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Clinical Characteristics and Predictors of In-Hospital Mortality among Older Patients with Acute Heart Failure. J Clin Med 2022; 11:jcm11020439. [PMID: 35054133 PMCID: PMC8781633 DOI: 10.3390/jcm11020439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/17/2022] Open
Abstract
Acute Heart Failure (AHF)-related hospitalizations and mortality are still high in western countries, especially among older patients. This study aimed to describe the clinical characteristics and predictors of in-hospital mortality of older patients hospitalized with AHF. We conducted a retrospective study including all consecutive patients ≥65 years who were admitted for AHF at a single academic medical center between 1 January 2008 and 31 December 2018. The primary outcome was all-cause, in-hospital mortality. We also analyzed deaths due to cardiovascular (CV) and non-CV causes and compared early in-hospital events. The study included 6930 patients, mean age 81 years, 51% females. The overall mortality rate was 13%. Patients ≥85 years had higher mortality and early death rate than younger patients. Infections were the most common condition precipitating AHF in our cohort, and pneumonia was the most frequent of these. About half of all hospital deaths were due to non-CV causes. After adjusting for confounding factors other than NYHA class at admission, infections were associated with an almost two-fold increased risk of mortality, HR 1.74, 95% CI 1.10-2.71 in patients 65-74 years (p = 0.014); HR 1.83, 95% CI 1.34-2.49 in patients 75-84 years (p = 0.001); HR 1.74, 95% CI 1.24-2.19 in patients ≥85 years (p = 0.001). In conclusion, among older patients with AHF, in-hospital mortality rates increased with increasing age, and infections were associated with an increased risk of in-hospital mortality. In contemporary patients with AHF, along with the treatment of the CV conditions, management should be focused on timely diagnosis and appropriate treatment of non-CV factors, especially pulmonary infections.
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Januzzi JL, Tan X, Yang L, Brady JE, Yang M, Banka P, Lautsch D. N-terminal pro-B-type natriuretic peptide testing patterns in patients with heart failure with reduced ejection fraction. ESC Heart Fail 2021; 9:87-99. [PMID: 34918487 PMCID: PMC8787988 DOI: 10.1002/ehf2.13749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is a commonly used biomarker in heart failure for diagnosis and prognostication. We aimed to determine the prevalence of NT‐proBNP testing, distribution of NT‐proBNP concentrations, and factors associated with receiving an NT‐proBNP test in patients with heart failure with reduced ejection fraction (HFrEF), including the subset with a worsening heart failure event (WHFE). Methods and results This was a retrospective cohort study using two US databases: (i) the de‐identified Humana Research Database between January 2015 and December 2018 and (ii) the Veradigm PINNACLE Registry® between July 2013 and September 2017. We included adult patients with a confirmed diagnosis of HFrEF. In each data source, a subgroup of patients with a WHFE was identified, where a WHFE was defined as a heart failure‐related hospitalization or receipt of intravenous diuretics. Bivariate and multivariate analyses were conducted to assess factors associated with receiving NT‐proBNP testing. In Cohort 1 (n = 249 238), 9.2% of patients with HFrEF and 10.8% of patients with a WHFE received NT‐proBNP testing. When restricted to patients with at least one laboratory claim, 11.3% of patients with HFrEF and 13.2% of those with a WHFE received NT‐proBNP testing. In Cohort 2 (n = 91 444), 2.3% of patients with HFrEF were tested. Median (inter‐quartile range) NT‐proBNP concentrations among patients with HFrEF were 1399 (423–4087) pg/mL in Cohort 1 and 394 (142–688) pg/mL in Cohort 2. Median (inter‐quartile range) NT‐proBNP concentrations in the subset of patients with a WHFE in each cohort were 2209 (740–5894) and 464 (174–783) pg/mL, respectively. In Cohort 1, 13.4% of all HFrEF patients receiving NT‐proBNP testing and 18.9% of patients with a WHFE had NT‐proBNP values >8000 pg/mL; in Cohort 2, these percentages were 1.0% and 2.5%, respectively. Conclusions In US clinical practice, NT‐proBNP testing was not frequently performed in patients with HFrEF. NT‐proBNP concentrations varied across data sources and subpopulations within HFrEF.
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Affiliation(s)
- James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Baim Institute for Clinical Research, Boston, MA, USA
| | - Xi Tan
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | - Mei Yang
- Merck & Co., Inc., Kenilworth, NJ, USA
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Huerta-Preciado J, Franco J, Formiga F, Iborra PL, Epelde F, Franco ÁG, Ormaechea G, Manzano L, Cepeda-Rodrigo JM, Montero-Pérez-Barquero M. Differential characteristics of acute heart failure in very elderly patients: the prospective RICA study. Aging Clin Exp Res 2020; 32:1789-1799. [PMID: 31621036 DOI: 10.1007/s40520-019-01363-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/21/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Acute heart failure (AHF) is a frequent epidemic in geriatrics. The main aim of this study was to evaluate the clinical and prognostic differences of very elderly patients with AHF compared to the rest, and evaluate the factors associated with 90-day mortality. METHODS We analyzed 3828 patients hospitalized for AHF with an age of ≥ 70 years. The population was divided into three groups: 70-79, 80-89 and ≥ 90 years old (nonagenarians). The baseline characteristics of patients nonagenarians were compared with the rest. In the group of nonagenarians, their clinical characteristics were analyzed according to the left ventricular ejection fraction (LVEF) and the factors associated with mortality at 90 days of follow-up. RESULTS Nonagenarians showed higher comorbidity and cognitive deterioration, worse basal functional status, and preserved LVEF. Alternatively, they presented a lower rate of diabetes mellitus, lower incidence of de novo AHF, and lower prescription of angiotensin-converting-enzyme inhibitors, aldosterone blockers, anticoagulants, and statins at hospital discharge. Of the total, 334 patients (9.3%) had died by 90 days. The 90-day mortality rate was highest in nonagenarians (7.1% vs 9.8% vs 17%; p = 0.001). Multivariate analysis showed that renal failure, New York Heart Association (NYHA) functional classifications of III-IV, and a more advanced functional deterioration at baseline are predictors of mortality within 90 days. CONCLUSIONS The AHF in patients nonagenarians has a different clinical profile compared to younger patients and a higher mortality. In this subgroup of patients having a worse baseline functional status, higher NYHA classification (III-IV), and renal failure are predictors of 90-day mortality.
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Affiliation(s)
- Jorge Huerta-Preciado
- Department of Internal Medicine, Hospital Universitario Quirón Dexeus, Barcelona, Spain.
| | - Jonathan Franco
- Department of Internal Medicine, Hospital Universitario Quirón Dexeus, Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Hospital Universitario Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Pau Llácer Iborra
- Department of Internal Medicine, Hospital de Manises, Manises, Spain
| | - Francisco Epelde
- Short-Stay Unit, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Álvaro González Franco
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Gabriela Ormaechea
- Multidisciplinary Unit on Heart Failure, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - Luis Manzano
- Department of Internal Medicine, Hospital Universitario Ramón y Cajal, Universidad de Alcalá/IRYCIS, Madrid, Spain
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Boully C, Vidal JS, Guibert E, Ghazali FN, Pesce A, Beauplet B, Roger JD, Carrière I, Timbely B, Idiri H, Constensoux JP, Durocher AM, Dubail D, Fargier M, Jeandel C, Berrut G, Hanon O. National survey on the management of heart failure in individuals over 80 years of age in French geriatric care units. BMC Geriatr 2019; 19:204. [PMID: 31370798 PMCID: PMC6670218 DOI: 10.1186/s12877-019-1215-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the prevalence and management of heart failure (HF) in very old patients in geriatric settings. METHODS Members of the French Society of Geriatrics and Gerontology throughout France were invited to participate in a point prevalence survey and to include all patients ≥80 years old, hospitalized in geriatric settings, with HF (stable or decompensated) on June 18, 2012. General characteristics, presence of comorbidities, blood tests and medications were recorded. RESULTS Among 7,197 patients in geriatric institution, prevalence of HF was 20.5% (n = 1,478): (27% in acute care, 24.2% in rehabilitation care and 18% in nursing home). Mean age was 88.2 (SD = 5.2) and Charlson co morbidity score was high (8.49 (SD = 2.21)). Left ventricular ejection fraction (LVEF) was available in 770 (52%) patients: 536 (69.6%) had a preserved LVEF (≥ 50%), 120 (15.6%) a reduced LVEF (< 40%), and 114 (14.8%) a midrange LVEF (40-49%). Prescription of recommended HF drugs was low: 42.6% (629) used Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARBs), 48.0% (709) β-blockers, and 21.9% (324) ACEI or ARB with β-blockers, even in reduced LVEF. In multivariate analysis ACEI or ARBs were more often used in patients with myocardial infarction (1.36 (1.04-1.78)), stroke (1.42 (1.06-1.91)), and diabetes (1.54 (1.14-2.06)). β blockers were more likely used in patients with myocardial infarction (2.06 (1.54-2.76)) and atrial fibrillation (1.70 (1.28-2.28)). CONCLUSION In this large very old population, prevalence of HF was high. Recommended HF drugs were underused even in reduced LVEF. These results indicate that management of HF in geriatric settings can still be improved.
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Affiliation(s)
- Clémence Boully
- Assistance Publique des Hopitaux de Paris, Hopital Broca, 54-56 rue Pascal, 75013, Paris, France.,Sorbonne Paris-Cité, Université Paris-Descartes, Equipe d'Accueil 4468, Paris, France
| | - Jean-Sébastien Vidal
- Assistance Publique des Hopitaux de Paris, Hopital Broca, 54-56 rue Pascal, 75013, Paris, France.,Sorbonne Paris-Cité, Université Paris-Descartes, Equipe d'Accueil 4468, Paris, France
| | - Etienne Guibert
- Ma Maison, Les Petites Sœurs des pauvres, 33000, Bordeaux, Paris, France.,Ma Maison, Les Petites Sœurs des pauvres, 47000, Agen, Paris, France.,Ma Maison, Les Petites Sœurs des pauvres, 17100, Saintes, Paris, France
| | - Fanny Nisrin Ghazali
- GH Nord-Vienne, Pole 4, Gériatrie, Soins de suite, HAD, 86100, Chatellerault, Paris, France
| | - Alain Pesce
- CH Princesse-Grace, Centre Rainier III, 98000, Monaco, Monaco
| | | | | | | | - Boubacar Timbely
- CH de Meaux, Service soins de suite, 77100, Meaux, Paris, France
| | | | | | | | - Delphine Dubail
- Assistance Publique des Hopitaux de Paris, Hopital Broca, 54-56 rue Pascal, 75013, Paris, France.,Sorbonne Paris-Cité, Université Paris-Descartes, Equipe d'Accueil 4468, Paris, France.,ORPEA Clamart Maison Blanche, 92140, Clamart, France.,Orpea Résidence La Chanterelle, 93310, Le Pre-Saint-Gervais, Paris, France
| | - Marc Fargier
- CH de Saint-Galmier, 42330, Saint-Galmier, Paris, France
| | - Claude Jeandel
- CHU de Montpellier, Centre Antonin Balmès, 34000, Montpellier, Paris, France
| | - Gilles Berrut
- CHU de Nantes, Hôpital Bellier, 44300, Nantes, Paris, France
| | - Olivier Hanon
- Assistance Publique des Hopitaux de Paris, Hopital Broca, 54-56 rue Pascal, 75013, Paris, France. .,Sorbonne Paris-Cité, Université Paris-Descartes, Equipe d'Accueil 4468, Paris, France.
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Age-dependent differences in clinical phenotype and prognosis in heart failure with mid-range ejection compared with heart failure with reduced or preserved ejection fraction. Clin Res Cardiol 2019; 108:1394-1405. [PMID: 30980205 DOI: 10.1007/s00392-019-01477-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/08/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND HFmrEF has been recently proposed as a distinct HF phenotype. How HFmrEF differs from HFrEF and HFpEF according to age remains poorly defined. We aimed to investigate age-dependent differences in heart failure with mid-range (HFmrEF) vs. preserved (HFpEF) and reduced (HFrEF) ejection fraction. METHODS AND RESULTS 42,987 patients, 23% with HFpEF, 22% with HFmrEF and 55% with HFrEF, enrolled in the Swedish heart failure registry were studied. HFpEF prevalence strongly increased, whereas that of HFrEF strongly decreased with higher age. All cardiac comorbidities and most non-cardiac comorbidities increased with aging, regardless of the HF phenotype. Notably, HFmrEF resembled HFrEF for ischemic heart disease prevalence in all age groups, whereas regarding hypertension it was more similar to HFpEF in age ≥ 80 years, to HFrEF in age < 65 years and intermediate in age 65-80 years. All-cause mortality risk was higher in HFrEF vs. HFmrEF for all age categories, whereas HFmrEF vs. HFpEF reported similar risk in ≥ 80 years old patients and lower risk in < 65 and 65-80 years old patients. Predictors of mortality were more likely cardiac comorbidities in HFrEF but more likely non-cardiac comorbidities in HFpEF and HFmrEF with < 65 years. Differences among HF phenotypes for comorbidities were less pronounced in the other age categories. CONCLUSION HFmrEF appeared as an intermediate phenotype between HFpEF and HFrEF, but for some characteristics such as ischemic heart disease more similar to HFrEF. With aging, HFmrEF resembled more HFpEF. Prognosis was similar in HFmrEF vs. HFpEF and better than in HFrEF.
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6
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Lee JY, Sunwoo JS, Kwon KY, Roh H, Ahn MY, Lee MH, Park BW, Hyon MS, Lee KB. Left Ventricular Ejection Fraction Predicts Poststroke Cardiovascular Events and Mortality in Patients without Atrial Fibrillation and Coronary Heart Disease. Korean Circ J 2018; 48:1148-1156. [PMID: 30403019 PMCID: PMC6221865 DOI: 10.4070/kcj.2018.0115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It is controversial that decreased left ventricular function could predict poststroke outcomes. The purpose of this study is to elucidate whether left ventricular ejection fraction (LVEF) can predict cardiovascular events and mortality in acute ischemic stroke (AIS) without atrial fibrillation (AF) and coronary heart disease (CHD). METHODS Transthoracic echocardiography was conducted consecutively in patients with AIS or transient ischemic attack at Soonchunhyang University Hospital between January 2008 and July 2016. The clinical data and echocardiographic LVEF of 1,465 patients were reviewed after excluding AF and CHD. Poststroke disability, major adverse cardiac events (MACE; nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and all-cause mortality during 1 year after index stroke were prospectively captured. Cox proportional hazards regressions analysis were applied adjusting traditional risk factors and potential determinants. RESULTS The mean follow-up time was 259.9±148.8 days with a total of 29 non-fatal strokes, 3 myocardial infarctions, 33 cardiovascular deaths, and 53 all-cause mortality. The cumulative incidence of MACE and all-cause mortality were significantly higher in the lowest LVEF (<55) group compared with the others (p=0.022 and 0.009). In prediction models, LVEF (per 10%) had hazards ratios of 0.54 (95% confidence interval [CI], 0.36-0.80, p=0.002) for MACE and 0.61 (95% CI, 0.39-0.97, p=0.037) for all-cause mortality. CONCLUSIONS LVEF could be an independent predictor of cardiovascular events and mortality after AIS in the absence of AF and CHD.
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Affiliation(s)
- Jeong Yoon Lee
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Jun Sang Sunwoo
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Kyum Yil Kwon
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Hakjae Roh
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Moo Young Ahn
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Min Ho Lee
- Department of Cardiology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Byoung Won Park
- Department of Cardiology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Min Su Hyon
- Department of Cardiology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea.
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7
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Atrial Fibrillation in Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction. JACC-HEART FAILURE 2017; 5:565-574. [DOI: 10.1016/j.jchf.2017.05.001] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/26/2017] [Accepted: 05/01/2017] [Indexed: 12/28/2022]
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8
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Takabayashi K, Ikuta A, Okazaki Y, Ogami M, Iwatsu K, Matsumura K, Ikeda T, Ichinohe T, Morikami Y, Yamamoto T, Fujita R, Takenaka K, Takenaka H, Haruna Y, Muranaka H, Ozaki M, Kitamura T, Kitaguchi S, Nohara R. Clinical Characteristics and Social Frailty of Super-Elderly Patients With Heart Failure ― The Kitakawachi Clinical Background and Outcome of Heart Failure Registry ―. Circ J 2017; 81:69-76. [DOI: 10.1253/circj.cj-16-0914] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Mariko Ogami
- Department of Cardiology, Hirakata Kohsai Hospital
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | | | - Tsutomu Ikeda
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | | | | | | | - Ryoko Fujita
- Department of Cardiology, Hirakata Kohsai Hospital
| | | | | | | | | | | | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | | | - Ryuji Nohara
- Department of Cardiology, Hirakata Kohsai Hospital
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Jhund PS, Fu M, Bayram E, Chen CH, Negrusz-Kawecka M, Rosenthal A, Desai AS, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR, McMurray JJV, Packer M. Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HF. Eur Heart J 2015; 36:2576-84. [PMID: 26231885 PMCID: PMC4595742 DOI: 10.1093/eurheartj/ehv330] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/25/2015] [Indexed: 12/11/2022] Open
Abstract
Background The age at which heart failure develops varies widely between countries and drug tolerance and outcomes also vary by age. We have examined the efficacy and safety of LCZ696 according to age in the Prospective comparison of angiotensin receptor neprilysin inhibitor with angiotensin converting enzyme inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure trial (PARADIGM-HF). Methods In PARADIGM-HF, 8399 patients aged 18–96 years and in New York Heart Association functional class II–IV with an LVEF ≤40% were randomized to either enalapril or LCZ696. We examined the pre-specified efficacy and safety outcomes according to age category (years): <55 (n = 1624), 55–64 (n = 2655), 65–74 (n = 2557), and ≥75 (n = 1563). Findings The rate (per 100 patient-years) of the primary outcome of cardiovascular (CV) death or heart failure hospitalization (HFH) increased from 13.4 to 14.8 across the age categories. The LCZ696:enalapril hazard ratio (HR) was <1.0 in all categories (P for interaction between age category and treatment = 0.94) with an overall HR of 0.80 (0.73, 0.87), P < 0.001. The findings for HFH were similar for CV and all-cause mortality and the age category by treatment interactions were not significant. The pre-specified safety outcomes of hypotension, renal impairment and hyperkalaemia increased in both treatment groups with age, although the differences between treatment (more hypotension but less renal impairment and hyperkalaemia with LCZ696) were consistent across age categories. Interpretation LCZ696 was more beneficial than enalapril across the spectrum of age in PARADIGM-HF with a favourable benefit–risk profile in all age groups.
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Affiliation(s)
- Pardeep S Jhund
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Michael Fu
- Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden
| | | | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | | | | | - Akshay S Desai
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Adel R Rizkala
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Jean L Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada
| | - Victor C Shi
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Scott D Solomon
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden National Heart and Lung Institute, Imperial College, London, UK
| | - Michael R Zile
- Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Milton Packer
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Cermakova P, Lund LH, Fereshtehnejad SM, Johnell K, Winblad B, Dahlström U, Eriksdotter M, Religa D. Heart failure and dementia: survival in relation to types of heart failure and different dementia disorders. Eur J Heart Fail 2015; 17:612-9. [PMID: 25581033 PMCID: PMC4674979 DOI: 10.1002/ejhf.222] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 11/17/2014] [Accepted: 11/28/2014] [Indexed: 11/28/2022] Open
Abstract
Aims Heart failure (HF) and dementia frequently coexist, but little is known about their types, relationships to each other and prognosis. The aims were to (i) describe patients with HF and dementia, assess (ii) the proportion of specific dementia disorders in types of HF based on ejection fraction and (iii) the prognostic role of types of HF and dementia disorders. Methods and results The Swedish Heart Failure Registry (RiksSvikt) and The Swedish Dementia Registry (SveDem) were record-linked. Associations between dementia disorders and HF types were assessed with multinomial logistic regression and survival was investigated with Kaplan–Meier analysis and multivariable Cox regression. We studied 775 patients found in both registries (55% men, mean age 82 years). Ejection fraction was preserved in 38% of patients, reduced in 34%, and missing in 28%. The proportions of dementia disorders were similar across HF types. Vascular dementia was the most common dementia disorder (36%), followed by other dementias (28%), mixed dementia (20%), and Alzheimer disease (16%). Over a mean follow-up of 1.5 years, 76% of patients survived 1 year. We observed no significant differences in survival with regard to HF type (P = 0.2) or dementia disorder (P = 0.5). After adjustment for baseline covariates, neither HF types nor dementia disorders were independently associated with survival. Conclusions Heart failure with preserved ejection fraction was the most common HF type and vascular dementia was the most common dementia disorder. The proportions of dementia disorders were similar across HF types. Neither HF types nor specific dementia disorders were associated with survival.
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Affiliation(s)
- Pavla Cermakova
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Novum, Blickagången 6, 141 57, Huddinge, Sweden.,International Clinical Research Center and St Anne's University Hospital, Brno, Czech Republic
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Seyed-Mohammad Fereshtehnejad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden
| | - Kristina Johnell
- Karolinska Institutet and Stockholm University, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Aging Research Center, Stockholm, Sweden
| | - Bengt Winblad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Novum, Blickagången 6, 141 57, Huddinge, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Dahlström
- Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden
| | - Maria Eriksdotter
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Dorota Religa
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Novum, Blickagången 6, 141 57, Huddinge, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
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11
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Jankowska EA, Kalicinska E, Drozd M, Kurian B, Banasiak W, Ponikowski P. Comparison of clinical profile and management of outpatients with heart failure with reduced left ventricular ejection fraction treated by general practitioners and cardiologists in contemporary Poland: the results from the DATA-HELP registry. Int J Cardiol 2014; 176:852-8. [PMID: 25156847 DOI: 10.1016/j.ijcard.2014.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/19/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to determine and compare clinical profile and management of outpatients with heart failure with reduced ejection fraction (HFREF) treated by cardiologists and general practitioners (GPs) in Poland. METHODS All the 790 randomly selected cardiologists and GPs in the DATA-HELP registry, which included 5563 patients, filled out questionnaires about 10 consecutive outpatients with HFREF. RESULTS Outpatients managed by GPs were older (69±10 vs 66±12 years), and the prevalence of men was less marked (58% vs 67%). They also had higher left ventricular ejection fraction (38±6% vs 35±8%) and had more pulmonary congestion (63% vs 49%) and peripheral oedema (66% vs 51%), compared with those treated by cardiologists (all p<0.001). Hypertension (74% vs 66%), previous stroke and/or transient ischaemic attack (21% vs 16%), diabetes (40% vs 30%), and chronic obstructive pulmonary disease (14% vs 11%) were more common in outpatients of GPs (all p<0.001). GPs were less likely to prescribe β-blocker (95% vs 97%, p<0.01), mineralocorticoid receptor antagonist (MRA) (56% vs 64%, p<0.001), and loop diuretic (61% vs 64%, p<0.05) or use PCI (33% vs 44%, p<0.001), CABG (11% vs 16%, p<0.001), ICD (4% vs 10%, p<0.001), or CRT (1% vs 5%, p<0.001). Prescription of renin-angiotensin system inhibitors (94% vs 94%, p>0.2) and digoxin (20% vs 21%, p>0.2) by GPs and cardiologists was similar. CONCLUSION In contemporary Poland, most outpatients with HFREF receive drugs that improve survival and undergo revascularisation procedures, although devices are rare, but the clinical profiles and management of those treated by GPs and cardiologists differ. Outpatients treated by GPs are older and have more co-morbidities. Outpatients treated by cardiologists more commonly receive β-blocker, MRA, ICD, and CRT, and undergo coronary revascularisations.
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Affiliation(s)
- Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.
| | - Elzbieta Kalicinska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Marcin Drozd
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Waldemar Banasiak
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
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Moro-García MA, Echeverría A, Galán-Artímez MC, Suárez-García FM, Solano-Jaurrieta JJ, Avanzas-Fernández P, Díaz-Molina B, Lambert JL, López-Larrea C, Morís de la Tassa C, Alonso-Arias R. Immunosenescence and inflammation characterize chronic heart failure patients with more advanced disease. Int J Cardiol 2014; 174:590-9. [PMID: 24801091 DOI: 10.1016/j.ijcard.2014.04.128] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/15/2014] [Accepted: 04/12/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Chronic heart failure (CHF) is characterized by an inflammatory status with high levels of cytokines such as IL-6. We hypothesized that patients with CHF may develop immunosenescence due to inflammation and that this may be associated with a worse stage of the disease. METHODS AND RESULTS We compared the immunological features of 58 elderly CHF patients (ECHF), 40 young CHF patients (YCHF), 60 healthy elderly controls (HEC) and 40 healthy young controls (HYC). We characterized leukocyte and lymphocyte subpopulations by flow cytometry, and IL-6 concentration by ELISA. The extent of CHF was classified according to functional and/or morphological criteria: New York Heart Association functional class, AHA/ACC heart failure stages, left ventricular ejection fraction, and left ventricular hypertrophy. CHF patients showed an increased number of leukocytes, neutrophils and monocytes, but a decreased number of lymphocytes. CHF patients had significantly lower levels of B-cells and CD4+ T-cells, increased NK-cells in YCHF, and increased CD8+ T-cells only in ECHF. CHF was associated with high differentiation in CD4+ and CD8+ T-lymphocyte subsets. Aging of T-lymphocyte subpopulations and high IL-6 levels were associated with a worse clinical status. IL-6 also correlated positively with the number of highly differentiated T-lymphocytes and with their accelerated aging. CONCLUSIONS We conclude that CHF patients show a higher degree of immunosenescence than age-matched healthy controls. T-lymphocyte differentiation and IL-6 levels are increased in patients with an advanced clinical status and may contribute to disease impairment through a compromised adaptive immune response due to accelerated aging of their immune system.
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Affiliation(s)
| | - Ainara Echeverría
- Immunology Department, Hospital Universitario Central de Asturias, 33006 Oviedo, Spain
| | | | | | | | - Pablo Avanzas-Fernández
- Servicio de Cardiología, Área del Corazón, Hospital Universitario Central de Asturias, 33006 Oviedo, Spain
| | - Beatríz Díaz-Molina
- Servicio de Cardiología, Área del Corazón, Hospital Universitario Central de Asturias, 33006 Oviedo, Spain
| | - J L Lambert
- Servicio de Cardiología, Área del Corazón, Hospital Universitario Central de Asturias, 33006 Oviedo, Spain
| | - Carlos López-Larrea
- Immunology Department, Hospital Universitario Central de Asturias, 33006 Oviedo, Spain; Fundación Renal "Iñigo Alvarez de Toledo", Madrid, Spain
| | - Cesar Morís de la Tassa
- Servicio de Cardiología, Área del Corazón, Hospital Universitario Central de Asturias, 33006 Oviedo, Spain
| | - Rebeca Alonso-Arias
- Immunology Department, Hospital Universitario Central de Asturias, 33006 Oviedo, Spain.
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Holmström A, Fu MLX, Hjalmarsson C, Bokemark L, Andersson B. Heart dysfunction in patients with acute ischemic stroke or TIA does not predict all-cause mortality at long-term follow-up. BMC Neurol 2013; 13:122. [PMID: 24053888 PMCID: PMC3852256 DOI: 10.1186/1471-2377-13-122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 09/18/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite heart failure being a substantial risk factor for stroke, few studies have evaluated the predictive value of heart dysfunction for all-cause mortality in patients with acute ischemic stroke, in particular in the elderly. The aim of this study was to investigate whether impaired heart function in elderly patients can predict all-cause mortality after acute ischemic stroke or transient ischemic attack (TIA). METHODS A prospective long-term follow-up analysis was performed on a hospital cohort consisting of n = 132 patients with mean age 73 ± 9 years, presenting with acute ischemic stroke or transient ischemic attack, without atrial fibrillation. All patients were examined by echocardiography during the hospital stay. Data about all-cause mortality were collected at the end of the follow-up period. The mean follow-up period was 56 ± 22 months. RESULTS In this cohort, 58% of patients with acute ischemic stroke or TIA had heart dysfunction. Survival analysis showed that heart dysfunction did not predict all-cause mortality in this cohort. Furthermore, in multivariate regression analysis age (HR 5.401, Cl 1.97-14.78, p < 0.01), smoking (HR 3.181, Cl 1.36-7.47, p < 0.01), myocardial infarction (HR 2.826, Cl 1.17-6.83, p < 0.05) were independent predictors of all-cause mortality. CONCLUSION In this population with acute ischemic stroke or TIA and without non-valvular atrial fibrillation, impaired heart function does not seem to be a significant predictor of all-cause mortality at long-term follow-up.
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Affiliation(s)
- Alexandra Holmström
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Guo Y, Lip GYH, Apostolakis S. The Challenge of Antiplatelet Therapy in Patients with Atrial Fibrillation and Heart Failure. J Cardiovasc Transl Res 2012. [DOI: 10.1007/s12265-012-9427-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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