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Guo M, Wei X, Min Y. Letter regarding 'Impact of MASLD and MetALD on clinical outcomes: A meta-analysis of preliminary evidence'. Liver Int 2024. [PMID: 39314075 DOI: 10.1111/liv.16040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 09/25/2024]
Affiliation(s)
- Menglu Guo
- Department of Dermatology, The People's Hospital of Leshan, Leshan, People's Republic of China
| | - Xiaoyuan Wei
- Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yu Min
- Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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2
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Heo GY, Park JT, Kim HJ, Kim KW, Kwon YU, Kim SH, Kim GO, Han SH, Yoo TH, Kang SW, Kim HW. Adequacy of Dialysis and Incidence of Atrial Fibrillation in Patients Undergoing Hemodialysis. Circ Cardiovasc Qual Outcomes 2024; 17:e010595. [PMID: 38873761 DOI: 10.1161/circoutcomes.123.010595] [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: 10/03/2023] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) can lead to stroke, heart failure, and mortality and has a greater prevalence in dialysis patients than in the general population. Several studies have suggested that uremic toxins may contribute to the development of AF. However, the association between dialysis adequacy and incident AF has not been well established. METHODS In this retrospective nationwide cohort study, we analyzed data from the Korean National Periodic Hemodialysis Quality Assessment from 2013 to 2015 of patients who received outpatient maintenance hemodialysis 3× a week. The main exposure was single pooled Kt/V (spKt/V), which is the dialysis adequacy index, and the primary outcome was the development of AF. For the primary analysis, patients were categorized into quartiles according to baseline spKt/V. The lowest quartile, representing the lowest adequacy, was used as the reference group. Fine-Gray subdistribution hazard models were used, treating all-cause mortality as a competing risk. RESULTS Of 25 173 patients, the mean age was 60 (51-69) years, and 14 772 (58.7%) were men. During a median follow-up of 5.7 years, incident AF occurred in a total of 3883 (15.4%) patients. Participants with a higher spKt/V tended to have lower AF incidence. In survival analysis, a graded association was observed between the risk of incident AF and spKt/V quartiles: subdistribution hazard ratios and 95% CIs for the second, third, and the highest quartile compared with the lowest quartile were 0.90 (95% CI, 0.82-0.98), 0.84 (95% CI, 0.77-0.93), and 0.79 (95% CI, 0.72-0.88), respectively. CONCLUSIONS This nationwide cohort study showed that a higher spKt/V is associated with a reduced risk of incident AF. These findings suggests that reducing uremic toxin burden through enhanced dialysis clearance may be associated with a lower risk of AF development in patients undergoing maintenance hemodialysis.
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Affiliation(s)
- Ga Young Heo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Hyo Jeong Kim
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea (H.J.K.)
| | - Kyung Won Kim
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (K.W.K.)
| | - Yong Uk Kwon
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, South Korea (Y.U.K.)
| | - Soo Hyun Kim
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea (S.H.K.)
| | - Gui Ok Kim
- Quality Assessment Management Division, Health Insurance Review and Assessment Service, Wonju, South Korea (G.O.K.)
| | - Seung Hyeok Han
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Shin-Wook Kang
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Hyung Woo Kim
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea (H.W.K.)
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3
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Fayol A, Schiele F, Ferrières J, Puymirat E, Bataille V, Tea V, Chamandi C, Albert F, Lemesle G, Cayla G, Weizman O, Simon T, Danchin N. Association of Use and Dose of Lipid-Lowering Therapy Post Acute Myocardial Infarction With 5-Year Survival in Older Adults. Circ Cardiovasc Qual Outcomes 2024; 17:e010685. [PMID: 38682335 DOI: 10.1161/circoutcomes.123.010685] [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: 11/01/2023] [Accepted: 03/18/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Older people are underrepresented in randomized trials. The association between lipid-lowering therapy (LLT) and its intensity after acute myocardial infarction and long-term mortality in this population deserves to be assessed. METHODS The FAST-MI (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) program consists of nationwide French surveys including all patients admitted for acute myocardial infarction ≤48 hours from onset over a 1- to 2-month period in 2005, 2010, and 2015, with long-term follow-up. Numerous data were collected and a centralized 10-year follow-up was organized. The present analysis focused on the association between prescription of LLT (atorvastatin ≥40 mg or equivalent, or any combination of statin and ezetimibe) and 5-year mortality in patients aged ≥80 years discharged alive. Cox multivariable analysis and propensity score matching were used to adjust for baseline differences. RESULTS Among the 2258 patients aged ≥80 years (mean age, 85±4 years; 51% women; 39% ST-segment elevation myocardial infarction; 58% with percutaneous coronary intervention), 415 were discharged without LLT (18%), 866 with conventional doses (38%), and 977 with high-dose LLT (43%). Five-year survival was 36%, 47.5%, and 58%, respectively. Compared with patients without LLT, high-dose LLT was significantly associated with lower 5-year mortality (adjusted hazard ratio, 0.78 [95% CI, 0.66-0.92]), whereas conventional-intensity LLT was not (adjusted hazard ratio, 0.93 [95% CI, 0.80-1.09]). In propensity score-matched cohorts (n=278 receiving high-intensity LLT and n=278 receiving no statins), 5-year survival was 52% with high-intensity LLT at discharge and 42% without statins (hazard ratio, 0.78 [95% CI, 0.62-0.98]). CONCLUSIONS In these observational cohorts, high-intensity LLT at discharge after acute myocardial infarction was associated with reduced all-cause mortality at 5 years in an older adult population. These results suggest that high-intensity LLT should not be denied to patients on the basis of old age. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00673036, NCT01237418, and NCT02566200.
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Affiliation(s)
- Antoine Fayol
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - François Schiele
- Department of Cardiology, University Hospital Jean-Minjoz, Besançon, France (F.S.)
| | - Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, Institut National pour la Santé Et la Recherche Médicale Unité Mixte de Recherche, Toulouse cedex, France Emergency Department, Rangueil Hospital, Toulouse (J.F., V.B.)
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Vincent Bataille
- Department of Cardiology, Toulouse Rangueil University Hospital, Institut National pour la Santé Et la Recherche Médicale Unité Mixte de Recherche, Toulouse cedex, France Emergency Department, Rangueil Hospital, Toulouse (J.F., V.B.)
| | - Victoria Tea
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Chekrallah Chamandi
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Franck Albert
- Department of Cardiology, Hospital of Chartres, France (F.A.)
| | - Gilles Lemesle
- Department of Cardiology, Heart and Lung Institute, University Hospital of Lille, France (G.L.)
- University of Lille, France (G.L.)
- Institut Pasteur de Lille, France (G.L.)
- FACT (French Alliance for Cardiovascular Trials), Paris (G.L.)
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nimes, University of Montpellier, France (G.C.)
| | - Orianne Weizman
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Tabassome Simon
- Department of Pharmacology and Clinical Research Platform of East of Paris (Unité de Recherche Clinique des hopitaux EST parisiens, Comité de Recherche Clinique des hopitaux EST parisiens, Centre de Ressources Biologiques), Hôpital St Antoine, Sorbonne University, and FACT (T.S.)
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- Hôpital Paris St Joseph, and FACT (N.D.)
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4
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Shakoor A, Abou Kamar S, Malgie J, Kardys I, Schaap J, de Boer RA, van Mieghem NM, van der Boon RMA, Brugts JJ. The different risk of new-onset, chronic, worsening, and advanced heart failure: A systematic review and meta-regression analysis. Eur J Heart Fail 2024; 26:216-229. [PMID: 37823229 DOI: 10.1002/ejhf.3048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
AIMS Heart failure (HF) is a chronic and progressive syndrome associated with a poor prognosis. While it may seem intuitive that the risk of adverse outcomes varies across the different stages of HF, an overview of these risks is lacking. This study aims to determine the risk of all-cause mortality and HF hospitalizations associated with new-onset HF, chronic HF (CHF), worsening HF (WHF), and advanced HF. METHODS AND RESULTS We performed a systematic review of observational studies from 2012 to 2022 using five different databases. The primary outcomes were 30-day and 1-year all-cause mortality, as well as 1-year HF hospitalization. Studies were pooled using random effects meta-analysis, and mixed-effects meta-regression was used to compare the different HF groups. Among the 15 759 studies screened, 66 were included representing 862 046 HF patients. Pooled 30-day mortality rates did not reveal a significant distinction between hospital-admitted patients, with rates of 10.13% for new-onset HF and 8.11% for WHF (p = 0.10). However, the 1-year mortality risk differed and increased stepwise from CHF to advanced HF, with a rate of 8.47% (95% confidence interval [CI] 7.24-9.89) for CHF, 21.15% (95% CI 17.78-24.95) for new-onset HF, 26.84% (95% CI 23.74-30.19) for WHF, and 29.74% (95% CI 24.15-36.10) for advanced HF. Readmission rates for HF at 1 year followed a similar trend. CONCLUSIONS Our meta-analysis of observational studies confirms the different risk for adverse outcomes across the distinct HF stages. Moreover, it emphasizes the negative prognostic value of WHF as the first progressive stage from CHF towards advanced HF.
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Affiliation(s)
- Abdul Shakoor
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Sabrina Abou Kamar
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jishnu Malgie
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jeroen Schaap
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Robert M A van der Boon
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
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5
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González-Del-Hoyo M, Rossello X. Worsening heart failure comes into focus, chronic heart failure takes a backseat. Eur J Heart Fail 2024; 26:230-232. [PMID: 38247189 DOI: 10.1002/ejhf.3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Affiliation(s)
- Maribel González-Del-Hoyo
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Xavier Rossello
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Facultat de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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6
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Schou M, Claggett B, Miao ZM, Fernandez A, Filippatos G, Granger C, Jering K, Maggioni AP, McCausland F, Villota JN, Rouleau JL, Mody FV, van der Meer P, Vinereanu D, McGrath M, Zhou Y, Mann DL, Solomon SD, Steg PG, Braunwald E, McMurray JJV, Pfeffer MA, Køber L. Sacubitril/valsartan compared to ramipril in high-risk post-myocardial infarction patients stratified according to use of mineralocorticoid receptor antagonists: Insight from the PARADISE MI trial. Eur J Heart Fail 2024; 26:130-139. [PMID: 37933184 DOI: 10.1002/ejhf.3079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023] Open
Abstract
AIM It is unknown whether safety and clinical endpoints by use of sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitor [ARNI]) are affected by mineralocorticoid receptor antagonists (MRA) in high-risk myocardial infarction (MI) patients. The aim of this study was to examine whether MRA modifies safety and clinical endpoints by use of sacubitril/valsartan in patients with a MI and left ventricular systolic dysfunction (LVSD) and/or pulmonary congestion. METHODS AND RESULTS Patients (n = 5661) included in the PARADISE MI trial (Prospective ARNI vs. ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After MI) were stratified according to MRA. Primary outcomes in this substudy were worsening heart failure or cardiovascular death. Safety was defined as symptomatic hypotension, hyperkalaemia >5.5 mmol/L, or permanent drug discontinuation. A total of 2338 patients (41%) were treated with MRA. Safety of ARNI compared to ramipril was not altered significantly by ± MRA, and both groups had similar increase in symptomatic hypotension with ARNI. In patients taking MRA, the risk of hyperkalaemia or permanent drug discontinuation was not significantly altered by ARNI (p > 0.05 for all comparisons). The effect of ARNI compared with ramipril was similar in those who were and were not taking MRA (hazard ratio [HR]MRA 0.96, 95% confidence interval [CI] 0.77-1.19 and HRMRA- 0.87, 95% CI 0.71-1.05, for the primary endpoint; p = 0.51 for interaction [Clinical Endpoint Committee adjudicated]); similar findings were observed if investigator-reported endpoints were evaluated (p = 0.61 for interaction). CONCLUSIONS Use of a MRA did not modify safety or clinical endpoints related to initiation of ARNI compared to ramipril in the post-MI setting in patients with LVSD and/or congestion.
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Affiliation(s)
- Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - Zi Michael Miao
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | | | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | | | - Karola Jering
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | | | - Finnian McCausland
- Renal Division, Department of Medicine (F.R.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Freny Vaghaiwalla Mody
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of Cardiology, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | - Martina McGrath
- Renal Division, Department of Medicine (F.R.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yinong Zhou
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Douglas L Mann
- Washington University School of Medicine, St Louis, MO, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - Philippe Gabriel Steg
- Université de Paris, AP-HP (Assistance Publique-Hôpitaux de Paris), FACT (French Alliance for Cardiovascular Trials) and INSERM U-1148, Paris, France
| | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - Lars Køber
- Rigshospitalet, Blegdamsvej, University of Copenhagen, Copenhagen, Denmark
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7
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Fan J, Liu Q, Dai H, Zhou D, Guo Y, Xu J, Wang L, Hu P, Jiang J, Lin X, Li C, Liu X, Wang J. Daily Physical Activity Measured by Wearable Smartwatch for Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the SMART TAVR Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010066. [PMID: 38088154 DOI: 10.1161/circoutcomes.123.010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/19/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND This study aims to evaluate limited data about daily physical activity patterns, influential factors, and their association with 1-year mortality or rehospitalization after transcatheter aortic valve replacement (TAVR) through smartwatches. METHODS Consecutive severe aortic stenosis patients undergoing elective transfemoral TAVR in a Chinese tertiary hospital were enrolled from July 2021 to May 2022 and received a Huawei smartwatch at least 1 day before TAVR. The primary outcome was a composite of all-cause mortality or hospital readmission within 1 year. Linear mixed-effects models were applied to determine influential factors of daily step counts, and Cox proportional hazard regression models were to estimate the association between baseline step counts within 1 month since discharge and composite outcome from months 2 to 12. The dose-response association was assessed using restricted cubic spline curves. RESULTS A total of 222 participants and 59 469 valid monitoring person-day records were included (mean age, 72.7 years; 61% women). Step counts increased rapidly within the first 2 months (P<0.001), followed by a slower increase for those without composite outcomes (P=0.029) and a gradual decrease for those who developed composite outcomes (P<0.001). In multivariate linear mixed models, a 1-m increase in baseline 6-minute walk test and a 1-month delay after discharge were associated with 4 (95% CI, 1-7) and 170 (95% CI, 145-194) additional step counts, respectively. In restricted cubic spline analysis, the hazard ratio declined progressively until ≈5000 steps per day, after which they leveled. Below 5000 steps, the adjusted hazard ratio of composite outcome associated with each 1000-step count increase was 0.67 (0.50-0.89; P=0.007). However, above 5000 steps, step counts were not significantly associated with the composite outcome (P=0.645), with a hazard ratio of 1.12 (0.70-1.79). CONCLUSIONS Daily step counts rapidly increased within the first 2 months post-TAVR. Increased physical activity was associated with a lower risk of 1-year mortality or rehospitalization after TAVR for patients with daily step counts below 5000. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04454177.
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Affiliation(s)
- Jiaqi Fan
- Department of Cardiology (J.F., Q.L., Y.G., L.W., P.H., J.J., X. Lin, X. Liu, J.W.), Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.F.)
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (J.F., Q.L., X.L., J.W.)
| | - Qiong Liu
- Department of Cardiology (J.F., Q.L., Y.G., L.W., P.H., J.J., X. Lin, X. Liu, J.W.), Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (J.F., Q.L., X.L., J.W.)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (Q.L., J.W.)
| | - Hanyi Dai
- Zhejiang University School of Medicine, Hangzhou, China (H.D., D.Z.)
| | - Dao Zhou
- Zhejiang University School of Medicine, Hangzhou, China (H.D., D.Z.)
| | - Yuchao Guo
- Department of Cardiology (J.F., Q.L., Y.G., L.W., P.H., J.J., X. Lin, X. Liu, J.W.), Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jianguo Xu
- Department of Electrocardiogram (J.X.), Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Lihan Wang
- Department of Cardiology (J.F., Q.L., Y.G., L.W., P.H., J.J., X. Lin, X. Liu, J.W.), Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Po Hu
- Department of Cardiology (J.F., Q.L., Y.G., L.W., P.H., J.J., X. Lin, X. Liu, J.W.), Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jubo Jiang
- Department of Cardiology (J.F., Q.L., Y.G., L.W., P.H., J.J., X. Lin, X. Liu, J.W.), Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xinping Lin
- Department of Cardiology (J.F., Q.L., Y.G., L.W., P.H., J.J., X. Lin, X. Liu, J.W.), Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (J.F., Q.L., X.L., J.W.)
| | - Cheng Li
- Department of Nursing (C.L.), Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xianbao Liu
- Department of Cardiology (J.F., Q.L., Y.G., L.W., P.H., J.J., X. Lin, X. Liu, J.W.), Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Department of Cardiology (J.F., Q.L., Y.G., L.W., P.H., J.J., X. Lin, X. Liu, J.W.), Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (J.F., Q.L., X.L., J.W.)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (Q.L., J.W.)
- Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou, China (J.W.)
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8
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Husaini M, Deych E, Waken RJ, Sells B, Lai A, Racette SB, Rich MW, Maddox KEJ, Peterson LR. Intensive Versus Traditional Cardiac Rehabilitation: Mortality and Cardiovascular Outcomes in a 2016-2020 Retrospective Medicare Cohort. Circ Cardiovasc Qual Outcomes 2023; 16:e010131. [PMID: 38037867 PMCID: PMC11149366 DOI: 10.1161/circoutcomes.123.010131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Traditional cardiac rehabilitation (CR) improves cardiovascular outcomes and reduces mortality, but less is known about the relative benefit of intensive CR (ICR) which incorporates greater lifestyle education through 72 sessions (versus 36 in CR). Our objective was to determine whether ICR is associated with a mortality and cardiovascular benefit compared with CR. METHODS Retrospective cohort study of Medicare Fee-For-Service beneficiaries in a 100% sample, claims data set. Qualifying events were captured from May 1, 2016 to December 31, 2019 and ICR/CR utilization captured from May 1, 2016 to December 31, 2020. Among patients attending at least 1 day of either CR or ICR, Cox proportional hazards models using a 1 to 5 propensity score match were used to compare utilization and the association of ICR versus CR participation with (1) all-cause mortality and (2) cardiovascular-related hospitalizations or nonfatal cardiac events. Dose-response was assessed by the number of days attended. RESULTS From 2016 to 2019, 1 277 358 unique patients met at least one qualifying indication for ICR/CR from 2016 to 2019. Of these, 262 579 (20.6%) and 4452 (0.4%) attended at least one session of CR or ICR, respectively (mean [SD] age, 73.2 [7.8] years; 32.3% female). In the matched sample, including 26 659 total patients (median, 2.4-year follow-up), ICR was associated with 12% lower all-cause mortality (multivariable adjusted hazard ratio, 0.88 [95% CI, 0.78-0.99]; P=0.036) compared with CR but no significant difference for cardiovascular-related hospitalization or nonfatal cardiac events. The mortality benefit was seen for both ICR and CR per day strata, with each modality demonstrating a clear dose-response benefit. CONCLUSIONS ICR is associated with lower mortality than traditional CR among Medicare beneficiaries but no difference in cardiovascular-related hospitalization or nonfatal cardiac events. Moreover, ICR and CR demonstrate a dose-response relationship for mortality. Additional studies are needed to confirm these observations and to better understand the mechanisms by which ICR may lead to a reduction in mortality.
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Affiliation(s)
- Mustafa Husaini
- Department of Medicine, Division of Cardiovascular Medicine, St. Louis, Missouri
| | - Elena Deych
- Department of Medicine, Division of Cardiovascular Medicine, St. Louis, Missouri
| | - RJ Waken
- Department of Medicine, Division of Cardiovascular Medicine, St. Louis, Missouri
| | - Blake Sells
- Department of Medicine, Division of Cardiovascular Medicine, St. Louis, Missouri
| | - Andrew Lai
- Department of Medicine, Division of Cardiovascular Medicine, St. Louis, Missouri
| | - Susan B. Racette
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Michael W. Rich
- Department of Medicine, Division of Cardiovascular Medicine, St. Louis, Missouri
| | | | - Linda R. Peterson
- Department of Medicine, Division of Cardiovascular Medicine, St. Louis, Missouri
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9
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Thompson MP, Hou H, Stewart JW, Pagani FD, Hawkins RB, Keteyian SJ, Sukul D, Likosky DS. Relationship Between Community-Level Distress and Cardiac Rehabilitation Participation, Facility Access, and Clinical Outcomes After Inpatient Coronary Revascularization. Circ Cardiovasc Qual Outcomes 2023; 16:e010148. [PMID: 37855157 PMCID: PMC10953712 DOI: 10.1161/circoutcomes.123.010148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Although disparities in cardiac rehabilitation (CR) participation are well documented, the role of community-level distress is poorly understood. This study evaluated the relationship between community-level distress and CR participation, access to CR facilities, and clinical outcomes. METHODS A retrospective cohort study was conducted on a 100% sample of Medicare beneficiaries undergoing inpatient coronary revascularization between July 2016 and December 2018. Community-level distress was defined using the Distressed Community Index quintile at the beneficiary zip code level, with the first and fifth quintiles representing prosperous and distressed communities, respectively. Outpatient claims were used to identify any CR use within 1 year of discharge. Beneficiary and CR facility zip codes were used to describe access to CR facilities. Adjusted logistic regression models evaluated the association between Distressed Community Index quintiles, CR use, and clinical outcomes, including one-year mortality, all-cause hospitalization, and acute myocardial infarction hospitalization. RESULTS A total of 414 730 beneficiaries were identified, with 96 929 (23.4%) located in the first and 67 900 (16.4%) in the fifth quintiles, respectively. Any CR use was lower for beneficiaries in distressed compared with prosperous communities (26.0% versus 46.1%, P<0.001), which was significant after multivariable adjustment (odds ratio, 0.41 [95% CI, 0.40-0.42]). A total of 98 458 (23.7%) beneficiaries had a CR facility within their zip code, which increased from 16.3% in prosperous communities to 26.6% in distressed communities. Any CR use was associated with absolute reductions in mortality (-6.8% [95% CI, -7.0% to -6.7%]), all-cause hospitalization (-5.9% [95% CI, -6.3% to -5.6%]), and acute myocardial infarction hospitalization (-1.3% [95% CI, -1.5% to -1.1%]), which were similar across each Distressed Community Index quintiles. CONCLUSIONS Although community-level distress was associated with lower CR participation, the clinical benefits were universally received. Addressing barriers to CR in distressed communities should be considered a significant priority to improve survival after coronary revascularization and reduce disparities.
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Affiliation(s)
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI
| | - James W Stewart
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | | | | | | | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
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10
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Rossello X. Globalization does not lead to homogenization in randomized controlled trials: Impact on sample size estimation. Eur J Heart Fail 2023; 25:1243-1245. [PMID: 37323085 DOI: 10.1002/ejhf.2934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Xavier Rossello
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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11
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Brant LCC, Ribeiro AH, Pinto-Filho MM, Kornej J, Preis SR, Fetterman JL, Eromosele OB, Magnani JW, Murabito JM, Larson MG, Benjamin EJ, Ribeiro ALP, Lin H. Association Between Electrocardiographic Age and Cardiovascular Events in Community Settings: The Framingham Heart Study. Circ Cardiovasc Qual Outcomes 2023; 16:e009821. [PMID: 37381910 PMCID: PMC10524985 DOI: 10.1161/circoutcomes.122.009821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/17/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Deep neural networks have been used to estimate age from ECGs, the electrocardiographic age (ECG-age), which predicts adverse outcomes. However, this prediction ability has been restricted to clinical settings or relatively short periods. We hypothesized that ECG-age is associated with death and cardiovascular outcomes in the long-standing community-based FHS (Framingham Heart Study). METHODS We tested the association of ECG-age with chronological age in the FHS cohorts in ECGs from 1986 to 2021. We calculated the gap between chronological and ECG-age (Δage) and classified individuals as having normal, accelerated, or decelerated aging, if Δage was within, higher, or lower than the mean absolute error of the model, respectively. We assessed the associations of Δage, accelerated and decelerated aging with death or cardiovascular outcomes (atrial fibrillation, myocardial infarction, and heart failure) using Cox proportional hazards models adjusted for age, sex, and clinical factors. RESULTS The study population included 9877 FHS participants (mean age, 55±13 years; 54.9% women) with 34 948 ECGs. ECG-age was correlated to chronological age (r=0.81; mean absolute error, 9±7 years). After 17±8 years of follow-up, every 10-year increase of Δage was associated with 18% increase in all-cause mortality (hazard ratio [HR], 1.18 [95% CI, 1.12-1.23]), 23% increase in atrial fibrillation risk (HR, 1.23 [95% CI, 1.17-1.29]), 14% increase in myocardial infarction risk (HR, 1.14 [95% CI, 1.05-1.23]), and 40% increase in heart failure risk (HR, 1.40 [95% CI, 1.30-1.52]), in multivariable models. In addition, accelerated aging was associated with a 28% increase in all-cause mortality (HR, 1.28 [95% CI, 1.14-1.45]), whereas decelerated aging was associated with a 16% decrease (HR, 0.84 [95% CI, 0.74-0.95]). CONCLUSIONS ECG-age was highly correlated with chronological age in FHS. The difference between ECG-age and chronological age was associated with death, myocardial infarction, atrial fibrillation, and heart failure. Given the wide availability and low cost of ECG, ECG-age could be a scalable biomarker of cardiovascular risk.
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Affiliation(s)
- Luisa C C Brant
- Faculty of Medicine and Telehealth Center, Hospital das Clínicas; from Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antônio H Ribeiro
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Marcelo M Pinto-Filho
- Faculty of Medicine and Telehealth Center, Hospital das Clínicas; from Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jelena Kornej
- Section of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Sarah R. Preis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and The Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | | | - Jared W. Magnani
- Center for Research on Health Care, Department of Medicine, University of Pittsburgh, PA, USA
| | - Joanne M. Murabito
- National Heart, Lung, and Blood Institute and Boston University’s Framingham Heart Study, Framingham, MA, USA
- Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- National Heart, Lung, and Blood Institute and Boston University’s Framingham Heart Study, Framingham, MA, USA
| | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute and Boston University’s Framingham Heart Study, Framingham, MA, USA
- Section of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Antonio L P Ribeiro
- Faculty of Medicine and Telehealth Center, Hospital das Clínicas; from Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
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12
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Hammoud A, Chen H, Ivanov A, Yeboah J, Nasir K, Cainzos-Achirica M, Bertoni A, Khan SU, Blaha M, Herrington D, Shapiro MD. Implications of Social Disadvantage Score in Cardiovascular Outcomes and Risk Assessment: Findings From the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Qual Outcomes 2023; 16:e009304. [PMID: 37403692 PMCID: PMC10524792 DOI: 10.1161/circoutcomes.122.009304] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/03/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Social determinants of health contribute to disparate cardiovascular outcomes, yet they have not been operationalized into the current paradigm of cardiovascular risk assessment. METHODS Data from the Multi-Ethnic Study of Atherosclerosis, which includes participants from 6 US field centers, were used to create an index of baseline Social Disadvantage Score (SDS) to explore its association with incident atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality and impact on ASCVD risk prediction. SDS, which ranges from 0 to 4, was calculated by tallying the following social factors: (1) household income less than the federal poverty level; (2) educational attainment less than a high school diploma; (3) single-living status; and (4) experience of lifetime discrimination. Cox models were used to examine the association between SDS and each outcome with adjustment for traditional cardiovascular risk factors. Changes in the discrimination and reclassification of ASCVD risk by incorporating SDS into the pooled cohort equations were examined. RESULTS A total of 6434 participants (mean age, 61.9±10.2 years; female 52.8%; non-white 60.9%) had available SDS 1733 (26.9%) with SDS 0; 2614 (40.6%) with SDS 1; 1515 (23.5%) with SDS 2; and 572 (8.9%) with SDS ≥3. In total, 775 incident ASCVD events and 1573 deaths were observed over a median follow-up of 17.0 years. Increasing SDS was significantly associated with incident ASCVD and all-cause mortality after adjusting for traditional risk factors (ASCVD: per unit increase in SDS hazard ratio, 1.15 [95% CI, 1.07-1.24]; mortality: per unit increase in SDS hazard ratio, 1.13 [95% CI, 1.08-1.19]). Adding SDS to pooled cohort equations components in a Cox model for 10-year ASCVD risk prediction did not significantly improve discrimination (P=0.208) or reclassification (P=0.112). CONCLUSIONS Although SDS is independently associated with incident ASCVD and all-cause mortality, it does not improve 10-year ASCVD risk prediction beyond pooled cohort equations.
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Affiliation(s)
- Aziz Hammoud
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Alexander Ivanov
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Joseph Yeboah
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Khurram Nasir
- Department of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Miguel Cainzos-Achirica
- Department of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Alain Bertoni
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Safi U. Khan
- Section of Hospital Medicine, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD
| | - David Herrington
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael D. Shapiro
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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13
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Teramoto K, Tay WT, Tromp J, Katherine Teng TH, Chandramouli C, Ouwerkerk W, Lawson CA, Huang W, Hung CL, Chopra V, Anand I, Mark Richards A, Lam CSP. Patient-Reported Versus Physician-Assessed Health Status in Heart Failure With Reduced and Preserved Ejection Fraction From ASIAN-HF Registry. Circ Cardiovasc Qual Outcomes 2023; 16:e009134. [PMID: 36484254 DOI: 10.1161/circoutcomes.122.009134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND We aimed to assess if discordance between patient-reported Kansas City Cardiomyopathy Questionnaire (KCCQ)-overall summary (os) score and physician-assessed New York Heart Association (NYHA) class is common among patients with heart failure (HF) with reduced or preserved ejection fraction, and determine its association with outcomes. METHODS A total of 4818 patients with HF were classified according to KCCQ-os score (range 0-100, dichotomized by median value 71.9 into high [good] versus low [bad]) and NYHA class (I/II [good] or III/IV [bad]) as concordant good (low NYHA class, high KCCQ-os score), concordant bad (high NYHA class, low KCCQ-os score), discordant worse NYHA class (high NYHA class, high KCCQ-os score), and discordant worse KCCQ-os score (low NYHA class, low-KCCQ-os score). The composite of HF hospitalization or death at 1 year was compared across groups. RESULTS There were 2070 (43.0%) concordant good, 1099 (22.8%) concordant bad, 331 (6.9%) discordant worse NYHA class, and 1318 (27.4%) discordant worse KCCQ-os score patients. Compared with concordant good, adverse outcomes were the highest in concordant bad (HR, 2.7 [95% CI, 2.2-3.5]) followed by discordant worse KCCQ-os score (HR, 1.8 [95% CI, 1.4-2.2]) and discordant worse NYHA class (HR, 1.5 [95% CI, 1.0-2.3]); with no modification by HF phenotype (preserved versus reduced ejection fraction, Pinteraction=0.52). At 6 months, 1403 (48%) experienced clinically significant improvement in KCCQ-os score (≥5 points increase over 6 months). Patients with improved KCCQ-os at 6 months (HR, 0.65 [95% CI, 0.47-0.92]) had better outcomes and the association was not modified by HF phenotype (Pinteraction=0.40). CONCLUSIONS One-third of patients with HF had discordance between patient-reported and clinician-assessed health status, largely attributable to worse patient-reported outcomes. Such discordance, particularly in those with discordantly worse KCCQ, should alert physicians to an increased risk of HF hospitalization and death, and prompt further assessment for potential drivers of worse patient-reported outcomes relative to physicians' assessment.
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Affiliation(s)
- Kanako Teramoto
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.)
| | - Wan Ting Tay
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.)
| | - Jasper Tromp
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Saw Swee Hock School of Public Health National University of Singapore and the National University Health System (J.T.)
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,School of Allied Health, University of Western Australia, Perth, Australia (T.-H.K.T.)
| | - Chanchal Chandramouli
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Duke-NUS Medical School, Singapore (J.T., T.-H.K.T., C.C., C.S.P.L.)
| | - Wouter Ouwerkerk
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Amsterdam Medical Center, Department of Dermatology, The Netherlands (W.O.)
| | - Claire A Lawson
- Department of Cardiovascular Research, University of Leicester, United Kingdom (C.A.L.)
| | - Weiting Huang
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.)
| | | | - Vijay Chopra
- Max Super Specialty Hospital, New Delhi, India (V.C.)
| | - Inder Anand
- Cardiovascular division, University of Minnesota, Minneapolis (I.A.)
| | - Arthur Mark Richards
- Cardiovascular Research Institute, National University of Singapore (A.M.R.).,Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.)
| | - Carolyn S P Lam
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Duke-NUS Medical School, Singapore (J.T., T.-H.K.T., C.C., C.S.P.L.).,Department of Cardiology, University Medical Center Groningen, The Netherlands (C.S.P.L.)
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14
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Mehta HB, An H, Ardeshirrouhanifard S, Raji MA, Alexander GC, Segal JB. Comparative Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin Among Adults With Cancer and Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2022; 15:e008951. [PMID: 36453260 PMCID: PMC9772095 DOI: 10.1161/circoutcomes.122.008951] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/27/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND While clinical guidelines recommend direct-acting oral anticoagulants (DOAC) over warfarin to treat isolated nonvalvular atrial fibrillation, guidelines are silent regarding nonvalvular atrial fibrillation treatment among individuals with cancer, reflecting the paucity of evidence in this setting. We quantified relative risk of ischemic stroke or systemic embolism and major bleeding (primary outcomes), and all-cause and cardiovascular death (secondary outcomes) among older individuals with cancer and nonvalvular atrial fibrillation comparing DOACs and warfarin. METHODS This retrospective cohort study used Surveillance, Epidemiology, and End Results cancer registry and linked US Medicare data from 2010 through 2016, and included individuals diagnosed with cancer and nonvalvular atrial fibrillation who newly initiated DOAC or warfarin. We used inverse probability of treatment weighting to control confounding. We used competing risk regression for primary outcomes and cardiovascular death, and Cox proportional hazard regression for all-cause death. RESULTS Among 7675 individuals included in the cohort, 4244 (55.3%) received DOACs and 3431 (44.7%) warfarin. In the inverse probability of treatment weighting analysis, there was no statistically significant difference among DOAC and warfarin users in the risk of ischemic stroke or systemic embolism (1.24 versus 1.19 events per 100 person-years, adjusted hazard ratio 1.41 [95% CI, 0.92-2.14]), major bleeding (3.08 versus 4.49 events per 100 person-years, adjusted hazard ratio 0.90 [95% CI, 0.70-1.17]), and cardiovascular death (1.88 versus 3.14 per 100 person-years, adjusted hazard ratio 0.82 [95% CI, 0.59-0.1.13]). DOAC users had significantly lower risk of all-cause death (7.09 versus 13.3 per 100 person-years, adjusted hazard ratio 0.81 [95% CI, 0.69-0.94]) compared to warfarin users. CONCLUSIONS Older adults with cancer and atrial fibrillation exposed to DOACs had similar risks of stroke and systemic embolism and major bleeding as those exposed to warfarin. Relative to warfarin, DOAC use was associated with a similar risk of cardiovascular death and a lower risk of all-cause death.
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Affiliation(s)
- Hemalkumar B. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Huijun An
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shirin Ardeshirrouhanifard
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mukaila A. Raji
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - G. Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD
| | - Jodi B. Segal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD
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15
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Wen XS, Luo R, Liu J, Duan Q, Qin S, Xiao J, Zhang DY. Short-term/long-term prognosis with or without beta-blockers in patients without heart failure and with preserved ejection fraction after acute myocardial infarction: a multicenter retrospective cohort study. BMC Cardiovasc Disord 2022; 22:193. [PMID: 35473676 PMCID: PMC9044853 DOI: 10.1186/s12872-022-02631-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background The role of beta-blockers in acute myocardial infarction patients without heart failure and with preserved left ventricular ejection fraction (LVEF ≥ 50%) is unknown. Our study aimed to retrospectively analyze the associations of beta-blockers on such patients. Methods This is a multicenter, retrospective study. After screening 5,332 acute myocardial infarction patients, a total of 2519 patients without heart failure and with LVEF ≥ 50% were included. The patients were divided into two groups: the prescribed (n = 2049) and unprescribed (n = 470) beta-blockers group. The propensity score inverse probability treatment weighting was used to control confounding factors. We analyzed the associations between beta-blockers and outcomes in the short-term (1-year) and long-term (median, 3.61 years). Results The primary outcome was all-cause mortality. The secondary outcomes were all-cause rehospitalization, cardiac death, recurrent myocardial infarction, new-onset heart failure rehospitalization. This study shows no statistically significant association between discharged with beta-blockers and all-cause mortality, either in the short-term [IPTW Adjusted, HR 1.02; 95%CI 0.43–2.40; P = 0.966] or long-term [IPTW Adjusted, HR 1.17; 95%CI 0.70–1.94; P = 0.547]. Discharged with beta-blockers was significantly associated with a reduced risk of short-term recurrent myocardial infarction [IPTW Adjusted, HR 0.44; 95%CI 0.20–0.97; P = 0.043], but there was no long-term relationship [IPTW Adjusted, HR 1.11; 95%CI 0.61–2.03; P = 0.735]. Other outcomes, such as new-onset heart failure rehospitalization and all-cause rehospitalization, were not observed with meaningful differences in either the short- or long-term. The results of sensitivity analysis were consistent with this. Conclusions Beta-blockers might be associated with a reduced risk of recurrent myocardial infarction in patients without heart failure and with preserved left ventricular ejection fraction after acute myocardial infarction, in the short term. Beta-blockers might not be related to all-cause mortality in those patients, either in the short-term or long-term. Clinical trial registration Influence of Beta-blockers on Prognosis in Patients with Acute Myocardial Infarction Complicated with Normal Ejection Fraction, NCT04485988, Registered on 24/07/2020. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02631-8.
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Affiliation(s)
- Xue-Song Wen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Chongqing, 400016, China
| | - Rui Luo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Chongqing, 400016, China
| | - Jie Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Chongqing, 400016, China
| | - Qin Duan
- Department of Cardiovascular Medicine, The First Branch of the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Shu Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Chongqing, 400016, China
| | - Jun Xiao
- Department of Cardiovascular Medicine, Chongqing University Center Hospital, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China.
| | - Dong-Ying Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Chongqing, 400016, China.
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Schjødt I, Johnsen SP, Strömberg A, DeVore AD, Valentin JB, Løgstrup BB. Evidence-Based Process Performance Measures and Clinical Outcomes in Patients With Incident Heart Failure With Reduced Ejection Fraction: A Danish Nationwide Cohort Study. Circ Cardiovasc Qual Outcomes 2022; 15:e007973. [PMID: 35272503 PMCID: PMC9015036 DOI: 10.1161/circoutcomes.121.007973] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on the association between quality of heart failure (HF) care and outcomes among patients with incident HF are sparse. We examined the association between process performance measures and clinical outcomes in patients with incident HF with reduced ejection fraction. METHODS Patients with incident HF with reduced ejection fraction (n=10 966) between January 2008 and October 2015 were identified from the Danish HF Registry. Data from public registries were linked. Multivariable regression analyses were used to assess the association between 6 guideline-recommended HF care processes (New York Heart Association assessment, use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists, exercise training, and patient education) and all-cause and HF readmission, all-cause and HF hospital days, and mortality within 3 to 12 months after HF diagnosis. The associations were analyzed according to the percentages of all relevant performance measures fulfilled for the individual patient (0%-50% [reference group], >50%-75%, and >75%-100%) and for the individual performance measures. RESULTS Fulfilling >75% to 100% of the performance measures (n=5341 [48.7%]) was associated with lower risk of all-cause readmission (adjusted hazard ratio, 0.78 [95% CI, 0.68-0.89]) and HF readmission (adjusted hazard ratio, 0.71 [95% CI, 0.54-0.92]), lower use of all-cause hospital days (adjusted mean ratio, 0.73 [95% CI, 0.70-0.76]) and HF hospital days (adjusted mean ratio, 0.79 [95% CI, 0.70-0.89]), and lower mortality (adjusted hazard ratio, 0.42 [95% CI, 0.32-0.53]). A dose-response relationship was observed between fulfilling more performance measures and mortality (adjusted hazard ratio, 0.62 [95% CI, 0.49-0.77] fulfilling >50%-75% of the measures). Fulfilling individual performance measures, except mineralocorticoid receptor antagonist therapy, was associated with lower adjusted all-cause readmission, lower adjusted use of all-cause and HF hospital days, and lower adjusted mortality. CONCLUSIONS Fulfilling more process performance measures was associated with better clinical outcomes in patients with incident HF with reduced ejection fraction.
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Affiliation(s)
- Inge Schjødt
- Department of Cardiology, Aarhus University Hospital, Denmark (I.S., B.B.L.)
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Denmark (S.P.J., J.B.V.)
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, and Department of Cardiology, Linköping University, Linköping, Sweden (A.S.)
| | - Adam D DeVore
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, United States (A.D.D.)
| | - Jan B Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Denmark (S.P.J., J.B.V.)
| | - Brian B Løgstrup
- Department of Cardiology, Aarhus University Hospital, Denmark (I.S., B.B.L.).,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (B.B.L.)
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