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Liu D, Cui X, Xu Y, Xu L, Xie Z, Yuan S, Wang P, Wang Y, Qian S, Gong H, Nordbeck P, Yang J, Zhou J, Ge J, Sun A. Impact of heart rate changes during hospitalization on outcome in heart failure with preserved ejection fraction. ESC Heart Fail 2024; 11:2901-2912. [PMID: 38514992 PMCID: PMC11424277 DOI: 10.1002/ehf2.14721] [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: 09/22/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 03/23/2024] Open
Abstract
AIMS The benefits of lowering heart rate (HR) in heart failure (HF) with preserved ejection fraction (HFpEF) patients are still a matter of debate. This study aimed to investigate the relationship between changes in HR during hospitalization and cardiovascular (CV) events and all-cause death in hospitalized HFpEF patients. METHODS AND RESULTS Hospitalized HF patients between January 2017 and December 2021 were consecutively enrolled in a national, multicentred, and prospective registry database, the China Cardiovascular Association Database-HF Center Registry. HF patients with a left ventricular ejection fraction of ≥50% were defined as HFpEF patients. The study analysed admission/discharge HR, change in HR during hospitalization (∆HR), and ∆HR ratio (∆HR/admission HR). The patients were categorized into three groups: no HR dropping group (ΔHR ratio > 0.0%), moderate HR dropping group (-15% < ΔHR ratio ≤ 0.0%), and excessive HR dropping group (ΔHR ratio ≤ -15%). All patients were followed up for 12 months. The primary endpoint was CV events (CV death or HF rehospitalization). The secondary endpoint was all-cause death. A total of 19 510 HFpEF patients (9750 males, mean age 71.9 ± 12.2 years) were included, with 4575 in the no HR dropping group, 8434 in the moderate HR dropping group, and 6501 in the excessive HR dropping group. Excessive HR dropping during hospitalization was significantly associated with an increased risk of CV events (17.1%) compared with the no HR dropping group (14.5%, P < 0.001) or the moderate HR dropping group (14.0%, P < 0.001), although all-cause mortality was similar among the three groups. After adjusting for multiple confounding factors, excessive HR dropping remained an independent predictor of increased CV event risk [hazard ratio 1.197, 95% confidence interval (CI) 1.078-1.328]. Subgroup analysis revealed that the prognostic impact of excessive HR dropping on increased CV event risk remained in the subgroups of older age, New York Heart Association class IV, ischaemic HF, higher left ventricular ejection fraction, absence of chronic kidney disease, and use of beta-blockers or ivabradine. Independent determinants associated with excessive HR dropping during admission included use of beta-blockers [odds ratio (OR) 1.683, 95% CI 1.558-1.819], lower discharge diastolic blood pressure (OR 0.988, 95% CI 0.985-0.991), no pacemaker (OR 0.501, 95% CI 0.416-0.603), coexisting atrial fibrillation or atrial flutter (OR 1.327, 95% CI 1.218-1.445), and use of digoxin (OR 1.340, 95% CI 1.213-1.480). CONCLUSIONS In hospitalized HFpEF patients, excessive HR dropping during hospitalization is associated with an increased risk of CV death or HF rehospitalization. These findings highlight the importance of HR monitoring and avoiding excessively slowing down HR in hospitalized HFpEF patients to reduce the risk of CV events.
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Affiliation(s)
- Dan Liu
- Department of Cardiology, Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Oberdürrbacher Str. 6, Würzburg, 97080, Germany
- Comprehensive Heart Failure Center, Würzburg, Germany
| | - Xiaotong Cui
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Yamei Xu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Lei Xu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Zhonglei Xie
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Shuai Yuan
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Peng Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Yanyan Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Sanli Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Hui Gong
- Department of Cardiology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Peter Nordbeck
- Department of Cardiology, Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Oberdürrbacher Str. 6, Würzburg, 97080, Germany
- Comprehensive Heart Failure Center, Würzburg, Germany
| | - Jiefu Yang
- Department of Cardiology, Institute of Geriatric Medicine, National Center of Gerontology, Beijing Hospital, Chinese Academy of Medical Sciences, Da Hua Road 1, Dong Dan, Beijing, 100730, China
| | - Jingmin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Aijun Sun
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
- Department of Cardiology, Jinshan Hospital of Fudan University, Shanghai, China
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Shao Y, Zhang S, Raman VK, Patel SS, Cheng Y, Parulkar A, Lam PH, Moore H, Sheriff HM, Fonarow GC, Heidenreich PA, Wu WC, Ahmed A, Zeng-Treitler Q. Artificial intelligence approaches for phenotyping heart failure in U.S. Veterans Health Administration electronic health record. ESC Heart Fail 2024; 11:3155-3166. [PMID: 38873749 PMCID: PMC11424308 DOI: 10.1002/ehf2.14787] [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: 01/11/2024] [Revised: 02/23/2024] [Accepted: 03/15/2024] [Indexed: 06/15/2024] Open
Abstract
AIMS Heart failure (HF) is a clinical syndrome with no definitive diagnostic tests. HF registries are often based on manual reviews of medical records of hospitalized HF patients identified using International Classification of Diseases (ICD) codes. However, most HF patients are not hospitalized, and manual review of big electronic health record (EHR) data is not practical. The US Department of Veterans Affairs (VA) has the largest integrated healthcare system in the nation, and an estimated 1.5 million patients have ICD codes for HF (HF ICD-code universe) in their VA EHR. The objective of our study was to develop artificial intelligence (AI) models to phenotype HF in these patients. METHODS AND RESULTS The model development cohort (n = 20 000: training, 16 000; validation 2000; testing, 2000) included 10 000 patients with HF and 10 000 without HF who were matched by age, sex, race, inpatient/outpatient status, hospital, and encounter date (within 60 days). HF status was ascertained by manual chart reviews in VA's External Peer Review Program for HF (EPRP-HF) and non-HF status was ascertained by the absence of ICD codes for HF in VA EHR. Two clinicians annotated 1000 random snippets with HF-related keywords and labelled 436 as HF, which was then used to train and test a natural language processing (NLP) model to classify HF (positive predictive value or PPV, 0.81; sensitivity, 0.77). A machine learning (ML) model using linear support vector machine architecture was trained and tested to classify HF using EPRP-HF as cases (PPV, 0.86; sensitivity, 0.86). From the 'HF ICD-code universe', we randomly selected 200 patients (gold standard cohort) and two clinicians manually adjudicated HF (gold standard HF) in 145 of those patients by chart reviews. We calculated NLP, ML, and NLP + ML scores and used weighted F scores to derive their optimal threshold values for HF classification, which resulted in PPVs of 0.83, 0.77, and 0.85 and sensitivities of 0.86, 0.88, and 0.83, respectively. HF patients classified by the NLP + ML model were characteristically and prognostically similar to those with gold standard HF. All three models performed better than ICD code approaches: one principal hospital discharge diagnosis code for HF (PPV, 0.97; sensitivity, 0.21) or two primary outpatient encounter diagnosis codes for HF (PPV, 0.88; sensitivity, 0.54). CONCLUSIONS These findings suggest that NLP and ML models are efficient AI tools to phenotype HF in big EHR data to create contemporary HF registries for clinical studies of effectiveness, quality improvement, and hypothesis generation.
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Affiliation(s)
- Yijun Shao
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Sijian Zhang
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Venkatesh K Raman
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Samir S Patel
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Yan Cheng
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Anshul Parulkar
- Veterans Affairs Medical Center, Providence, RI, USA
- Brown University, Providence, RI, USA
| | - Phillip H Lam
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Hans Moore
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
- Georgetown University, Washington, DC, USA
- Uniformed Services University, Bethesda, MD, USA
| | - Helen M Sheriff
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | | | - Paul A Heidenreich
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Wen-Chih Wu
- Veterans Affairs Medical Center, Providence, RI, USA
- Brown University, Providence, RI, USA
| | - Ali Ahmed
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Qing Zeng-Treitler
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
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Huang Y, Xie P, Zhang S, Liu M, Xiong Z, Huang R, Huang Z, Zhong X, Chen Z, Zhou Z, Zhang W, Guo Y, Yang D, Zhuang X, Liao X. Interplay of heart rate variability and resting heart rate on mortality in type 2 diabetes. Diabetes Metab Syndr 2024; 18:102930. [PMID: 38150792 DOI: 10.1016/j.dsx.2023.102930] [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: 11/06/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
AIMS Heart rate variability (HRV) and resting heart rate (RHR) are usually analyzed and interpreted separately. We aimed to assess the interplay of HRV and RHR on mortality in type 2 diabetes. METHODS The study included 7,529 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. HRV metrics included standard deviation of all normal-to-normal intervals (SDNN) and root mean square of successive differences between normal-to-normal intervals (rMSSD). Abnormal values were defined based on <25th percentile for HRV and >75th percentile for RHR. Interactions of HRV status and RHR status were tested on multiplicative and additive scales. Results were validated in a subset of patients with type 2 diabetes (n = 745) from the Multi-Ethnic Study of Atherosclerosis. RESULTS Low SDNN was associated with increased all-cause mortality in the high RHR group (HR 1.60; 95% CI 1.29-1.97), but not in the normal RHR group. Compared with those who had neither low SDNN nor high RHR, the presence of either low SDNN or high RHR was not significantly associated with an increased risk of all-cause mortality. In contrast, the combination of low SDNN and high RHR was associated with a significantly increased risk of all-cause mortality (HR 1.68; 95% CI 1.43-1.97). Significant multiplicative and additive interactions were found between HRV status and RHR status on risk of all-cause mortality (all Pinteraction < 0.05). Similar findings were observed for cardiovascular mortality, in analyses using rMSSD, and in the Multi-Ethnic Study of Atherosclerosis. CONCLUSIONS The association between HRV and mortality risk is modified by RHR levels. Furthermore, low HRV and high RHR have interdependent and synergistic associations with mortality risk.
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Affiliation(s)
- Yiquan Huang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Peihan Xie
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Shaozhao Zhang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Menghui Liu
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Zhenyu Xiong
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Rihua Huang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Zhuoshan Huang
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China; Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, China
| | - Xiangbin Zhong
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Zhuohui Chen
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Ziwei Zhou
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Wenjing Zhang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Yue Guo
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Daya Yang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Xiaodong Zhuang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China.
| | - Xinxue Liao
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China.
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Sin MK, Lee JA, Murphy PJM, Charles Faselis, Ahmed A. Upper extremity weakness: A novel risk factor for non-cardiovascular mortality among community-dwelling older adults. Arch Gerontol Geriatr 2023; 112:105021. [PMID: 37058816 PMCID: PMC10330262 DOI: 10.1016/j.archger.2023.105021] [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: 02/01/2023] [Revised: 03/13/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Aging-associated upper extremity weakness has been shown to be associated with adverse health outcomes in older adults, but less is known about the association between impaired upper extremity function and cause-specific mortalities. METHODS Among the 5512 prospective community-based longitudinal Cardiovascular Health Study participants, 1438 had difficulty with one of the three upper extremity functions of lifting, reaching, or gripping. We assembled a propensity score-matched cohort in which 1126 pairs of participants with and without difficulty with upper extremity function, balanced on 62 baseline characteristics including geriatric and functional variables such as physical and cognitive function. Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortalities associated with upper extremity weakness were estimated in the matched cohort. RESULTS Matched participants had a mean age of 73.1 years, 72.5% were women, and 17.0% African American. During 23 years of follow-up, all-cause mortality occurred in 83.7% (942/1126) and 81.2% (914/1126) of participants with and without upper extremity weakness, respectively (HR, 1.11; 95% CI, 1.01-1.22; p = 0.023). Upper extremity weakness was associated with a higher risk of non-cardiovascular mortality, occurring in 595 (52.8%) and 553 (49.1%) of participants, respectively (HR, 1.17; 95% CI, 1.04-1.31; p = 0.010), but had no association with cardiovascular mortality (30.8% vs 32.1% in those with and without upper extremity weakness, respectively; HR, 1.03; 95% CI, 0.89-1.19; p = 0.70). CONCLUSION Among community-dwelling older adults, upper extremity weakness had a weak, albeit independent, significant association with all-cause mortality, which was primarily driven by a higher risk of non-cardiovascular mortality. Future studies need to replicate these findings and understand the underlying reasons for the observed associations.
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Affiliation(s)
- Mo-Kyung Sin
- College of Nursing, Seattle University, 901 12th Ave, P.O. BOX 222000, Seattle, WA 98122-1090, United States.
| | - Jung-Ah Lee
- School of Nursing, University of California, Irvine, CA, United States
| | - Patrick J M Murphy
- College of Nursing, Seattle University, 901 12th Ave, P.O. BOX 222000, Seattle, WA 98122-1090, United States
| | - Charles Faselis
- Veterans Affairs Medical Center, Washington, DC, United States; School of Medicine, George Washington University, Washington, DC, United States; School of Medicine, Uniformed Services University, Washington, DC, United States
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC, United States; School of Medicine, George Washington University, Washington, DC, United States; School of Medicine, Georgetown University, Washington, DC, United States
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Yoshikawa T. New paradigm shift in the pharmacotherapy for heart failure-where are we now and where are we heading? J Cardiol 2023; 81:26-32. [PMID: 35227538 DOI: 10.1016/j.jjcc.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
Over the past 30 years, accumulating evidence has shown that three main therapies including angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, ß-blockers, and mineralocorticoid receptor antagonists are the standard treatment for patients with heart failure (HF) who exhibit reduced ejection fraction (EF). However, lessons learned from recent large-scale clinical trials have added a paradigm shift including angiotensin receptor-neprilysin inhibitor, sodium glucose co-transporter 2 inhibitor, and ivabradine. In addition, soluble guanyl cyclase stimulator and omecamtiv mecarbil are also suggested as next generation therapeutic measures for these patients. From these clinical trials, we learned some patients with preserved EF will benefit from certain agents, which has been one of the largest unmet needs over these decades. This article will review these paradigm shifts over the past 10 years and address a new therapeutic algorithm for patients with HF.
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Affiliation(s)
- Tsutomu Yoshikawa
- Department of Cardiology, Clinical Research and Education Center, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu 183-0003, Japan.
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Cai A, Qiu W, Zhou Y, Feng Y, Chen J, Xia S, Li W, Liao Y, Li X, Zhou J, Wang H, Jin W, Zhang Q, Sun Z, Chen M, Wang J, Kong H, Zhang Y, Dong W, Bai L, Xu D, Yuan J, Liu C, Jiang M, Xu Y, Li L, Dong Y, Yang J. Clinical characteristics and 1-year outcomes in hospitalized patients with heart failure with preserved ejection fraction: results from the China Cardiovascular Association Database-Heart Failure Center Registry. Eur J Heart Fail 2022; 24:2048-2062. [PMID: 36054149 DOI: 10.1002/ejhf.2654] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/03/2022] [Accepted: 08/20/2022] [Indexed: 01/18/2023] Open
Abstract
AIM We aimed to evaluate clinical characteristics and 1-year outcomes in hospitalized patients with heart failure with preserved ejection fraction (HFpEF) from China. Factors associated with outcomes (hospitalization for HF [HHF] and cardiovascular [CV] death) were assessed. METHOD AND RESULTS Data were from the China Cardiovascular Association (CCA) Database-HF Center Registry. Between January 2017 and June 2021, 41 708 hospitalized HFpEF patients with 1-year follow-up from 481 CCA Database-HF Center certified secondary and tertiary hospitals across overall 31 provinces of mainland China were included in this study. Of study participants (mean age 72.2 years, 49.3% female), 18.2% had HHF in prior 1 year and 55.8% had New York Heart Association class III/IV. Median left ventricular ejection fraction was 59%. Ischaemia (26.6%), infection (14.4%) and arrhythmia (10.5%) were the three most common precipitating factors for index HHF. Nearly 67.4% had ≥3 comorbidities. Hypertension (65.2%), coronary heart disease (60.3%) and atrial fibrillation (41.2%) were the three most common comorbidities. Device and medication therapy non-compliance with current HF guideline recommendation was observed. The 1-year rate of clinical outcomes was 16.4%, the 1-year rate of HHF was 13.6% and CV death was 3.1%. Factors associated with clinical outcomes included HHF in prior 1 year, serum level of sodium <135 mmol/L and N-terminal pro-B-type natriuretic peptide >1800 pg/ml. CONCLUSION Patients with HFpEF from China were characterized by high comorbid burden and high 1-year risk of HHF and CV death. Immediate efforts are needed to improve HFpEF management in China.
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Affiliation(s)
- Anping Cai
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weida Qiu
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingling Zhou
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingqing Feng
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuang Xia
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weimin Li
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yuhua Liao
- Department of Cardiology, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Hubei, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital to Nanjing Medical University, Jiangsu, China
| | - Jingmin Zhou
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Jin
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Liaoning, China
| | - Mulei Chen
- Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiang Wang
- Department of Cardiology, Xinqiao Hospital, PLA Army Medical University, Chongqing, China
| | - Hong Kong
- Department of Cardiology, Sichuan Provincial People's Hospital, Sichuan, China
| | - Yao Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Wei Dong
- Department of Cardiology, PLA General Hospital, Beijing, China
| | - Ling Bai
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Shanxi, China
| | - Dongjie Xu
- Department of Cardiology, The First Affiliated Hospital to Nanjing Medical University, Jiangsu, China
| | - Jing Yuan
- Department of Cardiology, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Hubei, China
| | - Chen Liu
- Department of Cardiology, Center for Translational Medicine, Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China
| | - Meng Jiang
- Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yamei Xu
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Liwen Li
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yugang Dong
- Department of Cardiology, Center for Translational Medicine, Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China
| | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Khodneva Y, Ringel JB, Rajan M, Goyal P, Jackson EA, Sterling MR, Cherrington A, Oparil S, Durant R, Safford MM, Levitan EB. Depressive symptoms, cognitive impairment, and all-cause mortality among REGARDS participants with heart failure. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac064. [PMID: 36330357 PMCID: PMC9617474 DOI: 10.1093/ehjopen/oeac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/06/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
Aims To ascertain whether depressive symptoms and cognitive impairment (CI) are associated with mortality among patients with heart failure (HF), adjusting for sociodemographic, comorbidities, and biomarkers. Methods and results We utilized Medicare-linked data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a biracial prospective ongoing cohort of 30 239 US community-dwelling adults, recruited in 2003-07. HF diagnosis was ascertained in claims analysis. Depressive symptoms were defined as a score ≥4 on the four-item Center for Epidemiological Studies-Depression scale. Cognitive impairment was defined as a score of ≤4 on the six-item screener that assessed three-item recall and orientation to year, month, and day of the week. Sequentially adjusted Cox proportional hazard models were used to estimate the risk of death. We analyzed 1059 REGARDS participants (mean age 73, 48%-African American) with HF; of those 146 (14%) reported depressive symptoms, 136 (13%) had CI and 31 (3%) had both. Over the median follow-up of 6.8 years (interquartile range, 3.4-10.3), 785 (74%) died. In the socio-demographics-adjusted model, CI was significantly associated with increased mortality, hazard ratio 1.24 (95% confidence interval 1.01-1.52), compared with persons with neither depressive symptoms nor CI, but this association was attenuated after further adjustment. Neither depressive symptoms alone nor their comorbidity with CI was associated with mortality. Risk factors of all-cause mortality included: low income, comorbidities, smoking, physical inactivity, and severity of HF. Conclusion Depressive symptoms, CI, or their comorbidity was not associated with mortality in HF in this study. Treatment of HF in elderly needs to be tailored to cognitive status and includes focus on medical comorbidities.
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Affiliation(s)
- Yulia Khodneva
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Joanna Bryan Ringel
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Mangala Rajan
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Parag Goyal
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
- Division of Cardiology, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Elizabeth A Jackson
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Madeline R Sterling
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Andrea Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Suzanne Oparil
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Raegan Durant
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Monika M Safford
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, Al 35294, USA
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Discharge heart rate and 1-year clinical outcomes in heart failure patients with atrial fibrillation. Chin Med J (Engl) 2021; 135:52-62. [PMID: 34982055 PMCID: PMC8850821 DOI: 10.1097/cm9.0000000000001768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level. METHODS In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65-85 bpm), and high (≥86 bpm) heart rate measured at discharge. Cox proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF rehospitalization. RESULTS Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60-77) years, median discharge heart rate was 75 (IQR: 69-84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05-1.68, P = 0.020) and high (HR: 1.34, 95% CI: 1.07-1.67, P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.38, 95% CI: 1.01-1.89, P = 0.046), whereas there was no difference between the groups with low and moderate heart rate. Among the patients with LVEF <50%, only those with low heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.46, 95% CI: 1.09-1.96, P = 0.012), whereas there was no difference between the groups with high and moderate heart rate. CONCLUSIONS Among the overall HF patients with AF, both low (<65 bpm) and high (≥86 bpm) heart rates were associated with poorer outcomes as compared with moderate (65-85 bpm) heart rate. Among patients with LVEF ≥50%, only a high heart rate was associated with higher risk; while among those with LVEF <50%, only a low heart rate was associated with higher risk as compared with the group with moderate heart rate. TRAIL REGISTRATION Clinicaltrials.gov; NCT02878811.
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9
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Kida K, Kitai T, Suzuki N, Ashikaga K, Kou S, Kagiyama N, Yamaguchi T, Okumura T, Mizuno A, Oishi S, Inuzuka Y, Akiyama E, Suzuki S, Yamamoto M, Matsue Y. Prognostic Implications of Reductions in Heart Rates in Patients With Acute Heart Failure and Atrial Fibrillation. Circ J 2021; 85:1869-1875. [PMID: 34248134 DOI: 10.1253/circj.cj-21-0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia in patients with acute heart failure (AHF). Heart rate (HR) also changes significantly over time. However, the association between changes in HR in AF patients and prognosis is uncertain. METHODS AND RESULTS We investigated the association between HR reduction in AF achieved within 48 h of admission and 60-day mortality in patients with AHF from the REALITY-AHF study. The percentage HR (%HR) reduction was calculated as (baseline HR-HR at 48 h) / baseline HR × 100. The primary endpoint was 60-day all-cause mortality. In 468 patients with confirmed AF at both admission and 48 h after admission, the median HR at these time points was 105±31 and 84±18 beats/min, respectively. The median %HR reduction was 15.4% (interquartile range 2.2-31.4%). During the 60 days of admission, 39 deaths (8.3%) were recorded, and the %HR reduction within 48 h was significantly associated with 60-day mortality in the unadjusted model (hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.77-0.95; P=0.005) and after adjusting for other covariates (HR 0.81; 95% CI 0.68-0.96; P=0.016).Furthermore, the %HR reduction was associated with a significant reduction in 60-day mortality in patients with higher baseline HR. CONCLUSIONS %HR reduction is associated with a better short-term prognosis in patients with AHF presenting with AF, particularly in those with a rapid ventricular response.
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Affiliation(s)
- Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Norio Suzuki
- Department of Internal Medicine, Division of Cardiology, St. Marianna University School of Medicine
| | - Kohei Ashikaga
- Department of Internal Medicine, Division of Cardiology, St. Marianna University School of Medicine
| | - Seisyou Kou
- Department of Internal Medicine, Division of Cardiology, St. Marianna University School of Medicine
| | - Nobuyuki Kagiyama
- Department of Cardiology, The Sakakibara Heart Institute of Okayama
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine
- Department of Digital Health and Telemedicine R&D, Juntendo University
| | - Tetsuo Yamaguchi
- Department of Cardiology, Cardiovascular Center, Toranomon Hospital
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital
| | - Shogo Oishi
- Department of Cardiology, Himeji Cardiovascular Center
| | | | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center
| | - Satoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
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10
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Faselis C, Safren L, Allman RM, Lam PH, Brar V, Morgan CJ, Ahmed AA, Deedwania P, Alagiakrishnan K, Sheikh FH, Fonarow GC, Ahmed A. Income disparity and incident cardiovascular disease in older Americans. Prog Cardiovasc Dis 2021; 71:92-99. [PMID: 34320387 DOI: 10.1016/j.pcad.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the association between income and cardiovascular disease (CVD) in community-dwelling older adults. METHODS Of the 5795 Medicare-eligible community-dwelling older Americans aged 65-100 years in the Cardiovascular Health Study (CHS), 4518 (78%) were free of baseline CVD, defined as heart failure, acute myocardial infarction, stroke, or peripheral arterial disease. Of them, 1846 (41%) had lower income, defined as a total annual household income <$16,000. Using propensity scores for lower income, estimated for each of the 4518 participants, we assembled a matched cohort of 1078 pairs balanced on 42 baseline characteristics. Outcomes included centrally adjudicated incident CVD and mortality. RESULTS Matched participants (n = 2156) had a mean age of 73 years, 63% were women, and 13% African American. During an overall follow-up of 23 years, incident CVD, all-cause mortality and the combined endpoint of incident CVD or mortality occurred in 1094 (51%), 1726 (80%) and 1867 (87%) individuals, respectively. Compared with the higher income group, hazard ratio (HR) for time to the first occurrence of incident CVD in the lower income group was 1.16 with a 95% confidence interval of 1.03 to 1.31. A lower income was also associated with a significantly higher risk of all-cause mortality (HR, 1.19; 95% CI, 1.08-1.30), and consequently a higher risk of the combined endpoint of incident CVD or death (HR, 1.20; 95% CI, 1.09-1.31). CONCLUSION Among community-dwelling older Americans free of baseline CVD, an annual household income <$16,000 is independently associated with significantly higher risks of new-onset CVD and death.
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Affiliation(s)
- Charles Faselis
- Veterans Affairs Medical Center, Washington, DC, United States of America; George Washington University, Washington, DC, United States of America; Uniformed Services University, Washington, DC, United States of America; University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Lowell Safren
- Veterans Affairs Medical Center, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America; MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Richard M Allman
- George Washington University, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America
| | - Phillip H Lam
- Veterans Affairs Medical Center, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America; MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Vijaywant Brar
- Veterans Affairs Medical Center, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America
| | - Charity J Morgan
- George Washington University, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America
| | - Amiya A Ahmed
- University of Maryland, Baltimore, MD, United States of America
| | - Prakash Deedwania
- Veterans Affairs Medical Center, Washington, DC, United States of America; University of California, San Francisco, CA, United States of America
| | | | - Farooq H Sheikh
- Georgetown University, Washington, DC, United States of America; MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Gregg C Fonarow
- University of California, Los Angeles, CA, United States of America
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC, United States of America; George Washington University, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America.
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11
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Rodrigues JCL, Rooms B, Hyde K, Rohan S, Nightingale AK, Paton J, Manghat N, Bucciarelli-Ducci C, Hamilton M, Zhang H, MacIver DH. The corrected left ventricular ejection fraction: a potential new measure of ventricular function. Int J Cardiovasc Imaging 2021; 37:1987-1997. [PMID: 33616783 DOI: 10.1007/s10554-021-02193-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/12/2021] [Indexed: 12/28/2022]
Abstract
Left ventricular ejection fraction (LVEF) has a limited role in predicting outlook in heart diseases including heart failure. We quantified the independent geometric factors that determine LVEF using cardiac MRI and sought to provide an improved measure of ventricular function by adjusting for such independent variables. A mathematical model was used to analyse the independent effects of structural variables and myocardial shortening on LVEF. These results informed analysis of cardiac MRI data from 183 patients (53 idiopathic dilated cardiomyopathy (DCM), 36 amyloidosis, 55 hypertensives and 39 healthy controls). Left ventricular volumes, LVEF, wall thickness, internal dimensions and longitudinal and midwall fractional shortening were measured. The modelling demonstrated LVEF increased in a curvilinear manner with increasing mFS and longitudinal shortening and wall thickness but decreased with increasing internal diameter. Controls in the clinical cohort had a mean LVEF 64 ± 7%, hypertensives 66 ± 8%, amyloid 49 ± 16% and DCM 30 ± 11%. The mean end-diastolic wall thickness in controls was 8 ± 1 mm, DCM 8 ± 1 mm, hypertensives 11 ± 3 mm and amyloid 14 ± 3 mm, P < 0.0001). LVEF correlated with absolute wall thickening relative to ventricular size (R2 = 0.766). A regression equation was derived from raw MRI data (R2 = 0.856) and used to 'correct' LVEF (EFc) by adjusting the wall thickness and ventricular size to the mean of the control group. Improved quantification of the effects of geometric changes and strain significantly enhances understanding the myocardial mechanics. The EFc resulted in reclassification of a 'ventricular function' in some individuals and may provide an improved measure of myocardial performance especially in thick-walled, low-volume ventricles.
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Affiliation(s)
- Jonathan Carl Luis Rodrigues
- NIHR Bristol Cardiovascular Biomedical Research Centre, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Department of Radiology, Royal United Hospital Bath NHS Foundation Trust, Bath, UK
| | - Benjamin Rooms
- Medical School, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - Katie Hyde
- Medical School, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - Stephen Rohan
- Medical School, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - Angus K Nightingale
- CardioNomics Research Group, Clinical Research and Imaging Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Julian Paton
- CardioNomics Research Group, Clinical Research and Imaging Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nathan Manghat
- Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- NIHR Bristol Cardiovascular Biomedical Research Centre, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Mark Hamilton
- Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Henggui Zhang
- Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - David H MacIver
- Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, UK. .,Department of Cardiology, Musgrove Park Hospital, Taunton, TA1 5DA, UK.
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12
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Arundel C, Lam PH, Faselis C, Sheriff HM, Dooley DJ, Morgan C, Fonarow GC, Aronow WS, Allman RM, Ahmed A. Length of stay and readmission in older adults hospitalized for heart failure. Arch Med Sci 2021; 17:891-899. [PMID: 34336017 PMCID: PMC8314416 DOI: 10.5114/aoms.2019.89702] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Hospital length of stay (LoS) and hospital readmissions are metrics of healthcare performance. We examined the association between these two metrics in older patients hospitalized with decompensated heart failure (HF). MATERIAL AND METHODS Eight thousand and forty-nine patients hospitalized for HF in 106 U.S. hospitals had a median LoS of 5 days; among them, 3777 had a LoS > 5 days. Using propensity scores for LoS > 5 days, we assembled 2723 pairs of patients with LoS 1-5 vs. > 5 days. The matched cohort of 5446 patients was balanced on 40 baseline characteristics. We repeated the above process in 7045 patients after excluding those with LoS > 10 days, thus assembling a second matched cohort of 2399 pairs of patients with LoS 1-5 vs. 6-10 days. Hazard ratios (HR) and 95% confidence intervals (CI) for outcomes associated with longer LoS were estimated in matched cohorts. RESULTS In the primary matched cohort (n = 5446), LoS > 5 days was associated with a higher risk of all-cause readmission at 30 days (HR = 1.16; 95% CI: 1.04-1.31; p = 0.010), but not during longer follow-up. A longer LoS was also associated with a higher risk of mortality during 8.8 years of follow-up (HR = 1.13; 95% CI: 1.06-1.21; p < 0.001). LoS had no association with HF readmission. Similar associations were observed among the matched sensitivity cohort (n = 4798) that excluded patients with LoS > 10 days. CONCLUSIONS In propensity score-matched balanced cohorts of patients with HF, a longer LoS was independently associated with poor outcomes, which persisted when LoS > 10 days were excluded.
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Affiliation(s)
- Cherinne Arundel
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Phillip H. Lam
- Veterans Affairs Medical Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Charles Faselis
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Helen M. Sheriff
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Daniel. J. Dooley
- Georgetown University, Washington, DC, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Charity Morgan
- Veterans Affairs Medical Center, Washington, DC, USA
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Wilbert S. Aronow
- Weschester Medical Center, Valhalla, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Richard M. Allman
- George Washington University, Washington, DC, USA
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
- Georgetown University, Washington, DC, USA
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13
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Singh S, Moore H, Karasik PE, Lam PH, Wopperer S, Arundel C, Tummala L, Anker MS, Faselis C, Deedwania P, Morgan CJ, Zeng Q, Allman RM, Fonarow GC, Ahmed A. Digoxin Initiation and Outcomes in Patients with Heart Failure (HFrEF and HFpEF) and Atrial Fibrillation. Am J Med 2020; 133:1460-1470. [PMID: 32603789 DOI: 10.1016/j.amjmed.2020.05.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Digoxin reduces the risk of heart failure hospitalization but has no effect on mortality in patients with heart failure without atrial fibrillation in the randomized controlled trial setting. Observational studies of digoxin use in patients with atrial fibrillation have suggested a higher risk for poor outcomes. Less is known about this association in patients with heart failure and atrial fibrillation, the examination of which was the objective of the current study. METHODS We conducted an observational propensity score-matched study of predischarge digoxin initiation in 1768 hospitalized patients with heart failure and atrial fibrillation in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, balanced on 56 baseline characteristics (mean age, 79 years; 55% women; 7% African American). Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes were estimated for the 884 patients initiated on digoxin compared with 884 not initiated on digoxin. RESULTS HRs (95% CIs) for 30-day, 2-year, and 4-year all-cause mortality were 0.80 (0.55-1.18; P = .261), 0.94 (0.87-1.16; P = .936), and 1.01 (0.90-1.14; P = .729), respectively. Respective HRs (95% CIs) for heart failure readmission were 0.67 (0.49-0.92; P = .014), 0.81 (0.69-0.94; P = .005), and 0.85 (0.74-0.97; P = .022), and those for all-cause readmission were 0.78 (0.64-0.96; P = .016), 0.90 (0.81-1.00; P = .057), and 0.91 (0.83-1.01; P = .603). These associations were homogeneous between patients with left ventricular ejection fraction ≤45% vs >45%. CONCLUSIONS Among hospitalized older patients with heart failure (HFrEF and HFpEF) and atrial fibrillation, initiation of digoxin was associated with a lower risk of heart failure readmission but had no association with mortality.
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Affiliation(s)
- Steven Singh
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC.
| | - Hans Moore
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC
| | - Pamela E Karasik
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC
| | - Phillip H Lam
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Washington Hospital Center, Washington, DC
| | - Samuel Wopperer
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC
| | - Cherinne Arundel
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; George Washington University, Washington, DC
| | - Lakshmi Tummala
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; George Washington University, Washington, DC
| | - Markus S Anker
- Charité Campus Virchow Klinikum, Berlin, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Germany; German Centre for Cardiovascular Research, Berlin, Germany
| | - Charles Faselis
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC
| | - Prakash Deedwania
- Veterans Affairs Medical Center, Washington, DC; University of California, San Francisco
| | - Charity J Morgan
- Veterans Affairs Medical Center, Washington, DC; University of Alabama at Birmingham
| | - Qing Zeng
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC
| | - Richard M Allman
- George Washington University, Washington, DC; University of Alabama at Birmingham
| | | | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; George Washington University, Washington, DC.
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14
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Ahn MS, Yoo BS, Son JW, Yu MH, Kang DR, Lee HY, Jeon ES, Kim JJ, Chae SC, Baek SH, Kang SM, Choi DJ, Kim KH, Cho MC, Kim SY. Beta-blocker Therapy at Discharge in Patients with Acute Heart Failure and Atrial Fibrillation. J Korean Med Sci 2020; 35:e278. [PMID: 32830467 PMCID: PMC7445305 DOI: 10.3346/jkms.2020.35.e278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/03/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND β-blockers (BBs) are considered primary therapy in stable heart failure (HF) with reduced ejection fraction (HFrEF) without atrial fibrillation (AF); evidence-based benefits of BB on outcome have been documented. However, BBs have not been shown to improve mortality or reduce hospital admissions in HF patients with AF. This study assessed the relationship between BBs at discharge and relevant clinical outcomes in acute heart failure (AHF) patients with AF. METHODS From the Korean Acute Heart Failure Registry, 936 HFrEF and 639 HF patients with preserved ejection fraction (HFpEF) and AF were selected. Propensity score (PS) matching accounted for BB selection bias when assessing associations. RESULTS BB-untreated patients in the overall cohort of HFrEF and HFpEF had greater deteriorated clinical and laboratory characteristics. In the 670 PS-matched cohort of HFrEF patients, incidences of all clinical events at 60 days and 1 year were not different according to use of BBs. In the 470 PS-matched cohort of HFpEF, rehospitalization and composite outcome at 6 months and 1 year more frequently occurred in non-users of BBs. After adjusting for covariates in the multivariable Cox model of matched cohorts, BB was not associated with clinical outcomes at 60 days and 1 year in HFrEF with AF patients. In HFpEF patients with AF, BB use was associated with reduced 6-month (hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.20-0.74) and 1-year rehospitalization (HR, 0.53; 95% CI, 0.34-0.82). CONCLUSION In the HFrEF with AF PS-matched cohort, the use of BBs at discharge was not associated with clinical outcome. However, in HFpEF with AF, the use of BB was associated with reduced rehospitalization during the 6-month and 1-year follow up.
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Affiliation(s)
- Min Soo Ahn
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Byung Su Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Jung Woo Son
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Heui Yu
- Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dae Ryong Kang
- Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hae Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Seok Jeon
- Department of Internal Medicine, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Jae Joong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Hong Baek
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kye Hun Kim
- Department of Internal Medicine, Heart Research Center of Chonnam National University, Gwangju, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
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15
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Faselis C, Arundel C, Patel S, Lam PH, Gottlieb SS, Zile MR, Deedwania P, Filippatos G, Sheriff HM, Zeng Q, Morgan CJ, Wopperer S, Nguyen T, Allman RM, Fonarow GC, Ahmed A. Loop Diuretic Prescription and 30-Day Outcomes in Older Patients With Heart Failure. J Am Coll Cardiol 2020; 76:669-679. [DOI: 10.1016/j.jacc.2020.06.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/17/2023]
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16
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Kokhan EV, Kiyakbaev GK, Kobalava ZD. [Frequency of use and Indications for Beta-Blockers in Heart Failure with Preserved Ejection Fraction]. KARDIOLOGIIA 2020; 60:30-40. [PMID: 32720613 DOI: 10.18087/cardio.2020.6.n1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
Aim To evaluate trends in beta-blocker prescribing and incidence of possible reasons for beta-blocker administration, including arterial hypertension (AH), atrial fibrillation (AF), ischemic heart disease (IHD), and myocardial infarction, in participants of clinical studies enrolling patients with chronic heart failure with preserved ejection fraction (CHF-PEF).Material and methods A systematic literature search was performed in the PubMed and EMBASE databases. The study included RCSs of pharmacological therapies for patients with CHF-PEF conducted from 1993 through 2019. Studies of beta-blocker efficacy or those including a specific population (CHF-PEF+IHD or CHF-PEF+AH, etc.) were excluded from the analysis. Baseline characteristics of patients, incidence rate of beta-blocker prescribing, and prevalence of AH, AF, IHD, and MI were recorded. Trends in prevalence of concomitant diseases and the proportion of patients using beta-blockers by the year of enrollment to the study were analyzed with the Mann-Kendall test.Results 14 RCSs of 718 selected publications completely met the inclusion and exclusion criteria. Beta-blocker prescribing significantly increased between 1993 and 2019 (tau=0.51; p=0.014) and reached 80 % in recent studies. Furthermore, prevalence of IHD, MI, AH, and AF did not significantly change among the RCS participants (p>0.05 for all). However, while for AH and AF, a tendency toward an increasing prevalence (tau=0.4; p=0.055 and tau=0.043; p=0.063, respectively) could be considered and became statistically significant for AF when the ALDO-DHF study was excluded from the analysis (tau=0.5; p=0.042), the MI prevalence tended to decrease (tau= -0.73; p=0.06).Conclusion Beta-blocker prescribing to patients upon inclusion into RCSs for CHF-PEF has significantly increased for the recent 20 years while the incidence of formal reasons for beta-blocker administration (AF, AH, MI, IHD) did not significantly change.
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Affiliation(s)
- E V Kokhan
- Peoples' Friendship University of Russia (RUDN University), Russia, Moscow
| | - G K Kiyakbaev
- Peoples' Friendship University of Russia (RUDN University), Russia, Moscow
| | - Zh D Kobalava
- Peoples' Friendship University of Russia (RUDN University), Russia, Moscow
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17
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Kim MN, Park SM. Heart failure with preserved ejection fraction: insights from recent clinical researches. Korean J Intern Med 2020; 35:514-534. [PMID: 32392659 PMCID: PMC7214356 DOI: 10.3904/kjim.2020.104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/23/2020] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for nearly half of the cases of HF and its incidence might be increasing with the aging society. Patients with HFpEF present with significant symptoms, including exercise intolerance, impaired quality of life, and have a poor prognosis as well as frequent hospitalization and increased mortality compared with HF with reduced ejection fraction. The concept of HFpEF is still evolving and may be a virtual complex rather than a real systemic disorder. Thus, beyond solely targeting cardiac abnormalities management strategies need to be extended, such as left ventricular diastolic dysfunction. In this review, we examine new diagnostic algorithms, pathophysiology, current management status, and ongoing trials based on heterogeneous pathophysiology and etiology in HFpEF.
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Affiliation(s)
- Mi-Na Kim
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
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18
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Wahlberg K, Arnold ME, Lustgarten D, Meyer M. Effects of a Higher Heart Rate on Quality of Life and Functional Capacity in Patients With Left Ventricular Diastolic Dysfunction. Am J Cardiol 2019; 124:1069-1075. [PMID: 31395299 DOI: 10.1016/j.amjcard.2019.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 01/23/2023]
Abstract
There is no evidence-based treatment for heart failure with preserved ejection fraction. Although lower heart rates (HRs) provide an unequivocal benefit for patients with HF with reduced ejection fraction, higher HR might convey important hemodynamic and substrate-modifying benefits in patients with diastolic dysfunction. In a prospective study of 20 stable outpatients with diastolic dysfunction and pacemakers, we evaluated the effects of a 4-week increase in the lower pacemaker rate to 80 beats/min followed by reversal to the previous lower HR setting from weeks 4 to 6. We assessed quality of life (Minnesota Living with Heart Failure Questionnaire), 6-minute walk test and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Pacing at 80 beats/min significantly improved quality of life and the 6-minute walk test (p ≤0.05). There was a strong positive correlation between the pacing-induced changes in NT-proBNP and baseline QRS intervals (r2 = 0.31, p <0.01). Stratification by QRS duration revealed that pacing at 80 beats/min led to -21 ± 26% reduction in NT-proBNP in patients with QRS ≤150 ms, whereas QRS >150 ms was associated with a 26 ± 35% increase in NT-proBNP (p <0.01). Patients physiologically paced from the conduction system had a -46 ± 26% reduction in NT-proBNP at 80 beats/min as compared with 4 ± 26% and 13 ± 26% change with pacing from the right atrial appendage and right ventricular apical septum (pinteraction = 0.04). In conclusion, increasing the lower rate setting of pacemakers to 80 beats/min in patients with diastolic dysfunction improves quality of life, functional capacity, and NT-proBNP for those patients with a baseline QRS ≤150 ms. These findings suggest that higher HRs may provide meaningful benefits to patients with left ventricular diastolic dysfunction and heart failure with preserved ejection fraction.
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Affiliation(s)
- Kramer Wahlberg
- Cardiology Division, Larner College of Medicine at the University of Vermont, Burlington, Vermont.
| | - Maren E Arnold
- Cardiology Division, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Daniel Lustgarten
- Cardiology Division, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Markus Meyer
- Cardiology Division, Larner College of Medicine at the University of Vermont, Burlington, Vermont
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19
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Arundel C, Lam PH, Gill GS, Patel S, Panjrath G, Faselis C, White M, Morgan CJ, Allman RM, Aronow WS, Singh SN, Fonarow GC, Ahmed A. Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol 2019; 73:3054-3063. [PMID: 31221253 PMCID: PMC10656059 DOI: 10.1016/j.jacc.2019.04.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND National guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with reduced ejection fraction (HFrEF) and hypertension be maintained below 130 mm Hg. OBJECTIVES This study sought to determine associations of SBP <130 mm Hg with outcomes in patients with HFrEF. METHODS Of the 25,345 patients in the Medicare-linked OPTIMIZE-HF registry, 10,535 had an ejection fraction (EF) ≤40%. Of these, 5,615 had stable SBP (≤20 mm Hg admission to discharge variation), and 3,805 (68%) had a discharge SBP <130 mm Hg. Propensity scores for SBP <130 mm Hg, estimated for each of the 5,615 patients, were used to assemble a matched cohort of 1,189 pairs of patients with SBP <130 versus ≥130 mm Hg, balanced on 58 baseline characteristics (mean age 76 years; mean EF 28%, 45% women, 13% African American). This process was repeated in 3,946 patients, after excluding 1,669 patients (30% of 5,615) with a discharge SBP <110 mm Hg and assembled a second matched balanced cohort of 1,099 pairs of patients with SBP 110 to 129 mm Hg versus ≥130 mm Hg. RESULTS Thirty-day all-cause mortality occurred in 7% and 4% of matched patients with SBP <130 mm Hg versus ≥130 mm Hg, respectively (hazard ratio [HR]: 1.76; 95% confidence interval [CI]: 1.24 to 2.48; p = 0.001). HRs (95% CIs) for all-cause mortality, all-cause readmission, and HF readmission at 1 year, associated with SBP <130 mm Hg, were 1.32 (1.15 to 1.53; p < 0.001), 1.11 (1.01 to 1.23; p = 0.030), and 1.24 (1.09 to 1.42; p = 0.001), respectively. HRs (95% CIs) for 30-day and 1-year all-cause mortality associated with SBP 110 to 129 mm Hg (vs. ≥130 mm Hg) were 1.50 (1.03 to 2.19; p = 0.035), and 1.19 (1.02 to 1.39; p = 0.029), respectively. CONCLUSIONS Among hospitalized older patients with HFrEF, SBP <130 mm Hg is associated with poor outcomes. This association persisted when the analyses were repeated after excluding patients with SBP <110 mm Hg. There is an urgent need for randomized controlled trials to evaluate optimal SBP reduction goals in patients with HFrEF.
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Affiliation(s)
- Cherinne Arundel
- Medical Service, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, George Washington University, Washington, DC; Department of Medicine, Georgetown University, Washington, DC
| | - Phillip H Lam
- Department of Medicine, Georgetown University, Washington, DC; Department of Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gauravpal S Gill
- Medical Service, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Samir Patel
- Medical Service, Veterans Affairs Medical Center, Washington, DC
| | - Gurusher Panjrath
- Department of Medicine, George Washington University, Washington, DC
| | - Charles Faselis
- Medical Service, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, George Washington University, Washington, DC
| | - Michel White
- Department of Medicine, University of Montreal and Montreal Heart Institute, Montreal, Quebec, Canada
| | - Charity J Morgan
- Medical Service, Veterans Affairs Medical Center, Washington, DC; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard M Allman
- Department of Medicine, George Washington University, Washington, DC
| | - Wilbert S Aronow
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, New York
| | - Steven N Singh
- Medical Service, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC
| | - Gregg C Fonarow
- Department of Medicine, University of California, Los Angeles, California
| | - Ali Ahmed
- Medical Service, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, George Washington University, Washington, DC; Department of Medicine, Georgetown University, Washington, DC.
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20
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Beale AL, Nanayakkara S, Kaye DM. Impact of Sex on Ventricular-Vascular Stiffness and Long-Term Outcomes in Heart Failure With Preserved Ejection Fraction: TOPCAT Trial Substudy. J Am Heart Assoc 2019; 8:e012190. [PMID: 31230508 PMCID: PMC6662372 DOI: 10.1161/jaha.119.012190] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Women have higher vascular stiffness with aging. The aim of this study was to characterize sex differences in vascular and ventricular structure and function, and to investigate the impact on the primary outcome in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial). Methods and Results Data from the Americas cohort of the TOPCAT trial were analyzed. Patients with echocardiography (n=654) were compared according to sex, and achievement of the primary end point (a composite of death from cardiovascular causes and heart failure hospitalization) assessed. Echocardiography revealed higher arterial, systolic, and diastolic ventricular elastance and worse ventricular‐vascular coupling in women. Women had better overall survival and heart failure hospitalization outcomes (hazard ratio 0.74, 95% CI 0.57–0.98, P=0.034), however, determinants of achievement of the primary outcome differed between the sexes. Pulse pressure was a key determinant of outcome in women (hazard ratio 1.04, 95% CI 1–1.09, P=0.034) whereas in men heart rate (hazard ratio 1.61, 95% CI 1.02–2.52 per 10 mm Hg increase, P=0.04) and B‐type natriuretic peptide (hazard ratio 1.01, 95% CI 1–1.02 per 10 ng/mL increase P=0.02) were associated with poorer outcome. Conclusions Outcomes in patients with heart failure with preserved ejection fraction appear to be differentially influenced by key physiological factors that vary according to sex. In women, ventricular‐vascular stiffening was the most significant determinant of outcome, whereas in men overall survival was influenced by heart rate and B‐type natriuretic peptide; this highlights key sex differences in the pathophysiology and outcomes of heart failure with preserved ejection fraction and warrants further exploration. Clinical Trial Registration URL: https://clinicaltrials.gov. Unique identifier: NCT00094302.
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Affiliation(s)
- Anna L Beale
- 1 Department of Cardiology Alfred Hospital Melbourne Australia.,2 Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,3 Department of Medicine Monash University Melbourne Australia
| | - Shane Nanayakkara
- 1 Department of Cardiology Alfred Hospital Melbourne Australia.,2 Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,3 Department of Medicine Monash University Melbourne Australia
| | - David M Kaye
- 1 Department of Cardiology Alfred Hospital Melbourne Australia.,2 Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,3 Department of Medicine Monash University Melbourne Australia
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21
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Schilling J, Vader J. Be Still My Beating Heart: Should Heart Rate Be a Target of Therapy After Heart Transplantation? J Card Fail 2019; 25:257-258. [PMID: 30853511 DOI: 10.1016/j.cardfail.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Joel Schilling
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.
| | - Justin Vader
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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22
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Shufelt CL, Pacheco C, Tweet MS, Miller VM. Sex-Specific Physiology and Cardiovascular Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1065:433-454. [PMID: 30051400 PMCID: PMC6768431 DOI: 10.1007/978-3-319-77932-4_27] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sex differences in cardiovascular diseases can be classified as those which are specific to one sex and those that differ in incidence, prevalence, etiology, symptomatology, response to treatment, morbidity, and mortality in one sex compared to the other. All sex differences in cardiovascular conditions have their basis in the combined expression of genetic and hormonal differences between women and men. This chapter addresses how understanding basic mechanisms of hormone responses, imaging diagnostics, and integration of genomics and proteomics has advanced diagnosis and improved outcomes for cardiovascular conditions, apart from those related to pregnancy that are more prevalent in women. These conditions include obstructive coronary artery disease, coronary microvascular dysfunction, spontaneous coronary artery dissection, diseases of the cardiac muscle including heart failure and takotsubo cardiomyopathy, and conditions related to neurovascular dysregulation including hot flashes and night sweats associated with menopause and effects of exogenous hormones on vascular function. Improvement in technologies allowing for noninvasive assessment of neuronally mediated vascular reactivity will further improve our understanding of the basic etiology of the neurovascular disorders. Consideration of sex, hormonal status, and pregnancy history in diagnosis and treatment protocols will improve prevention and outcomes of cardiovascular disease in women as they age.
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Affiliation(s)
- Chrisandra L Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Smidt Heart Insititute, Los Angeles, CA, USA.
| | - Christine Pacheco
- Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Smidt Heart Insititute, Los Angeles, CA, USA
| | - Marysia S Tweet
- Department of Cardiovascular Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Surgery and Physiology, Women's Health Research Center, College of Medicine, Mayo Clinic, Rochester, MN, USA
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23
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Alzaghari O, Wallace DC. The Impact of Physiological Factors on 30-day Unplanned Rehospitalization in Adults with Heart Failure. J Community Health Nurs 2019; 36:31-41. [PMID: 30793963 DOI: 10.1080/07370016.2018.1555308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Heart failure (HF) patients have high rates of 30-day unplanned rehospitalization. This study assessed the impact of physiological factors on 30-day HF unplanned rehospitalization. METHODS The cross-sectional study used secondary data from electronic medical records of 270 patients. RESULTS Findings revealed several factor types were related to 30-day HF unplanned rehospitalization such as chronic kidney disease (p = 0.001), the use of CPAP machine (p = 0.028), and B-type natriuretic peptide (p = 0.050). CONCLUSION Many physiological factors were associated with 30-day HF unplanned rehospitalization. Identifying these factors will help health care providers to plan a variety of interventions that reduce 30-day HF unplanned rehospitalization.
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Affiliation(s)
- Omar Alzaghari
- a College of Health and Human Services , University of North Carolina Wilmington , Wilmington , NC , USA
| | - Debra C Wallace
- b UNC Greensboro School of Nursing , University of North Carolina Greensboro , Greensboro , NC , USA
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24
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Sartipy U, Savarese G, Dahlström U, Fu M, Lund LH. Association of heart rate with mortality in sinus rhythm and atrial fibrillation in heart failure with preserved ejection fraction. Eur J Heart Fail 2019; 21:471-479. [PMID: 30698317 DOI: 10.1002/ejhf.1389] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 12/13/2022] Open
Abstract
AIMS To assess the association between atrial fibrillation (AF) and mortality, and also the association between resting heart rate (HR) and mortality in both sinus rhythm (SR) and AF in patients with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS A total of 9090 patients with HFpEF (ejection fraction ≥ 50%) were included from the Swedish Heart Failure registry; 4296 (47%) had SR and 4794 (53%) had AF. Patients with AF were older (80.3 vs. 75.0 years) and more symptomatic compared with patients in SR. The outcome measure was all-cause mortality. The adjusted hazard ratio (95% confidence interval) for AF vs. SR was 1.21 (1.11-1.32). Compared with HR ≤ 60 b.p.m., the adjusted hazard ratios (95% confidence interval) were in SR: 1.06 (0.92-1.21) for HR 61-70 b.p.m., 1.30 (1.12-1.52) for HR 71-80 b.p.m., 1.27 (1.07-1.51) for HR 81-90 b.p.m., and 1.77 (1.45-2.17) for HR > 90 b.p.m. Due to non-proportional hazards in AF, hazard ratios were estimated in three time periods. Compared with HR ≤ 60 b.p.m., the adjusted hazard ratios (95% confidence interval) were in AF: 1.30 (1.07-1.57), 1.07 (0.83-1.39), and 1.01 (0.70-1.48) for HR 61-70 b.p.m., 1.35 (1.12-1.62), 0.99 (0.77-1.27), and 0.96 (0.66-1.40) for HR 71-80 b.p.m., 1.41 (1.16-1.73), 1.01 (0.76-1.36), and 0.79 (0.51-1.22) for HR 81-90 b.p.m., and 1.78 (1.46-2.17), 1.08 (0.80-1.46), and 0.73 (0.46-1.17) for HR > 90 b.p.m., during 0-2, 2-4, and 4-6 years of follow-up, respectively. CONCLUSION In a large and unselected cohort of patients with HFpEF, AF was independently associated with all-cause mortality. A higher HR was associated with increased mortality in SR. In AF, the effect of a higher HR on mortality was only present during the first years of follow-up, with convergence in outcomes according to baseline HR groups over long-term follow-up.
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Affiliation(s)
- Ulrik Sartipy
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Ulf Dahlström
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Michael Fu
- Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
| | - Lars H Lund
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Spironolactone and Outcomes in Older Patients with Heart Failure and Reduced Ejection Fraction. Am J Med 2019; 132:71-80.e1. [PMID: 30240686 PMCID: PMC6511886 DOI: 10.1016/j.amjmed.2018.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The efficacy of mineralocorticoid receptor antagonists or aldosterone antagonists in heart failure with reduced ejection fraction (HFrEF) is well known. Less is known about their effectiveness in real-world older patients with HFrEF. METHODS Of the 8206 patients with heart failure and ejection fraction ≤35% without prior spironolactone use in the Medicare-linked OPTIMIZE-HF registry, 6986 were eligible for spironolactone therapy based on serum creatinine criteria (men ≤2.5 mg/dL, women ≤2.0 mg/dL) and 865 received a discharge prescription for spironolactone. Using propensity scores for spironolactone use, we assembled a matched cohort of 1724 (862 pairs) patients receiving and not receiving spironolactone, balanced on 58 baseline characteristics (Creatinine Cohort: mean age, 75 years, 42% women, 17% African American). We repeated the above process to assemble a secondary matched cohort of 1638 (819 pairs) patients with estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2 (eGFR Cohort: mean age, 75 years, 42% women, 17% African American). RESULTS In the matched Creatinine Cohort, spironolactone-associated hazard ratios (95% confidence intervals) for all-cause mortality, heart failure readmission, and combined endpoint of heart failure readmission or all-cause mortality were 0.92 (0.81-1.03), 0.87 (0.77-0.99), and 0.87 (0.79-0.97), respectively. Respective hazard ratios (95% confidence intervals) in the matched eGFR Cohort were 0.87 (0.77-0.98), 0.92 (0.80-1.05), and 0.91 (0.82-1.02). CONCLUSIONS These findings provide evidence of consistent, albeit modest, clinical effectiveness of spironolactone in older patients with HFrEF regardless of renal eligibility criteria used. Additional strategies are needed to improve the effectiveness of aldosterone antagonists in clinical practice.
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Lam PH, Gupta N, Dooley DJ, Singh S, Deedwania P, Zile MR, Bhatt DL, Morgan CJ, Pitt B, Fonarow GC, Ahmed A. Role of High-Dose Beta-Blockers in Patients with Heart Failure with Preserved Ejection Fraction and Elevated Heart Rate. Am J Med 2018; 131:1473-1481. [PMID: 30076815 PMCID: PMC10463568 DOI: 10.1016/j.amjmed.2018.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Beta-blockers in high target doses are recommended for heart failure with reduced ejection fraction (HFrEF) but not for preserved ejection fraction (HFpEF). Treatment benefits are often more pronounced in high-risk subgroups, and patients with HFpEF with heart rate ≥70 beats per minute have emerged as such a high-risk subgroup. We examined the associations of high-dose beta-blocker use with outcomes in these patients. METHODS Of the 8462 hospitalized patients with heart failure with ejection fraction ≥50% in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, 5422 had a discharge heart rate ≥70 beats per minute. Of these, 4537 had no contraindications to beta-blocker use, of which 2797 (2592 with dose data) received prescriptions for beta-blockers. Of the 2592, 730 received high-dose beta-blockers, defined as atenolol ≥100 mg/day, carvedilol ≥50 mg/day, metoprolol tartrate or succinate ≥200 mg/day, or bisoprolol ≥10 mg/day, and 1740 received no beta-blockers. Using propensity scores for the receipt of high-dose beta-blockers, we assembled a matched cohort of 1280 patients, balanced on 58 characteristics. RESULTS All-cause mortality occurred in 63% and 68% of matched patients receiving high-dose beta-blocker vs no beta-blocker, respectively, during 6 years (median, 2.8) of follow-up (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P = .027). The hazard ratios (95% confidence intervals) for all-cause readmission and the combined endpoint of all-cause readmission or all-cause mortality associated with high-dose beta-blocker use were 0.90 (0.81-1.02) and 0.89 (0.80-1.00), respectively. CONCLUSIONS In patients with HFpEF and heart rate ≥70 beats per minute, high-dose beta-blocker use was associated with a significantly lower risk of death. Future randomized controlled trials are needed to examine this association.
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Affiliation(s)
- Phillip H Lam
- Veterans Affairs Medical Center, Washington, DC; Brigham and Women's Hospital Heart & Vascular Center, Boston, Mass
| | - Neha Gupta
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Heart and Vascular Institute, Washington, DC
| | - Daniel J Dooley
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Heart and Vascular Institute, Washington, DC
| | - Steven Singh
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC
| | - Prakash Deedwania
- Veterans Affairs Medical Center, Washington, DC; University of California, San Francisco, Fresno
| | - Michael R Zile
- Ralph H. Johnson VA Medical Center and Medical University of South Carolina, Charleston
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Boston, Mass; Harvard Medical School, Boston, Mass
| | | | | | | | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
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Xie X, Wang Y, Yang Y, Xu J, Zhang Y, Tang W, Guo T, Wang Q, Shen H, Zhang Y, Yan D, Peng Z, Chen Y, He Y, Ma X. Long-term exposure to fine particulate matter and tachycardia and heart rate: Results from 10 million reproductive-age adults in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 242:1371-1378. [PMID: 30138829 DOI: 10.1016/j.envpol.2018.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Epidemiological evidence of the association of long-term ambient fine particulate matter (aerodynamic diameter ≤2.5 μm; PM2.5) exposure with resting heart rate is limited. We explored the association of long-term (3-year average) ambient PM2.5 exposure with tachycardia and resting heart rate. METHODS This cross-sectional study surveyed 10,427,948 reproductive-age (20-49 years) adults across China in 2015. Tachycardia was classified as a resting heart rate of >80 beats per minute (bpm). The annual average ambient PM2.5 concentrations were obtained from a hybrid satellite-based geophysical statistical model. Linear mixed models and mixed effects logistic regressions adjusted for potential confounding were performed to explore the associations of PM2.5 with resting heart rate and PM2.5 with tachycardia, respectively. The effect modifiers by sex, age, body mass index, urbanity, race, region, smoking status, and drinking status were also assessed. Attributable cases and population fraction were estimated according to the PM2.5- tachycardia relationship. RESULTS The mean age was 28 years, and 16.3% of the participants had tachycardia. The odds ratio for tachycardia was 1.018 (95% confidence intervals [CI]: 1.017, 1.020) per 10 μg/m3 increase in the 3-year average PM2.5 exposure. A 10 μg/m3 increase in the 3-year average ambient PM2.5 level was associated with a 0.076 (95% CI: 0.073, 0.079) bpm elevation in the resting heart rate. Of the tachycardia burden, 4.0% (95% CI: 3.8%, 4.3%) could be attributed to ambient PM2.5 exposure in Chinese reproductive-age adults. CONCLUSIONS Exposures to ambient PM2.5 were associated with elevated resting heart rate. It might be possible to decrease China's avoidable tachycardia burden in reproductive-age adults through decreasing PM2.5 levels.
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Affiliation(s)
- Xiaoxu Xie
- National Research Institute for Health and Family Planning, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Health and Family Planning, Beijing, China
| | - Ying Yang
- National Research Institute for Health and Family Planning, Beijing, China
| | - Jihong Xu
- National Research Institute for Health and Family Planning, Beijing, China
| | - Ya Zhang
- National Research Institute for Health and Family Planning, Beijing, China
| | - Wenbin Tang
- National Research Institute for Health and Family Planning, Beijing, China
| | - Tongjun Guo
- National Research Institute for Health and Family Planning, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Health and Family Planning, Beijing, China
| | - Yixin Chen
- National Research Institute for Health and Family Planning, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China; Department of Computer Science and Engineering, Washington University in St. Louis, MO, 63130, USA
| | - Yuan He
- National Research Institute for Health and Family Planning, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China; Research Center for Population Health and Risk Assessment, National Human Genetic Resources Center, Beijing, China.
| | - Xu Ma
- National Research Institute for Health and Family Planning, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China; Research Center for Population Health and Risk Assessment, National Human Genetic Resources Center, Beijing, China.
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da Silva RMFL, Borges ASR, Silva NP, Resende ES, Tse G, Liu T, Roever L, Biondi-Zoccai G. How Heart Rate Should Be Controlled in Patients with Atherosclerosis and Heart Failure. Curr Atheroscler Rep 2018; 20:54. [PMID: 30225613 DOI: 10.1007/s11883-018-0757-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Resting heart rate is an independent risk factor for all-cause and cardiovascular mortality in patients with heart failure. The main objectives are to discuss the prognosis of heart rate, its association with coronary atherosclerosis, and the modalities of control of the heart rate in sinus rhythm and in the rhythm of atrial fibrillation in patients with chronic heart failure. RECENT FINDINGS As a therapeutic option for control heart rate, medications such as beta-blockers, digoxin, and finally ivabradine have been studied. Non-dihydropyridine calcium channel blockers are contraindicated in patients with heart failure and reduced ejection fraction. The influence of the magnitude of heart rate reduction and beta-blocker dose on morbidity and mortality will be discussed. Regarding the patients with heart failure and atrial fibrillation, there are different findings in heart rate control with the use of a beta-blocker. Patients eligible for ivabradine have clinical benefits and increased ejection fraction. Vagal nerve stimulation has low efficacy for the control of heart rate. Complementary therapies such as tai chi and yoga showed no effect on heart rate. In this review, we discuss the main therapeutic options for the control of heart rate in patients with atherosclerosis and heart failure. More research is needed to examine the effects of therapeutic options for heart rate control in different population types, as well as their effects on clinical outcomes and impact on morbidity and mortality.
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Affiliation(s)
| | | | - Nilson Penha Silva
- Department of Clinical Research, Federal University of Uberlandia, Uberlândia, Brazil
| | - Elmiro Santos Resende
- Department of Clinical Research, Federal University of Uberlandia, Uberlândia, Brazil
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- Faculty of Medicine, Li KaShing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlandia, Uberlândia, Brazil
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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Verma AK, Sun JL, Hernandez A, Teerlink JR, Schulte PJ, Ezekowitz J, Voors A, Starling R, Armstrong P, O'Conner CM, Mentz RJ. Rate pressure product and the components of heart rate and systolic blood pressure in hospitalized heart failure patients with preserved ejection fraction: Insights from ASCEND-HF. Clin Cardiol 2018; 41:945-952. [PMID: 29781109 DOI: 10.1002/clc.22981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Heart rate and systolic blood pressure (SBP) are prognostic markers in heart failure (HF) with reduced ejection fraction (HFrEF). Their combination in rate pressure product (RPP) as well as their role in heart failure with preserved ejection fraction (HFpEF) remains unclear. HYPOTHESIS RPP and its components are associated with HFpEF outcomes. METHODS We performed an analysis of Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure (ASCEND-HF; http://www.clinicaltrials.gov NCT00475852), which studied 7141 patients with acute HF. HFpEF was defined as left ventricular ejection fraction ≥40%. Outcomes were assessed by baseline heart rate, SBP, and RPP, as well as the change of these variables using adjusted Cox models. RESULTS After multivariable adjustment, in-hospital change but not baseline heart rate, SBP, and RPP were associated with 30-day mortality/HF hospitalization (hazard ratio [HR]: 1.17 per 5-bpm heart rate, HR: 1.20 per 10-mm Hg SBP, and HR: 1.02 per 100 bpm × mm Hg RPP; all P < 0.05). Baseline SBP was associated with 180-day mortality (HR: 0.88 per 10-mm Hg, P = 0.028). Though change in RPP was associated with 30-day mortality/HF hospitalization, the RPP baseline variable did not provide additional associative information with regard to outcomes when compared with assessment of baseline heart rate and SBP variables alone. CONCLUSIONS An increase in heart rate and SBP from baseline to discharge was associated with increased 30-day mortality/HF hospitalization in HFpEF patients with acute exacerbation. These findings suggest value in monitoring the trend of vital signs during HFpEF hospitalization.
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Affiliation(s)
- Amanda K Verma
- Department of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Jie-Lena Sun
- Department of Statistics, Duke University Medical Center, Durham, North Carolina
| | - Adrian Hernandez
- Department of Cardiology, Duke Clinical Research Institute, Duke Hospital, Durham, North Carolina
| | - John R Teerlink
- Department of Cardiology, School of Medicine, University of California, San Francisco
| | - Phillip J Schulte
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Adriaan Voors
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Paul Armstrong
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Christopher M O'Conner
- Department of Cardiology, Duke Clinical Research Institute, Duke Hospital, Durham, North Carolina
| | - Robert J Mentz
- Department of Cardiology, Duke Clinical Research Institute, Duke Hospital, Durham, North Carolina
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Hohendanner F, Messroghli D, Bode D, Blaschke F, Parwani A, Boldt L, Heinzel FR. Atrial remodelling in heart failure: recent developments and relevance for heart failure with preserved ejection fraction. ESC Heart Fail 2018; 5:211-221. [PMID: 29457877 PMCID: PMC5880666 DOI: 10.1002/ehf2.12260] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Felix Hohendanner
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Daniel Messroghli
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
- Department of Internal Medicine—CardiologyDeutsches Herzzentrum BerlinBerlinGermany
| | - David Bode
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Florian Blaschke
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Abdul Parwani
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Leif‐Hendrik Boldt
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Frank R. Heinzel
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
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Tsimploulis A, Lam PH, Arundel C, Singh SN, Morgan CJ, Faselis C, Deedwania P, Butler J, Aronow WS, Yancy CW, Fonarow GC, Ahmed A. Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Preserved Ejection Fraction. JAMA Cardiol 2018; 3:288-297. [PMID: 29450487 PMCID: PMC5875342 DOI: 10.1001/jamacardio.2017.5365] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
Abstract
Importance Lower systolic blood pressure (SBP) levels are associated with poor outcomes in patients with heart failure. Less is known about this association in heart failure with preserved ejection fraction (HFpEF). Objective To determine the associations of SBP levels with mortality and other outcomes in HFpEF. Design, Setting, and Participants A propensity score-matched observational study of the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry included 25 354 patients who were discharged alive; 8873 (35.0%) had an ejection fraction of at least 50%, and of these, 3915 (44.1%) had stable SBP levels (≤20 mm Hg admission to discharge variation). Data were collected from 259 hospitals in 48 states between March 1, 2003, and December 31, 2004. Data were analyzed from March 1, 2003, to December 31, 2008. Exposure Discharge SBP levels less than 120 mm Hg. A total of 1076 of 3915 (27.5%) had SBP levels less than 120 mm Hg, of whom 901 (83.7%) were matched by propensity scores with 901 patients with SBP levels of 120 mm Hg or greater who were balanced on 58 baseline characteristics. Main Outcomes and Measures Thirty-day, 1-year, and overall all-cause mortality and heart failure readmission through December 31, 2008. Results The 1802 matched patients had a mean (SD) age of 79 (10) years; 1147 (63.7%) were women, and 134 (7.4%) were African American. Thirty-day all-cause mortality occurred in 91 (10%) and 45 (5%) of matched patients with discharge SBP of less than 120 mm Hg vs 120 mm Hg or greater, respectively (hazard ratio [HR], 2.07; 95% CI, 1.45-2.95; P < .001). Systolic blood pressure level less than 120 mm Hg was also associated with a higher risk of mortality at 1 year (39% vs 31%; HR, 1.36; 95% CI, 1.16-1.59; P < .001) and during a median follow-up of 2.1 (overall 6) years (HR, 1.17; 95% CI, 1.05-1.30; P = .005). Systolic blood pressure level less than 120 mm Hg was associated with a higher risk of heart failure readmission at 30 days (HR, 1.47; 95% CI, 1.08-2.01; P = .02) but not at 1 or 6 years. Hazard ratios for the combined end point of heart failure readmission or all-cause mortality associated with SBP level less than 120 mm at 30 days, 1 year, and overall were 1.71 (95% CI, 1.34-2.18; P < .001), 1.21 (95% CI, 1.07-1.38; P = .004), and 1.12 (95% CI, 1.01-1.24; P = .03), respectively. Conclusions and Relevance Among hospitalized patients with HFpEF, an SBP level less than 120 mm Hg is significantly associated with poor outcomes. Future studies need to prospectively evaluate optimal SBP treatment goals in patients with HFpEF.
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Affiliation(s)
- Apostolos Tsimploulis
- Veterans Affairs Medical Center, Washington, DC
- Georgetown University, Washington, DC
- MedStar Washington Hospital Center, Washington, DC
| | - Phillip H. Lam
- Veterans Affairs Medical Center, Washington, DC
- Georgetown University, Washington, DC
- MedStar Washington Hospital Center, Washington, DC
| | - Cherinne Arundel
- Veterans Affairs Medical Center, Washington, DC
- Georgetown University, Washington, DC
- George Washington University, Washington, DC
| | - Steven N. Singh
- Veterans Affairs Medical Center, Washington, DC
- Georgetown University, Washington, DC
| | - Charity J. Morgan
- Veterans Affairs Medical Center, Washington, DC
- University of Alabama at Birmingham, Birmingham
| | - Charles Faselis
- Veterans Affairs Medical Center, Washington, DC
- George Washington University, Washington, DC
| | - Prakash Deedwania
- Veterans Affairs Medical Center, Washington, DC
- University of California-San Francisco, Fresno
| | - Javed Butler
- Stony Brook University, Stony Brook, New York
- University of Mississippi, Jackson
| | - Wilbert S. Aronow
- Westchester Medical Center, Valhalla, New York
- New York Medical College, Valhalla
| | - Clyde W. Yancy
- Northwestern University, Chicago, Illinois
- Deputy Editor, JAMA Cardiology
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, University of California, Los Angeles
- Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC
- George Washington University, Washington, DC
- University of Alabama at Birmingham, Birmingham
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32
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Forman DE, Kim DH. Limitations of Treating Heart Rate as the Primary Outcome Determinant in Older Adults. J Am Coll Cardiol 2017; 70:1872-1874. [PMID: 28982500 DOI: 10.1016/j.jacc.2017.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 08/27/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Daniel E Forman
- Divisions of Cardiology and Geriatrics, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Geriatric, Research, Education, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
| | - Dae Hyun Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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