95% CI (1.97, 2.58), P < 0.001], increase 6-min walking distance (6MWD) [SMD = 1.87, 95% CI (1.33, 2.41), P < 0.0001] and left ventricular ejection fraction (LVEF) [SMD = 1.08, 95% CI (0.83, 1.33), P < 0.0001], and decrease the Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores [SMD = -2.03, 95% CI (-3.0, -1.07), P < 0.0001], BNP levels [SMD = -2.07, 95% CI (-2.81, -1.33), P < 0.0001] and NT-ProBNP levels [SMD = -2.77, 95% CI (-4.90, -0.63), P < 0.05]. A total of 21 studies (n = 2,742) evaluated their adverse effects, of which 13 studies reported no adverse effects and 8 studies reported minor adverse effects. Conclusion Our results suggest that the combined application of QSYQ can further improve patients' cardiac function and exercise tolerance, improve their quality of life, and ultimately improve patients' prognosis with a favorable safety profile. Nonetheless, limited by the quality and high heterogeneity of the literature, we must be conservative and cautious about the present results. Systematic Review Registration PROSPERO (CRD42023449251).
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Affiliation(s)
- Wang Xingmeng
- The First School of Clinical Medicine, Graduate School of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Dai Guohua
- Department of Geriatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guan Hui
- Department of Geriatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Gao Wulin
- Department of Geriatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qu Huiwen
- The First School of Clinical Medicine, Graduate School of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fan Maoxia
- The First School of Clinical Medicine, Graduate School of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Li Runmin
- The First School of Clinical Medicine, Graduate School of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ren Lili
- Department of Geriatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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3
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Nielsen RR, Anker N, Stødkilde-Jørgensen N, Thrane PG, Hansen MK, Pryds K, Mortensen MB, Olesen KKW, Maeng M. Impact of Coronary Artery Disease in Women With Newly Diagnosed Heart Failure and Reduced Ejection Fraction. JACC. HEART FAILURE 2023; 11:1653-1663. [PMID: 37632494 DOI: 10.1016/j.jchf.2023.07.013] [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: 06/05/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The representation of women in heart failure studies has been inadequate, resulting in a knowledge gap regarding the prognostic impact of coronary artery disease (CAD) on all-cause mortality in women with newly diagnosed heart failure and reduced ejection fraction (HFrEF). OBJECTIVES This study aims to assess the prognostic impact of CAD in women with HFrEF. METHODS Using the Western Denmark Heart Registry, the authors identified 891 women and 2,403 men referred for first-time coronary angiography because of HFrEF. The authors stratified for presence of CAD, estimated 10-year all-cause mortality, and calculated crude and adjusted HRs (aHRs) with 95% CIs. RESULTS The 10-year mortality was 60% in women with CAD and 27% in women without CAD; for men, the corresponding numbers were 54% and 36%. When adjusted for comorbidities, women without CAD had a lower relative 10-year mortality than men without CAD (aHR: 0.73; 95% CI: 0.58-0.91), whereas women with CAD had similar relative mortality as men with CAD (aHR: 1.00; 95% CI: 0.81-1.24) (Pinteraction = 0.037). Assessed by the number of coronary vessels with significant stenosis, CAD extent was associated with mortality for both women (P < 0.01) and men (P < 0.01). However, compared to those without CAD, the aHR was higher for women with any degree of CAD (aHR ranging from 1.61 [95% CI: 1.09-2.38] for diffuse CAD to 2.01 [95% CI: 1.19-3.40] for 3-vessel disease) than for men with 3-vessel disease (aHR: 1.51; 95% CI: 1.19-1.91). CONCLUSIONS In patients with newly diagnosed HFrEF, the presence and extent of CAD has significantly greater prognostic impact among women than among men.
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Affiliation(s)
- Roni Ranghoej Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark.
| | - Nanna Anker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark
| | - Nina Stødkilde-Jørgensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark
| | | | | | - Kasper Pryds
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark; Department of Cardiology, Johns Hopkins, Baltimore, Maryland, USA
| | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark
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Drissa M, Drissa H, Helali S, Oughlani K, Farah A, Chebbi M. Epidemiology and management of heart failure with reduced ejection fraction in a Tunisian university hospital. Cardiovasc J Afr 2023; 34:68-72. [PMID: 37132406 PMCID: PMC10512042 DOI: 10.5830/cvja-2018-070] [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: 05/24/2018] [Accepted: 11/19/2018] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Despite considerable advances in treatment, heart failure (HF) remains a serious public health problem linked to a high rate of mortality. The aim of this work was to describe the epidemiological, clinical and evolutionary features of HF in a Tunisian university hospital. METHODS This was a retrospective study including 350 hospitalised patients diagnosed with HF with reduced ejection fraction (≤ 40%) during the period between 2013 and 2017. RESULTS The average age was 59 ± 12 years. A male predominance was noted. The main cardiovascular risk factor was the use of tobacco (47%). The electrocardiogram showed atrial fibrillation in 41% of patients and left bundle branch block in 36% of patients. Laboratory results revealed an electrolyte disorder in 30 cases, renal insufficiency in 25% of patients and anaemia in 20%. Echocardiography revealed reduced ejection fraction, with an average of 34 ± 6% (range: 20-40%). The main causes of HF were ischaemic heart disease in 157 patients. The most commonly used medications were diuretics (90% of patients), angiotensin converting enzyme inhibitors (88%), beta-blockers (91%) and mineralocorticoid receptor antagonists (35%). Cardiac resynchronisation therapy was performed on 30 patients and cardioverter defibrillator implantation on 15 patients. The hospital mortality rate was 10% and the average hospital stay was 12 ± 5 days. During six months of follow up, 56 patients died and 126 were re-admitted. Multivariate model predictors of six-month mortality were: age [odds ratio (OR): 8, p = 0.003], ischaemic HF (OR: 1.63, p = 0.01) and diabetes (OR: 21, p = 0.004). CONCLUSION This study illustrates the main characteristics of HF in our population. These include relatively young age, a predominance of males, ischaemic heart disease as the main aetiology, insufficient care strategies and a poor prognosis.
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Affiliation(s)
- Meriem Drissa
- Department of Cardiology, Rabta Hospital, Tunis, Tunisia
| | - Habiba Drissa
- Department of Cardiology, Rabta Hospital, Tunis, Tunisia.
| | - Sana Helali
- Department of Cardiology, Rabta Hospital, Tunis, Tunisia
| | | | - Amani Farah
- Department of Cardiology, Rabta Hospital, Tunis, Tunisia
| | - Marwa Chebbi
- Department of Cardiology, Rabta Hospital, Tunis, Tunisia
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5
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Zehnder AR, Pedrosa Carrasco AJ, Etkind SN. Factors associated with hospitalisations of patients with chronic heart failure approaching the end of life: A systematic review. Palliat Med 2022; 36:1452-1468. [PMID: 36172637 PMCID: PMC9749018 DOI: 10.1177/02692163221123422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Heart failure has high mortality and is linked to substantial burden for patients, carers and health care systems. Patients with chronic heart failure frequently experience recurrent hospitalisations peaking at the end of life, but most prefer to avoid hospital. The drivers of hospitalisations are not well understood. AIM We aimed to synthesise the evidence on factors associated with all-cause and heart failure hospitalisations of patients with advanced chronic heart failure. DESIGN Systematic review of studies quantitatively evaluating factors associated with all-cause or heart failure hospitalisations in adult patients with advanced chronic heart failure. DATA SOURCES Five electronic databases were searched from inception to September 2020. Additionally, searches for grey literature, citation searching and hand-searching were performed. We assessed the quality of individual studies using the QualSyst tool. Strength of evidence was determined weighing number, quality and consistency of studies. Findings are reported narratively as pooling was not deemed feasible. RESULTS In 54 articles, 68 individual, illness-level, service-level and environmental factors were identified. We found high/moderate strength evidence for specialist palliative or hospice care being associated with reduced risk of all-cause and heart failure hospitalisations, respectively. Based on high strength evidence, we further identified black/non-white ethnicity as a risk factor for all-cause hospitalisations. CONCLUSION Efforts to integrate hospice and specialist palliative services into care may reduce avoidable hospitalisations in advanced heart failure. Inequalities in end-of-life care in terms of race/ethnicity should be addressed. Further research should investigate the causality of the relationships identified here.
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Affiliation(s)
- Aina R Zehnder
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,Rautipraxis, Zürich, Switzerland
| | | | - Simon N Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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6
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Mao J, Zhang J, Lam CSP, Zhu M, Yao C, Chen S, Liu Z, Wang F, Wang Y, Dai X, Niu T, An D, Miao Y, Xu T, Dong B, Ma X, Zhang F, Wang X, Fan R, Zhao Y, Jiang T, Zhang Y, Wang X, Hou Y, Zhao Z, Su Q, Zhang J, Wang B, Zhang B. Qishen Yiqi dripping pills for chronic ischaemic heart failure: results of the CACT-IHF randomized clinical trial. ESC Heart Fail 2020; 7:3881-3890. [PMID: 32954647 PMCID: PMC7754900 DOI: 10.1002/ehf2.12980] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 07/04/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022] Open
Abstract
Aims Qishen Yiqi dripping pills (QSYQ) may be beneficial in patients with ischaemic heart failure (IHF). We aimed to assess the efficacy and safety of QSYQ administered together with guideline‐directed medical therapy in patients with IHF. Methods and results This prospective randomized, double‐blind, multicentre placebo‐controlled study enrolled 640 patients with IHF between March 2012 and August 2014. Patients were randomly assigned to receive 6 months of QSYQ or placebo in addition to standard treatment. The primary outcome was 6 min walking distance at 6 months. Among the 638 IHF patients (mean age 65 years, 72% men), the 6 min walking distance increased from 336.15 ± 100.84 to 374.47 ± 103.09 m at 6 months in the QSYQ group, compared with 334.40 ± 100.27 to 340.71 ± 104.57 m in the placebo group (mean change +38.32 vs. +6.31 m respectively; P < 0.001). The secondary outcomes in composite clinical events, including all‐cause mortality and emergency treatment/hospitalization due to heart failure, were non‐significantly lower at 6 months with QSYQ compared with placebo (13% vs. 17%; P = 0.45), and the change of brain natriuretic peptide was non‐significantly greater with QSYQ compared with placebo (median change −14.55 vs. −12.30 pg/mL, respectively; P = 0.21). By contrast, the Minnesota Living with Heart Failure Questionnaire score significantly improved with QSYQ compared with placebo (−11.78 vs. −9.17; P = 0.004). Adverse events were minor and infrequent with QSYQ, similar to the placebo group. Conclusions Treatment with QSYQ for 6 months in addition to standard therapy improved exercise tolerance of IHF patients and was well tolerated.
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Affiliation(s)
- Jingyuan Mao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jian Zhang
- Fuwai Hospital of Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore.,University Medical Centre Groningen, Groningen, The Netherlands.,The George Institute for Global Health, Sydney, Australia
| | - Mingjun Zhu
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan, China
| | - Chen Yao
- Peking University Clinical Research Institute, Beijing, China
| | | | - Zhongyong Liu
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Jiangxi, China
| | - Fengrong Wang
- The First Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning, China
| | - Yonggang Wang
- The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Shaanxi, China
| | - Xiaohua Dai
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Anhui, China
| | - Tianfu Niu
- Shanxi Traditional Chinese Medical Hospital, Shanxi, China
| | - Dongqing An
- Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Yang Miao
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Tao Xu
- The Second Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guizhou, China
| | - Bo Dong
- The Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning, China
| | - Xiaofeng Ma
- Affiliated Nanhua Hospital, University of South China, Hunan, China
| | - Fengru Zhang
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolong Wang
- Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ruihong Fan
- Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine, Tianjin, China
| | - Yingqiang Zhao
- Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tiemin Jiang
- Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China
| | - Yuhui Zhang
- Fuwai Hospital of Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Xianliang Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yazhu Hou
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhiqiang Zhao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Quan Su
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junhua Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Baohe Wang
- Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Boli Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Ellis AG, Trikalinos TA, Wessler BS, Wong JB, Dahabreh IJ. Propensity Score-Based Methods in Comparative Effectiveness Research on Coronary Artery Disease. Am J Epidemiol 2018; 187:1064-1078. [PMID: 28992207 DOI: 10.1093/aje/kwx214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 03/30/2017] [Indexed: 12/20/2022] Open
Abstract
This review examines the conduct and reporting of observational studies using propensity score-based methods to compare coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy for patients with coronary artery disease. A systematic selection process identified 48 studies: 20 addressing CABG versus PCI; 21 addressing bare-metal stents versus drug-eluting stents; 5 addressing CABG versus medical therapy; 1 addressing PCI versus medical therapy; and 1 addressing drug-eluting stents versus balloon angioplasty. Of 32 studies reporting information on variable selection, 7 relied exclusively on statistical criteria for the association of covariates with treatment, and 5 used such criteria to determine whether product or nonlinear terms should be included in the propensity score model. Twenty-five (52%) studies reported assessing covariate balance using the estimated propensity score, but only 1 described modifications to the propensity score model based on this assessment. The over 400 variables used in the 48 propensity score models were classified into 12 categories and 60 subcategories; only 17 subcategories were represented in at least half of the propensity score models. Overall, reporting of propensity score-based methods in observational studies comparing CABG, PCI, and medical therapy was incomplete; when adequately described, the methods used were often inconsistent with current methodological standards.
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Affiliation(s)
- Alexandra G Ellis
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Benjamin S Wessler
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center, Boston, Massachusetts
- Department of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - John B Wong
- Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Issa J Dahabreh
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
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8
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Lavoie L, Khoury H, Welner S, Briere JB. Burden and Prevention of Adverse Cardiac Events in Patients with Concomitant Chronic Heart Failure and Coronary Artery Disease: A Literature Review. Cardiovasc Ther 2017; 34:152-60. [PMID: 26915344 PMCID: PMC5084727 DOI: 10.1111/1755-5922.12180] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Chronic heart failure (HF) or coronary artery disease (CAD) confers risk for thromboembolism and secondary adverse cardiac events (ACEs) (e.g., mortality, myocardial infarction, and stroke). When HF and CAD occur concomitantly, ACE risk is reported to be elevated. We investigated ACEs, their epidemiology, and the resulting burden among patients with concomitant HF and CAD through a structured review of recent literature. Antithrombotic treatment for ACE prevention was assessed. Methods Pertinent databases (PubMed, other) were searched for relevant articles published from January 2004 to March 2015. Data collected included ACE incidence, healthcare resource use, costs, change in quality of life attributed to ACEs, and treatment practice for prevention of ACEs in patients with concomitant HF and CAD. Results Mortality rates for patients with both HF and CAD ranged from 4.9–12.3% at 30 days to 13.7–86% for periods between 9.9 months and 10 years. Incidence of ACEs among HF patients with CAD is, respectively, at least 82% and 15% higher than for patients without HF or without CAD, except for stroke investigated in two studies. All‐cause and HF‐related hospitalization is the main driver of the economic burden in patients with HF, the majority of whom had CAD origin. Despite high prevalence of ischemic complications, there is limited evidence to support the use of warfarin‐type antithrombotics among HF patients. Conclusion This study confirms that patients with concomitant HF and CAD are at elevated risk for ACEs and suggests the need for effective new antithrombotic treatments to further decrease ischemic complication rates in this population.
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Affiliation(s)
| | | | | | - Jean-Baptiste Briere
- Bayer Pharma AG, Global Health Economics & Outcomes Research General Medicine, Berlin, Germany
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9
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Arundel C, Lam PH, Khosla R, Blackman MR, Fonarow GC, Morgan C, Zeng Q, Fletcher RD, Butler J, Wu WC, Deedwania P, Love TE, White M, Aronow WS, Anker SD, Allman RM, Ahmed A. Association of 30-Day All-Cause Readmission with Long-Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure. Am J Med 2016; 129:1178-1184. [PMID: 27401949 PMCID: PMC5075494 DOI: 10.1016/j.amjmed.2016.06.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Heart failure is the leading cause for 30-day all-cause readmission. We examined the impact of 30-day all-cause readmission on long-term outcomes and cost in a propensity score-matched study of hospitalized patients with heart failure. METHODS Of the 7578 Medicare beneficiaries discharged with a primary diagnosis of heart failure from 106 Alabama hospitals (1998-2001) and alive at 30 days after discharge, 1519 had a 30-day all-cause readmission. Using propensity scores for 30-day all-cause readmission, we assembled a matched cohort of 1516 pairs of patients with and without a 30-day all-cause readmission, balanced on 34 baseline characteristics (mean age 75 years, 56% women, 24% African American). RESULTS During 2-12 months of follow-up after discharge from index hospitalization, all-cause mortality occurred in 41% and 27% of matched patients with and without a 30-day all-cause readmission, respectively (hazard ratio 1.68; 95% confidence interval 1.48-1.90; P <.001). This harmful association of 30-day all-cause readmission with mortality persisted during an average follow-up of 3.1 (maximum, 8.7) years (hazard ratio 1.33; 95% confidence interval 1.22-1.45; P <.001). Patients with a 30-day all-cause readmission had higher cumulative all-cause readmission (mean, 6.9 vs 5.1; P <.001), a longer cumulative length of stay (mean, 51 vs 43 days; P <.001), and a higher cumulative cost (mean, $38,972 vs $34,025; P = .001) during 8.7 years of follow-up. CONCLUSIONS Among Medicare beneficiaries hospitalized for heart failure, 30-day all-cause readmission was associated with a higher risk of subsequent all-cause mortality, higher number of cumulative all-cause readmission, longer cumulative length of stay, and higher cumulative cost.
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Affiliation(s)
| | - Phillip H Lam
- Georgetown University Hospital/Washington Hospital Center, Washington, DC
| | | | | | | | | | - Qing Zeng
- George Washington University, Washington, DC
| | | | | | - Wen-Chih Wu
- Veterans Affairs Medical Center, Providence, RI
| | | | | | | | | | | | - Richard M Allman
- Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC.,University of Alabama at Birmingham, Birmingham, AL
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Johansson I, Dahlström U, Edner M, Näsman P, Rydén L, Norhammar A. Prognostic Implications of Type 2 Diabetes Mellitus in Ischemic and Nonischemic Heart Failure. J Am Coll Cardiol 2016; 68:1404-1416. [DOI: 10.1016/j.jacc.2016.06.061] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 12/20/2022]
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11
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Kim BS, Yang JH, Jang WJ, Song YB, Hahn JY, Choi JH, Kim WS, Lee YT, Gwon HC, Lee SH, Choi SH. Clinical outcomes of multiple chronic total occlusions in coronary arteries according to three therapeutic strategies: Bypass surgery, percutaneous intervention and medication. Int J Cardiol 2015; 197:2-7. [DOI: 10.1016/j.ijcard.2015.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 06/04/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
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Johansson I, Edner M, Dahlström U, Näsman P, Rydén L, Norhammar A. Is the prognosis in patients with diabetes and heart failure a matter of unsatisfactory management? An observational study from the Swedish Heart Failure Registry. Eur J Heart Fail 2015; 16:409-18. [PMID: 24464683 DOI: 10.1002/ejhf.44] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/21/2013] [Accepted: 10/25/2013] [Indexed: 11/08/2022] Open
Abstract
AIMS To analyse the long-term outcome, risk factor panorama, and treatment pattern in patients with heart failure (HF) with and without type 2 diabetes (T2DM) from a daily healthcare perspective. METHODS AND RESULTS Patients with (n=8809) and without (n=27,465) T2DM included in the Swedish Heart Failure Registry (S-HFR) 2003–2011 due to a physician-based HF diagnosis were prospectively followed for long-term mortality (median follow-up time: 1.9 years, range 0–8.7 years). Left ventricular function expressed as EF did not differ between patients with and without T2DM. Survival was significantly shorter in patients with T2DM, who had a median survival time of 3.5 years compared with 4.6 years (P<0.0001). In subjects with T2DM. unadjusted and adjusted odds ratios (ORs) for mortality were 1.37 [95% confidence interval (CI) 1.30–1.44) and 1.60 (95% CI 1.50–1.71), and T2DM predicted mortality in all age groups. Ischaemic heart disease was an important predictor for mortality (OR 1.68, 95% CI 1.47–1.94), more abundant in patients with T2DM (59% vs. 45%) among whom only 35% had been subjected to coronary angiography and 32% to revascularization. Evidence-based pharmacological HF treatment was somewhat more extensive in patients with T2DM. CONCLUSION The combination of T2DM and HF seriously compromises long-term prognosis. Ischaemic heart disease was identified as one major contributor; however, underutilization of available diagnostic and therapeutic facilities for ischaemic heart disease was obvious and may be an important area for future improvement in patients with T2DM and HF.
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Zannad F, Greenberg B, Cleland JGF, Gheorghiade M, van Veldhuisen DJ, Mehra MR, Anker SD, Byra WM, Fu M, Mills RM. Rationale and design of a randomized, double-blind, event-driven, multicentre study comparing the efficacy and safety of oral rivaroxaban with placebo for reducing the risk of death, myocardial infarction or stroke in subjects with heart failure and significant coronary artery disease following an exacerbation of heart failure: the COMMANDER HF trial. Eur J Heart Fail 2015; 17:735-42. [PMID: 25919061 PMCID: PMC5029775 DOI: 10.1002/ejhf.266] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/04/2015] [Accepted: 03/11/2015] [Indexed: 01/06/2023] Open
Abstract
AIMS Thrombin is a critical element of crosstalk between pathways contributing to worsening of established heart failure (HF). The aim of this study is to explore the efficacy and safety of rivaroxaban 2.5 mg bid compared with placebo (with standard care) after an exacerbation of HF in patients with reduced ejection fraction (HF-rEF) and documented coronary artery disease. METHODS This is an international prospective, multicentre, randomized, double-blind, placebo-controlled, event-driven study of approximately 5000 patients for a targeted 984 events. Patients must have a recent symptomatic exacerbation of HF, increased plasma concentrations of natriuretic peptides (B-type natriuretic peptide ≥200 pg/mL or N-terminal pro-B-type natriuretic peptide ≥800 pg/mL), with left ventricular ejection fraction ≤40% and coronary artery disease. Patients requiring anticoagulation for atrial fibrillation or other conditions will be excluded. After an index event (overnight hospitalization, emergency department or observation unit admission, or unscheduled outpatient parenteral treatment for worsening HF), patients will be randomized 1:1 to rivaroxaban or placebo (with standard of care). The primary efficacy outcome event is a composite of all-cause mortality, myocardial infarction or stroke. The principal safety outcome events are the composite of fatal bleeding or bleeding into a critical space with potential permanent disability, bleeding events requiring hospitalization and major bleeding events according to International Society on Thrombosis and Haemostasis bleeding criteria. CONCLUSION COMMANDER HF is the first prospective study of a target-specific oral antithrombotic agent in HF. It will provide important information regarding rivaroxaban use following an HF event in an HF-rEF patient population with coronary artery disease.
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Affiliation(s)
- Faiez Zannad
- Inserm Centre d'Investigation Clinique CIC 1433, UMR 1116, CHU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Université de Lorraine, Nancy, France
| | - Barry Greenberg
- Department of Medicine, Cardiology Division, University of California, San Diego, La Jolla, CA, USA
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, England
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mandeep R Mehra
- Brigham and Women's Hospital Heart and Vascular Center, and Harvard Medical School, Boston, MA, USA
| | - Stefan D Anker
- Division of Innovative Clinical Trials, Department of Cardiology, University Medical Centre Göttingen (UMG), Göttingen, Germany
| | - William M Byra
- Janssen Research & Development, LLC, 920 US 202, Raritan, NJ, USA
| | - Min Fu
- Janssen Research & Development, LLC, 920 US 202, Raritan, NJ, USA
| | - Roger M Mills
- Janssen Research & Development, LLC, 920 US 202, Raritan, NJ, USA
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Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis. Int J Cardiol 2015; 196:98-106. [PMID: 26080284 PMCID: PMC4518480 DOI: 10.1016/j.ijcard.2015.05.180] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 04/13/2015] [Accepted: 05/26/2015] [Indexed: 01/14/2023]
Abstract
Background Non-cardiovascular comorbidities are recognised as independent prognostic factors in selected heart failure (HF) populations, but the evidence on non-selected HF and how comorbid disease severity and change impacts on outcomes has not been synthesised. We identified primary HF comorbidity follow-up studies to compare the impact of non-cardiovascular comorbidity, severity and change on the outcomes of quality of life, all-cause hospital admissions and all-cause mortality. Methods Literature databases (Jan 1990–May 2013) were screened using validated strategies and quality appraisal (QUIPS tool). Adjusted hazard ratios for the main HF outcomes were combined using random effects meta-analysis and inclusion of comorbidity in prognostic models was described. Results There were 68 primary HF studies covering nine non-cardiovascular comorbidities. Most were on diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD) and renal dysfunction (RD) for the outcome of mortality (93%) and hospital admissions (16%), median follow-up of 4 years. The adjusted associations between HF comorbidity and mortality were DM (HR 1.34; 95% CI 1.2, 1.5), COPD (1.39; 1.2, 1.6) and RD (1.52; 1.3, 1.7). Comorbidity severity increased mortality from moderate to severe disease by an estimated 78%, 42% and 80% respectively. The risk of hospital admissions increased up to 50% for each disease. Few studies or prognostic models included comorbidity change. Conclusions Non-cardiovascular comorbidity and severity significantly increases the prognostic risk of poor outcomes in non-selected HF populations but there is a major gap in investigating change in comorbid status over time. The evidence supports a step-change for the inclusion of comorbidity severity in new HF interventions to improve prognostic outcomes. We synthesise the prognosis evidence on non-CVD comorbidity and severity in non-selected HF Most studies focused on three comorbid diseases for mortality and admissions and none for QoL COPD, diabetes and CKD increased mortality and admission risk in non-selected HF Severity studies were few but where available, risk increased with disease severity Comorbidity severity is important but has yet to be included in HF prognostic models
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Chen J, Yaniz-Galende E, Kagan HJ, Liang L, Hekmaty S, Giannarelli C, Hajjar R. Abnormalities of capillary microarchitecture in a rat model of coronary ischemic congestive heart failure. Am J Physiol Heart Circ Physiol 2015; 308:H830-40. [PMID: 25659485 DOI: 10.1152/ajpheart.00583.2014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/02/2015] [Indexed: 11/22/2022]
Abstract
The aim of the present study is to explore the role of capillary disorder in coronary ischemic congestive heart failure (CHF). CHF was induced in rats by aortic banding plus ischemia-reperfusion followed by aortic debanding. Coronary arteries were perfused with plastic polymer containing fluorescent dye. Multiple fluorescent images of casted heart sections and scanning electric microscope of coronary vessels were obtained to characterize changes in the heart. Cardiac function was assessed by echocardiography and in vivo hemodynamics. Stenosis was found in all levels of the coronary arteries in CHF. Coronary vasculature volume and capillary density in remote myocardium were significantly increased in CHF compared with control. This occurred largely in microvessels with a diameter of ≤3 μm. Capillaries in CHF had a tortuous structure, while normal capillaries were linear. Capillaries in CHF had inconsistent diameters, with assortments of narrowed and bulged segments. Their surfaces appeared rough, potentially indicating endothelial dysfunction in CHF. Segments of main capillaries between bifurcations were significantly shorter in length in CHF than in control. Transiently increasing preload by injecting 50 μl of 30% NaCl demonstrated that the CHF heart had lower functional reserve; this may be associated with congestion in coronary microcirculation. Ischemic coronary vascular disorder is not limited to the main coronary arteries, as it occurs in arterioles and capillaries. Capillary disorder in CHF included stenosis, deformed structure, proliferation, and roughened surfaces. This disorder in the coronary artery architecture may contribute to the reduction in myocyte contractility in the setting of heart failure.
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Affiliation(s)
- Jiqiu Chen
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, New York
| | - Elisa Yaniz-Galende
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, New York
| | - Heather J Kagan
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, New York
| | - Lifan Liang
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, New York
| | - Saboor Hekmaty
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, New York
| | - Chiara Giannarelli
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, New York
| | - Roger Hajjar
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, New York
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16
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Jones LG, Sin MK, Hage FG, Kheirbek RE, Morgan CJ, Zile MR, Wu WC, Deedwania P, Fonarow GC, Aronow WS, Prabhu SD, Fletcher RD, Ahmed A, Allman RM. Characteristics and outcomes of patients with advanced chronic systolic heart failure receiving care at the Veterans Affairs versus other hospitals: insights from the Beta-blocker Evaluation of Survival Trial (BEST). Circ Heart Fail 2014; 8:17-24. [PMID: 25480782 DOI: 10.1161/circheartfailure.114.001300] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Characteristics and outcomes of patients with heart failure and reduced ejection fraction receiving care at Veterans Affairs (VA) versus non-VA hospitals have not been previously reported. METHODS AND RESULTS In the randomized controlled Beta-blocker Evaluation of Survival Trial (BEST; 1995-1999), of the 2707 (bucindolol=1353; placebo=1354) patients with heart failure and left ventricular ejection fraction ≤35%, 918 received care at VA hospitals, of which 98% (n=898) were male. Of the 1789 receiving care at non-VA hospitals, 68% (n=1216) were male. Our analyses were restricted to these 2114 male patients. VA patients were older with higher symptom and comorbidity burdens. There was no significant between-group difference in unadjusted primary end point of 2-year all-cause mortality (35% VA versus 32% non-VA; hazard ratio associated with VA hospitals, 1.09; 95% confidence interval, 0.94-1.26), which remained unchanged after adjustment for age and race (hazard ratio, 1.00; 95% confidence interval, 0.86-1.16) or multivariable adjustment, including cardiovascular morbidities (hazard ratio, 0.94; 95% confidence interval, 0.80-1.10). There was no between-group difference in cause-specific mortalities or hospitalizations. Chronic kidney disease, pulmonary edema, left ventricular ejection fraction <20%, and peripheral arterial disease were significant predictors of mortality for both groups. African America race, New York Heart Association class IV symptoms, atrial fibrillation, and right ventricular ejection fraction <20% were associated with higher mortality among non-VA hospital patients only; however, these differences from VA patients were not significant. CONCLUSIONS Patients with heart failure and reduced ejection fraction receiving care at VA hospitals were older and sicker; yet their risk of mortality and hospitalization was similar to younger and healthier patients receiving care at non-VA hospitals. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00000560.
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Affiliation(s)
- Linda G Jones
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Mo-Kyung Sin
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Fadi G Hage
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Raya E Kheirbek
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Charity J Morgan
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Michael R Zile
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Wen-Chih Wu
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Prakash Deedwania
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Gregg C Fonarow
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Wilbert S Aronow
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Sumanth D Prabhu
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Ross D Fletcher
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
| | - Ali Ahmed
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
| | - Richard M Allman
- From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.)
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Kusumoto FM, Calkins H, Boehmer J, Buxton AE, Chung MK, Gold MR, Hohnloser SH, Indik J, Lee R, Mehra MR, Menon V, Page RL, Shen WK, Slotwiner DJ, Stevenson LW, Varosy PD, Welikovitch L. HRS/ACC/AHA Expert Consensus Statement on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials. J Am Coll Cardiol 2014; 64:1143-77. [DOI: 10.1016/j.jacc.2014.04.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Rusinaru D, Houpe D, Szymanski C, Lévy F, Maréchaux S, Tribouilloy C. Coronary artery disease and 10-year outcome after hospital admission for heart failure with preserved and with reduced ejection fraction. Eur J Heart Fail 2014; 16:967-76. [PMID: 25111982 DOI: 10.1002/ejhf.142] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/22/2014] [Accepted: 06/27/2014] [Indexed: 11/08/2022] Open
Abstract
AIMS The prognostic impact of coronary artery disease (CAD) in heart failure is debated. Whereas causes of death have been well described in patients with cardiomyopathy, little is known about how CAD influences causes of death in heart failure with preserved ejection fraction (HFPEF). We undertook a 10-year study and analysed causes of death in relation with CAD in HFPEF and in heart failure with reduced ejection fraction (HFREF). METHODS AND RESULTS Our prospective analysis included 591 consecutive patients (320 HFPEF and 271 HFREF) hospitalized for the first time for heart failure during 2000 and followed for 10 years. History of CAD was documented in 25% of HFPEF and 39% of HFREF patients (P < 0.001). Overall, CAD was independently predictive of all-cause and cardiovascular death. CAD had powerful prognostic impact in HFREF [adjusted hazard ratio (HR) 1.60 (1.19-2.15) for all-cause death, and adjusted HR 2.01 (1.38-2.92) for cardiovascular death]. In HFPEF, the association between CAD and cardiovascular death was no longer observed after adjustment [adjusted HR 1.01 (0.69-1.50)]. In HFREF, CAD was associated with increased risk of heart failure-related (adjusted HR 2.03 (1.21-3.43)] and myocardial infarction-related fatal events [adjusted HR 3.84 (1.16-12.7)], while HFPEF patients with CAD appeared at greater risk of sudden death [adjusted HR 2.22 (1.05-4.95)]. CONCLUSION The prognostic impact of CAD is different in HFPEF compared with HFREF. Patients with HFPEF and CAD are at high risk of cardiovascular death, especially sudden death.
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Affiliation(s)
- Dan Rusinaru
- Pôle cardiovasculaire et thoracique, Centre Hospitalier Universitaire Amiens, Amiens, France; Service de Cardiologie, Centre Hospitalier de Saint Quentin, Saint Quentin, France
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HRS/ACC/AHA Expert Consensus Statement on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials. Heart Rhythm 2014; 11:1271-303. [DOI: 10.1016/j.hrthm.2014.03.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Indexed: 01/16/2023]
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Zhang X, Cheng X, Liu H, Zheng C, Rao K, Fang Y, Zhou H, Xiong S. Identification of key genes and crucial modules associated with coronary artery disease by bioinformatics analysis. Int J Mol Med 2014; 34:863-9. [PMID: 24969630 DOI: 10.3892/ijmm.2014.1817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/28/2014] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to identify key genes associated with coronary artery disease (CAD) and to explore the related signaling pathways. Gene expression profiles of 110 CAD and 112 non-CAD, healthy patients [CAD index (CADi) >23 and =0, respectively] were downloaded from the Gene Expression Omnibus (GEO) database (accession: GSE12288). The differentially expressed genes (DEGs) in CAD were identified using t-tests, and protein-protein interaction (PPI) networks for these DEGs were constructed using the Search Tool for the Retrieval of InteractiNg Genes (STRING) database. The Database for Annotation, Visualization and Integrated Discovery (DAVID) tool was used to identify potentially enriched biological processes (BP) among the DEGs using Gene Ontology (GO) terms, and to identify the related pathways using the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway database. In addition, expression-activated subnetworks (crucial modules) of the constructed PPI networks were identified using the jActiveModule plug-in, and their topological properties were analyzed using NetworkAnalyzer, both available from Cytoscape. The patient specimens were classified as grade I, II and III based on CADi values. There were 151 DEGs in grade I, 362 in grade II and 425 in grade III. In the PPI network, the gene GRB2, encoding the growth factor receptor-bound protein 2, was the only common DEG among the three grades. In addition, 10 crucial modules were identified in the PPIs, 4 of which showed significant enrichment for GO BP terms. In the 12 nodes with the highest betweenness centrality, we found two genes, encoding GRB2 and the heat shock 70 kDa protein 8 (HSPA8). Moreover, the chemokine and focal adhesion signaling pathways were selected based on their relative abundance in CAD. The GRB2 and HSPA8 proteins, as well as the chemokine and focal adhension signaling pathways, might therefore be critical for the development of CAD.
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Affiliation(s)
- Xuemei Zhang
- Department of Cardiology, Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, P.R. China
| | - Xiaoshu Cheng
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, P.R. China
| | - Huifeng Liu
- Department of Cardiology, Xiaolan People's Hospital, Zhongshan, Guangdong 528415, P.R. China
| | - Chunhua Zheng
- Department of Cardiology, Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, P.R. China
| | - Kunrui Rao
- Department of Cardiology, Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, P.R. China
| | - Yi Fang
- Department of Cardiology, Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, P.R. China
| | - Hairong Zhou
- Department of Cardiology, Second People's Hospital, Mudanjiang, Heilongjiang 157000, P.R. China
| | - Shenghe Xiong
- Department of Cardiology, Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, P.R. China
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Kusumoto FM, Calkins H, Boehmer J, Buxton AE, Chung MK, Gold MR, Hohnloser SH, Indik J, Lee R, Mehra MR, Menon V, Page RL, Shen WK, Slotwiner DJ, Stevenson LW, Varosy PD, Welikovitch L. HRS/ACC/AHA expert consensus statement on the use of implantable cardioverter-defibrillator therapy in patients who are not included or not well represented in clinical trials. Circulation 2014; 130:94-125. [PMID: 24815500 DOI: 10.1161/cir.0000000000000056] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Fred M Kusumoto
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Hugh Calkins
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - John Boehmer
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Alfred E Buxton
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Mina K Chung
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Michael R Gold
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Stefan H Hohnloser
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Julia Indik
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Richard Lee
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Mandeep R Mehra
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Venu Menon
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Richard L Page
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Win-Kuang Shen
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - David J Slotwiner
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Lynne Warner Stevenson
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Paul D Varosy
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Lisa Welikovitch
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
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Five-year survival of patients with chronic systolic heart failure of ischemic and non-ischemic etiology: analysis of prognostic factors. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 11:56-62. [PMID: 26336396 PMCID: PMC4283904 DOI: 10.5114/kitp.2014.41933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 11/26/2013] [Accepted: 02/13/2014] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Despite advances in pharmacotherapy, electrotherapy and interventional treatment, chronic heart failure (HF) is still associated with poor long-term outcome. AIM OF THE STUDY To determine the death rate and risk factors in patients with HF of ischemic and non-ischemic etiology in five-year follow-up. MATERIAL AND METHODS Consecutive patients with chronic systolic HF hospitalized in the period 2006-2008 were analyzed retrospectively. Study exclusion criteria were: infections (< 3 months before hospitalization), hemodynamically significant valve disease, advanced chronic kidney disease, liver cirrhosis and neoplastic diseases (< 5 years before hospitalization). RESULTS The analysis encompassed 266 patients divided into two groups: Group A, with HF of ischemic etiology (n = 157), and Group B, with HF of non-ischemic etiology (n = 109). Mortality was significantly higher in Group A than in Group B (49% vs. 28.4%, p = 0.001). The independent risk factors for death in Group A were: New York Heart Association (NYHA) class (HR = 1.81; p < 0.001); concentrations of high-sensitivity C-reactive protein (hs-CRP) (HR = 1.01; p < 0.05), fibrinogen (HR = 1.04; p < 0.001) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) (HR = 1.02; p < 0.001); and right ventricular end-diastolic diameter (RVEDd) (HR = 1.07; p < 0.01). In Group B they were age (HR = 1.07; p < 0.05) and NT-proBNP concentration (HR = 1.03; p < 0.001). CONCLUSIONS Mortality was significantly lower in Group B than in Group A. The independent risk factors for death in Group B were age and NT-proBNP serum concentration, whilst in Group A they were NYHA class, serum concentrations of hs-CRP, NT-proBNP and fibrinogen, and RVEDd.
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Shirani J. Is ischemia the most powerful indicator of myocardial viability? Curr Cardiol Rep 2013; 15:354. [PMID: 23512623 DOI: 10.1007/s11886-013-0354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chronic symptomatic ischemic heart failure remains a major cause of morbidity and mortality in the adult. Recently, the utility of coronary revascularization in early management of patients with stable ischemic heart failure has come into question by several randomized clinical trials. Some of these studies have also challenged the notion that determination of the predominant state of the dysfunctional left ventricular myocardium (viable or scarred) may facilitate identification of patients who would benefit the most from revascularization. These prospective, randomized, multi-center trials have also exposed many of the practical impediments to conducting an ideal clinical investigation particularly in the context of increasingly recognized need for goal-directed and personalized approaches to management of ischemic heart disease. This review summarizes the present evidence for an ischemia-guided approach to evaluation and treatment of chronic ischemic heart disease with left ventricular systolic dysfunction.
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Affiliation(s)
- Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA.
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Pinto N, Haluska B, Mundy J, Griffin R, Wood A, Shah P. Ischemic cardiomyopathy: midterm survival and its predictors. Asian Cardiovasc Thorac Ann 2013; 20:669-74. [PMID: 23284108 DOI: 10.1177/0218492312442509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND the aim of the study was to analyze all-cause mortality and predictors of long-term survival after myocardial revascularization for ischemic cardiomyopathy. METHOD data of 101 patients (mean age, 63.86 years; age range, 30-85 years; 92% male), operated on with stable coronary artery disease and left ventricular ejection fraction <30% between April 2000 and June 2010, were analyzed. RESULTS operative mortality was 1.9% (2/101). There was a significant improvement in left ventricular ejection fraction from 25.99% ± 3.8% preoperatively to 34% ± 12% postoperatively (p <0.0001). The mean duration of follow-up was 56.3 ± 33 months, and it was 97% complete (98/101). There were 18/96 (18.75%) late deaths. Overall actuarial survival at 1, 3, 5, and 10 years was 96%, 89%, 83% and 75%, respectively. Univariate predictors of late death were preoperative arrhythmia, cerebrovascular disease, peripheral vascular disease, and logistic EuroSCORE. Multivariate predictors of late death were cerebrovascular disease and preoperative arrhythmia. CONCLUSION our study suggests that myocardial revascularization for ischemic cardiomyopathy improves left ventricular ejection fraction and is associated with favorable long-term survival. Patients with cerebrovascular disease and preoperative arrhythmias had poorer outcomes.
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Affiliation(s)
- Nigel Pinto
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Australia
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Mentz RJ, Allen BD, Kwasny MJ, Konstam MA, Udelson JE, Ambrosy AP, Fought AJ, Vaduganathan M, O'Connor CM, Zannad F, Maggioni AP, Swedberg K, Bonow RO, Gheorghiade M. Influence of documented history of coronary artery disease on outcomes in patients admitted for worsening heart failure with reduced ejection fraction in the EVEREST trial. Eur J Heart Fail 2012; 15:61-8. [PMID: 22968743 DOI: 10.1093/eurjhf/hfs139] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS Data on the prognosis of heart failure (HF) patients with coronary artery disease (CAD) have been conflicting. We describe the clinical characteristics and mode-specific outcomes of HF patients with reduced ejection fraction (EF) and documented CAD in a large randomized trial. METHODS AND RESULTS EVEREST was a prospective, randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with worsening HF and reduced EF. Patients were classified as having CAD based on patient-reported myocardial infarction (MI) or coronary revascularization. We analysed the characteristics and outcomes [all-cause mortality and cardiovascular (CV) mortality/HF hospitalization] of patients with and without documented CAD. All events were centrally adjudicated. Documented CAD was present in 2353 patients (57%). Patients with CAD were older and had more co-morbidities compared with those without CAD. Patients with CAD were more likely to receive a beta-blocker, but less likely to receive an angiotensin-converting enzyme (ACE) inhibitor or aldosterone antagonist (P < 0.01). After risk adjustment, patients with documented CAD had similar mortality [hazard ratio (HR) 1.12, 95% confidence interval (CI) 0.97-1.30], but were at an increased risk for CV mortality/HF hospitalization (HR 1.25, 95% CI 1.12-1.41) due to an increased risk for HF hospitalization (HR 1.26, 95% CI 1.10-1.44). Patients with CAD had increased HF- and MI-related events, but similar rates of sudden cardiac death. CONCLUSION Documented CAD in patients hospitalized for worsening HF with reduced EF was associated with a higher burden of co-morbidities, lower use of HF therapies (except beta-blockers), and increased HF hospitalization, while all-cause mortality was similar.
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Current World Literature. Curr Opin Cardiol 2012; 27:318-26. [DOI: 10.1097/hco.0b013e328352dfaf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ahmed A, Fonarow GC, Zhang Y, Sanders PW, Allman RM, Arnett DK, Feller MA, Love TE, Aban IB, Levesque R, Ekundayo OJ, Dell'Italia LJ, Bakris GL, Rich MW. Renin-angiotensin inhibition in systolic heart failure and chronic kidney disease. Am J Med 2012; 125:399-410. [PMID: 22321760 PMCID: PMC3324926 DOI: 10.1016/j.amjmed.2011.10.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 10/03/2011] [Accepted: 10/04/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND The role of renin-angiotensin inhibition in older patients with systolic heart failure with chronic kidney disease remains unclear. METHODS Of the 1665 patients (aged≥65 years) with systolic heart failure (ejection fraction<45%) and chronic kidney disease (estimated glomerular filtration rate<60 mL/min/1.73 m(2)), 1046 received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Propensity scores for the receipt of these drugs, estimated for each of the 1665 patients, were used to assemble a matched cohort of 444 pairs of patients receiving and not receiving these drugs who were balanced on 56 baseline characteristics. RESULTS During more than 8 years of follow-up, all-cause mortality occurred in 75% and 79% of matched patients with chronic kidney disease receiving and not receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, respectively (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.74-0.996; P=.045). There was no significant association with heart failure hospitalization (HR, 0.86; 95% CI, 0.72-1.03; P=.094). Similar mortality reduction (HR, 0.83; 95% CI, 0.70-1.00; P=.046) occurred in a subgroup of matched patients with estimated glomerular filtration rate less than 45 mL/min/1.73 m(2). Among 171 pairs of propensity-matched patients without chronic kidney disease, the use of these drugs was associated with a significant reduction in all-cause mortality (HR, 0.72; 95% CI, 0.55-0.94; P=.015) and heart failure hospitalization (HR, 0.71; 95% CI, 0.52-0.95; P=.023). CONCLUSION Discharge prescription of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant modest reduction in all-cause mortality in older patients with systolic heart failure with chronic kidney disease, including those with more advanced chronic kidney disease.
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Affiliation(s)
- Ali Ahmed
- University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA.
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Kozdag G, Ertas G, Emre E, Yaymaci M, Celikyurt U, Kahraman G, Yilmaz I, Kuruüzüm K, Ural D. A Turkish perspective on coronary artery bypass surgery and percutaneous coronary artery intervention in chronic heart failure patients. Angiology 2012; 64:125-30. [PMID: 22334879 DOI: 10.1177/0003319711436074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The impact of coronary revascularization methods (coronary artery bypass graft [CABG] surgery and stent implantation) on clinical outcome has not been determined yet in patients with systolic heart failure (SHF). We examined outcomes in patients discharged from our hospital after hospitalization for decompensated SHF. Of 637 patients with SHF (mean age, 64 ± 13 years; mean ejection fraction, 26.5% ± 9%), 402 patients (63%) had coronary artery disease (CAD) and 235 patients (37%) had no CAD; 223 patients (35%) died because of cardiovascular reasons during follow-up. Patients who had stenting alone and patients who had CABG surgery and stenting had better prognosis than patients with CAD but no revascularization procedure (P < .001 and P = .013, respectively). In the patients with SHF having CAD who had stenting and CABG surgery + stenting may have better prognosis compared with patients with CAD who had no revascularization procedure in their past.
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Affiliation(s)
- Güliz Kozdag
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Zhang Y, Kilgore ML, Arora T, Mujib M, Ekundayo OJ, Aban IB, Feller MA, Desai RV, Love TE, Allman RM, Fonarow GC, Ahmed A. Design and rationale of studies of neurohormonal blockade and outcomes in diastolic heart failure using OPTIMIZE-HF registry linked to Medicare data. Int J Cardiol 2011; 166:230-5. [PMID: 22119116 DOI: 10.1016/j.ijcard.2011.10.089] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/04/2011] [Accepted: 10/18/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure (HF) is the leading cause of hospitalization for Medicare beneficiaries. Nearly half of all HF patients have diastolic HF or HF with preserved ejection fraction (HF-PEF). Because these patients were excluded from major randomized clinical trials of neurohormonal blockade in HF there is little evidence about their role in HF-PEF. METHODS The aims of the American Recovery & Reinvestment Act-funded National Heart, Lung, and Blood Institute-sponsored "Neurohormonal Blockade and Outcomes in Diastolic Heart Failure" are to study the long-term effects of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and aldosterone antagonists in four separate propensity-matched populations of HF-PEF patients in the OPTIMIZE-HF (Organized Program to Initiate Life-Saving Treatment in Hospitalized Patients with Heart Failure) registry. Of the 48,612 OPTIMIZE-HF hospitalizations occurring during 2003-2004 in 259 U.S. hospitals, 20,839 were due to HF-PEF (EF ≥40%). For mortality and hospitalization we used Medicare national claims data through December 31, 2008. RESULTS Using a two-step (hospital-level and hospitalization-level) probabilistic linking approach, we assembled a cohort of 11,997 HF-PEF patients from 238 OPTIMIZE-HF hospitals. These patients had a mean age of 75 years, mean EF of 55%, were 62% women, 15% African American, and were comparable with community-based HF-PEF cohorts in key baseline characteristics. CONCLUSIONS The assembled Medicare-linked OPTIMIZE-HF cohort of Medicare beneficiaries with HF-PEF with long-term outcomes data will provide unique opportunities to study clinical effectivenss of various neurohormonal antagonists with outcomes in HF-PEF using propensity-matched designs that allow outcome-blinded assembly of balanced cohorts, a key feature of randomized clinical trials.
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Affiliation(s)
- Yan Zhang
- University of Alabama at Birmingham, Birmingham, AL 35294–2041, USA
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