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Adachi T, Tsunekawa Y, Tanimura D. Cognitive decline assessed using a brief screening test and cardiovascular and non-cardiovascular events in older patients with heart failure. Aging Clin Exp Res 2023; 35:3233-3238. [PMID: 37921906 DOI: 10.1007/s40520-023-02591-9] [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: 05/09/2023] [Accepted: 10/10/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND Although cognitive decline is recognized as a prognostic factor of heart failure (HF), the association of cognitive decline with specific clinical outcomes in patients with HF remains unclear. AIM This study examines the relationship between cognitive decline using a brief test and cardiovascular and non-cardiovascular events in older patients with HF. METHODS This study included 146 hospitalised patients with HF (median age, 77 years; male, 56.8%). Cognitive decline was defined as a score of ≤ 9 points on the Rapid Dementia Screening Test at the time of discharge. RESULTS Cumulative incidence of cardiovascular events after discharge was twofold higher in patients with cognitive decline (Model 1 adjusted for basic characteristics, hazard ratio (HR) = 2.01, 95% confidence interval (CI): 0.94-4.31; Model 2 adjusted for potential confounders, HR = 2.30, 95% CI: 1.07-4.97). The association between cognitive decline and non-cardiovascular events decreased after adjusting for potential confounders. CONCLUSION The results of this study emphasize the clinical utility of cognitive assessment for risk stratification of worsening cardiovascular conditions, including HF.
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Affiliation(s)
- Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-Ku, Nagoya, 461-8673, Japan.
- Department of Rehabilitation, Nagoya Ekisaikai Hospital, 4-66 Syonen-Cho, Nakagawa-Ku, Nagoya, 454-8502, Japan.
| | - Yuki Tsunekawa
- Department of Rehabilitation, Nagoya Ekisaikai Hospital, 4-66 Syonen-Cho, Nakagawa-Ku, Nagoya, 454-8502, Japan
| | - Daisuke Tanimura
- Department of Cardiology, Nagoya Ekisaikai Hospital, 4-66 Syonen-Cho, Nakagawa-Ku, Nagoya, 454-8502, Japan
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Kwok CS, Tafuro J, Wong CW, Bennett S, Zachariah D, Barker D, Morley-Davies A, Satchithananda D, Gunning M, Borovac JA. What Are the Causes of Death among Patients Admitted to a Contemporary Tertiary-Level Cardiology Department? An Analysis of 10 Years of Morbidity and Mortality Meetings. PATHOPHYSIOLOGY 2023; 30:467-479. [PMID: 37873854 PMCID: PMC10594450 DOI: 10.3390/pathophysiology30040034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
Despite the efforts to deliver the best evidence-based care, in-hospital death is an inevitable event among some patients hospitalized in cardiology departments. We conducted a retrospective evaluation of mortality events from inpatient admissions to the cardiology department between 2010 and 2019. Data were collected from morbidity and mortality meeting presentations that evaluated comorbidities, medical history, treatments, and causes of death for the overall cohort and according to age group and sex. There were 1182 registered deaths. The most common causes of death among patients were acute myocardial infarction (AMI, 53.0%), heart failure (HF, 11.7%), cardiac arrest (CA, 6.6%), HF with complication/defined cardiomyopathy (6.3%), and sepsis (4.4%). We observed a decline in deaths from AMI from 61.9% in 2010 to 46.7% in 2019, while there was a clear increase in deaths from HF (11.1% in 2010 to 25.9% in 2019). Compared to patients ≥65 years, younger patients were more likely to have died from CA (15.7% vs. 4.3%, p < 0.001) and other cardiac reasons (3.0% vs. 0.4%, p < 0.001). The majority of deaths were due to AMI, HF, and CA. We observed a significant declining trend in the proportion of deaths due to AMI in recent years, with an increase in deaths due to HF.
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Affiliation(s)
- Chun Shing Kwok
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham B5 5JU, UK
| | - Jacopo Tafuro
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Chun Wai Wong
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Sadie Bennett
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Donah Zachariah
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Diane Barker
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Adrian Morley-Davies
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Duwarakan Satchithananda
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Mark Gunning
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Josip A. Borovac
- Division of Interventional Cardiology, Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
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3
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Foroutan F, Rayner DG, Ross HJ, Ehler T, Srivastava A, Shin S, Malik A, Benipal H, Yu C, Alexander Lau TH, Lee JG, Rocha R, Austin PC, Levy D, Ho JE, McMurray JJV, Zannad F, Tomlinson G, Spertus JA, Lee DS. Global Comparison of Readmission Rates for Patients With Heart Failure. J Am Coll Cardiol 2023; 82:430-444. [PMID: 37495280 DOI: 10.1016/j.jacc.2023.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/09/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Heart failure (HF) readmission rates are low in some jurisdictions. However, international comparisons are lacking and could serve as a foundation for identifying regional patient management strategies that could be shared to improve outcomes. OBJECTIVES This study sought to summarize 30-day and 1-year all-cause readmission and mortality rates of hospitalized HF patients across countries and to explore potential differences in rates globally. METHODS We performed a systematic review and meta-analysis using MEDLINE, Embase, and CENTRAL for observational reports on hospitalized adult HF patients at risk for readmission or mortality published between January 2010 and March 2021. We conducted a meta-analysis of proportions using a random-effects model, and sources of heterogeneity were evaluated with meta-regression. RESULTS In total, 24 papers reporting on 30-day and 23 papers on 1-year readmission were included. Of the 1.5 million individuals at risk, 13.2% (95% CI: 10.5%-16.1%) were readmitted within 30 days and 35.7% (95% CI: 27.1%-44.9%) within 1 year. A total of 33 papers reported on 30-day and 45 papers on 1-year mortality. Of the 1.5 million individuals hospitalized for HF, 7.6% (95% CI: 6.1%-9.3%) died within 30 days and 23.3% (95% CI: 20.8%-25.9%) died within 1 year. Substantial variation in risk across countries was unexplained by countries' gross domestic product, proportion of gross domestic product spent on health care, and Gini coefficient. CONCLUSIONS Globally, hospitalized HF patients exhibit high rates of readmission and mortality, and the variability in readmission rates was not explained by health care expenditure, risk of mortality, or comorbidities.
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Affiliation(s)
- Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Daniel G Rayner
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Tamara Ehler
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Ananya Srivastava
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sheojung Shin
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Abdullah Malik
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Harsukh Benipal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clarissa Yu
- Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | | | - Joshua G Lee
- Faculty of Medical Sciences, Western University, London, Ontario, Canada
| | | | - Peter C Austin
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Daniel Levy
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA
| | - Jennifer E Ho
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Faiez Zannad
- Clinical Investigation Centre (Inserm-CHU) and Academic Hospital (CHU), Nancy, France
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - John A Spertus
- St Luke's Mid-America Heart Institute, Kansas City, Missouri, USA
| | - Douglas S Lee
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada.
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Adachi T, Iritani N, Kamiya K, Iwatsu K, Kamisaka K, Iida Y, Yamada S. Prognostic effects of cardiac rehabilitation in heart failure patients classified according to physical frailty: A propensity score-matched analysis of a nationwide prospective cohort study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 17:200177. [PMID: 36941975 PMCID: PMC10024177 DOI: 10.1016/j.ijcrp.2023.200177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 03/08/2023]
Abstract
Background Research regarding cardiac rehabilitation (CR) in the prognosis of heart failure (HF) patients and frailty remains lacking. Here, the effects of CR on the 2-year prognosis of HF patients were examined according to their frailty status. Methods This multicenter prospective cohort study enrolled patients hospitalized for HF. Patients who underwent ≥1 session per 2 weeks of CR within 3 months after discharge were categorized in the CR group. Patients were divided in a non-frailty (≤8 points) and physical frailty group (≥9 points) based on their FLAGSHIP frailty score. The score is based on HF prognosis, with a higher score indicating worsened physical frailty. A propensity score-matched analysis was performed to compare survival rates between the two groups according to their physical frailty status. Endpoints included HF re-hospitalization and all-cause mortality during a 2-year follow-up period. Results Of 2697 patients included in the analysis, 285 and 95 matched pairs were distributed in the non-frailty and physical frailty groups, respectively, after propensity-score matching. CR was associated with lower incidence of HF rehospitalization in both non-frailty (hazard ratio 0.65; 95% confidence interval 0.44-0.96; p = 0.032) and physical frailty (0.54; 0.32-0.90; p = 0.019) groups. CR was not associated with all-cause mortality in either group (log-rank test, p > 0.05). Conclusion These findings suggest the effects of CR on reduced HF rehospitalization, regardless of physical frailty status.
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Affiliation(s)
- Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Iritani
- Department of Cardiac Rehabilitation, Toyohashi Heart Center, Toyohashi, Japan
| | - Kuniyasu Kamiya
- Department of Hygiene & Public Health, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Kenta Kamisaka
- Department of Rehabilitation, Tazuke Kofukai Medical Institute Kitano Hospital, Osaka, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University, Toyohashi, Japan
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Corresponding author. PT Department of Cardiology, Aichi Medical University 1Yazakokarimata, Nagakute, 480TEL, Japan.
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Wakabayashi K, Higuchi S, Miyachi H, Minatsuki S, Ito R, Kondo S, Miyauchi K, Yamasaki M, Tanaka H, Yamashita J, Kishi M, Abe K, Mase T, Yahagi K, Asano T, Saji M, Iwata H, Mitsuhashi Y, Nagao K, Yamamoto T, Shinke T, Takayama M. Clinical features and predictors of non-cardiac death in patients hospitalised for acute myocardial infarction: Insights from the Tokyo CCU network multicentre registry. Int J Cardiol 2023; 378:1-7. [PMID: 36791966 DOI: 10.1016/j.ijcard.2023.02.022] [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: 09/18/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) commonly have multiple comorbidities, and some die in hospitals due to causes other than cardiac complications. However, limited information is available on noncardiac death in patients hospitalised for AMI. Therefore, the present study was performed to determine the incidence, annual trend, clinical characteristics, and predictors of in-hospital non-cardiac death in patients with AMI using the Tokyo Cardiovascular Care Unit (CCU) network registry. METHODS The registry included 38,589 consecutive patients with AMI who were admitted to the CCU between 2010 and 2019. The primary endpoint was in-hospital noncardiac death. Further, predictors of cardiac and non-cardiac death were identified. RESULTS The incidence of all-cause in-hospital mortality was 7.0% (n = 2700), and the proportion of mortality was 15.6% (n = 420) and 84.4% (n = 2280) for noncardiac and cardiac causes, respectively. The proportion of noncardiac deaths did not change annually over the last decade (p = 0.66). After adjusting for all variables, age, Killip classification grade, peak creatine kinase, hemoglobin, serum creatinine, and C-reactive protein were common predictors of cardiac and non-cardiac deaths. Indicators of malnutrition, such as lower body mass index (kg/m2) [odds 0.94, 95%CI (0.90-0.97), p < 0.001] and serum low-density lipoprotein cholesterol level (per 10 mg/dl) [odds 0.92, 95%CI (0.89-0.96), p < 0.001] were the specific predictors for non-cardiac deaths. CONCLUSIONS The incidence of in-hospital noncardiac death was significant in patients with AMI, accounting for 15.6% of all in-hospital mortalities. Thus, prevention and management of non-cardiac complications are vital to improve acute-phase outcomes, especially those with predictors of non-cardiac death.
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Affiliation(s)
- Kohei Wakabayashi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan; Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
| | | | | | | | - Ryosuke Ito
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Seita Kondo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | - Jun Yamashita
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Mikio Kishi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Kaito Abe
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Takaaki Mase
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Taku Asano
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Mike Saji
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Hiroshi Iwata
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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Sharma Y, Horwood C, Hakendorf P, Thompson C. Characteristics and outcomes of patients with heart failure discharged from different speciality units in Australia: an observational study. QJM 2022; 115:727-734. [PMID: 35176164 DOI: 10.1093/qjmed/hcac051] [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] [Received: 01/11/2022] [Revised: 02/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous studies have reported differing clinical outcomes among hospitalized heart failure (HF) patients admitted under cardiology and general medicine (GM) without consideration of patients' frailty. AIMS To explore outcomes in patients admitted under the two specialities after taking into account their frailty and other characteristics. METHODS This retrospective study included all HF patients ≥18 years admitted between 1 January 2013 and 31 December 2019 at two Australian tertiary hospitals. Frailty was determined by use of the Hospital Frailty Risk Score (HFRS) and patients with HFRS ≥ 5 were classified as frail. Propensity score matching (PSM) was used to match 11 variables between the two specialities. The primary outcomes included the days-alive-and-out-of-hospital (DAOH90) at 90 days of discharge, 30-day mortality and readmissions. RESULTS Of 4913 HF patients, mean age 76.2 (14.1) years, 51% males, 2653 (54%) were admitted under cardiology compared to 2260 (46%) under GM. Patients admitted under GM were more likely to be older females, with a higher Charlson index and poor renal function than those admitted under cardiology. Overall, 23.8% patients were frail and frail patients were more likely to be admitted under GM than cardiology (33.6% vs. 15.3%, P < 0.001). PSM created 1532 well-matched patients in each group. After PSM, the DAOH90 was not significantly different among patients admitted in GM when compared to cardiology (coefficient -5.36, 95% confidence interval -11.73 to 1.01, P = 0.099). Other clinical outcomes were also similar between the two specialities. CONCLUSIONS Clinical characteristics of HF patients differ between GM and cardiology; however, clinical outcomes were not significantly different after taking into account frailty and other variables.
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Affiliation(s)
- Y Sharma
- From the College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
- Division of Medicine, Cardiac and Critical Care, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia
| | - C Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA 5042, Australia
| | - P Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA 5042, Australia
| | - C Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, SA 5005, Australia
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Canepa M, Leporatti L, Persico L, Ameri P, Porto I, Ansaldi F, Montefiori M. Frequency, characteristics and prognostic impact of hospital readmissions in elderly patients with heart failure: A population study from 2013 to 2017 in Liguria, Northern Italy. Int J Cardiol 2022; 363:111-118. [PMID: 35728700 DOI: 10.1016/j.ijcard.2022.06.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hospital readmissions are a key determinant of prognosis in elderly patients with heart failure (HF). We investigated their frequency, predictors and prognostic impact using a large administrative database from Liguria, the oldest region of Italy. METHODS Patients aged ≥18 years with at least one hospitalization with HF and being prescribed a diuretic medication between January 2013 and December 2017 were included in the analysis. Their demographics and Charlson comorbidity index (CCI) were collected. Patients were grouped by number of readmissions, and negative binomial and Cox proportional hazard models were used to explore independent predictors of readmissions and mortality, respectively. RESULTS There were 207,130 hospital admissions from 35,316 patients (mean age 81.6 years, 43.7% ≥85 years of age, 47.2% male, mean CCI 1.7, overall mortality 52.8%). About a quarter of patients (8.878, 25.1%) had more than eight readmissions during follow-up, for a total of 108.146 admissions (52.2% of admissions). Male gender, lower educational level and higher CCI were independently associated with increased number of readmissions and increased mortality. There was an independent inverse relationship between number of admissions and survival, with patients hospitalized 8 or more times displaying a 3-fold increase in mortality, and a significant interaction between older age and readmissions on mortality. CONCLUSION A quarter of older comorbid HF patients contributed to more than half of HF hospital readmissions recorded over a 5-year period in Liguria, with a dismal impact on prognosis. Aging societies should pay greater attention to this matter and personalized disease-management programs should be implemented.
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Affiliation(s)
- Marco Canepa
- Department of Internal Medicine, University of Genoa, Italy; Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Lucia Leporatti
- Department of Economics, Study and Research Centre Aphec, University of Genoa, Genoa, Italy
| | - Luca Persico
- Department of Economics, Study and Research Centre Aphec, University of Genoa, Genoa, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genoa, Italy; Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genoa, Italy; Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Filippo Ansaldi
- A.Li.Sa. (Azienda Sanitaria Regione Liguria), Genoa, Italy; Department of Health Science, University of Genoa, Genoa, Italy
| | - Marcello Montefiori
- Department of Economics, Study and Research Centre Aphec, University of Genoa, Genoa, Italy
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8
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Adachi T, Tsunekawa Y, Tanimura D. Reply to the comments on "Association among mild cognitive impairment, social frailty, and clinical events in elderly patients with cardiovascular disease". Heart Lung 2022; 56:191-192. [PMID: 35715243 DOI: 10.1016/j.hrtlng.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan; Department of Rehabilitation, Nagoya Ekisaikai Hospital, 4-66 Syonen-cho, Nakagawa-ku, Nagoya 454-8502, Japan.
| | - Yuki Tsunekawa
- Department of Rehabilitation, Nagoya Ekisaikai Hospital, 4-66 Syonen-cho, Nakagawa-ku, Nagoya 454-8502, Japan
| | - Daisuke Tanimura
- Department of Cardiology, Nagoya Ekisaikai Hospital, 4-66 Syonen-cho, Nakagawa-ku, Nagoya 454-8502, Japan
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9
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Fukuoka R, Kohsaka S, Shiraishi Y, Sawano M, Abe T, Levy WC, Nagatomo Y, Nishihata Y, Goda A, Kohno T, Kawamura A, Fukuda K, Yoshikawa T. Sudden cardiac death after acute decompensation in heart failure patients: implications of discharge haemoglobin levels. ESC Heart Fail 2021; 8:3917-3928. [PMID: 34323007 PMCID: PMC8497203 DOI: 10.1002/ehf2.13414] [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: 11/28/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/19/2022] Open
Abstract
Aims Heart failure (HF) patients have a high risk of mortality due to sudden cardiac death (SCD) and non‐SCD, including pump failure death (PFD). Anaemia predicts more severe symptomatic burden and higher morbidity, as noted by markedly increased hospitalizations and readmission rates, and mortality, underscoring its importance in HF management. Herein, we aimed to determine whether haemoglobin (Hb) level at discharge affects the mode of death and influences SCD risk prediction. Methods We evaluated the data of 3020 consecutive acute HF patients from a Japanese prospective multicentre registry. Patients were divided into four groups based on discharge Hb levels. SCD was defined as an unexpected and otherwise unexplained death in a previously stable patient or death due to documented or presumed cardiac arrhythmia without a clear non‐cardiovascular cause. The mode of death (SCD, PFD or other cause) was adjudicated by a central committee. Finally, we investigated whether adding Hb level to the Seattle Proportional Risk Model (SPRM; established risk score utilized to estimate ‘proportion’ of SCD among death events) would affect its performance. Results The mean age of studied patients was 74.3 ± 12.9 years, and 59.8% were male. The mean Hb level was 12.0 ± 2.1 g/dL (61.3% of patients had anaemia defined by World Health Organization criteria). During the 2‐year follow‐up, 474 deaths (15.7%) occurred, including 93 SCDs (3.1%), 171 PFDs (5.7%) and 210 other deaths (7.0%; predominantly non‐cardiac death). Absolute risk of PFD (P < 0.001) or other death (P < 0.001) increased along with the severity of anaemia, whereas the incidence of SCD was low but remained consistent across all four groups (P = 0.440). As a proportion of total deaths in each Hb level group, the contributions from non‐SCD increased and from SCD decreased along with anaemia severity (P = 0.007). Adding Hb level to the SPRM improved the overall discrimination (c‐index: 0.62 [95% confidence interval (CI) 0.56–0.69] to 0.65 [95% CI 0.59–0.71]), regardless of the baseline ejection fraction (EF) (c‐index: 0.64 [95% CI 0.55–0.73] to 0.67 [95% CI 0.58–0.75] for reduced EF and 0.55 [95% CI 0.45–0.66] to 0.61 [95% CI 0.52–0.70] for preserved EF). Conclusions The discharge Hb level provides information about both absolute and proportional risks for each mode of death in acute HF patients, and the addition of Hb level improves the performance of SPRM by identifying more non‐SCD cases. Future ‘proportional’ SCD risk models should incorporate Hb level as a covariate to meet this high performance.
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Affiliation(s)
- Ryoma Fukuoka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Department of Cardiology, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Abe
- School of Data Science, Yokohama City University, Yokohama, Japan
| | - Wayne C Levy
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa, Japan
| | - Yosuke Nishihata
- Department of Cardiology, Cardiovascular Centre, St. Luke's International Hospital, Tokyo, Japan
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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10
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The C-reactive protein to prealbumin ratio on admission and its relationship with outcome in patients hospitalized for acute heart failure. J Cardiol 2021; 78:308-313. [PMID: 34120831 DOI: 10.1016/j.jjcc.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Inflammation and malnutrition are common problems in patients who are hospitalized for acute heart failure (AHF). C-reactive protein (CRP) is an acute-phase reactant and nonspecific marker for evaluating systemic inflammation. There has been growing interest in prealbumin for nutritional assessment. Additionally, prealbumin is a negative acute-phase protein because its synthesis is suppressed in the inflammatory setting in which cytokines stimulate hepatic production of acute-phase proteins (e.g. CRP). Therefore, the CRP to prealbumin ratio (CP ratio) may be a comprehensive marker of inflammation and malnutrition. We evaluated the relationship of the CP ratio with mortality in patients with AHF. METHODS We analyzed 257 hospitalized patients with AHF who had CRP and prealbumin levels examined on admission. RESULTS The median CP ratio on admission was 0.57, with an interquartile range of 0.11 to 1.94. In receiver operating characteristic curve analysis, the area under the curve was 0.729 and the optimal cut-off point of the CP ratio for all-cause death was >1.60 (sensitivity: 67.5%; specificity: 77.6%; p = 0.003). Kaplan-Meier survival curves showed that patients with a high CP ratio (>1.60) had a significantly greater risk of all-cause, cardiac, and non-cardiac death (log-rank test, all p<0.001) than patients with a low CP ratio (≤1.60). Multivariable analysis adjusted for imbalanced baseline variables showed that a high CP ratio was independently associated with higher all-cause mortality (adjusted hazard ratio 3.88; 95% confidence interval 1.91-7.86; p<0.001). CONCLUSIONS The ratio of two hepatic proteins, CRP and prealbumin, may be useful in risk stratification of patients with AHF.
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11
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Salamanca-Bautista P, Álvarez-García J, Aramburu-Bodas Ó, Ferrero-Gregori A, Arias-Jiménez JL, Delgado JF, Formiga F, Vázquez R, Manzano L, Puig T, Llàcer P, Vives-Borras M, Cinca J, Montero-Pérez-Barquero M. Modes of death in heart failure according to age, sex and left ventricular ejection fraction. Intern Emerg Med 2021; 16:643-652. [PMID: 32813117 DOI: 10.1007/s11739-020-02468-z] [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: 04/11/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
Modes of death in patients with heart failure (HF) have been well characterized in randomized studies, but data from real-life are scarce, especially in the elderly, women and in HF with mid-range or preserved left ventricular ejection fraction (LVEF). Our purpose was to examine modes of death in HF patients according to age, sex and LVEF. We analysed the mode of death of HF patients from two prospective multicentre contemporary Spanish registries conducted by cardiologists (REDINSCOR, n = 2150) and by internists (RICA, n = 1396). Mode of death was pre-specified. Out of 3546 patients, 485 (13.7%) died during the 9-month follow-up. Cardiovascular (CV) causes were the most frequent, regardless of the age, sex and LVEF. More than half of patients died due to worsening HF in both groups of patients, followed by other non-CV causes in those attended by internists, and sudden cardiac death in those cared by cardiologists. Stroke was more common among elderly patients, women and HF with preserved LVEF. Non-CV causes, particularly infectious diseases, accounted for a remarkable proportion of deaths, especially in the elderly and in HF patients with preserved LVEF. Functional class, age and anaemia had a strong influence on both CV and non-CV death. CV death due to refractory HF was the most prevalent among our population, irrespective of age, sex or LVEF. However, a significant proportion of HF patients died from non-CV causes, particularly elderly with mid-range and preserved LVEF. These patients could benefit significantly from a multidisciplinary follow-up.
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Affiliation(s)
- Prado Salamanca-Bautista
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain.
| | - Jesús Álvarez-García
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Óscar Aramburu-Bodas
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Andreu Ferrero-Gregori
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - José Luis Arias-Jiménez
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Juan F Delgado
- Cardiology Department, Fundación de Investigación i+12, Hospital Universitario Doce de Octubre, CIBERCV, Facultad de Medicina UCM, Madrid, Spain
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Rafael Vázquez
- Cardiology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Luis Manzano
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, University of Alcalá, IRYCIS, Madrid, Spain
| | - Teresa Puig
- Epidemiology and Public Health Department, Hospital de la Santa Creu I Sant Pau, II-B SantPau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pau Llàcer
- Internal Medicine Department, Hospital de Manises, Valencia, Spain
| | - Miquel Vives-Borras
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
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12
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Causes of death in hospitalized patients in internal medicine departments with heart failure according to ejection fraction. RICA registry. Med Clin (Barc) 2021; 158:13-19. [PMID: 33485617 DOI: 10.1016/j.medcli.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION There are few data in the Spanish population about the causes of death in patients admitted to internal medicine departments for heart failure. Their study according to left ventricular ejection fraction (reduced: rEF, mid-range: mEF, and preserved: pEF) could improve the knowledge of patients and their prognosis. METHODS Prospective multicentre cohort study of 4144 patients admitted with heart failure to internal medicine departments. Their clinical characteristics, mortality rate and causes were classified according to pEF (≥ 50%), mEF (40%-49%) and rEF (<40%). Patients were followed-up for a median of one year. RESULTS There were 1198 deaths (29%). The cause of death was cardiovascular (CV) in 833 patients (69.5%), mainly heart failure (50%) and sudden cardiac death (7.5%). Non-cardiovascular (NoCV) causes were responsible for 365 deaths (30.5%). The most common NoCV causes were infections (13%). The most frequent and early cause in all groups was heart failure. Patients with pEF, compared to the other groups, had lower risk of sudden cardiac death and higher risk of infections (P <.05). The causes of death in patients with mrEF were closer to those with pEF. CONCLUSIONS The causes of death in patients with heart failure were different depending on ejection fraction strata. Patients with mEF and pEF, due to their high comorbidity and higher frequency of NoCV death, would require comprehensive management by internal medicine.
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13
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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: 12] [Impact Index Per Article: 3.0] [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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14
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Ferreira JP, Ouwerkerk W, Tromp J, Ng L, Dickstein K, Anker S, Filippatos G, Cleland JG, Metra M, van Veldhuisen DJ, Voors AA, Zannad F. Cardiovascular and non-cardiovascular death distinction: the utility of troponin beyond N-terminal pro-B-type natriuretic peptide. Findings from the BIOSTAT-CHF study. Eur J Heart Fail 2019; 22:81-89. [PMID: 31793144 DOI: 10.1002/ejhf.1654] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Heart failure (HF) patients are at high-risk of cardiovascular (CV) events, including CV death. Nonetheless, a substantial proportion of these patients die from non-CV causes. Identifying patients at higher risk for each individual event may help selecting patients for clinical trials and tailoring cardiovascular therapies. The aims of the present study are to: (i) characterize patients according to CV vs. non-CV death; (ii) develop models for the prediction of the respective events; (iii) assess the models' performance to differentiate CV from non-CV death. METHODS AND RESULTS This study included 2309 patients with HF from the BIOSTAT-CHF (a systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure) study. Competing-risk models were used to assess the best combination of variables associated with each cause-specific death. Results were validated in an independent cohort of 1738 HF patients. The best model to predict CV death included low blood pressure, estimated glomerular filtration rate ≤ 60 mL/min, peripheral oedema, previous HF hospitalization, ischaemic HF, chronic obstructive pulmonary disease, elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin (c-index = 0.73). The non-CV death model incorporated age > 75 years, anaemia and elevated NT-proBNP (c-index = 0.71). Both CV and non-CV death rose by quintiles of the risk scores; yet these models allowed the identification of patients in whom absolute CV death rates clearly outweigh non-CV death ones. These findings were externally replicated, but performed worse in a less severely diseased population. CONCLUSIONS Risk models for predicting CV and non-CV death allowed the identification of patients at higher absolute risk of dying from CV causes (vs. non-CV ones). Troponin helped in predicting CV death only, whereas NT-proBNP helped in the prediction of both CV and non-CV death. These findings can be useful both for tailoring therapies and for patient selection in HF trials in order to attain CV event enrichment.
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Affiliation(s)
- João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques- Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Hospital Drive, Singapore.,Department of Dermatology, Amsterdam UMC, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Jasper Tromp
- National Heart Centre Singapore, Hospital Drive, Singapore.,Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Leong Ng
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | | | - Stefan Anker
- Department of Cardiology (CVK), and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece.,University of Cyprus, School of Medicine, Nicosia, Cyprus
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques- Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
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15
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Oikawa T, Sakata Y, Nochioka K, Miura M, Abe R, Kasahara S, Sato M, Aoyanagi H, Shiroto T, Sugimura K, Takahashi J, Miyata S, Shimokawa H. Increased risk of cancer death in patients with chronic heart failure with a special reference to inflammation-A report from the CHART-2 Study. Int J Cardiol 2019; 290:106-112. [PMID: 31104823 DOI: 10.1016/j.ijcard.2019.04.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/24/2019] [Accepted: 04/25/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although several factors, including heart failure (HF) and inflammation, are known to increase the incidence of cancer, it remains unknown whether HF may increase cancer mortality, especially with a reference to inflammation. METHODS AND RESULTS We examined 8843 consecutive cardiovascular patients without a prior history of cancer in our CHART-2 Study (mean 68 yrs., female 30.9%). As compared with patients without HF (Stage A/B, N = 4622), those with HF (Stage C/D, N = 4221) were characterized by higher prevalence of diabetes, previous myocardial infarction, atrial fibrillation, and stroke. During the median 6.5-year follow-up (52,675 person-years), 282 cancer deaths occurred. HF patients had significantly higher cancer mortality than those without HF in both the overall (3.7 vs, 2.8%, hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.12-1.79, P = 0.004) and the propensity score-matched cohorts (HR 1.46, 95%CI 1.10-1.93, P = 0.008), which was confirmed in the competing risk models. The multivariable Cox proportional hazard model in the matched cohort showed that HF was associated with increased cancer mortality in patients with C-reactive protein (CRP) ≥ 2.0 mg/L (HR 1.87, 95%CI 1.18-2.96, P = 0.008) at baseline, but not in those with CRP < 2.0 mg/L (HR 0.89, 95%CI 0.54-1.45, P = 0.64) (P for interaction = 0.03). Furthermore, temporal changes in CRP levels were associated with cancer death in the overall cohort; HF patients with CRP ≥ 2.0 mg/L at both baseline and 1-year had significantly increased cancer death, while those with CRP ≥ 2.0 mg/L at baseline and < 2.0 mg/L at 1-year not. CONCLUSIONS These results provide the first evidence that HF is associated with increased cancer death, especially when associated with prolonged inflammation.
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Affiliation(s)
- Takuya Oikawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Big Data Medicine Center, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Big Data Medicine Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masanobu Miura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Big Data Medicine Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ruri Abe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shintaro Kasahara
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hajime Aoyanagi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Big Data Medicine Center, Tohoku University Graduate School of Medicine, Sendai, Japan
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16
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Prognostic impact of chronic obstructive pulmonary disease on adverse prognosis in hospitalized heart failure patients with preserved ejection fraction - A report from the JASPER registry. J Cardiol 2019; 73:459-465. [PMID: 30718015 DOI: 10.1016/j.jjcc.2019.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/03/2019] [Accepted: 01/06/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The prognostic impact of chronic obstructive pulmonary disease (COPD) on heart failure (HF) with preserved ejection fraction (HFpEF) patients and its clinical characteristics have not yet been fully examined. METHODS The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, prospective registration of consecutive Japanese hospitalized HFpEF patients with left ventricular ejection fraction (LVEF) of ≥50%. Among 535 patients enrolled in the registry, 10 lacking COPD data, and seven who died during the first hospitalization, were excluded. Finally, 518 patients were enrolled in this analysis. We divided these patients into two groups: the COPD group (n=40, 7.7%) and the non-COPD group (n=478, 92.3%). This analysis had two primary endpoints: (1) all-cause death and (2) all-cause death or rehospitalization for HF. RESULTS The COPD group showed a higher prevalence of male sex (70.0% vs. 48.1%, p=0.008), history of prior hospitalization for HF (63.2% vs. 35.1%, p=0.001), smoking history (71.8% vs. 43.3%, p=0.001), and a higher usage of loop diuretics (70.0% vs. 50.0%, p=0.015). In the follow-up period after discharge (median 733 days), there were 82 all-cause deaths and 127 rehospitalizations for HF. In the Kaplan-Meier analysis, the COPD group showed higher all-cause death and reached the composite endpoint more often than in the non-COPD group (all-cause death, log-rank 0.035; all-cause death or rehospitalization for HF, log-rank 0.025). In the Cox proportional hazard analysis, COPD was a predictor of all-cause death (hazard ratio 1.957, 95% confidence interval 1.037-3.694, p=0.038) and the composite endpoint (hazard ratio 1.694, 95% confidence interval 1.064-2.697, p=0.026). CONCLUSIONS COPD is associated with adverse prognosis in hospitalized patients with HFpEF.
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17
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Wollert KC. Growth differentiation factor-15 reveals the dark side of heart failure. Eur J Heart Fail 2018; 20:1710-1712. [PMID: 30328666 DOI: 10.1002/ejhf.1327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 08/30/2018] [Accepted: 09/02/2018] [Indexed: 01/13/2023] Open
Affiliation(s)
- Kai C Wollert
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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