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Chunawala ZS, Bhatt DL, Qamar A, Vaduganathan M, Mentz RJ, Matsushita K, Grodin JL, Pandey A, Caughey MC. Peripheral artery disease, chronic kidney disease, and recurrent admissions for acute decompensated heart failure: The ARIC study. Atherosclerosis 2024; 395:118521. [PMID: 38968642 DOI: 10.1016/j.atherosclerosis.2024.118521] [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: 03/13/2024] [Revised: 05/09/2024] [Accepted: 06/11/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND AND AIMS Peripheral artery disease (PAD) has not only been associated with recurrent hospitalization for acute decompensated heart failure (ADHF) but is also associated with chronic kidney disease (CKD), a known risk factor for worse heart failure outcomes. The interaction of CKD with PAD in post-discharge ADHF outcomes is not well known. METHODS Since 2005, hospitalizations for ADHF were sampled from 4 US regions by the Atherosclerosis Risk in Communities (ARIC) study and classified by physician review. We examined the adjusted association of PAD with 1-year ADHF readmissions, in patients with and without CKD (defined by glomerular filtration rate [GFR] ≤60 mL/min/1.73 m2 [stage 3a or worse]). RESULTS From 2005 to 2018, there were 1049 index hospitalizations for patients with ADHF (mean age 77 years, 66 % white) with creatinine data, who were discharged alive. Of these, 155 (15 %) had PAD and 66 % had CKD. In comparison to those without PAD, patients with PAD had more comorbid conditions and higher 1-year ADHF readmission rates, irrespective of CKD status. After adjustment, PAD was associated with a greater risk of 1-year ADHF readmissions, both for patients with concomitant CKD (HR, 1.70; 95 % CI: 1.29-2.24) and those without CKD (HR, 1.97; 95 % CI: 1.14-3.40); p-interaction = 0.8. CONCLUSION Among patients hospitalized with ADHF, those with concurrent PAD have more prevalent cardiovascular comorbidities and higher likelihood of 1-year ADHF readmission, irrespective of CKD status. Integrating a more holistic approach in management of patients with concomitant heart failure, PAD and CKD may be an important strategy to improve the prognosis in this vulnerable population.
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Affiliation(s)
- Zainali S Chunawala
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arman Qamar
- Section of Interventional Cardiology, Division of Cardiology, NorthShore University Healthsystem, Evanston, IL, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justin L Grodin
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melissa C Caughey
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, NC, USA.
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Ali MR, Lam CSP, Strömberg A, Hand SPP, Booth S, Zaccardi F, Squire I, McCann GP, Khunti K, Lawson CA. Symptoms and signs in patients with heart failure: association with 3-month hospitalisation and mortality. Heart 2024; 110:578-585. [PMID: 38040451 DOI: 10.1136/heartjnl-2023-323295] [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: 08/04/2023] [Accepted: 11/01/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVES To determine the association between symptoms and signs reported in primary care consultations following a new diagnosis of heart failure (HF), and 3-month hospitalisation and mortality. DESIGN Nested case-control study with density-based sampling. SETTING Clinical Practice Research Datalink, linked to hospitalisation and mortality (1998-2020). PARTICIPANTS Database cohort of 86 882 patients with a new HF diagnosis. In two separate analyses for (1) first hospitalisation and (2) death, we compared the 3-month history of symptoms and signs in cases (patients with HF with the event), with their respective controls (patients with HF without the respective event, matched on diagnosis date (±1 month) and follow-up time). Controls could be included more than once and later become a case. MAIN OUTCOME MEASURES All-cause, HF and non-cardiovascular disease (non-CVD) hospitalisation and mortality. RESULTS During a median follow-up of 3.22 years (IQR: 0.59-8.18), 56 677 (65%) experienced first hospitalisation and 48 146 (55%) died. These cases were matched to 356 714 and 316 810 HF controls, respectively. For HF hospitalisation, the strongest adjusted associations were for symptoms and signs of fluid overload: pulmonary oedema (adjusted OR 3.08; 95% CI 2.52, 3.64), shortness of breath (2.94; 2.77, 3.11) and peripheral oedema (2.16; 2.00, 2.32). Generic symptoms also showed significant associations: depression (1.50; 1.18, 1.82), anxiety (1.35; 1.06, 1.64) and pain (1.19; 1.10, 1.28). Non-CVD hospitalisation had the strongest associations with chest pain (2.93; 2.77, 3.09), fatigue (1.87; 1.73, 2.01), general pain (1.87; 1.81, 1.93) and depression (1.59; 1.44, 1.74). CONCLUSIONS In the primary care HF population, routinely recorded cardiac and non-specific symptoms showed differential risk associations with hospitalisation and mortality.
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Affiliation(s)
- Mohammad Rizwan Ali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, NIHR Leicester Biomedical Research Centre, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Carolyn S P Lam
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Medical School, National University of Singapore, Singapore
| | - Anna Strömberg
- Department of Medical and Health Science, Linkopings universitet, Linkoping, Sweden
- Faculty of Medicine, Linkoping University, Linkoping, Sweden
| | - Simon P P Hand
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Booth
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Cardiovascular Research Unit, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Claire Alexandra Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, NIHR Leicester Biomedical Research Centre, Leicester, UK
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Lee J, Oh O, Park DI, Nam G, Lee KS. Scoping Review of Measures of Comorbidities in Heart Failure. J Cardiovasc Nurs 2024; 39:5-17. [PMID: 37550833 DOI: 10.1097/jcn.0000000000001016] [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: 08/09/2023]
Abstract
BACKGROUND Comorbidities are risk factors for poor clinical outcomes in patients with heart failure. However, no consensus has been reached on how to assess comorbidities related to clinical outcomes in patients with heart failure. OBJECTIVE The aims of this study were to review (1) how comorbidities have been assessed, (2) what chronic conditions have been identified as comorbidities and (3) the rationale for choosing the comorbidity instruments and/or specific comorbidities when exploring clinical outcomes in patients with heart failure. METHODS The clinical outcomes of interest were mortality, hospitalization, quality of life, and self-care. Three electronic databases and reference list searches were used in the search. RESULTS In this review, we included 39 articles using 3 different ways to assess comorbidities in the relationship with clinical outcomes: using an instrument (ie, Charlson Comorbidity Index), disease count, and including individual comorbidities. A total of 90 comorbidities were investigated in the 39 articles; however, definitions and labels for the diseases were inconsistent across the studies. More than half of the studies (n = 22) did not provide a rationale for selecting the comorbidity instruments and/or all of the specific comorbidities. Some of the rationale for choosing the instruments and/or specific comorbidities was inappropriate. CONCLUSIONS We found several issues related to measuring comorbidities when examining clinical outcomes in patients with heart failure. Researchers need to consider these methodological issues when measuring comorbidities in patients with heart failure. Further efforts are needed to develop guidelines on how to choose proper measures for comorbidities.
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Ogura A, Izawa KP, Tawa H, Wada M, Kanai M, Kubo I, Makihara A, Yoshikawa R, Matsuda Y. End-tidal oxygen partial pressure is a strong prognostic predictive factor in patients with cardiac disease. Clin Physiol Funct Imaging 2023; 43:404-412. [PMID: 37293922 DOI: 10.1111/cpf.12838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/20/2023] [Accepted: 06/07/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) variables represent central and peripheral factors and combined factors in the pathology of patients with cardiac disease. The difference in end-tidal oxygen partial pressure from resting to anaerobic threshold (ΔPETO2 ) may represent predominantly peripheral factors. This study aimed to verify the prognostic significance of ΔPETO2 for major adverse cardiac and cerebrovascular events (MACCE) in cardiac patients, including comparison with the minute ventilation-carbon dioxide production relationship (VE/VCO2 slope), and peak oxygen uptake (VO2 ). METHODS In total, 185 patients with cardiac disease who underwent CPET were consecutively enroled in this retrospective study. The primary endpoint was 3-year MACCE. The ability of ΔPETO2 , VE/VCO2 slope, and peak VO2 to predict MACCE was examined. RESULTS Optimal cut-off values for predicting MACCE were 2.0 mmHg for ΔPETO2 (area under the curve [AUC]: 0.829), 29.8 for VE/VCO2 slope (AUC: 0.734), and 19.0 mL/min/kg for peak VO2 (AUC: 0.755). The AUC of ΔPETO2 was higher than those of VE/VCO2 slope and peak VO2 . The MACCE-free survival rate was significantly lower in the ΔPETO2 ≤ 2.0 group versus the ΔPETO2 > 2.0 group (44.4% vs. 91.2%, p < 0.001). ΔPETO2 ≤ 2.0 was an independent predictor of MACCE after adjustment for age and VE/VCO2 slope (hazard ratio [HR], 7.28; p < 0.001) and after adjustment for age and peak VO2 (HR, 6.52; p < 0.001). CONCLUSION ΔPETO2 was a strong predictor of MACCE independent of and superior to VE/VCO2 slope and peak VO2 in patients with cardiac disease.
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Affiliation(s)
- Asami Ogura
- Department of Rehabilitation, Sanda City Hospital, Sanda, Japan
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
- Cardiovascular Stroke Renal Project (CRP), Hyogo, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
- Cardiovascular Stroke Renal Project (CRP), Hyogo, Japan
| | - Hideto Tawa
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Masaaki Wada
- Department of Rehabilitation, Sanda City Hospital, Sanda, Japan
| | - Masashi Kanai
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
- Cardiovascular Stroke Renal Project (CRP), Hyogo, Japan
| | - Ikko Kubo
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
- Cardiovascular Stroke Renal Project (CRP), Hyogo, Japan
| | - Ayano Makihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
- Cardiovascular Stroke Renal Project (CRP), Hyogo, Japan
| | | | - Yuichi Matsuda
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
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Lee KS, Park DI, Lee J, Oh O, Kim N, Nam G. Relationship between comorbidity and health outcomes in patients with heart failure: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:498. [PMID: 37817062 PMCID: PMC10563307 DOI: 10.1186/s12872-023-03527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The prevalence of heart failure (HF) is expected to rise due to increased survivorship and life expectancy of patients with acute heart conditions. Patients with HF and other multiple comorbid conditions are likely to have poor health outcomes. This study aimed to assimilate the current body of knowledge and to provide the pooled effect of HF patients' comorbid conditions on health outcomes. METHODS A systematic search was performed using MEDLINE, EMBASE and CINAHL databases. Observational studies evaluating the relationship between comorbid conditions and the health outcomes of HF were included. The pooled effect sizes of comorbidity on the identified health outcomes were calculated using a random effects model, and the heterogeneity was evaluated using I2 statistics. RESULTS A total of 42 studies were included in this review, and a meta-analysis was performed using the results of 39 studies. In the pooled analysis, the presence of a comorbid condition showed a significant pooled effect size in relation to the prognostic health outcomes: all-cause mortality (HR 1.31; 95% CI 1.18, 1.45), all-cause readmission (HR 1.16; 95% CI 1.09, 1.23), HF-related readmission (HR 1.13; 95% CI 1.05, 1.23), and non-HF-related readmission (HR 1.17; 95% CI 1.07, 1.27). Also, comorbidity was significantly associated with health-related quality of life and self-care confidence. Furthermore, we identified a total of 32 comorbid conditions from included studies. From these, 16 individual conditions were included in the meta-analyses, and we identified 10 comorbid conditions to have negative effects on overall prognostic outcomes: DM (HR 1.16, 95% CI 1.11, 1.22), COPD (HR 1.31, 95% CI 1.23, 1.39), CKD (HR 1.18, 95% CI 1.14, 1.23, stroke (HR 1.25, 95% CI 1.17, 1.31), IHD (HR 1.17, 95% CI 1.11, 1.23), anemia (HR 1.42, 95% CI 1.14, 1.78), cancer (HR 1.17, 95% CI 1.04, 1.32), atrial fibrillation (HR 1.25, 95% CI 1.01, 1.54), dementia (HR 1.19, 95% CI 1.03, 1.36) and depression (HR 1.17, 95% CI 1.04, 1.31). CONCLUSIONS Comorbid conditions have significantly negative pooled effects on HF patient health outcomes, especially in regard to the prognostic health outcomes. Clinicians should carefully identify and manage these conditions when implementing HF interventions to improve prognostic outcomes.
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Affiliation(s)
- Kyoung Suk Lee
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Da-In Park
- Department of Nursing, College of Life Science and Nano Technology, Hannam University, Daejeon, Republic of Korea.
| | - Jihyang Lee
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Oonjee Oh
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Nayoung Kim
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Gyumi Nam
- Seoul National University Hospital, Seoul, Republic of Korea
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Sison SDM, Lin KJ, Najafzadeh M, Ko D, Patorno E, Bessette LG, Zakoul H, Kim DH. Common non-cardiovascular multimorbidity groupings and clinical outcomes in older adults with major cardiovascular disease. J Am Geriatr Soc 2023; 71:3179-3188. [PMID: 37354026 PMCID: PMC10592495 DOI: 10.1111/jgs.18479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Among older adults, non-cardiovascular multimorbidity often coexists with cardiovascular disease (CVD) but their clinical significance is uncertain. We identified common non-cardiovascular comorbidity patterns and their association with clinical outcomes in Medicare fee-for-service beneficiaries with acute myocardial infarction (AMI), congestive heart failure (CHF), or atrial fibrillation (AF). METHODS Using 2015-2016 Medicare data, we took 1% random sample to create 3 cohorts of beneficiaries diagnosed with AMI (n = 24,808), CHF (n = 57,285), and AF (n = 36,277) prior to 1/1/2016. Within each cohort, we applied latent class analysis to classify beneficiaries based on 9 non-cardiovascular comorbidities (anemia, cancer, chronic kidney disease, chronic lung disease, dementia, depression, diabetes, hypothyroidism, and musculoskeletal disease). Mortality, cardiovascular and non-cardiovascular hospitalizations, and home time lost over a 1-year follow-up period were compared across non-cardiovascular multimorbidity classes. RESULTS Similar non-cardiovascular multimorbidity classes emerged from the 3 CVD cohorts: (1) minimal, (2) depression-lung, (3) chronic kidney disease (CKD)-diabetes, and (4) multi-system class. Across CVD cohorts, multi-system class had the highest risk of mortality (hazard ratio [HR], 2.7-3.9), cardiovascular hospitalization (HR, 1.6-3.3), non-cardiovascular hospitalization (HR, 3.1-7.2), and home time lost (rate ratio, 2.7-5.4). Among those with AMI, the CKD-diabetes class was more strongly associated with all the adverse outcomes than the depression-lung class. In CHF and AF, differences in risk between the depression-lung and CKD-diabetes classes varied per outcome; and the depression-lung and multi-system classes had double the rates of non-cardiovascular hospitalizations than cardiovascular hospitalizations. CONCLUSION Four non-cardiovascular multimorbidity patterns were found among Medicare beneficiaries with CHF, AMI, or AF. Compared to the minimal class, the multi-system, CKD-diabetes, and depression-lung classes were associated with worse outcomes. Identification of these classes offers insight into specific segments of the population that may benefit from more than the usual cardiovascular care.
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Affiliation(s)
- Stephanie Denise M. Sison
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Department of Internal Medicine, University of Massachusetts Chan Medical School, Worcester, MA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Mehdi Najafzadeh
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Darae Ko
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Lily G. Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Heidi Zakoul
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Dae Hyun Kim
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
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Yang M, Kondo T, Adamson C, Butt JH, Abraham WT, Desai AS, Jering KS, Køber L, Kosiborod MN, Packer M, Rouleau JL, Solomon SD, Vaduganathan M, Zile MR, Jhund PS, McMurray JJV. Impact of comorbidities on health status measured using the Kansas City Cardiomyopathy Questionnaire in patients with heart failure with reduced and preserved ejection fraction. Eur J Heart Fail 2023; 25:1606-1618. [PMID: 37401511 DOI: 10.1002/ejhf.2962] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/18/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023] Open
Abstract
AIM Patients with heart failure (HF) often suffer from a range of comorbidities, which may affect their health status. The aim of this study was to assess the impact of different comorbidities on health status in patients with HF and reduced (HFrEF) and preserved ejection fraction (HFpEF). METHODS AND RESULTS Using individual patient data from HFrEF (ATMOSPHERE, PARADIGM-HF, DAPA-HF) and HFpEF (TOPCAT, PARAGON-HF) trials, we examined the Kansas City Cardiomyopathy Questionnaire (KCCQ) domain scores and overall summary score (KCCQ-OSS) across a range of cardiorespiratory (angina, atrial fibrillation [AF], stroke, chronic obstructive pulmonary disease [COPD]) and other comorbidities (obesity, diabetes, chronic kidney disease [CKD], anaemia). Of patients with HFrEF (n = 20 159), 36.2% had AF, 33.9% CKD, 33.9% diabetes, 31.4% obesity, 25.5% angina, 12.2% COPD, 8.4% stroke, and 4.4% anaemia; the corresponding proportions in HFpEF (n = 6563) were: 54.0% AF, 48.7% CKD, 43.4% diabetes, 53.3% obesity, 28.6% angina, 14.7% COPD, 10.2% stroke, and 6.5% anaemia. HFpEF patients had lower KCCQ domain scores and KCCQ-OSS (67.8 vs. 71.3) than HFrEF patients. Physical limitations, social limitations and quality of life domains were reduced more than symptom frequency and symptom burden domains. In both HFrEF and HFpEF, COPD, angina, anaemia, and obesity were associated with the lowest scores. An increasing number of comorbidities was associated with decreasing scores (e.g. KCCQ-OSS 0 vs. ≥4 comorbidities: HFrEF 76.8 vs. 66.4; HFpEF 73.7 vs. 65.2). CONCLUSIONS Cardiac and non-cardiac comorbidities are common in both HFrEF and HFpEF patients and most are associated with reductions in health status although the impact varied among comorbidities, by the number of comorbidities, and by HF phenotype. Treating/correcting comorbidity is a therapeutic approach that may improve the health status of patients with HF.
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Affiliation(s)
- Mingming Yang
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Toru Kondo
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Carly Adamson
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Jawad H Butt
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Karola S Jering
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MS, USA
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Jean L Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Michael R Zile
- RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston, SC, USA
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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Amirova A, Taylor L, Volkmer B, Ahmed N, Chater AM, Fteropoulli T. Informing behaviour change intervention design using systematic review with Bayesian meta-analysis: physical activity in heart failure. Health Psychol Rev 2023; 17:456-484. [PMID: 35701235 DOI: 10.1080/17437199.2022.2090411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/02/2022] [Indexed: 12/11/2022]
Abstract
Embracing the Bayesian approach, we aimed to synthesise evidence regarding barriers and enablers to physical activity in adults with heart failure (HF) to inform behaviour change intervention. This approach helps estimate and quantify the uncertainty in the evidence and facilitates the synthesis of qualitative and quantitative studies. Qualitative evidence was annotated using the Theoretical Domains Framework and represented as a prior distribution using an expert elicitation task. The maximum a posteriori probability (MAP) for the probability distribution for the log OR was used to estimate the relationship between physical activity and each determinant according to qualitative, quantitative, and qualitative and quantitative evidence combined. The probability distribution dispersion (SD) was used to evaluate uncertainty in the evidence. Three qualitative and 16 quantitative studies were included (N = 2739). High pro-b-type natriuretic peptide (MAP = -1.16; 95%CrI: [-1.21; -1.11]) and self-reported symptoms (MAP = - 0.48; 95%CrI: [ -0.40; -0.55]) were suggested as barriers to physical activity with low uncertainty (SD = 0.18 and 0.19, respectively). Modifiable barriers were symptom distress (MAP = -0.46; 95%CrI: [-0.68; -0.24], SD = 0.36), and negative attitude (MAP = -0.40; 95%CrI: [-0.49; -0.31], SD = 0.26). Modifiable enablers were social support (MAP = 0.56; 95%CrI: [0.48; 0.63], SD = 0.26), self-efficacy (MAP = 0.43; 95%CrI: [0.32; 0.54], SD = 0.37), positive physical activity attitude (MAP = 0.92; 95%CrI: [0.77; 1.06], SD = 0.36).
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Affiliation(s)
- Aliya Amirova
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lauren Taylor
- Department of Psychology, University of Surrey, Guildford, UK
| | - Brittannia Volkmer
- Psychology department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nafiso Ahmed
- Mental Health Policy Research Unit, UCL Division of Psychiatry, London, UK
| | - Angel M Chater
- Centre for Behaviour Change, Clinical, Educational & Health Psychology, Division of Psychology & Language Sciences, Faculty of Brain Sciences, UCL, London, UK
- Institute for Sport and Physical Activity Research (ISPAR), Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, UK
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Miró Ò, Conde-Martel A, Llorens P, Salamanca-Bautista P, Gil V, González-Franco Á, Jacob J, Casado J, Tost J, Montero-Pérez-Barquero M, Alquézar-Arbé A, Trullàs JC. The influence of comorbidities on the prognosis after an acute heart failure decompensation and differences according to ejection fraction: Results from the EAHFE and RICA registries. Eur J Intern Med 2023; 111:97-104. [PMID: 36914535 DOI: 10.1016/j.ejim.2023.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE The role of comorbidities in heart failure (HF) outcome has been previously investigated, although mostly individually. We investigated the individual effect of 13 comorbidities on HF prognosis and looked for differences according to left-ventricular ejection fraction (LVEF), classified as reduced (HFrEF), mildly-reduced (HFmrEF) and preserved (HFpEF). METHODS We included patients from the EAHFE and RICA registries and analysed the following comorbidities: hypertension, dyslipidaemia, diabetes mellitus (DM), atrial fibrillation (AF), coronary artery disease (CAD), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), heart valve disease (HVD), cerebrovascular disease (CVD), neoplasia, peripheral artery disease (PAD), dementia and liver cirrhosis (LC). Association of each comorbidity with all-cause mortality was assessed by an adjusted Cox regression analysis that included the 13 comorbidities, age, sex, Barthel index, New York Heart Association functional class and LVEF and expressed as adjusted Hazard Ratios (HR) with 95% confidence intervals (95%CI). RESULTS We analysed 8,336 patients (82 years-old; 53% women; 66% with HFpEF). Mean follow-up was 1.0 years. Respect to HFrEF, mortality was lower in HFmrEF (HR:0.74;0.64-0.86) and HFpEF (HR:0.75;0.68-0.84). Considering patients all together, eight comorbidities were associated with mortality: LC (HR:1.85;1.42-2.42), HVD (HR:1.63;1.48-1.80), CKD (HR:1.39;1.28-1.52), PAD (HR:1.37;1.21-1.54), neoplasia (HR:1.29;1.15-1.44), DM (HR:1.26;1.15-1.37), dementia (HR:1.17;1.01-1.36) and COPD (HR:1.17;1.06-1.29). Associations were similar in the three LVEF subgroups, with LC, HVD, CKD and DM remaining significant in the three subgroups. CONCLUSION HF comorbidities are associated differently with mortality, LC being the most associated with mortality. For some comorbidities, this association can be significantly different according to the LVEF.
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Affiliation(s)
- Òscar Miró
- Emergency Department Hospital Clinic Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Alicia Conde-Martel
- Internal Medicine Department, University Hospital of Gran Canaria (Dr. Negrín), Spain
| | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization Hospital Doctor Balmis, Alicante, Spain
| | - Prado Salamanca-Bautista
- Internal Medicine Department, University Hospital Virgen Macarena of Sevilla University of Seville, Spain
| | - Víctor Gil
- Emergency Department Hospital Clinic Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge Hospitalet del Llobregat, Catalonia, Spain
| | - Jesús Casado
- Internal Medicine Department, University Hospital of Getafe, Madrid, Spain
| | - Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | | | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Joan Carles Trullàs
- Internal Medicine Department, Hospital d'Olot i comarcal de la Garrotxa, Olot, Girona, Catalonia, Spain; Laboratori de Reparació i Regeneració Tissular (TR2Lab) Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya Vic, Barcelona, Catalonia, Spain.
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10
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Blum M, McKendrick K, Gelfman LP, Pinney SP, Goldstein NE. Using Latent Class Analysis to Identify Different Clinical Profiles Among Patients With Advanced Heart Failure. J Pain Symptom Manage 2023; 65:111-119. [PMID: 36911500 PMCID: PMC9994448 DOI: 10.1016/j.jpainsymman.2022.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Context Although palliative care is guideline-indicated for patients with advanced heart failure (HF), the scarcity of a specialty-trained palliative care workforce demands better identification of patients who are most burdened by the disease. Objectives We sought to identify latent subgroups with variations regarding symptom burden, functional status, and multimorbidity in an advanced HF population. Methods We performed a latent class analysis (LCA) of baseline data from a trial enrolling advanced HF patients. As LCA input variables, we chose indicators of HF severity, physical and psychological symptom burden, functional status, and the number of comorbidities. Results Among 563 patients, two subgroups emerged from LCA, Class A (352 [62.5%]) and Class B (211 [37.5%]). Patients in Class A were less often classified as NYHA class III or IV (88.0% vs. 97.5%, P < 0.001), as compared to Class B patients. Class A patients had fewer symptoms, fewer comorbidities, only 25.9% had impairments in activities of daily living (ADL), and virtually none suffered from clinically significant anxiety (0.4%) or depression (0.9%). In Class B, every patient reported more than three symptoms, almost all patients (92.6%) had some impairment in ADL, and nearly a third had anxiety (30.2%) or depression (28.3%). All-cause mortality after 12 months was higher in Class B, as compared to Class A (18.5% vs. 12.5%, P = 0.047). Conclusion Among advanced HF patients, we identified a distinct subgroup characterized by a conjunction of high symptom burden, anxiety, depression, multimorbidity, and functional status impairment, which might profit particularly from palliative care interventions. J Pain Symptom Manage 2022;000:1-9.
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Affiliation(s)
- Moritz Blum
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Internal Medicine/Cardiology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Karen McKendrick
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura P. Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), Bronx, New York, USA
| | | | - Nathan E. Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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11
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Gargiulo P, Acampa W, Asile G, Abbate V, Nardi E, Marzano F, Assante R, Nappi C, Parlati ALM, Basile C, Dellegrottaglie S, Paolillo S, Cuocolo A, Perrone-Filardi P. 123I-MIBG imaging in heart failure: impact of comorbidities on cardiac sympathetic innervation. Eur J Nucl Med Mol Imaging 2023; 50:813-824. [PMID: 36071220 PMCID: PMC9852124 DOI: 10.1007/s00259-022-05941-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Heart failure (HF) is a primary cause of morbidity and mortality worldwide, with significant impact on life quality and extensive healthcare costs. Assessment of myocardial sympathetic innervation function plays a central role in prognosis assessment in HF patients. The aim of this review is to summarize the most recent evidence regarding the clinical applications of iodine-123 metaiodobenzylguanidine (123I-MIBG) imaging in patients with HF and related comorbidities. METHODS A comprehensive literature search was conducted on PubMed and Web of Science databases. Articles describing the impact of 123I-MIBG imaging on HF and related comorbidities were considered eligible for the review. RESULTS We collected several data reporting that 123I-MIBG imaging is a safe and non-invasive tool to evaluate dysfunction of cardiac sympathetic neuronal function and to assess risk stratification in HF patients. HF is frequently associated with comorbidities that may affect cardiac adrenergic innervation. Furthermore, HF is frequently associated with comorbidities and chronic conditions, such as diabetes, obesity, kidney disease and others, that may affect cardiac adrenergic innervation. CONCLUSION Comorbidities and chronic conditions lead to more severe impairment of sympathetic nervous system in patients with HF, with a negative impact on disease progression and outcome. Cardiac imaging with 123I-MIBG can be a useful tool to reduce morbidity and prevent adverse events in HF patients.
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Affiliation(s)
- Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Gaetano Asile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenza Abbate
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Ermanno Nardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Christian Basile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Perrone-Filardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ,Mediterranea Cardiocentro, Naples, Italy
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Khazovа EV, Boulashova OV, Valeeva EV. Study of the rs1800795 polymorphism of the <i>IL6</i> gene to verify the clinical portrait of a patient with chronic heart failure: gender aspects. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.10.201757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. Genetic studies in cardiology allow to identify predisposition and predict the course of multifactorial cardiovascular diseases by identifying the association of polymorphic loci of candidate genes with the clinical phenotype. One of these diseases associated with poor prognosis is chronic heart failure (CHF). Activation of pro-inflammatory cytokines is one of the key aspects of the development and progression of CHF.
Aim. To identify the features of the clinical course of CHF of ischemic etiology in patients, taking into account the gender and genotype of the rs1800795 polymorphism of the IL6 gene.
Materials and methods. Four hundred fourteen patients of both sexes with stable CHF of ischemic origin, aged 66.410.4 years, were included. Clinical characteristics of men and women of each genotype of the rs1800795 polymorphism of the IL6 gene were compared. Genotyping of the rs1800795 polymorphism of the IL6 gene was performed by real-time polymerase chain reaction.
Results. In male patients with CHF, the frequency of allele C was higher than in the control group (p=0.04). Homozygous carriers of the C allele showed a greater risk of developing atrial fibrillation (p=0.021). In terms of biochemical parameters, in patients with a heterozygous genotype, compared with homozygotes for the G allele of the rs1800795 polymorphism of the IL6 gene, the levels of cholesterol, triglycerides (TG), cholesterol not associated with high-density lipoproteins (non-HDL-cholesterol) were higher (p=0.044, p=0.019, p=0.016). Patients with the CC genotype of the rs1800795 polymorphism of the IL6 gene females compared with men were more likely to have IIIIV functional class of CHF (p=0.001) and had a high heart rate (p=0.021). Male patients of the CG genotype were more likely to undergo coronary interventions (p=0.001). In women of the CG genotype, CHF was more often combined with DM (p=0.015), the level of non-HDL-cholesterol (p=0.04) was higher, and glomerular filtration rate was lower than in men (p=0.001). Comparison of the GG genotype revealed a higher incidence of chronic kidney disease in women (p=0.022). Women had significantly lower glomerular filtration rate (p=0.001), systolic blood pressure (p=0.004). The level of such biochemical parameters as cholesterol (p=0.001), TG (p=0.019), low-density lipoprotein cholesterol (p=0.002) was reduced, except for high non-HDL-cholesterol (p=0.001). There were more men with left ventricular ejection fraction 40% (p=0.009), women with left ventricular ejection fraction 50% (p=0.002).
Conclusion. The identified phenotypic and gender differences create prerequisites for determining patient-oriented genetic risk, opening up new opportunities for preventing the progression and complications of CHF.
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Phenotypic Disease Network-Based Multimorbidity Analysis in Idiopathic Cardiomyopathy Patients with Hospital Discharge Records. J Clin Med 2022; 11:jcm11236965. [PMID: 36498544 PMCID: PMC9736397 DOI: 10.3390/jcm11236965] [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: 10/18/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Idiopathic cardiomyopathy (ICM) is a rare disease affecting numerous physiological and biomolecular systems with multimorbidity. However, due to the small sample size of uncommon diseases, the whole spectrum of chronic disease co-occurrence, especially in developing nations, has not yet been investigated. To grasp the multimorbidity pattern, we aimed to present a multidimensional model for ICM and differences among age groups. METHODS Hospital discharge records were collected from a rare disease centre of ICM inpatients (n = 1036) over 10 years (2012 to 2021) for this retrospective analysis. One-to-one matched controls were also included. First, by looking at the first three digits of the ICD-10 code, we concentrated on chronic illnesses with a prevalence of more than 1%. The ICM and control inpatients had a total of 71 and 69 chronic illnesses, respectively. Second, to evaluate the multimorbidity pattern in both groups, we built age-specific cosine-index-based multimorbidity networks. Third, the associated rule mining (ARM) assessed the comorbidities with heart failure for ICM, specifically. RESULTS The comorbidity burden of ICM was 78% larger than that of the controls. All ages were affected by the burden, although those over 50 years old had more intense interactions. Moreover, in terms of disease connectivity, central, hub, and authority diseases were concentrated in the metabolic, musculoskeletal and connective tissue, genitourinary, eye and adnexa, respiratory, and digestive systems. According to the age-specific connection, the impaired coagulation function was required for raising attention (e.g., autoimmune-attacked digestive and musculoskeletal system disorders) in young adult groups (ICM patients aged 20-49 years). For the middle-aged (50-60 years) and older (≥70 years) groups, malignant neoplasm and circulatory issues were the main confrontable problems. Finally, according to the result of ARM, the comorbidities and comorbidity patterns of heart failure include diabetes mellitus and metabolic disorder, sleeping disorder, renal failure, liver, and circulatory diseases. CONCLUSIONS The main cause of the comorbid load is aging. The ICM comorbidities were concentrated in the circulatory, metabolic, musculoskeletal and connective tissue, genitourinary, eye and adnexa, respiratory, and digestive systems. The network-based approach optimizes the integrated care of patients with ICM and advances our understanding of multimorbidity associated with the disease.
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The Interaction Effect of Cardiac and Noncardiac Co-morbidities on Mortality Rates in Patients With Heart Failure. Am J Cardiol 2022; 179:51-57. [PMID: 35868895 DOI: 10.1016/j.amjcard.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022]
Abstract
The prevalence of heart failure (HF) and co-morbidities are increasing. The prognostic impact of interaction between co-morbidity and HF remains unknown. The purpose of the present study was to examine if HF interacts with co-morbidity burden to increase mortality. We conducted a cohort study of all adult Danish patients (aged ≥18 years) with a hospital inpatient or outpatient clinic diagnosis of HF (n = 252,726) between 1995 and 2016. We matched each patient with up to 3 members of the general population without a history of HF (n = 744,372). Noncardiac co-morbidities were assessed using the Charlson co-morbidity index and were defined by 4 categories of co-morbidity: 0 (none), 1 (low), 2 to 3 (moderate), and ≥4 (severe). Cardiac co-morbidities were assessed individually. Among patients with HF with severe co-morbidity, 42% of the mortality rate during 30 days of follow-up was explained by the interaction with co-morbidity. The interaction effect was also substantial in patients with moderate (31%) and low co-morbidity burden (16%). During 31 to 365 days of follow-up, interaction effects were 1% for low co-morbidity, 8% for moderate co-morbidity, and 22% for severe co-morbidity. Beyond 1 year of follow-up, no interaction effect was observed. With the exception of cardiomyopathy, cardiac co-morbidities did not interact substantially with HF during the first year of follow-up. During longer follow-up, pulmonary hypertension, cardiomyopathy, and endocarditis showed interaction. In conclusion, noncardiac co-morbidities had biological interaction with HF that increased short-term mortality substantially beyond the individual effects of HF and co-morbidity.
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15
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Méndez-Bailón M, Lorenzo-Villalba N, Romero-Correa M, Josa-Laorden C, Inglada-Galiana L, Menor-Campos E, Gómez-Aguirre N, Clemente-Sarasa C, Salas-Campos R, García-Redecillas C, Asenjo-Martínez M, Trullàs JC, Cortés-Rodríguez B, de la Guerra-Acebal C, Serrado Iglesias A, Aparicio-Santos R, Formiga F, Andrès E, Aramburu-Bodas O, Salamanca-Bautista P. Chronic Obstructive Pulmonary Disease in Elderly Patients with Acute and Advanced Heart Failure: Palliative Care Needs-Analysis of the EPICTER Study. J Clin Med 2022; 11:jcm11133709. [PMID: 35806992 PMCID: PMC9267665 DOI: 10.3390/jcm11133709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/12/2022] [Accepted: 06/24/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: There are studies that evaluate the association between chronic obstructive pulmonary disease (COPD) and heart failure (HF) but there is little evidence regarding the prognosis of this comorbidity in older patients admitted for acute HF. In addition, little attention has been given to the extracardiac and extrapulmonary symptoms presented by patients with HF and COPD in more advanced stages. The aim of this study was to evaluate the prognostic impact of COPD on mortality in elderly patients with acute and advanced HF and the clinical manifestations and management from a palliative point of view. Methods: The EPICTER study (“Epidemiological survey of advanced heart failure”) is a cross-sectional, multicenter project that consecutively collected patients admitted for HF in 74 Spanish hospitals. Demographic, clinical, treatment, organ-dependent terminal criteria (NYHA III-IV, LVEF <20%, intractable angina, HF despite optimal treatment), and general terminal criteria (estimated survival <6 months, patient/family acceptance of palliative approach, and one of the following: evidence of HF progression, multiple Emergency Room visits or admissions in the last six months, 10% weight loss in the last six months, and functional impairment) were collected. Terminal HF was considered if the patient met at least one organ-dependent criterion and all the general criteria. Both groups (HF with COPD and without COPD) were compared. A Kaplan−Meier survival analysis was performed to evaluate the presence of COPD on the vital prognosis of patients with HF. Results: A total of 3100 patients were included of which 812 had COPD. In the COPD group, dyspnea and anxiety were more frequently observed (86.2% vs. 75.3%, p = 0.001 and 35.4% vs. 31.2%, p = 0.043, respectively). In patients with a history of COPD, presentation of HF was in the form of acute pulmonary edema (21% vs. 14.4% in patients without COPD, p = 0.0001). Patients with COPD more frequently suffered from advanced HF (28.9% vs. 19.4%; p < 0.001). Consultation with the hospital palliative care service during admission was more frequent when patients with HF presented with associated COPD (94% vs. 6.8%; p = 0.036). In-hospital and six-month follow-up mortality was 36.5% in patients with COPD vs. 30.7% in patients without COPD, p = 0.005. The mean number of hospital admissions during follow-up was higher in patients with HF and COPD than in those with isolated HF (0.63 ± 0.98 vs. 0.51 ± 0.84; p < 0.002). Survival analysis showed that patients with a history of COPD had fewer survival days during follow-up than those without COPD (log Rank chi-squared 4.895 and p = 0.027). Conclusions: patients with HF and COPD had more severe symptoms (dyspnea and anxiety) and also a worse prognosis than patients without COPD. However, the prognosis of patients admitted to our setting is poor and many patients with HF and COPD may not receive the assessment and palliative care support they need. Palliative care is necessary in chronic non-oncologic diseases, especially in multipathologic and symptom-intensive patients. This is a clinical care aspect to be improved and evaluated in future research studies.
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Affiliation(s)
- Manuel Méndez-Bailón
- Servicio de Medicina Interna, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid Instituto de Investigación Sanitaria (IdISSC), 28040 Madrid, Spain;
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
- Correspondence:
| | - Miriam Romero-Correa
- Servicio de Medicina Interna, Hospital General de Riotinto, 21660 Huelva, Spain; (M.R.-C.); (E.A.)
| | - Claudia Josa-Laorden
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain;
| | - Luis Inglada-Galiana
- Servicio de Medicina Interna, Hospital Universitario Río Hortega, 47012 Valladolid, Spain;
| | - Eva Menor-Campos
- Servicio de Medicina Interna, Hospital Universitario de Jerez de la Frontera, 11407 Jerez de la Frontera, Spain;
| | - Noelia Gómez-Aguirre
- Servicio de Medicina Interna, Hospital Ernest Lluch Martín, 50299 Calatayud, Spain;
| | | | - Rosario Salas-Campos
- Servicio de Medicina Interna, Hospital Universitario Sagrat Cor, 08029 Barcelona, Spain;
| | | | - María Asenjo-Martínez
- Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos, 28933 Móstoles, Spain;
| | - Joan Carles Trullàs
- Servicio de Medicina Interna, Hospital d’Olot i Comarcal de la Garrotxa, 17800 Olot, Spain;
| | | | | | - Ana Serrado Iglesias
- Servicio de Medicina Interna, Hospital Municipal de Badalona, 08911 Badalona, Spain;
| | - Reyes Aparicio-Santos
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, 41930 Bormujos, Spain;
| | - Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, 08907 Barcelona, Spain;
| | - Emmanuel Andrès
- Servicio de Medicina Interna, Hospital General de Riotinto, 21660 Huelva, Spain; (M.R.-C.); (E.A.)
| | - Oscar Aramburu-Bodas
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (O.A.-B.); (P.S.-B.)
- Department of Medecine, Universidad de Sevilla, San Fernando, 4, 41004 Sevilla, Spain
| | - Prado Salamanca-Bautista
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (O.A.-B.); (P.S.-B.)
- Department of Medecine, Universidad de Sevilla, San Fernando, 4, 41004 Sevilla, Spain
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Polaska P, Jerzak-Wodzynska G, Smigielski W, Gajda J, Rozentryt P, Korewicki J, Sobieszczanska-Malek M, Zielinski T, Rywik TM. Long term outcome of heart failure patients disqualified from heart transplantation. Acta Cardiol 2021; 76:525-533. [PMID: 33432873 DOI: 10.1080/00015385.2020.1852755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The prognosis of patients with advanced heart failure is unfavourable. However, little is known about the survival of patients referred for heart transplantation but finally disqualified from transplantation due to contraindications. This study aimed to evaluate the prognosis of patients' disqualified from heart transplantation. METHODS It was a retrospective study based on medical records of patients disqualified from heart transplantation. RESULTS One hundred and fifty-one patients were included and 94 deaths were recorded during long-term follow-up (range 0.02-10.1 years). The survival rate at 5 years was 25%. The mean age of the studied population was 57.7 years and the majority of patients were males, 87.4%. The ischaemic aetiology (66.2%) was the most dominant aetiology of heart failure. In the Cox regression model, supervision by the specialist cardiology centre (HR 0.61;p = 0.04) and pharmacotherapy with beta-blockers (HR = 0.47;p = 0.02) positively influenced the prognosis. On the contrary, well-known heart failure risk factors like a renal failure (HR 1.59;p = 0.049), pulmonary hypertension (HR 1.55;p = 0.046), liver failure (HR 2.65;p = 0.02) were negative predictors of outcome. By Kaplan-Meier analysis, patients with other than pulmonary hypertension causes of disqualification from heart transplantation had a better survival rate, p = 0.047. CONCLUSIONS The prognosis of patients disqualified from heart transplantation is unfavourable. However, some of the patients experience relatively long survival. Therefore, careful clinical assessment and identification of factors influencing prognosis may improve adequate patients' qualifications for heart transplantation.
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Affiliation(s)
- Paula Polaska
- Heart Failure and Transplantology Department, Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Grazyna Jerzak-Wodzynska
- Heart Failure and Transplantology Department, Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Witold Smigielski
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Janusz Gajda
- Department of Statistics and Econometrics, Faculty of Economic Science, University of Warsaw, Poland
| | - Piotr Rozentryt
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
- Silesian Centre for Heart Disease, Zabrze, Poland
| | - Jerzy Korewicki
- Heart Failure and Transplantology Department, Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | | | - Tomasz Zielinski
- Heart Failure and Transplantology Department, Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Tomasz M. Rywik
- Heart Failure and Transplantology Department, Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
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Bencivenga L, Komici K, Femminella GD, Paolillo S, Gargiulo P, Formisano R, Assante R, Nappi C, Puzone B, Sepe I, Cittadini A, Vitale DF, Ferrara N, Cuocolo A, Filardi PP, Rengo G. Impact of the number of comorbidities on cardiac sympathetic derangement in patients with reduced ejection fraction heart failure. Eur J Intern Med 2021; 86:86-90. [PMID: 33485737 DOI: 10.1016/j.ejim.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Heart failure (HF) is frequently associated with comorbidities. 123I-metaiodobenzylguanidine (123I-mIBG) imaging constitutes an effective tool to measure cardiac adrenergic innervation and to improve prognostic stratification in HF patients, including the risk of major arrhythmic events. Although comorbidities have been individually associated with reduced cardiac adrenergic innervation, thus suggesting increased arrhythmic risk, very comorbid HF patients seem to be less likely to experience fatal arrhythmias. We evaluated the impact of the number of comorbidities on cardiac adrenergic innervation, assessed through 123I-mIBG imaging, in patients with systolic HF. METHODS Patients with systolic HF underwent clinical examination, transthoracic echocardiography and cardiac 123I-mIBG scintigraphy. The presence of 7 comorbidities/conditions (smoking, chronic obstructive pulmonary disease, diabetes mellitus, peripheral artery disease, atrial fibrillation, chronic ischemic heart disease and chronic kidney disease) was documented in the overall study population. RESULTS The study population consisted of 269 HF patients with a mean age of 66±11 years, a left ventricular ejection fraction (LVEF) of 31±7%, and 153 (57%) patients presented ≥3 comorbidities. Highly comorbid patients presented a reduced late heart to mediastinum (H/M) ratio, while no significant differences emerged in terms of early H/M ratio and washout rate. Multiple regression analysis revealed that the number of comorbidities was not associated with mIBG parameters of cardiac denervation, which were correlated with age, body mass index and LVEF. CONCLUSION In systolic HF patients, the number of comorbidities is not associated with alterations in cardiac adrenergic innervation. These results are consistent with the observation that very comorbid HF patients suffer lower risk of sudden cardiac death.
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Affiliation(s)
- Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Roberto Formisano
- Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), Telese Terme (BN), Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Brunella Puzone
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Immacolata Sepe
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Nicola Ferrara
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy; Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), Telese Terme (BN), Italy.
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18
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Benes J, Kotrc M, Jarolim P, Hoskova L, Hegarova M, Dorazilova Z, Podzimkova M, Binova J, Lukasova M, Malek I, Franekova J, Jabor A, Kautzner J, Melenovsky V. The effect of three major co-morbidities on quality of life and outcome of patients with heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:1417-1426. [PMID: 33512782 PMCID: PMC8006738 DOI: 10.1002/ehf2.13227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/28/2020] [Accepted: 01/13/2021] [Indexed: 12/18/2022] Open
Abstract
Aims Diabetes mellitus, chronic obstructive pulmonary disease, and chronic kidney disease are prevalent in patients with heart failure with reduced ejection fraction (HFrEF). We have analysed the impact of co‐morbidities on quality of life (QoL) and outcome. Methods and results A total of 397 patients (58.8 ± 11.0 years, 73.6% with New York Heart Association functional class ≥3) with stable advanced HFrEF were followed for a median of 1106 (inter‐quartile range 379–2606) days, and 68% of patients (270 patients) experienced an adverse outcome (death, urgent heart transplantation, and implantation of mechanical circulatory support). Chronic obstructive pulmonary disease was present in 16.4%, diabetes mellitus in 44.3%, and chronic kidney disease in 34.5% of patients; 33.5% of patients had none, 40.0% had one, 21.9% had two, and 3.8% of patient had three co‐morbidities. Patients with more co‐morbidities reported similar QoL (assessed by Minnesota Living with Heart Failure Questionnaire, 45.46 ± 22.21/49.07 ± 21.69/47.52 ± 23.54/46.77 ± 23.60 in patients with zero to three co‐morbidities, P for trend = 0.51). Multivariable regression analysis revealed that furosemide daily dose, systolic blood pressure, New York Heart Association functional class, and body mass index, but not the number of co‐morbidities, were significantly (P < 0.05) associated with QoL. Increasing co‐morbidity burden was associated with worse survival (P < 0.0001), lower degree of angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker treatment (P = 0.001), and increasing levels of BNP (mean of 685, 912, 1053, and 985 ng/L for patients with zero to three co‐morbidities, P for trend = 0.008) and cardiac troponin (sm‐cTnI, P for trend = 0.0496), which remained significant (P < 0.05) after the adjustment for left ventricular ejection fraction, left ventricular end‐diastolic diameter, right ventricular dysfunction grade, body mass index, and estimated glomerular filtration rate. Conclusions In stable advanced HFrEF patients, co‐morbidities are not associated with impaired QoL, but negatively affect the prognosis both directly and indirectly through lower level of HF pharmacotherapy and increased myocardial stress and injury.
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Affiliation(s)
- Jan Benes
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic.,Department of Internal Medicine, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Martin Kotrc
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Petr Jarolim
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Hoskova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Marketa Hegarova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Zora Dorazilova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Mariana Podzimkova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Jana Binova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Marianna Lukasova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Ivan Malek
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Janka Franekova
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Antonin Jabor
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
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19
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Dai Y, Qin S, Pan H, Chen T, Bian D. Impacts of Comorbid Chronic Obstructive Pulmonary Disease and Congestive Heart Failure on Prognosis of Critically Ill Patients. Int J Chron Obstruct Pulmon Dis 2020; 15:2707-2714. [PMID: 33149568 PMCID: PMC7604246 DOI: 10.2147/copd.s275573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/23/2020] [Indexed: 12/30/2022] Open
Abstract
Background Comorbid congestive heart failure (CHF) was associated with worse prognosis in patients with chronic obstructive pulmonary disease (COPD), while few studies specially investigated critically ill patients. This study investigated the associations between comorbid COPD with or without CHF and prognosis of patients admitted to intensive care units (ICU). Methods We conducted a retrospective cohort study in the Medical Information Mart for Intensive Care III database. Adult ICU patients were included and categorized as patients without COPD and CHF, patients with COPD but without CHF, patients with CHF but without COPD, and patients with both COPD and CHF. The study outcomes were 28-day mortality and 90-day mortality after ICU admission. Kaplan–Meier curves were plotted to estimate the survival distributions between groups and multivariable Cox regression analyses were employed to evaluate the associations between comorbid COPD and/or CHF and the study outcomes. Results A total of 29,589 patients were included with 20,507 patients without COPD and CHF, 1575 patients with COPD, 6190 patients with CHF, and 1317 patients with both COPD and CHF. The highest 28-day mortality rate and 90-day mortality rate were found in patients with both COPD and CHF (15.95% and 25.74%, respectively), while patients with COPD and patients with CHF had similar mortality rates, also observed in Kaplan–Meier curves. Compared with patients without COPD or CHF, comorbid COPD or CHF both significantly increased the risk of 28-day mortality and 90-day mortality, but comorbid COPD and CHF together was associated with the highest risk of mortality (hazard ratio 1.55 (95% confidence interval (CI) 1.33–1.80) and 1.25 (95% CI 1.16–1.35) for 28-day mortality and 90-day mortality, respectively), while no significant interaction between COPD and CHF was found. Conclusion ICU patients with comorbid COPD or CHF both experienced greater mortalities, while these two risk factors seemed to play an independent role.
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Affiliation(s)
- Ying Dai
- Department of Respiratory and Critical Care Medicine, Taizhou People's Hospital, Taizhou, People's Republic of China
| | - Shaoyun Qin
- Department of Respiratory and Critical Care Medicine, Taizhou People's Hospital, Taizhou, People's Republic of China
| | - Huaqin Pan
- Department of Respiratory and Critical Care Medicine, Taizhou People's Hospital, Taizhou, People's Republic of China
| | - Tianyu Chen
- Department of Respiratory and Critical Care Medicine, Taizhou People's Hospital, Taizhou, People's Republic of China
| | - Dachen Bian
- Department of Respiratory and Critical Care Medicine, Taizhou People's Hospital, Taizhou, People's Republic of China
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Okabe T, Yakushiji T, Kido T, Kimura T, Asukai Y, Shimazu S, Saito J, Oyama Y, Igawa W, Ono M, Ebara S, Yamashita K, Yamamoto MH, Amemiya K, Isomura N, Ochiai M. Poor prognosis of heart failure patients with in-hospital worsening renal function and elevated BNP at discharge. ESC Heart Fail 2020; 7:2912-2921. [PMID: 32643875 PMCID: PMC7524072 DOI: 10.1002/ehf2.12901] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/23/2020] [Accepted: 06/24/2020] [Indexed: 11/29/2022] Open
Abstract
Aims Our purpose was to investigate the association between the B‐type natriuretic peptide (BNP) level at discharge, the occurrence of worsening renal function (WRF), and long‐term outcomes in patients with heart failure (HF). Methods and results We enrolled hospitalized acute HF patients. We divided patients into four groups on the basis of BNP <250 pg/mL (BNP−) or BNP ≥250 pg/mL (BNP+) at discharge and the occurrence of WRF during admission: BNP−/WRF−, BNP−/WRF+, BNP+/WRF−, and BNP+/WRF+. We evaluated the association between BNP at discharge, WRF, and cardiovascular/all‐cause mortality/hospitalization due to HF. Clinical follow‐up was completed in 301 patients. At discharge, percentages of the patients with clinical signs of HF were low and similar among four groups. The median follow‐up period was 1206 days (interquartile range, 733–1825 days). The composite endpoint of cardiovascular mortality and HF hospitalization was significantly different between the four groups [12.9% (BNP−/WRF−), 22.7% (BNP−/WRF+), 35.8% (BNP+/WRF−), and 55.4% (BNP+/WRF+), P < 0.0001]. All‐cause mortality was also different etween the four groups (15.1%, 38.6%, 28.7%, and 39.3%, respectively, P = 0.003). In the multivariate Cox proportional hazards model, the combination of BNP ≥250 pg/mL and WRF showed the highest hazard ratio (HR) for composite endpoint (HR, 5.201; 95% confidence interval, 2.582–11.11; P < 0.0001), and BNP−/WRF+ was associated with increased all‐cause mortality (HR, 2.286; 95% confidence interval, 1.089–4.875; P = 0.03). Patients in BNP+/WRF+ had a higher cardiovascular mortality (28.6%), and those in BNP−/WRF+ had a high non‐cardiovascular mortality (29.5%). Conclusions Heart failure patients with BNP ≥250 pg/mL at discharge and in‐hospital occurrence of WRF had the highest risk for the composite endpoint (cardiovascular mortality and HF hospitalization) among groups.
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Affiliation(s)
- Toshitaka Okabe
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Tadayuki Yakushiji
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Takehiko Kido
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Taro Kimura
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Yu Asukai
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Suguru Shimazu
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Jumpei Saito
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Yuji Oyama
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Wataru Igawa
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Morio Ono
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Seitaro Ebara
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Kennosuke Yamashita
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Myong Hwa Yamamoto
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Kisaki Amemiya
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Naoei Isomura
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Masahiko Ochiai
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan
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21
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Aimo A, Barison A, Castiglione V, Emdin M. The unbearable underreporting of comorbidities in heart failure clinical trials. Eur J Heart Fail 2020; 22:1043-1044. [DOI: 10.1002/ejhf.1846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 08/30/2023] Open
Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna Pisa Italy
- Cardiology DivisionUniversity Hospital of Pisa Pisa Italy
| | - Andrea Barison
- Institute of Life Sciences, Scuola Superiore Sant'Anna Pisa Italy
- Cardiology DivisionFondazione Toscana ‘Gabriele Monasterio’ Pisa Italy
| | - Vincenzo Castiglione
- Institute of Life Sciences, Scuola Superiore Sant'Anna Pisa Italy
- Cardiology DivisionUniversity Hospital of Pisa Pisa Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna Pisa Italy
- Cardiology DivisionFondazione Toscana ‘Gabriele Monasterio’ Pisa Italy
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Axson EL, Ragutheeswaran K, Sundaram V, Bloom CI, Bottle A, Cowie MR, Quint JK. Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis. Respir Res 2020; 21:54. [PMID: 32059680 PMCID: PMC7023777 DOI: 10.1186/s12931-020-1312-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/04/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Discrepancy exists amongst studies investigating the effect of comorbid heart failure (HF) on the morbidity and mortality of chronic obstructive pulmonary disease (COPD) patients. METHODS MEDLINE and Embase were searched using a pre-specified search strategy for studies comparing hospitalisation, rehospitalisation, and mortality of COPD patients with and without HF. Studies must have reported crude and/or adjusted rate ratios, risk ratios, odds ratios (OR), or hazard ratios (HR). RESULTS Twenty-eight publications, reporting 55 effect estimates, were identified that compared COPD patients with HF with those without HF. One study reported on all-cause hospitalisation (1 rate ratio). Two studies reported on COPD-related hospitalisation (1 rate ratio, 2 OR). One study reported on COPD- or cardiovascular-related hospitalisation (4 HR). One study reported on 90-day all-cause rehospitalisation (1 risk ratio). One study reported on 3-year all-cause rehospitalisation (2 HR). Four studies reported on 30-day COPD-related rehospitalisation (1 risk ratio; 5 OR). Two studies reported on 1-year COPD-related rehospitalisation (1 risk ratio; 1 HR). One study reported on 3-year COPD-related rehospitalisation (2 HR). Eighteen studies reported on all-cause mortality (1 risk ratio; 4 OR; 24 HR). Five studies reported on all-cause inpatient mortality (1 risk ratio; 4 OR). Meta-analyses of hospitalisation and rehospitalisation were not possible due to insufficient data for all individual effect measures. Meta-analysis of studies requiring spirometry for the diagnosis of COPD found that risk of all-cause mortality was 1.61 (pooled HR; 95%CI: 1.38, 1.83) higher in patients with HF than in those without HF. CONCLUSIONS In this systematic review, we investigated the effect of HF comorbidity on hospitalisation and mortality of COPD patients. There is substantial evidence that HF comorbidity increases COPD-related rehospitalisation and all-cause mortality of COPD patients. The effect of HF comorbidity may differ depending on COPD phenotype, HF type, or HF severity and should be the topic of future research.
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Affiliation(s)
- Eleanor L Axson
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK.
| | - Kishan Ragutheeswaran
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Varun Sundaram
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Alex Bottle
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Martin R Cowie
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
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Bhatt SP. Acute Exacerbations of Chronic Lung Disease: Cardiac Considerations. CARDIAC CONSIDERATIONS IN CHRONIC LUNG DISEASE 2020. [PMCID: PMC7282481 DOI: 10.1007/978-3-030-43435-9_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The importance of appropriately recognizing and managing patients with cardiovascular and pulmonary comorbidities is underscored by the poor outcomes described in complex comorbid patients. Patients with chronic obstructive pulmonary disease (COPD) have an increased risk, up to one-third greater than the general population, of cardiovascular comorbidities including hypertension and diabetes [1].
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Affiliation(s)
- Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL USA
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24
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Almas A, Moller J, Iqbal R, Lundin A, Forsell Y. Does depressed persons with non-cardiovascular morbidity have a higher risk of CVD? A population-based cohort study in Sweden. BMC Cardiovasc Disord 2019; 19:260. [PMID: 31752710 PMCID: PMC6873677 DOI: 10.1186/s12872-019-1252-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/11/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Depression often co-exists with non-cardiovascular morbid conditions. Whether this comorbidity increases the risk of cardiovascular disease has so far not been studied. Thus, the aim of this study was to determine if non-cardiovascular morbidity modifies the effect of depression on future risk of CVD. METHODS Data was derived from the PART study (acronym in Swedish for: Psykisk hälsa, Arbete och RelaTioner: Mental Health, Work and Relationships), a longitudinal cohort study on mental health, work and relations, including 10,443 adults (aged 20-64 years). Depression was assessed using the Major Depression Inventory (MDI) and self-reported data on non-cardiovascular morbidity was assessed in 1998-2000. Outcomes of CVD were assessed using the National Patient Register during 2001-2014. RESULTS Both depression (HR 1.5 (95% CI, 1.1, 2.0)) and non-cardiovascular morbidity (HR 2.0 (95% CI, 1.8, 2.6)) were associated with an increased future risk of CVD. The combined effect of depression and non-cardiovascular comorbidity on future CVD was HR 2.1 (95%, CI 1.3, 3.4) after adjusting for age, gender and socioeconomic position. Rather similar associations were seen after further adjustment for hypertension, diabetes and unhealthy lifestyle factors. CONCLUSION Persons affected by depression in combination with non-cardiovascular morbidity had a higher risk of CVD compared to those without non-cardiovascular morbidity or depression alone.
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Affiliation(s)
- Aysha Almas
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska huset, 3rd floor, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Jette Moller
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska huset, 3rd floor, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Andreas Lundin
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska huset, 3rd floor, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska huset, 3rd floor, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
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Gazizyanova VM, Bulashova OV, Hazova EV, Hasanov NR, Oslopov VN. [Clinical features and prognosis in heart failure patients with chronic obstructive pulmonary diseases]. ACTA ACUST UNITED AC 2019; 59:51-60. [PMID: 31340749 DOI: 10.18087/cardio.2674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multimorbidity is a specific characteristic of the modern patient with chronic heart failure (CHF) which significantly changes clinical course, prognosis of the syndrome, leads to socio‑economic losses and makes significant adjustments to treatment tactics. The goal is to study the clinical features and prognosis of patients with CHF in combination with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS We studied 183 HF patients, including with stable CHF, including 105 with CHF combined with COPD. The clinical phenotype was assessed by its belonging to the functional class and the severity of COPD. A 6‑minute walk test (6‑MWT), spirometry, echocardioscopy, testing on a scale assessing the clinical condition, quality of life were studied. The end points during the year were: all‑cause mortality and cardiovascular mortality, myocardial infarction, stroke, pulmonary embolism, and hospitalization rates due to acute decompensation of CHF. RESULTS The clinical phenotype of CHF combined with COPD was characterized by a high frequency of smoking, low quality of life and exercise tolerance. Respiratory dysfunction in CHF in combination with COPD was characterized by mixed disorders (68.4%), in CHF without lung disease, restrictive (25.6%). Cardiovascular mortality in comorbid pathology was 4.0%, in CHF without COPD - 4.6%; myocardial infarction was observed 1.7 times more often with lung disease than in patients with CHF only (16.8% and 10.8%); stroke was observed exclusively in comorbid pathology (8.9%). The combined endpoint (all cardiovascular events) with CHF in combination with COPD was achieved 2.3 times more often in comparison with patients with COPD only (29.7% and 15.4%). Hospitalization due to acute decompensation of CHF occurred 2 times more often with CHF in combination with COPD than without it (32.7% and 15.4%) with a tendency to increase as the left ventricular ejection fraction decreased. CONCLUSION The results of the study demonstrate that COPD contributes to the formation of the clinical phenotype of CHF from the standpoint of the mutual influence of the characteristics of the cardiovascular and respiratory systems, and also aggravates the prognosis that requires an integrated approach to the differential diagnosis and individualization of pharmacotherapy.
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Méndez-Bailón M, Jiménez-García R, Hernández-Barrera V, Comín-Colet J, Esteban-Hernández J, de Miguel-Díez J, de Miguel-Yanes JM, Muñoz-Rivas N, Lorenzo-Villalba N, López-de-Andrés A. Significant and constant increase in hospitalization due to heart failure in Spain over 15 year period. Eur J Intern Med 2019; 64:48-56. [PMID: 30827807 DOI: 10.1016/j.ejim.2019.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/05/2019] [Accepted: 02/23/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND To examine trends in the incidence, characteristics, and in-hospital outcomes of heart failure (HF) hospitalizations from 2001 to 2015 in Spain. METHODS Using the Spanish National Hospital Discharge Database (SNHDD) we selected admissions with a primary or secondary diagnosis of HF. The primary end points were trends in the incidence of hospitalizations and in-hospital mortality (IHM). Trends with primary and secondary diagnosis of HF were evaluated separately. RESULTS The incidence of HF coding increased significantly from 466.16 cases per 100,000 inhabitants in 2001-03 to 780.4 in 2013-15 (p < .001). Age increased over time (76.33 ± 10.92 years in 2001-03 vs. 79.4 ± 10.78 years in 2013-15; p < .001). We found a decrease in the percentage of women over the study period (53.07% vs. 52%; p < .001). We detected a significant increase in comorbidity according to the Charlson Comorbidity Index over time (mean 2.17 ± 0.98 in 2001-03 vs. 2.46 ± 1.04 in 2013-15). The most common associated comorbidities were atrial fibrillation (42.23%), hypertension (38.87%) and type 2 diabetes (34.3%). For the total time period, IHM was 12.79%. IHM decreased significantly over time from 13.47% in 2001-03 to 12.30% in 2013-15. Patients with HF coded as a secondary diagnosis have 66% higher risk of dying in the hospital that those with HF coded as a primary diagnosis. CONCLUSIONS This research shows an increase of hospitalizations due to HF in Spain, particularly in patients with HF as a secondary diagnosis. Advance age and comorbidity in acute HF has increased in the recent years. However, IHM is decreasing while readmissions remain stable.
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Affiliation(s)
- Manuel Méndez-Bailón
- Internal Medicine Department, Clínico San Carlos University Hospital, Medicine Department, Complutense University of Madrid (UCM), Clínico San Carlos Hospital Biomedical Research Institute (IdISSC), Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Josep Comín-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Jesús Esteban-Hernández
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - José M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Spain
| | - Nuria Muñoz-Rivas
- Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Additive Value of Biomarkers and Echocardiography to Stratify the Risk of Death in Heart Failure Patients with Reduced Ejection Fraction. Cardiol Res Pract 2019; 2019:1824816. [PMID: 31192003 PMCID: PMC6525851 DOI: 10.1155/2019/1824816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/01/2019] [Accepted: 03/19/2019] [Indexed: 01/20/2023] Open
Abstract
Background Risk stratification is a crucial issue in heart failure. Clinicians seek useful tools to tailor therapies according to patient risk. Methods A prospective, observational, multicenter study on stable chronic heart failure outpatients with reduced left ventricular ejection fraction (HFrEF). Baseline demographics, blood, natriuretic peptides (NPs), high-sensitivity troponin I (hsTnI), and echocardiographic data, including the ratio between tricuspid annular plane excursion and systolic pulmonary artery pressure (TAPSE/PASP), were collected. Association with death for any cause was analyzed. Results Four hundred thirty-one (431) consecutive patients were enrolled in the study. Fifty deaths occurred over a median follow-up of 32 months. On the multivariable Cox model analysis, TAPSE/PASP ratio, number of biomarkers above the threshold values, and gender were independent predictors of death. Both the TAPSE/PASP ratio ≥0.36 and TAPSE/PASP unavailable groups had a three-fold decrease in risk of death in comparison to the TAPSE/PASP ratio <0.36 group. The risk of death increased linearly by 1.6 for each additional positive biomarker and by almost two for women compared with men. Conclusions In a HFrEF outpatient cohort, the evaluation of plasma levels of both NPs and hsTnI can contribute significantly to identifying patients who have a worse prognosis, in addition to the echocardiographic assessment of right ventricular-arterial coupling.
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Marrero-Rivera GE, Vargas P, López-Candales A. Heart failure readmissions: a losing battle or an opportunity for improvement? Postgrad Med 2019; 131:182-184. [PMID: 30843457 DOI: 10.1080/00325481.2019.1589154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite great strides in diagnosis and management of heart failure (HF), this chronic illness continues to be a worldwide epidemic with approximately 23 million people afflicted across the globe. In the US, over 6.5 million carry a HF diagnosis with almost 90% of all HF deaths occurring in patients over the age of 70. Since one in five Americans are expected to be older than 65 years by 2050, almost 1,000,000 new HF cases are expected to be diagnosed every year. The staggering nature of these numbers only pales in comparison to current dismal HF survival statistics. The unavoidable natural history of HF continues to be characterized by the occurrence of repetitive hospital admissions. Not only are hospital readmissions demarcated as one of the most important risk factors associated with mortality; but also, a well-recognized trigger for additional hospital readmissions. Even when HF treatment guidelines have been recently updated; the mere fact that four HF societies have issued individual recommendations without reaching a common unifying consensus statement adds to the complexity of HF patient management. The purpose of this Editorial not only to fuel more interest on this topic but also to spark the notion that we have a potential catastrophe in our hands and is the responsibility of all health-care professionals to attend to this vital issue.
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Affiliation(s)
| | - Pedro Vargas
- b Cardiovascular Medicine Division of the University of Puerto Rico School of Medicine , San Juan , Puerto Rico
| | - Angel López-Candales
- b Cardiovascular Medicine Division of the University of Puerto Rico School of Medicine , San Juan , Puerto Rico
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Jepma P, Ter Riet G, van Rijn M, Latour CHM, Peters RJG, Scholte Op Reimer WJM, Buurman BM. Readmission and mortality in patients ≥70 years with acute myocardial infarction or heart failure in the Netherlands: a retrospective cohort study of incidences and changes in risk factors over time. Neth Heart J 2019; 27:134-141. [PMID: 30715672 PMCID: PMC6393584 DOI: 10.1007/s12471-019-1227-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives To determine the risk of first unplanned all-cause readmission and mortality of patients ≥70 years with acute myocardial infarction (AMI) or heart failure (HF) and to explore which effects of baseline risk factors vary over time. Methods A retrospective cohort study was performed on hospital and mortality data (2008) from Statistics Netherlands including 5,175 (AMI) and 9,837 (HF) patients. We calculated cumulative weekly incidences for first unplanned all-cause readmission and mortality during 6 months post-discharge and explored patient characteristics associated with these events. Results At 6 months, 20.4% and 9.9% (AMI) and 24.6% and 22.4% (HF) of patients had been readmitted or had died, respectively. The highest incidences were found in week 1. An increased risk for 14-day mortality after AMI was observed in patients who lived alone (hazard ratio (HR) 1.57, 95% confidence interval (CI) 1.01–2.44) and within 30 and 42 days in patients with a Charlson Comorbidity Index ≥3. In HF patients, increased risks for readmissions within 7, 30 and 42 days were found for a Charlson Comorbidity Index ≥3 and within 42 days for patients with an admission in the previous 6 months (HR 1.42, 95% CI 1.12–1.80). Non-native Dutch HF patients had an increased risk of 14-day mortality (HR 1.74, 95% CI 1.09–2.78). Conclusion The risk of unplanned readmission and mortality in older AMI and HF patients was highest in the 1st week post-discharge, and the effect of some risk factors changed over time. Transitional care interventions need to be provided as soon as possible to prevent early readmission and mortality. Electronic supplementary material The online version of this article (10.1007/s12471-019-1227-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Jepma
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - G Ter Riet
- Amsterdam UMC, Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Rijn
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - C H M Latour
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - R J G Peters
- Amsterdam UMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - W J M Scholte Op Reimer
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - B M Buurman
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam, The Netherlands
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Rosa GM, Scagliola R, Ghione P, Valbusa A, Brunelli C, Carbone F, Montecucco F, Monacelli F. Predictors of cardiovascular outcome and rehospitalization in elderly patients with heart failure. Eur J Clin Invest 2019; 49:e13044. [PMID: 30368802 DOI: 10.1111/eci.13044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart failure (HF) is a major public health problem and represents the only cardiac disease continuing to increase in prevalence, in particular among elderly patients. The frequent rehospitalizations have a negative impact on quality of life of patients with HF, constituting a substantial cost for patients and the health system. The aim of this review was to look into biochemical, echocardiographic and socioeconomical parameters as predictors of clinical outcomes and rehospitalizations. METHODS This narrative review is based on the material searched for and obtained via PubMed from January 2000 up to March 2018. The search terms we used were as follows: "elderly, heart failure, cardiovascular" in combination with "biomarker, echocardiography and hospitalization." RESULTS This review analyses the potential predictive role of biochemical and echocardiographic and socioeconomical parameters on clinical outcomes (particularly cardiovascular) and hospital readmissions in patients with chronic HF. We focused on risk stratification of elderly patients with HF, who constitute a category of frail subjects at higher risk for readmission to hospital. CONCLUSIONS In elderly subjects with chronic HF, the risk stratification could benefit of a multiparametric approach combining biochemical, echocardiographic, demographic and socioeconomical parameters, thus ensuring a better quality of life and at the same time a better allocation of financial resources.
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Affiliation(s)
- Gian M Rosa
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | | | - Paola Ghione
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Alberto Valbusa
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Claudio Brunelli
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy.,Department of Internal Medicine, and Centre of Excellence for Biomedical Research (CEBR), First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy.,Department of Internal Medicine, Geriatric Unit, University of Genoa, Genoa, Italy
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Lawson CA, Mamas MA, Jones PW, Teece L, McCann G, Khunti K, Kadam UT. Association of Medication Intensity and Stages of Airflow Limitation With the Risk of Hospitalization or Death in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease. JAMA Netw Open 2018; 1:e185489. [PMID: 30646293 PMCID: PMC6324325 DOI: 10.1001/jamanetworkopen.2018.5489] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE In heart failure (HF), chronic obstructive pulmonary disease (COPD) increases the risk of poor outcomes, but the effect of COPD severity is unknown. This information is important for early intervention tailored to the highest-risk groups. OBJECTIVES To determine the associations between COPD medication intensity or stage of airflow limitation and the risk of hospitalization or death in patients with HF. DESIGN, SETTING, AND PARTICIPANTS This UK population-based, nested case-control study with risk-set sampling used the Clinical Practice Research Datalink linked to Hospital Episode Statistics between January 1, 2002, to January 1, 2014. Participants included patients aged 40 years and older with a new diagnosis of HF in their family practice clinical record. Data analysis was conducted from 2017 to 2018. EXPOSURES In patients with HF, those with COPD were compared with those without it. International COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD]) guidelines were used to stratify patients with COPD by 7 medication intensity levels and 4 airflow limitation severity stages using automatically recorded prescriptions and routinely requested forced expiratory volume in 1 second (FEV1) data. MAIN OUTCOMES AND MEASURES First all-cause admission or all-cause death. RESULTS There were 50 114 patients with new HF (median age, 79 years [interquartile range, 71-85 years]; 46% women) during the study period. In patients with HF, COPD (18 478 [13.8%]) was significantly associated with increased mortality (adjusted odds ratio [AOR], 1.31; 95% CI, 1.26-1.36) and hospitalization (AOR, 1.33; 95% CI, 1.26-1.39). The 3 most severe medication intensity levels showed significantly increasing mortality associations from full inhaler therapy (AOR, 1.17; 95% CI, 1.06-1.29) to oral corticosteroids (AOR, 1.69; 95% CI, 1.57-1.81) to oxygen therapy (AOR, 2.82; 95% CI, 2.42-3.28). The respective estimates for hospitalization were AORs of 1.17 (95% CI, 1.03-1.33), 1.75 (95% CI, 1.59-1.92), and 2.84 (95% CI, 1.22-3.63). Availability of spirometry data was limited but showed that increasing airflow limitation was associated with increased risk of mortality, with the following AORs: FEV1 80% or more, 1.63 (95% CI, 1.42-1.87); FEV1 50% to 79%, 1.69 (95% CI, 1.56-1.83); FEV1 30% to 49%, 2.21 (95% CI, 2.01-2.42); FEV1 less than 30%, 2.93 (95% CI, 2.49-3.43). The strength of associations between FEV1 and hospitalization risk were similar among stages ranging from FEV1 80% or more (AOR, 1.48; 95% CI, 1.31-1.68) to FEV1 less than 30% (AOR, 1.73; 95% CI, 1.40-2.12). CONCLUSIONS AND RELEVANCE In the UK HF community setting, increasing COPD severity was associated with increasing risk of mortality and hospitalization. Prescribed COPD medication intensity and airflow limitation provide the basis for targeting high-risk groups.
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Affiliation(s)
- Claire A Lawson
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keel University, Stoke-on-Trent, United Kingdom
| | - Peter W Jones
- Faculty of Medicine and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Lucy Teece
- Faculty of Medicine and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Gerry McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | - Umesh T Kadam
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
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Breathlessness, but not cough, suggests chronic obstructive pulmonary disease in elderly smokers with stable heart failure. Multidiscip Respir Med 2018; 13:35. [PMID: 30305900 PMCID: PMC6166269 DOI: 10.1186/s40248-018-0148-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/20/2018] [Indexed: 12/28/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common comorbidity of heart failure (HF), but remains often undiagnosed, and we aimed to identify symptoms predicting COPD in HF. As part of an observational, prospective study, we investigated stable smokers with a confirmed diagnosis of HF, using the 8-item COPD-Assessment-Test (CAT) questionnaire to assess symptoms. All the items were correlated with the presence of COPD, and logistic regression models were used to identify independent predictors. 96 HF patients were included, aged 74, 33% with COPD. Patients with HF and COPD were more symptomatic, but only breathlessness when walking up a hill was an independent predictor of COPD (odds ratio = 1.33, p = 0.0484). Interestingly, COPD-specific symptoms such as cough and phlegm were not significant. Thus, in elderly smokers with stable HF, significant breathlessness when walking up a hill is most indicative of associated COPD, and may indicate the need for further lung function evaluation.
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Saito M, Yamaoka M, Ohzawa M, Tominaga E, Takahashi K, Morofuji T, Sumimoto T, Inaba S. Impact of residence altitude on readmission in patients with heart failure. Open Heart 2018; 5:e000865. [PMID: 30245838 PMCID: PMC6144892 DOI: 10.1136/openhrt-2018-000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 11/25/2022] Open
Abstract
Objective Mountain districts normally have tougher geographic conditions than plain districts, which might worsen heart failure (HF) conditions in patients. Also, those places frequently are associated with social problems of ageing, underpopulation and fewer medical services, which might cause delay in detection of disease progression and require more admissions. We investigated the association of residence altitude with readmission in patients with HF. Methods We followed 452 patients with HF to determine all-cause readmissions over a median of 1.1 years. The altitude of patient residences, population, proportion of the elderly and number of hospitals or clinics in a minor administrative district (Cho-Aza district) located at the residences were examined using data from the 2010 census and Google Maps. Results All-cause readmissions were observed in 269 (60%) patients. The altitude of ≥200 m was significantly associated with readmissions (HR, 1.49; 95 % CI 1.12 to 1.96; p=0.006) after adjustment for physical and haemodynamic parameters, left ventricular ejection fraction, brain natriuretic peptide and components of the established score for predicting readmission for HF. Altitude was significantly associated with ageing, underpopulation, fewer hospitals or clinics and lower temperature (all p<0.01), with an increased tendency for readmission during the winter season; however, it was not associated with patient clinical parameters. Conclusions High altitude residence may be an important predictor for readmission in patients with HF. This relationship may be confounded by unfavourable sociogeographic conditions at higher altitudes.
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Lawson CA, Testani JM, Mamas M, Damman K, Jones PW, Teece L, Kadam UT. Chronic kidney disease, worsening renal function and outcomes in a heart failure community setting: A UK national study. Int J Cardiol 2018; 267:120-127. [PMID: 29957251 PMCID: PMC6024224 DOI: 10.1016/j.ijcard.2018.04.090] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/06/2018] [Accepted: 04/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Routine heart failure (HF) monitoring and management is in the community but the natural course of worsening renal function (WRF) and its influence on HF prognosis is unknown. We investigated the influence of routinely monitored renal decline and related comorbidities on imminent hospitalisation and death in the HF community population. METHODS A nested case-control study within an incident HF cohort (N = 50,114) with 12-years follow-up. WRF over 6-months before first hospitalisation and 12-months before death was defined by >20% reduction in estimated glomerular filtration rate (eGFR). Additive interactions between chronic kidney disease (CKD) and comorbidities were investigated. RESULTS Prevalence of CKD (eGFR<60 ml/min/1.73m2) in the HF community was 63%, which was associated with an 11% increase in hospitalisation and 17% in mortality. Both risk associations were significantly worse in the presence of diabetes. Compared to HF patients with eGFR,60-89, there was no or minimal increase in risk for mild to moderate CKD (eGFR,30-59) for both outcomes. Adjusted risk estimates for hospitalisation were increased only for severe CKD(eGFR,15-29); Odds Ratio 1.49 (95%CI;1.36,1.62) and renal failure(eGFR,<15); 3.38(2.67,4.29). The relationship between eGFR and mortality was U-shaped; eGFR, ≥90; 1.32(1.17,1.48), eGFR,15-29; 1.68(1.58,1.79) and eGFR,<15; 3.04(2.71,3.41). WRF is common and associated with imminent hospitalisation (1.50;1.37,1.64) and mortality (1.92;1.79,2.06). CONCLUSIONS In HF, the risk associated with CKD differs between the community and the acute HF setting. In the community setting, moderate CKD confers no risk but severe CKD, WRF or CKD with other comorbidities identifies patients at high risk of imminent hospitalisation and death.
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Affiliation(s)
- Claire A Lawson
- Leicester Diabetes Centre, Leicester University, UK; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK.
| | - J M Testani
- Yale University, New Haven, CT, United States
| | - M Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
| | - K Damman
- University of Groningen, University Medical Center, Groningen, The Netherlands
| | - P W Jones
- Faculty of Medicine and Health Sciences, Keele University, England, UK
| | - L Teece
- Faculty of Medicine and Health Sciences, Keele University, England, UK
| | - U T Kadam
- Leicester Diabetes Centre, Leicester University, UK; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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Kilvert A, Fox C. Palliative care and heart failure in diabetes. PRACTICAL DIABETES 2018. [DOI: 10.1002/pdi.2182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Anne Kilvert
- Northampton General Hospital NHS Trust; Northampton UK
| | - Charles Fox
- Northampton General Hospital NHS Trust; Northampton UK
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Golas SB, Shibahara T, Agboola S, Otaki H, Sato J, Nakae T, Hisamitsu T, Kojima G, Felsted J, Kakarmath S, Kvedar J, Jethwani K. A machine learning model to predict the risk of 30-day readmissions in patients with heart failure: a retrospective analysis of electronic medical records data. BMC Med Inform Decis Mak 2018; 18:44. [PMID: 29929496 PMCID: PMC6013959 DOI: 10.1186/s12911-018-0620-z] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/30/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Heart failure is one of the leading causes of hospitalization in the United States. Advances in big data solutions allow for storage, management, and mining of large volumes of structured and semi-structured data, such as complex healthcare data. Applying these advances to complex healthcare data has led to the development of risk prediction models to help identify patients who would benefit most from disease management programs in an effort to reduce readmissions and healthcare cost, but the results of these efforts have been varied. The primary aim of this study was to develop a 30-day readmission risk prediction model for heart failure patients discharged from a hospital admission. METHODS We used longitudinal electronic medical record data of heart failure patients admitted within a large healthcare system. Feature vectors included structured demographic, utilization, and clinical data, as well as selected extracts of un-structured data from clinician-authored notes. The risk prediction model was developed using deep unified networks (DUNs), a new mesh-like network structure of deep learning designed to avoid over-fitting. The model was validated with 10-fold cross-validation and results compared to models based on logistic regression, gradient boosting, and maxout networks. Overall model performance was assessed using concordance statistic. We also selected a discrimination threshold based on maximum projected cost saving to the Partners Healthcare system. RESULTS Data from 11,510 patients with 27,334 admissions and 6369 30-day readmissions were used to train the model. After data processing, the final model included 3512 variables. The DUNs model had the best performance after 10-fold cross-validation. AUCs for prediction models were 0.664 ± 0.015, 0.650 ± 0.011, 0.695 ± 0.016 and 0.705 ± 0.015 for logistic regression, gradient boosting, maxout networks, and DUNs respectively. The DUNs model had an accuracy of 76.4% at the classification threshold that corresponded with maximum cost saving to the hospital. CONCLUSIONS Deep learning techniques performed better than other traditional techniques in developing this EMR-based prediction model for 30-day readmissions in heart failure patients. Such models can be used to identify heart failure patients with impending hospitalization, enabling care teams to target interventions at their most high-risk patients and improving overall clinical outcomes.
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Affiliation(s)
- Sara Bersche Golas
- Partners Connected Health Innovation, Partners HealthCare, 25 New Chardon St., Suite 300, Boston, MA, 02114, USA.
| | | | - Stephen Agboola
- Partners Connected Health Innovation, Partners HealthCare, 25 New Chardon St., Suite 300, Boston, MA, 02114, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Hiroko Otaki
- Research and Development Group, Hitachi, Ltd, Tokyo, Japan
| | - Jumpei Sato
- Research and Development Group, Hitachi, Ltd, Tokyo, Japan
| | - Tatsuya Nakae
- Research and Development Group, Hitachi, Ltd, Tokyo, Japan
| | - Toru Hisamitsu
- Research and Development Group, Hitachi, Ltd, Tokyo, Japan
| | - Go Kojima
- Research and Development Group, Hitachi, Ltd, Tokyo, Japan
| | - Jennifer Felsted
- Partners Connected Health Innovation, Partners HealthCare, 25 New Chardon St., Suite 300, Boston, MA, 02114, USA
| | - Sujay Kakarmath
- Partners Connected Health Innovation, Partners HealthCare, 25 New Chardon St., Suite 300, Boston, MA, 02114, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joseph Kvedar
- Partners Connected Health Innovation, Partners HealthCare, 25 New Chardon St., Suite 300, Boston, MA, 02114, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kamal Jethwani
- Partners Connected Health Innovation, Partners HealthCare, 25 New Chardon St., Suite 300, Boston, MA, 02114, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Zielinski M, Gasior M, Jastrzebski D, Desperak A, Ziora D. Influence of Gaseous Pollutants on COPD Exacerbations in Patients with Cardiovascular Comorbidities. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1114:11-17. [PMID: 29679365 DOI: 10.1007/5584_2018_206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are a serious public health issue. Ambient pollution and meteorological factors are considered among precipitating factors. There are few data concerning the impact of ambient pollutants other than particulates on COPD exacerbations. Among gaseous pollutants four main groups of substances are primarily monitored: nitrogen oxides (NOx), sulphur dioxide (SO2), carbon monoxide (CO), and ozone (O3). In this study, 12,889 hospitalizations in the years 2006-2014 due to exacerbations of COPD in patients having a co-existing cardiovascular pathology were retrospectively analyzed. Cardiovascular disease was ruled out as the underlying reason of hospitalization. Data concerning the then accompanying gaseous pollutants and weather conditions were collected. The findings were that the impact of SO2 content was significantly associated with the relative risk (RR) of COPD exacerbation when the exposure took place at least 30 days or longer before hospital admission (RR 1.04-1.05; p < 0.05). In contrast, risk of COPD exacerbation rose when a shortening of the time lag between exposure to NOx and hospital admission was considered (RR 1.02-1.04; p < 0.05). O3 exposure was associated with a lower risk irrespective of the length of exposure/exacerbation lag (RR 0.77-0.90; p < 0.05). There were insignificant associations observed for CO. In conclusion, the study demonstrates a salient influence of a co-existing cardiovascular malady on the appearance of COPD-related respiratory exacerbations when the pollutant SO2 and NOx contents rose. In contrast, higher O3 content was associated with a lower risk of COPD exacerbation.
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Affiliation(s)
- Michal Zielinski
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.
| | - Mariusz Gasior
- Third Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Dariusz Jastrzebski
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Aneta Desperak
- Third Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Dariusz Ziora
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
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Tavazzi L. It's time to move on from counting co-morbidities to curing them: the case of chronic heart failure-chronic obstructive pulmonary disease co-morbidity. Eur J Heart Fail 2017; 20:193-196. [PMID: 29164746 DOI: 10.1002/ejhf.1083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/15/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
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40
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Lawson CA, Jones PW, Teece L, Dunbar SB, Seferovic PM, Khunti K, Mamas M, Kadam UT. Association Between Type 2 Diabetes and All-Cause Hospitalization and Mortality in the UK General Heart Failure Population: Stratification by Diabetic Glycemic Control and Medication Intensification. JACC-HEART FAILURE 2017; 6:18-26. [PMID: 29032131 DOI: 10.1016/j.jchf.2017.08.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/14/2017] [Accepted: 08/07/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study sought to investigate in the general heart failure (HF) population, whether the associations between type 2 diabetes (T2D) and risk of hospitalization and death, are modified by changing glycemic or drug treatment intensity. BACKGROUND In the general HF population, T2D confers a higher risk of poor outcomes, but whether this risk is modified by the diabetes status is unknown. METHODS A nested case-control study in an incident HF database cohort (2002 to 2014) compared patients with T2D with those without for risk of all-cause first hospitalization and death. T2D was stratified by categories of glycosylated hemoglobin (HbA1c) or drug treatments measured 6 months before hospitalization and 1 year before death and compared with the HF group without T2D. RESULTS In HF, T2D was associated with risk of first hospitalization (adjusted odds ratio [aOR]: 1.29; 95% confidence interval [CI]: 1.24 to 1.34) and mortality (aOR: 1.24; 95% CI: 1.29 to 1.40). Stratification of T2D by HbA1c levels, compared with the reference HF group without T2D, showed U-shaped associations with both outcomes. Highest risk categories were HbA1c >9.5% (hospitalization, aOR: 1.75; 95% CI: 1.52 to 2.02; mortality, aOR: 1.30; 95% CI: 1.24 to 1.47) and <5.5% (hospitalization, aOR: 1.42; 95% CI: 1.12 to 1.80; mortality, aOR: 1.29; 95% CI: 1.10 to 1.51, respectively). T2D group with change in HbA1c of >1% decrease was associated with hospitalization (aOR: 1.33; 95% CI: 1.18 to 1.49) and mortality (aOR: 1.36; 95% CI: 1.24 to 1.48). T2D drug group associations with hospitalization were no medication (aOR: 1.12; 95% CI: 1.04 to 1.19), oral antihyperglycemic only (aOR: 1.34; 95% CI: 1.27 to 1.41), oral antihyperglycemic+insulin (aOR: 1.36; 95% CI: 1.21 to 1.52), and insulin only (aOR: 1.61; 95% CI: 1.43 to 1.81); and with mortality for the same drug groups were 1.31 (95% CI: 1.23 to 1.39), 1.16 (95% CI: 1.11 to 1.22), 1.19 (95% CI: 1.06 to 1.34), and 1.43 (95% CI: 1.31 to 1.57), respectively. The T2D group with reduced drug treatments were associated with hospitalization (aOR: 2.13; 95% CI: 1.68 to 2.69) and mortality (aOR: 2.09; 95% CI: 1.81 to 2.41). CONCLUSIONS In the general HF population, T2D stratified by glycemic control and drug treatments showed differential risk associations. Routine measures of dynamic diabetes status provide important prognostic indication of poor outcomes in HF.
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Affiliation(s)
- Claire A Lawson
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
| | - Peter W Jones
- Faculty of Medicine and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
| | - Lucy Teece
- Faculty of Medicine and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
| | | | | | - Kamlesh Khunti
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
| | - Umesh T Kadam
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
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41
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Bernabeu-Wittel M, Barón-Franco B, Nieto-Martín D, Moreno-Gaviño L, Ramírez-Duque N, Ollero-Baturone M. Prognostic stratification and the healthcare approach in patients with multiple pathologies. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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42
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Bernabeu-Wittel M, Barón-Franco B, Nieto-Martín D, Moreno-Gaviño L, Ramírez-Duque N, Ollero-Baturone M. Estratificación pronóstica y abordaje asistencial de los pacientes pluripatológicos. Rev Clin Esp 2017; 217:410-419. [DOI: 10.1016/j.rce.2017.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/24/2017] [Indexed: 11/26/2022]
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43
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Lawson C, Pati S, Green J, Messina G, Strömberg A, Nante N, Golinelli D, Verzuri A, White S, Jaarsma T, Walsh P, Lonsdale P, Kadam UT. Development of an international comorbidity education framework. NURSE EDUCATION TODAY 2017; 55:82-89. [PMID: 28535380 DOI: 10.1016/j.nedt.2017.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 04/27/2017] [Accepted: 05/08/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT The increasing number of people living with multiple chronic conditions in addition to an index condition has become an international healthcare priority. Health education curricula have been developed alongside single condition frameworks in health service policy and practice and need redesigning to incorporate optimal management of multiple conditions. AIM Our aims were to evaluate current teaching and learning about comorbidity care amongst the global population of healthcare students from different disciplines and to develop an International Comorbidity Education Framework (ICEF) for incorporating comorbidity concepts into health education. METHODS We surveyed nursing, medical and pharmacy students from England, India, Italy and Sweden to evaluate their understanding of comorbidity care. A list of core comorbidity content was constructed by an international group of higher education academics and clinicians from the same disciplines, by searching current curricula and analysing clinical frameworks and the student survey data. This list was used to develop the International Comorbidity Education Framework. RESULTS The survey sample consisted of 917 students from England (42%), India (48%), Italy (8%) and Sweden (2%). The majority of students across all disciplines said that they lacked knowledge, training and confidence in comorbidity care and were unable to identify specific teaching on comorbidities. All student groups wanted further comorbidity training. The health education institution representatives found no specific references to comorbidity in current health education curricula. Current clinical frameworks were used to develop an agreed list of core comorbidity content and hence an International Comorbidity Education Framework. CONCLUSIONS Based on consultation with academics and clinicians and on student feedback we developed an International Comorbidity Education Framework to promote the integration of comorbidity concepts into current healthcare curricula.
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Affiliation(s)
- C Lawson
- Keele University, Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, UK.
| | - S Pati
- Public Health Foundation of India, Indian Institute of Public Health-Bhubaneswar, India
| | - J Green
- Keele University, Department of Nursing and Midwifery, UK
| | - G Messina
- University of Siena, Department of Public Health, Italy
| | - A Strömberg
- Linkoping University, Medical and Health Sciences, Sweden
| | - N Nante
- University of Siena, Department of Public Health, Italy
| | - D Golinelli
- University of Siena, Department of Public Health, Italy
| | - A Verzuri
- University of Siena, Department of Public Health, Italy
| | - S White
- Keele University, Department of Pharmacy, UK
| | - T Jaarsma
- Linkoping University, Social and Welfare Studies, Sweden
| | - P Walsh
- Keele University, Department of Nursing and Midwifery, UK
| | - P Lonsdale
- Keele University, Department of Nursing and Midwifery, UK
| | - U T Kadam
- Keele University, Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, UK
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44
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Roversi S, Fabbri LM, Sin DD, Hawkins NM, Agustí A. Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care. Am J Respir Crit Care Med 2017; 194:1319-1336. [PMID: 27589227 DOI: 10.1164/rccm.201604-0690so] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a global health issue with high social and economic costs. Concomitant chronic cardiac disorders are frequent in patients with COPD, likely owing to shared risk factors (e.g., aging, cigarette smoke, inactivity, persistent low-grade pulmonary and systemic inflammation) and add to the overall morbidity and mortality of patients with COPD. The prevalence and incidence of cardiac comorbidities are higher in patients with COPD than in matched control subjects, although estimates of prevalence vary widely. Furthermore, cardiac diseases contribute to disease severity in patients with COPD, being a common cause of hospitalization and a frequent cause of death. The differential diagnosis may be challenging, especially in older and smoking subjects complaining of unspecific symptoms, such as dyspnea and fatigue. The therapeutic management of patients with cardiac and pulmonary comorbidities may be similarly challenging: bronchodilators may have cardiac side effects, and, vice versa, some cardiac medications should be used with caution in patients with lung disease. The aim of this review is to summarize the evidence of the relationship between COPD and the three most frequent and important cardiac comorbidities in patients with COPD: ischemic heart disease, heart failure, and atrial fibrillation. We have chosen a practical approach, first summarizing relevant epidemiological and clinical data, then discussing the diagnostic and screening procedures, and finally evaluating the impact of lung-heart comorbidities on the therapeutic management of patients with COPD and heart diseases.
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Affiliation(s)
- Sara Roversi
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | - Leonardo M Fabbri
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | | | - Nathaniel M Hawkins
- 3 Division of Cardiology, Department of Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Alvar Agustí
- 4 Thorax Institute, Hospital Clinic in Barcelona, University of Barcelona, Barcelona, Spain
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45
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Agabiti N, Corbo GM. COPD and bronchodilators: should the heart pay the bill for the lung? Eur Respir J 2017; 49:49/5/1700370. [PMID: 28536252 DOI: 10.1183/13993003.00370-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Nera Agabiti
- Dept of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Imaizumi Y, Eguchi K, Murakami T, Saito T, Hoshide S, Kario K. Locomotive syndrome is associated with large blood pressure variability in elderly hypertensives: the Japan Ambulatory Blood Pressure Prospective (JAMP) substudy. J Clin Hypertens (Greenwich) 2016; 19:388-394. [PMID: 27862879 DOI: 10.1111/jch.12946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 01/24/2023]
Abstract
Chronic pain, represented by locomotive syndrome (LS), and psychosocial factors are possible factors of blood pressure (BP) variability (BPV). The authors tested the hypothesis that there are links among LS, depression, and BPV. In 85 Japanese elderly hypertensive patients with normal daily activities, the authors performed ambulatory BP monitoring, determined the LS scale (LSS), and administered the Self-Rating Questionnaire for Depression (SRQD). The LSS score but not the SRQD score was associated with the standard deviation (SD) and coefficient of variation (CV) of daytime systolic BP (SBP) and SD of nighttime SBP (all P<.05). Higher LSS score (in quartiles) was associated with a higher SD of daytime SBP (P=.041), even after adjusting for covariates. Regarding the components of the LSS score, movement-related difficulty and usual care difficulty were associated with the SD and CV of daytime SBP. In elderly hypertensive patients, the LSS score was associated with exaggerated systolic BPV. The LS state could be an important determinant of systolic BPV.
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Affiliation(s)
- Yuki Imaizumi
- Kotake Municipal Hospital, Kotake, Fukuoka, Japan.,Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | | | - Tomohiro Saito
- Department of Orthopedics, Fukuoka Mirai Hospital, Fukuoka, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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47
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Mommersteeg PMC, Schoemaker RG, Naudé PJW, Eisel ULM, Garrelds IM, Schalkwijk CG, Westerhuis BWJJM, Kop WJ, Denollet J. Depression and markers of inflammation as predictors of all-cause mortality in heart failure. Brain Behav Immun 2016; 57:144-150. [PMID: 27013355 DOI: 10.1016/j.bbi.2016.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/04/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND In patients with heart failure (HF) depressive symptoms have been associated with mortality, as well as biological risk factors, including inflammation, nitric oxide (NO) regulation, and oxidative stress. We investigated the joint predictive value of depressive symptoms, inflammation and NO regulation on all-cause mortality in patients with HF, adjusted for covariates. METHODS Serum levels of inflammation (TNFα, sTNFr1, sTNFr2, IL-6, hsCRP, NGAL), NO regulation (l-arginine, ADMA, and SDMA), and oxidative stress (isoprostane 8-Epi Prostaglandin F2 Alpha) were measured in 104 patients with HF (mean age 65.7±SD 8.4years, 28% women). Depressive symptoms (Beck Depression Inventory, BDI) were measured as continuous total, cognitive, and somatic symptoms, as well as categorized presence of mild/moderate depression (cut-off BDI ⩾10). In Cox proportional hazard models we adjusted for age, sex, poor exercise tolerance and comorbidity. RESULTS After on average 6.1years follow-up (SD=2.9, range 0.4-9.2), 49 patients died. Total and somatic depressive symptoms, mild/moderate depression, higher NGAL, sTNFr2, IL-6, hsCRP and SDMA serum levels were significantly associated with a higher all-cause mortality rate, adjusted for covariates. The findings were most consistent for CRP level and somatic depressive symptoms. When combined, both depressive symptoms and markers of inflammation and NO regulation remained significantly associated with all-cause mortality. These associations were not confounded by age, sex, poor exercise tolerance and comorbidity. CONCLUSION Depressive symptoms and markers of inflammation and NO regulation are codominant risk factors for all-cause mortality in heart failure.
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Affiliation(s)
- Paula M C Mommersteeg
- CoRPS, Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
| | - Regien G Schoemaker
- Department of Molecular Neurobiology, University of Groningen, Nijenborgh 7, 9747 AG Groningen, The Netherlands; Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
| | - Petrus J W Naudé
- Department of Molecular Neurobiology, University of Groningen, Nijenborgh 7, 9747 AG Groningen, The Netherlands; Department of Neurology and Alzheimer Research Centre, University of Groningen, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands.
| | - Ulrich L M Eisel
- Department of Molecular Neurobiology, University of Groningen, Nijenborgh 7, 9747 AG Groningen, The Netherlands; Department of Neurology and Alzheimer Research Centre, University of Groningen, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands.
| | - Ingrid M Garrelds
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus Medical Center, The Netherlands.
| | - Casper G Schalkwijk
- Department of Internal Medicine, Laboratory for Metabolism and Vascular Medicine, CARIM, Maastricht University Medical Centre, Peter Debeyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Bert W J J M Westerhuis
- Clinical Chemistry and Hematology Laboratory, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - Willem J Kop
- CoRPS, Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
| | - Johan Denollet
- CoRPS, Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
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Martín-Sánchez FJ, Christ M, Miró Ò, Peacock WF, McMurray JJ, Bueno H, Maisel AS, Cullen L, Cowie MR, Di Somma S, Platz E, Masip J, Zeymer U, Vrints C, Price S, Mueller C. Practical approach on frail older patients attended for acute heart failure. Int J Cardiol 2016; 222:62-71. [PMID: 27458825 DOI: 10.1016/j.ijcard.2016.07.151] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/15/2016] [Indexed: 12/12/2022]
Abstract
Acute heart failure (AHF) is a multi-organ dysfunction syndrome. In addition to known cardiac dysfunction, non-cardiac comorbidity, frailty and disability are independent risk factors of mortality, morbidity, cognitive and functional decline, and risk of institutionalization. Frailty, a treatable and potential reversible syndrome very common in older patients with AHF, increases the risk of disability and other adverse health outcomes. This position paper highlights the need to identify frailty in order to improve prognosis, the risk-benefits of invasive diagnostic and therapeutic procedures, and the definition of older-person-centered and integrated care plans.
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Affiliation(s)
- Francisco J Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - Michael Christ
- Department of Emergency and Critical Care Medicine, Klinikum Nürnberg, Germany
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain; Institut de Recerca Biomàdica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - W Frank Peacock
- Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | - John J McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Instituto de Investigación i+12 y Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Alan S Maisel
- Coronary Care Unit and Heart Failure Program, Veteran Affairs (VA) San Diego, United States
| | - Louise Cullen
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Martin R Cowie
- Cardiology Department, Imperial College London (Royal Brompton Hospital), London, England, United Kingdom
| | - Salvatore Di Somma
- Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Josep Masip
- ICU Department, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain; Cardiology Department, Hospital Sanitas CIMA, Barcelona, Spain
| | - Uwe Zeymer
- Klinikum Ludwigshafen und Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Christiaan Vrints
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Susanna Price
- Royal Brompton and Harefield National Health Service Foundation Trust, United Kingdom
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
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49
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Baudouin C, Groshens S, Gueneau P, Rousseau M, Saura M, Hryschyschyn N, Hillani A, Dagorn J, Pitthan E, Jourdain P. [Medico-economic impact of an innovative management of CHF by HF unit]. Ann Cardiol Angeiol (Paris) 2015; 64:318-324. [PMID: 26482635 DOI: 10.1016/j.ancard.2015.09.036] [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: 07/26/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Chronic heart failure remains a frequent, severe and costly disease. Despite encouraging data from different countries, heart failure clinics are scarce in France. We have analyzed the impact of a heart failure clinic (UTIC of Pontoise) in terms of reduction of rehospitalizations and in hospitalization costs in 4855 consecutive patients. In our study, heart failure clinic management dramatically reduces HF related hospitalizations (RRR: -28 %, P=0.001) and HF related costs (55% reduction, P<0.001) regardless of comorbidities or disease severity. HF clinics have to be developed in France in order to optimize management of CHF and reduce the HF related costs.
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Affiliation(s)
- C Baudouin
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | | | - P Gueneau
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - M Rousseau
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - M Saura
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - N Hryschyschyn
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - A Hillani
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - J Dagorn
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - E Pitthan
- Instituto de Cardiologia, Porto Alegre, RS, 90040-371, Brésil
| | - P Jourdain
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France.
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50
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Lainscak M, Anker SD. Heart failure, chronic obstructive pulmonary disease, and asthma: numbers, facts, and challenges. ESC Heart Fail 2015; 2:103-107. [PMID: 27708851 PMCID: PMC5042034 DOI: 10.1002/ehf2.12055] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF), chronic obstructive pulmonary disease (COPD), and asthma are considered as major health problems. They affect 1–3%, 4–10%, and 8–19% of population, respectively, and frequently coexist. Pulmonary function testing and echocardiography are needed for reliable diagnosis, but in clinical practice, diagnosis often is based on history and disease self‐reporting. Concomitant HF can be diagnosed in about 20% of patients with COPD, and at least 50% had systolic dysfunction. In patients with HF, prevalence of COPD is up to 35%, and less than 25% of patients have COPD GOLD stage III or IV. COPD is more severe in patients with HF with preserved ejection fraction. When HF and COPD coexist, hazard of death is increased for 39% but can even exceed the mortality in individual disease by threefold. In patients with acute deterioration, natriuretic peptides and lung ultrasound, along with other laboratory biomarkers and imaging, need to be implemented to differentiate underlying cause and to manage patients accordingly. COPD is not contraindication for beta‐blockers, and if used, the risk of death is reduced by 31%; if indicated, cardio‐selective agents can be used in asthma. Recent pan‐European registry reported that about 90% of patients with HF receive beta‐blockers, whereas dosing remains a large unmet need with only 17% being treated with target daily dose. Concurrent HF and COPD reduce the prescription of beta blockers threefold, which results in about 20% of patients actually being treated with beta‐blockers. In COPD/asthma, beta‐agonists are strongly associated with new HF (relative risk of 3.41) and HF hospitalizations (odds ratio of 1.74).
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Affiliation(s)
- Mitja Lainscak
- Department of CardiologyGeneral Hospital CeljeCeljeSlovenia; Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Stefan D Anker
- Institute of Innovative Clinical Trials, Clinic of Cardiology and Pneumology University Medical Center Göttingen Germany
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