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López-Vilella R, Guerrero Cervera B, Donoso Trenado V, Martínez Dolz L, Almenar Bonet L. Clinical profiling of patients admitted with acute heart failure: a comprehensive survival analysis. Front Cardiovasc Med 2024; 11:1381514. [PMID: 38836065 PMCID: PMC11148778 DOI: 10.3389/fcvm.2024.1381514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
Background In heart failure (HF), not all episodes of decompensation are alike. The study aimed to characterize the clinical groups of decompensation and perform a survival analysis. Methods A retrospective study was conducted on patients consecutively admitted for HF from 2018 to 2023. Patients who died during admission were excluded (final number 1,668). Four clinical types of HF were defined: low cardiac output (n:83), pulmonary congestion (n:1,044), mixed congestion (n:353), and systemic congestion (n:188). Results The low output group showed a higher prevalence of reduced left ventricular ejection fraction (93%) and increased biventricular diameters (p < 0.01). The systemic congestion group exhibited a greater presence of tricuspid regurgitation with dilatation and right ventricular dysfunction (p:0.0001), worse renal function, and higher uric acid and CA125 levels (p:0.0001). Diuretics were more commonly used in the mixed and, especially, systemic congestion groups (p:0.0001). The probability of overall survival at 5 years was 49%, with higher survival in pulmonary congestion and lower in systemic congestion (p:0.002). Differences were also found in survival at 1 month and 1 year (p:0.0001). Conclusions Mortality in acute HF is high. Four phenotypic profiles of decompensation differ clinically, with distinct characteristics and varying prognosis in the short, medium, and long term.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Víctor Donoso Trenado
- Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luis Martínez Dolz
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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Fernández-Bergés D, González-Fernández R, Félix-Redondo FJ, Arevalo Lorido J, Yeguas Rosa L, Hernández-González M, Rubini A, Galán Montejano M, Gamero MC, Lozano Mera L. Evolución del perfil clínico y pronóstico de pacientes con alta hospitalaria por insuficiencia cardíaca en las dos primeras décadas del sigloxxi. El Registro INCA-Ex. Aten Primaria 2022; 54:102357. [PMID: 35576889 PMCID: PMC9118354 DOI: 10.1016/j.aprim.2022.102357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Abstract
Objetivo Estudiar la evolución del perfil clínico de una población dada de alta con diagnóstico principal de insuficiencia cardíaca (IC) en las dos primeras décadas del siglo y las variables predictoras de mortalidad y reingreso en el primer año de alta. Diseño Estudio observacional, retrospectivo, longitudinal. Emplazamiento Área de salud Don Benito-Villanueva de la Serena, Badajoz, España. Participantes Todos los pacientes dados de alta con diagnóstico principal de IC entre 2000 y 2019 en un complejo hospitalario general. Mediciones principales Se recogieron variables sociodemográficas y clínicas, y se realizó un seguimiento de un año; la variable resultado fue un compuesto de mortalidad y/o reingreso. Resultados Se incluyeron 4.107 altas, edad media 77,1 (DE 10,5) años, 53,1% de mujeres. El número de ingresos, la edad, los antecedentes de neoplasias, los ictus, la insuficiencia renal y la anemia fueron en aumento, así como los reingresos (p de tendencias < 0,001), mientras permaneció constante la mortalidad. Fueron variables predictoras de reingreso y/o muerte HR (IC 95%): edad (por año) 1,04 (1,03-1,04), diabetes: 1,11 (1,01-1,24), IC previa 1,41 (1,28-1,57), variable compuesta infarto, ictus y/o arteriopatía periférica 1,24 (1,11-1,38), enfermedad pulmonar obstructiva crónica (EPOC) 1,29 (1,15-1,44), neoplasia 1,33 (1,16-1,53), anemia 1,63 (1,41-1,86), insuficiencia renal 1,42 (1,26-1,60). Conclusiones En los últimos 20 años se han incrementado los ingresos de pacientes por IC, su edad y la comorbilidad. Fueron variables predictoras de mortalidad y/o reingreso la edad, la diabetes, la enfermedad cardiovascular previa, las neoplasias, la EPOC, la insuficiencia renal y la anemia; sin embargo, la mortalidad al año se mantuvo constante.
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Affiliation(s)
- Daniel Fernández-Bergés
- Unidad de Investigación, Área de Salud Don Benito-Villanueva, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, España; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España.
| | - Reyes González-Fernández
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España; Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Badajoz, Badajoz, España
| | - Francisco Javier Félix-Redondo
- Unidad de Investigación, Área de Salud Don Benito-Villanueva, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, España; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España; Centro de Salud Villanueva Norte, Villanueva de la Serena, Badajoz, España
| | - José Arevalo Lorido
- Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, España
| | - Lorena Yeguas Rosa
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España
| | - Miriam Hernández-González
- Unidad de Investigación, Área de Salud Don Benito-Villanueva, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, España; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España
| | - Alessia Rubini
- Unidad de Investigación, Área de Salud Don Benito-Villanueva, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, España; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España
| | - Miguel Galán Montejano
- Departamento de Medicina Interna, Complejo Hospitalario Don Benito-Villanueva, Don Benito, Badajoz, España
| | | | - Luis Lozano Mera
- Unidad de Investigación, Área de Salud Don Benito-Villanueva, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, España; Centro de Salud Mérida Urbano I, Mérida, Badajoz, España
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3
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Salinas-Botrán A, Sanz-Cánovas J, Pérez-Somarriba J, Pérez-Belmonte L, Cobos-Palacios L, Rubio-Rivas M, de-Cossío-Tejido S, Ramos-Rincón J, Méndez-Bailón M, Gómez-Huelgas R. [Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain]. Rev Clin Esp 2022; 222:255-265. [PMID: 34305156 PMCID: PMC8285252 DOI: 10.1016/j.rce.2021.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/17/2021] [Indexed: 01/12/2023]
Abstract
Background There are few studies on patients with heart failure (HF) hospitalized for COVID-19. Our aim is to describe the clinical characteristics of patients with HF hospitalized for COVID-19 and identify risk factors for in-hospital mortality upon admission. Methods We conducted a retrospective, multicenter study in patients with HF hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A multivariate logistic regression analysis was performed to identify admission risk factors associated with in-hospital mortality. Results A total of 1,718 patients were analyzed (56.5% men; median age 81.4 years). The overall case fatality rate was 47.6% (n=819). The independent risk factors at admission for in-hospital mortality were: age (adjusted odds ratio [AOR]: 1.03; 95% confidence interval [95%CI]: 1.02-1.05; p< .001); severe dependence (AOR: 1.62; 95%CI: 1.19-2.20; p=.002); tachycardia (AOR: 1.01; 95%CI: 1.00-1.01; p=.004); and high C-reactive protein (AOR: 1.004; 95%CI:1.002-1.004; p< .001), LDH (AOR: 1.001; 95%CI: 1.001-1.002; p< .001), and serum creatinine levels (AOR: 1.35; 95%CI: 1.18-1.54; p< .001). Conclusions Patients with HF hospitalized for COVID-19 have a high in-hospital mortality rate. Some simple clinical and laboratory tests can help to identify patients with a worse prognosis.
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Affiliation(s)
- A. Salinas-Botrán
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España,Autores para correspondencia
| | - J. Sanz-Cánovas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
| | - J. Pérez-Somarriba
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - L.M. Pérez-Belmonte
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
| | - L. Cobos-Palacios
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
| | - M. Rubio-Rivas
- Servicio de Medicina Interna, Hospital Universitario Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, España
| | - S. de-Cossío-Tejido
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - J.M. Ramos-Rincón
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Alicante, España
| | - M. Méndez-Bailón
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - R. Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
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Spitaleri G, Zamora E, Cediel G, Codina P, Santiago-Vacas E, Domingo M, Lupón J, Santesmases J, Diez-Quevedo C, Troya MI, Boldo M, Altimir S, Alonso N, González B, Bayes-Genis A. Cause of Death in Heart Failure Based on Etiology: Long-Term Cohort Study of All-Cause and Cardiovascular Mortality. J Clin Med 2022; 11:jcm11030784. [PMID: 35160236 PMCID: PMC8837120 DOI: 10.3390/jcm11030784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 12/04/2022] Open
Abstract
We assessed differences in long-term all-cause and cardiovascular (CV) mortality in heart failure (HF) outpatients based on the etiology of HF. Consecutive patients admitted to the HF Clinic from August 2001 to September 2019 (N = 2587) were considered for inclusion. HF etiology was divided into ischemic heart disease (IHD), dilated cardiomyopathy (DCM), hypertensive heart disease, alcoholic cardiomyopathy, drug-induced cardiomyopathy (DICM), valvular heart disease, and hypertrophic cardiomyopathy. All-cause death and CV death were the primary end points. Among 2387 patients included in the analysis (mean age 66.5 ± 12.5 years, 71.3% men), 1317 deaths were recorded (731 from CV cause) over a maximum follow-up of 18 years (median 4.1 years, interquartile range (IQR) 2–7.8). Considering IHD as the reference, only DCM had a lower risk of all-cause death (adjusted hazard ratio (aHR) 0.68, 95% confidence interval (CI) 0.56–0.83, p < 0.001), and only DICM had a higher risk of all-cause death (aHR 1.47, 95% CI 1.02–2.11, p = 0.04). However, almost all etiologies had a significantly lower risk of CV death than IHD. Among the studied HF etiologies, DCM and DICM have the lowest and highest risk of all-cause death, respectively, whereas IHD has the highest adjusted risk of CV death.
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Affiliation(s)
- Giosafat Spitaleri
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Elisabet Zamora
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
- Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - German Cediel
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
- Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Pau Codina
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Evelyn Santiago-Vacas
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Mar Domingo
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Josep Lupón
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
- Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier Santesmases
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
- Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Crisanto Diez-Quevedo
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Maria Isabel Troya
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Maria Boldo
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Salvador Altimir
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Núria Alonso
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Beatriz González
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Antoni Bayes-Genis
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
- Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-934978915; Fax: +34-934978939
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Mene-Afejuku TO, Bamgboje AO, Ogunniyi MO, Akinboboye O, Ibebuogu UN. Ventricular Arrhythmias in Seniors with Heart Failure: Present Dilemmas and Therapeutic Considerations: A Systematic Review. Curr Cardiol Rev 2022; 18:e181021197279. [PMID: 34666644 PMCID: PMC9413729 DOI: 10.2174/1573403x17666211018095324] [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] [Received: 01/05/2021] [Revised: 07/28/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Heart Failure (HF) is a global public health problem, which affects over 23 million people worldwide. The prevalence of HF is higher among seniors in the USA and other developed countries. Ventricular Arrhythmias (VAs) account for 50% of deaths among patients with HF. We aim to elucidate the factors associated with VAs among seniors with HF, as well as therapies that may improve the outcomes. METHODS PubMed, Web of Science, Scopus, Cochrane Library databases, Science Direct, and Google Scholar were searched using specific keywords. The reference lists of relevant articles were searched for additional studies related to HF and VAs among seniors as well as associated outcomes. RESULTS The prevalence of VAs increases with worsening HF. A 24-hour Holter electrocardiogram may be useful in risk stratifying patients for device therapy if they do not meet the criterion of low ventricular ejection fraction. Implantable Cardiac Defibrillators (ICDs) are superior to anti-arrhythmic drugs in reducing mortality in patients with HF. Guideline-Directed Medical Therapy (GDMT) together with device therapy may be required to reduce symptoms. In general, the proportion of seniors on GDMT is low. A combination of ICDs and cardiac resynchronization therapy may improve outcomes in selected patients. CONCLUSION Seniors with HF and VAs have high mortality even with the use of device therapy and GDMT. The holistic effect of device therapy on outcomes among seniors with HF is equivocal. More studies focused on seniors with advanced HF as well as therapeutic options are, therefore, required.
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Affiliation(s)
- Tuoyo O Mene-Afejuku
- Department of Medicine, Mayo Clinic Health System, Mankato, 1025 Marsh St, Mankato, MN 56001, USA.,Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Abayomi O Bamgboje
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, NY, USA
| | - Modele O Ogunniyi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Uzoma N Ibebuogu
- Department of Internal Medicine (Cardiology), University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
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6
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Roy I, Malagon L, Martínez J, Romero J, Munarriz A, Basterra N. [Cancer and implantable cardiac defibrillator. Causality, confusion or chance?]. Med Clin (Barc) 2021; 157:459-463. [PMID: 33069386 DOI: 10.1016/j.medcli.2020.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/04/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES implantable cardiac defibrillator (ICD) has been established as a therapy for malignant ventricular arrhythmias in patients at high risk of suffering them. Some studies suggest a possible relationship between the development of cancer and some prosthetic materials. Likewise, some investigations describe a higher incidence of cancer in patients with an ICD that suggest a potential relationship. METHODS Retrospective cohort study of patients that underwent implantation of an ICD in the Complejo Hospitalario de Navarra between 2000 and 2016. The follow-up finished in June 2018. Sociodemographic, comorbidities and oncological data was analysed. Cancer incidence rates were estimated and compared with the general population data and with data of a cohort of patients with reduced LVEF heart failure. Risk of cancer models were adjusted by competitive risk models. RESULTS 497 patients were included, mostly male (89.1%), with a mean age of 59.98 (14.98) years and a proportion of smokers of 67.6% and of ischaemic heart disease of 51.6%. The cancer incidence rate in the sample was 1230.9 per 100.000 person-year. In our study, features associated with cancer were older age, higher tobacco use and ischaemic cardiopathy. CONCLUSIONS In our sample of ICD carriers the incidence of cancer is high. This finding mainly seems to be related to tobacco usage and higher age.
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Affiliation(s)
- Ignacio Roy
- Cardiología, Área Clínica del Corazón, Complejo Hospitalario de Navarra, Pamplona, España.
| | - Lorena Malagon
- Cardiología, Área Clínica del Corazón, Complejo Hospitalario de Navarra, Pamplona, España
| | - Javier Martínez
- Cardiología, Área Clínica del Corazón, Complejo Hospitalario de Navarra, Pamplona, España
| | - Javier Romero
- Cardiología, Área Clínica del Corazón, Complejo Hospitalario de Navarra, Pamplona, España
| | - Aitziber Munarriz
- Cardiología, Área Clínica del Corazón, Complejo Hospitalario de Navarra, Pamplona, España
| | - Nuria Basterra
- Cardiología, Área Clínica del Corazón, Complejo Hospitalario de Navarra, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Navarra, España
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7
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Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain. Rev Clin Esp 2021; 222:255-265. [PMID: 34629304 PMCID: PMC8497960 DOI: 10.1016/j.rceng.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022]
Abstract
Background There are few studies on patients with heart failure (HF) hospitalized for COVID-19. Our aim is to describe the clinical characteristics of patients with HF hospitalized for COVID-19 and identify risk factors for in-hospital mortality upon admission. Methods We conducted a retrospective, multicenter study in patients with HF hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A multivariate logistic regression analysis was performed to identify admission factors associated with in-hospital mortality. Results A total of 1718 patients were analyzed (56.5% men; median age 81.4 years). The overall case fatality rate was 47.6% (n = 819). The independent risk factors at admission for in-hospital mortality were: age (adjusted odds ratio [AOR]: 1.03; 95% confidence interval [95%CI]: 1.02–1.05; p < 0.001); severe dependence (AOR: 1.62; 95%CI: 1.19–2.20; p = 0.002); tachycardia (AOR: 1.01; 95%CI: 1.00–1.01; p = 0.004); and high C-reactive protein (AOR: 1.004; 95%CI:1.002−1.004; p < 0.001), LDH (AOR: 1.001; 95%CI: 1.001−1.002; p < 0.001), and serum creatinine levels (AOR: 1.35; 95%CI: 1.18−1.54; p < 0.001). Conclusions Patients with HF hospitalized for COVID-19 have a high in-hospital mortality rate. Some simple clinical and laboratory tests can help to identify patients with a worse prognosis.
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Chen X, Huang W, Zhao L, Li Y, Wang L, Mo F, Guo W. Relationship Between the Eosinophil/Monocyte Ratio and Prognosis in Decompensated Heart Failure: A Retrospective Study. J Inflamm Res 2021; 14:4687-4696. [PMID: 34557013 PMCID: PMC8453176 DOI: 10.2147/jir.s325229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/23/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose The aim of this study was to assess the value of the eosinophil/monocyte ratio (EMR) for predicting the prognosis of decompensated heart failure (HF). Patients and Methods This was a retrospective cohort study. We included adults (≥18 years old) diagnosed with decompensated HF for whom EMR data were available. The patients were divided into three groups according to EMR tertiles (T1 [EMR≤0.15], T2 [0.15<EMR≤0.32], and T3 [EMR>0.32]). The primary endpoint was the composite outcome of cardiovascular death or HF rehospitalization. Results Initially, the records of 2264 patients with decompensated HF were screened; 1883 of these patients had EMR data and were therefore included in the study. There were 627 patients in the T1 group, 628 in the T2 group, and 628 in the T3 group. The risk of cardiovascular death or HF rehospitalization was significantly different among the three groups (Log rank test, P=0.007). Compared with the T3 group, both the T1 group (hazard ratio [HR]: 1.50, 95% confidence interval [CI]: 1.16–1.94, P=0.002) and the T2 group (HR: 1.34, 95% CI: 1.03–1.74, P=0.030) had significantly higher rates of cardiovascular death or HF rehospitalization. A Cochran-Armitage test for trend showed a positive correlation between the EMR and the composite outcome of cardiovascular death or HF. There was a significant difference between the three groups in terms of cardiovascular death (Log rank test, P<0.001) and HF rehospitalization (Log rank test, P=0.03). Conclusion The EMR is positively correlated with the risk of cardiovascular death or HF rehospitalization in patients with decompensated HF. Specifically, the lower the EMR, the higher the risk of cardiovascular death or HF rehospitalization.
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Affiliation(s)
- Xiehui Chen
- Department of Cardiology, Shenzhen Longhua District Central Hospital, Shenzhen, People's Republic of China
| | - Weichao Huang
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
| | - Lingyue Zhao
- Department of Ambulatory Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Yichong Li
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
| | - Lili Wang
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
| | - Fanrui Mo
- Department of Cardiology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, People's Republic of China
| | - Wenqin Guo
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
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9
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Di Gioia G, De Bruyne B, Pellicano M, Bartunek J, Colaiori I, Fiordelisi A, Canciello G, Xaplanteris P, Fournier S, Katbeh A, Franco D, Kodeboina M, Morisco C, Van Praet F, Casselman F, Degrieck I, Stockman B, Vanderheyden M, Barbato E. Fractional flow reserve in patients with reduced ejection fraction. Eur Heart J 2021; 41:1665-1672. [PMID: 31419282 DOI: 10.1093/eurheartj/ehz571] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 07/29/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Fractional flow reserve (FFR) has never been investigated in patients with reduced ejection fraction and associated coronary artery disease (CAD). We evaluated the impact of FFR on the management strategies of these patients and related outcomes. METHODS AND RESULTS From 2002 to 2010, all consecutive patients with left ventricular ejection fraction (LVEF) ≤50% undergoing coronary angiography with ≥1 intermediate coronary stenosis [diameter stenosis (DS)% 50-70%] treated based on angiography (Angiography-guided group) or according to FFR (FFR-guided group) were screened for inclusion. In the FFR-guided group, 433 patients were matched with 866 contemporary patients of the Angiography-guided group. For outcome comparison, 617 control patients with LVEF >50% were included. After FFR, stenotic vessels per patient were significantly downgraded compared with the Angiography-guided group (1.43 ± 0.98 vs. 1.97 ± 0.84; P < 0.001). This was associated with lower revascularization rate (52% vs. 62%; P < 0.001) in the FFR-guided vs. the Angiography-guided group. All-cause death at 5 years of follow-up was significantly lower in the FFR-guided as compared with Angiography-guided group [22% vs. 31%. HR (95% CI) 0.64 (0.51-0.81); P < 0.001]. Similarly, rate of major adverse cardiovascular and cerebrovascular events (MACCE: composite of all-cause death, myocardial infarction, revascularization, and stroke) was significantly lower in the FFR-guided group [40% vs. 46% in the Angiography-guided group. HR (95% CI) 0.81 (0.67-0.97); P = 0.019]. Higher rates of death and MACCE were observed in patients with reduced LVEF compared with the control cohort. CONCLUSIONS In patients with reduced LVEF and CAD, FFR-guided revascularization was associated with lower rates of death and MACCE at 5 years as compared with the Angiography-guided strategy. This beneficial impact was observed in parallel with less coronary artery bypass grafting and more patients deferred to percutaneous coronary intervention or medical therapy.
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Affiliation(s)
- Giuseppe Di Gioia
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Mariano Pellicano
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Iginio Colaiori
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Antonella Fiordelisi
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Grazia Canciello
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | | | - Stephane Fournier
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Asim Katbeh
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Danilo Franco
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Monika Kodeboina
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Carmine Morisco
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Frank Van Praet
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Filip Casselman
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Ivan Degrieck
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Bernard Stockman
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
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Salamanca-Bautista P, Álvarez-García J, Aramburu-Bodas Ó, Ferrero-Gregori A, Arias-Jiménez JL, Delgado JF, Formiga F, Vázquez R, Manzano L, Puig T, Llàcer P, Vives-Borras M, Cinca J, Montero-Pérez-Barquero M. Modes of death in heart failure according to age, sex and left ventricular ejection fraction. Intern Emerg Med 2021; 16:643-652. [PMID: 32813117 DOI: 10.1007/s11739-020-02468-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
Modes of death in patients with heart failure (HF) have been well characterized in randomized studies, but data from real-life are scarce, especially in the elderly, women and in HF with mid-range or preserved left ventricular ejection fraction (LVEF). Our purpose was to examine modes of death in HF patients according to age, sex and LVEF. We analysed the mode of death of HF patients from two prospective multicentre contemporary Spanish registries conducted by cardiologists (REDINSCOR, n = 2150) and by internists (RICA, n = 1396). Mode of death was pre-specified. Out of 3546 patients, 485 (13.7%) died during the 9-month follow-up. Cardiovascular (CV) causes were the most frequent, regardless of the age, sex and LVEF. More than half of patients died due to worsening HF in both groups of patients, followed by other non-CV causes in those attended by internists, and sudden cardiac death in those cared by cardiologists. Stroke was more common among elderly patients, women and HF with preserved LVEF. Non-CV causes, particularly infectious diseases, accounted for a remarkable proportion of deaths, especially in the elderly and in HF patients with preserved LVEF. Functional class, age and anaemia had a strong influence on both CV and non-CV death. CV death due to refractory HF was the most prevalent among our population, irrespective of age, sex or LVEF. However, a significant proportion of HF patients died from non-CV causes, particularly elderly with mid-range and preserved LVEF. These patients could benefit significantly from a multidisciplinary follow-up.
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Affiliation(s)
- Prado Salamanca-Bautista
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain.
| | - Jesús Álvarez-García
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Óscar Aramburu-Bodas
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Andreu Ferrero-Gregori
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - José Luis Arias-Jiménez
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Juan F Delgado
- Cardiology Department, Fundación de Investigación i+12, Hospital Universitario Doce de Octubre, CIBERCV, Facultad de Medicina UCM, Madrid, Spain
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Rafael Vázquez
- Cardiology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Luis Manzano
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, University of Alcalá, IRYCIS, Madrid, Spain
| | - Teresa Puig
- Epidemiology and Public Health Department, Hospital de la Santa Creu I Sant Pau, II-B SantPau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pau Llàcer
- Internal Medicine Department, Hospital de Manises, Valencia, Spain
| | - Miquel Vives-Borras
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
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Causes of death in hospitalized patients in internal medicine departments with heart failure according to ejection fraction. RICA registry. Med Clin (Barc) 2021; 158:13-19. [PMID: 33485617 DOI: 10.1016/j.medcli.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION There are few data in the Spanish population about the causes of death in patients admitted to internal medicine departments for heart failure. Their study according to left ventricular ejection fraction (reduced: rEF, mid-range: mEF, and preserved: pEF) could improve the knowledge of patients and their prognosis. METHODS Prospective multicentre cohort study of 4144 patients admitted with heart failure to internal medicine departments. Their clinical characteristics, mortality rate and causes were classified according to pEF (≥ 50%), mEF (40%-49%) and rEF (<40%). Patients were followed-up for a median of one year. RESULTS There were 1198 deaths (29%). The cause of death was cardiovascular (CV) in 833 patients (69.5%), mainly heart failure (50%) and sudden cardiac death (7.5%). Non-cardiovascular (NoCV) causes were responsible for 365 deaths (30.5%). The most common NoCV causes were infections (13%). The most frequent and early cause in all groups was heart failure. Patients with pEF, compared to the other groups, had lower risk of sudden cardiac death and higher risk of infections (P <.05). The causes of death in patients with mrEF were closer to those with pEF. CONCLUSIONS The causes of death in patients with heart failure were different depending on ejection fraction strata. Patients with mEF and pEF, due to their high comorbidity and higher frequency of NoCV death, would require comprehensive management by internal medicine.
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12
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Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure. Clin Res Cardiol 2021; 110:1249-1258. [PMID: 33399955 PMCID: PMC8318949 DOI: 10.1007/s00392-020-01792-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/09/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Frailty is common in patients with chronic heart failure (CHF) and is associated with poor outcomes. The natural history of frail patients with CHF is unknown. METHODS Frailty was assessed using the clinical frailty scale (CFS) in 467 consecutive patients with CHF (67% male, median age 76 years, median NT-proBNP 1156 ng/L) attending a routine follow-up visit. Those with CFS > 4 were classified as frail. We investigated the relation between frailty and treatments, hospitalisation and death in patients with CHF. RESULTS 206 patients (44%) were frail. Of 291 patients with HF with reduced ejection fraction (HeFREF), those who were frail (N = 117; 40%) were less likely to receive optimal treatment, with many not receiving a renin-angiotensin-aldosterone system inhibitor (frail: 25% vs. non-frail: 4%), a beta-blocker (16% vs. 8%) or a mineralocorticoid receptor antagonist (50% vs 41%). By 1 year, there were 56 deaths and 322 hospitalisations, of which 25 (45%) and 198 (61%), respectively, were due to non-cardiovascular (non-CV) causes. Most deaths (N = 46, 82%) and hospitalisations (N = 215, 67%) occurred in frail patients. Amongst frail patients, 43% of deaths and 64% of hospitalisations were for non-CV causes; 58% of cardiovascular (CV) deaths were due to advancing HF. Among non-frail patients, 50% of deaths and 57% of hospitalisations were for non-CV causes; all CV deaths were due to advancing HF. CONCLUSION Frailty in patients with HeFREF is associated with sub-optimal medical treatment. Frail patients are more likely to die or be admitted to hospital, but whether frail or not, many events are non-CV.
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13
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Josa-Laorden C, Giménez-López I, Rubio-Gracia J, Garcés Horna V, Sánchez-Marteles M, Pérez-Calvo JI. Prognostic significance of acute kidney injury and small increases in creatinine concentration during acute decompensation of heart failure. Rev Clin Esp 2020; 220:561-568. [PMID: 31882130 DOI: 10.1016/j.rce.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/12/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Diagnosis of acute kidney injury (AKI) during acute decompensations of heart failure (ADHF) remain challenging. We analysed the incidence and prognosis of AKI, and the significance of small increases of creatinine, during ADHF and after stabilization. PATIENTS AND METHODS Patients admitted for ADHF were prospectively included. Creatinine was measured at admission, 48h thereafter and 24h before discharge. AKI was diagnosed when creatinine increased≥50% in 7 days (RIFLE criteria) or≥0.3mg/dL in 48h (AKIN criteria) during admission. Changes between baseline creatinine (measured within 3-month before admission) and one month after discharge were assessed, to seek for residual impairment of renal function and its significance. RESULTS Two hundred and four patients were included. Incidence of AKI was 28.4% (n=58). Creatinine peaked by day 5 in patients with AKI vs. non-AKI (1.9 vs. 1.1mg/dL; P<.000) and remained significantly higher among patients with AKI 3 months after discharge (increase of 20 vs. 4%; P=.013). Twelve-months mortality was associated with increases in cystatin C, NT-proBNP and AKI (15.5 vs. 44.8%, P<.000), being the latter the most powerful independent predictor of death ?Exp(B)=5.34; P=.009?. Minor increases in creatinine (20% or 0.2mg/dL) during admission associated lesser 12-months survival (P=.033 and P=.019, respectively). Increases in creatinine≥10% between baseline and one month after discharge are associated with higher mortality (12.6 vs. 22.5%, P=.044). CONCLUSIONS AKI is a strong predictor of mortality after ADHF. Minor increments in creatinine concentrations, below the accepted threshold for AKI definition, are prognostically meaningful.
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Affiliation(s)
- C Josa-Laorden
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS-A), Zaragoza, España
| | - I Giménez-López
- Instituto de Investigación Sanitaria de Aragón (IIS-A), Zaragoza, España; Faculta de Medicina, Universidad de Zaragoza, Zaragoza, España
| | - J Rubio-Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS-A), Zaragoza, España
| | - V Garcés Horna
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS-A), Zaragoza, España
| | - M Sánchez-Marteles
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS-A), Zaragoza, España
| | - J I Pérez-Calvo
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS-A), Zaragoza, España; Faculta de Medicina, Universidad de Zaragoza, Zaragoza, España.
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Josa-Laorden C, Giménez-López I, Rubio-Gracia J, Garcés Horna V, Sánchez-Marteles M, Pérez-Calvo J. Prognostic significance of acute kidney injury and small increases in creatinine concentration during acute decompensation of heart failure. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Torralba-Morón Á, Guerra-Vales JM, Medrano-Ortega FJ, Navarro-Puerto MA, Lora-Pablos D, Marín-León I, Calderón-Sandubete E, Gómez-de la Cámara A. Renal function at admission as a prognostic marker for patients hospitalised for a first episode of heart failure. Results of the PREDICE study. Rev Clin Esp 2020; 220:537-547. [PMID: 31776005 DOI: 10.1016/j.rce.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/18/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Heart failure (HF) is a frequent condition that deteriorates quality of life and results in high morbidity and mortality. A considerable number of studies have been implemented in recent years to determine the factors that affect the prognosis of HF; however, few studies have assessed the prognosis of patients hospitalised for their first episode of HF. The aim of our study was to analyse the prognostic impact of renal function on patients hospitalised for a first episode of HF. MATERIAL AND METHODS We recruited 600 patients hospitalised for a first episode of HF in 3 tertiary Spanish hospitals. We analysed the mortality risk during the first year of follow-up according to renal function at the time of admission. RESULTS The patients with the highest degree of kidney failure at admission were older (P<.001), were more often women (p=.01) and presented a higher degree of dependence (P<.05), as well as a higher prevalence of arterial hypertension (P<.001), chronic renal failure (P<.001) and anaemia (P<.001). In the multivariate analysis, the degree of kidney failure at admission remained an independent predictor of increased mortality risk during the first year of follow-up. CONCLUSIONS The presence of kidney failure at admission was a marker of poor prognosis in our cohort of patients hospitalised for a first episode of HF.
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Affiliation(s)
- Á Torralba-Morón
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J M Guerra-Vales
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España; Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, España
| | - F J Medrano-Ortega
- Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - M A Navarro-Puerto
- Servicio de Medicina Interna, Hospital Universitario Nuestra Señora de Valme, Sevilla, España
| | - D Lora-Pablos
- Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Unidad de Investigación Clínica, Hospital Universitario 12 de Octubre, Madrid, España
| | - I Marín-León
- Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - E Calderón-Sandubete
- Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - A Gómez-de la Cámara
- Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Unidad de Investigación Clínica, Hospital Universitario 12 de Octubre, Madrid, España
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Torralba-Morón Á, Guerra-Vales J, Medrano-Ortega F, Navarro-Puerto M, Lora-Pablos D, Marín-León I, Calderón-Sandubete E, Gómez-de la Cámara A. Renal function at admission as a prognostic marker for patients hospitalized for a first episode of heart failure. Results of the PREDICE study. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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A Clinically Relevant Functional Model of Type-2 Cardio-Renal Syndrome with Paraventricular Changes consequent to Chronic Ischaemic Heart Failure. Sci Rep 2020; 10:1261. [PMID: 31988300 PMCID: PMC6985167 DOI: 10.1038/s41598-020-58071-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/24/2019] [Indexed: 11/25/2022] Open
Abstract
Cardiorenal syndrome, de novo renal pathology arising secondary to cardiac insufficiency, is clinically recognised but poorly characterised. This study establishes and characterises a valid model representative of Type 2 cardiorenal syndrome. Extensive permanent left ventricular infarction, induced by ligation of the left anterior descending coronary artery in Lewis rats, was confirmed by plasma cardiac troponin I, histology and cardiac haemodynamics. Renal function and morphology was assessed 90-days post-ligation when heart failure had developed. The involvement of the paraventricular nucleus was investigated using markers of inflammation, apoptosis, reactive oxygen species and of angiotensin II involvement. An extensive left ventricular infarct was confirmed following coronary artery ligation, resulting in increased left ventricular weight and compromised left ventricular diastolic function and developed pressure. Glomerular filtration was significantly decreased, fractional excretion of sodium and caspase activities were increased and basement membrane thickening, indicating glomerulosclerosis, was evident. Interestingly, angiotensin II receptor I expression and reactive oxygen species levels in the hypothalamic paraventricular nucleus remained significantly increased at 90-days post-coronary artery ligation, suggesting that these hypothalamic changes may represent a novel, valuable pharmacological target. This model provides conclusive morphological, biochemical and functional evidence of renal injury consequent to heart failure, truly representative of Type-2 cardiorenal syndrome.
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Yang X, Lupón J, Vidán MT, Ferguson C, Gastelurrutia P, Newton PJ, Macdonald PS, Bueno H, Bayés-Genís A, Woo J, Fung E. Impact of Frailty on Mortality and Hospitalization in Chronic Heart Failure: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 7:e008251. [PMID: 30571603 PMCID: PMC6405567 DOI: 10.1161/jaha.117.008251] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Although frailty has been associated with increased risks for hospitalization and mortality in chronic heart failure, the precise average effect remains uncertain. We performed a systematic review and meta‐analysis to summarize the hazards for mortality and incident hospitalization in patients with heart failure and frailty compared with those without frailty and explored the heterogeneity underlying the effect size estimates. Methods and Results MEDLINE, EMBASE, and Cochrane databases were queried for articles published between January 1966 and March 2018. Predefined selection criteria were used. Hazard ratios (HRs) were pooled for meta‐analyses, and where odds ratios were used previously, original data were recalculated for HR. Overlapping data were consolidated, and only unique data points were used. Study quality and bias were assessed. Eight studies were included for mortality (2645 patients), and 6 studies were included for incident hospitalization (2541 patients) during a median follow‐up of 1.82 and 1.12 years, respectively. Frailty was significantly associated with an increased hazard for mortality (HR, 1.54; 95% confidence interval, 1.34–1.75; P<0.001) and incident hospitalization (HR, 1.56; 95% confidence interval, 1.36–1.78; P<0.001) in chronic heart failure. The Fried phenotype estimated a 16.9% larger effect size than the combined Fried/non‐Fried frailty assessment for the end point of mortality (HR, 1.80; 95% confidence interval, 1.41–2.28; P<0.001), but not for hospitalization (HR, 1.57; 95% confidence interval, 1.30–1.89; P<0.001). Study heterogeneity was found to be low (I2=0%), and high quality of studies was verified by the Newcastle‐Ottawa scale. Conclusions Overall, the presence of frailty in chronic heart failure is associated with an increased hazard for death and hospitalization by ≈1.5‐fold.
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Affiliation(s)
- Xiaobo Yang
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,2 Laboratory for Heart Failure and Circulation Research Li Ka Shing Institute of Health Sciences Prince of Wales Hospital Hong Kong, SAR
| | - Josep Lupón
- 3 Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain.,4 Department of Medicine Universitat Autonòma de Barcelona Spain.,5 CIBERCV Instituto de Salud Carlos III Madrid Spain
| | - Maria T Vidán
- 6 Department of Geriatrics Instituto de Investigación IiSGM and CIBERFES Hospital General Universitario Gregorio Marañón Madrid Spain.,7 Universidad Complutense de Madrid Spain
| | - Caleb Ferguson
- 8 Western Sydney Nursing and Midwifery Research Centre Western Sydney University and Western Sydney Local Health District Sydney Australia
| | - Paloma Gastelurrutia
- 5 CIBERCV Instituto de Salud Carlos III Madrid Spain.,9 Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol Badalona Spain
| | - Phillip J Newton
- 8 Western Sydney Nursing and Midwifery Research Centre Western Sydney University and Western Sydney Local Health District Sydney Australia
| | - Peter S Macdonald
- 10 Heart and Lung Transplant Unit St Vincent's Hospital University of New South Wales Sydney Australia.,11 Transplantation Research Laboratory Victor Chang Cardiac Research Institute Sydney Australia
| | - Héctor Bueno
- 7 Universidad Complutense de Madrid Spain.,12 Centro Nacional de Investigaciones Cardiovasculares Madrid Spain.,13 Instituto de Investigación i+12 and Cardiology Department Hospital Universitario 12 de Octubre Madrid Spain
| | - Antoni Bayés-Genís
- 3 Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain.,4 Department of Medicine Universitat Autonòma de Barcelona Spain.,5 CIBERCV Instituto de Salud Carlos III Madrid Spain
| | - Jean Woo
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,14 CUHK Jockey Club Institute of Ageing The Chinese University of Hong Kong Hong Kong, SAR
| | - Erik Fung
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,2 Laboratory for Heart Failure and Circulation Research Li Ka Shing Institute of Health Sciences Prince of Wales Hospital Hong Kong, SAR.,15 School of Public Health Imperial College London London United Kingdom.,16 CARE Programme Lui Che Woo Institute of Innovative Medicine Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,17 Gerald Choa Cardiac Research Centre Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR
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Vergaro G, Ghionzoli N, Innocenti L, Taddei C, Giannoni A, Valleggi A, Borrelli C, Senni M, Passino C, Emdin M. Noncardiac Versus Cardiac Mortality in Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction. J Am Heart Assoc 2019; 8:e013441. [PMID: 31587602 PMCID: PMC6818034 DOI: 10.1161/jaha.119.013441] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background A thorough analysis of noncardiac determinants of mortality in heart failure (HF) is missing. Furthermore, evidence conflicts on the outcome of patients with HF and no or mild systolic dysfunction. We aimed to investigate the prevalence of noncardiac and cardiac causes of death in a cohort of chronic HF patients, covering the whole spectrum of systolic function. Methods and Results We enrolled 2791 stable HF patients, classified into HF with reduced ejection fraction (HFrEF; left ventricular ejection fraction [EF] <40%), HR with midrange EF (HFmrEF; left ventricular EF 41–49%), or HF with preserved EF (HFpEF; left ventricular EF ≥50%), and followed up for all‐cause, cardiac, and noncardiac mortality (adjudicated as due to cancer, sepsis, respiratory disease, renal disease, or other causes). Over follow‐up of 39 months, adjusted mortality was lower in HFpEF and HFmrEF versus HFrEF (hazard ratio: 0.75 [95% CI, 0.67–0.84], P<0.001 for HFpEF; hazard ratio: 0.78 [95% CI, 0.63–0.96], P=0.017 for HFmrEF). HFrEF had the highest rates of cardiac death, whereas noncardiac mortality was similar across left ventricular EF categories. Noncardiac causes accounted for 62% of deaths in HFpEF, 54% in HFmrEF and 35% in HFrEF; cancer was twice as frequent as a cause of death in HFpEF and HFmrEF versus HFrEF. Yearly rates of noncardiac death exceeded those of cardiac death since the beginning of follow‐up in HFpEF and HFmrEF. Conclusions Noncardiac death is a major determinant of outcome in stable HF, exceeding cardiac‐related mortality in HFpEF and HFmrHF. Comorbidities should be regarded as main therapeutic targets and objects of dedicated quality improvement initiatives, especially in patients with no or mild systolic dysfunction.
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Affiliation(s)
- Giuseppe Vergaro
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy.,Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Nicolò Ghionzoli
- Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Lisa Innocenti
- Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Claudia Taddei
- Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Alberto Giannoni
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy.,Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Alessandro Valleggi
- Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Chiara Borrelli
- Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Michele Senni
- Cardiology Division Cardiovascular Department Papa Giovanni XXIII Hospital Bergamo Italy
| | - Claudio Passino
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy.,Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Michele Emdin
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy.,Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
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Jones NR, Roalfe AK, Adoki I, Hobbs FDR, Taylor CJ. Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis. Eur J Heart Fail 2019; 21:1306-1325. [PMID: 31523902 PMCID: PMC6919428 DOI: 10.1002/ejhf.1594] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022] Open
Abstract
Aim To provide reliable survival estimates for people with chronic heart failure and explain variation in survival by key factors including age at diagnosis, left ventricular ejection fraction, decade of diagnosis, and study setting. Methods and results We searched in relevant databases from inception to August 2018 for non‐interventional studies reporting survival rates for patients with chronic or stable heart failure in any ambulatory setting. Across the 60 included studies, there was survival data for 1.5 million people with heart failure. In our random effects meta‐analyses the pooled survival rates at 1 month, 1, 2, 5 and 10 years were 95.7% (95% confidence interval 94.3–96.9), 86.5% (85.4–87.6), 72.6% (67.0–76.6), 56.7% (54.0–59.4) and 34.9% (24.0–46.8), respectively. The 5‐year survival rates improved between 1970–1979 and 2000–2009 across healthcare settings, from 29.1% (25.5–32.7) to 59.7% (54.7–64.6). Increasing age at diagnosis was significantly associated with a reduced survival time. Mortality was lowest in studies conducted in secondary care, where there were higher reported prescribing rates of key heart failure medications. There was significant heterogeneity among the included studies in terms of heart failure diagnostic criteria, participant co‐morbidities, and treatment rates. Conclusion These results can inform health policy and individual patient advanced care planning. Mortality associated with chronic heart failure remains high despite steady improvements in survival. There remains significant scope to improve prognosis through greater implementation of evidence‐based treatments. Further research exploring the barriers and facilitators to treatment is recommended.
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Affiliation(s)
- Nicholas R Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrea K Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ibiye Adoki
- Foundation Training Programme, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare J Taylor
- Foundation Training Programme, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
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21
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Tran P, McDonald M, Kunaselan L, Umar F, Banerjee P. A hundred heart failure deaths: lessons learnt from the Dr Foster heart failure hospital mortality alert. Open Heart 2019; 6:e000970. [PMID: 31168377 PMCID: PMC6519425 DOI: 10.1136/openhrt-2018-000970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/26/2019] [Accepted: 02/16/2019] [Indexed: 11/11/2022] Open
Abstract
Background Despite advances in evidence-based pharmacotherapy, the latest National Heart Failure Audit (NHFA) has shown that in-hospital mortality of heart failure (HF) remains high with large interhospital variations. University Hospitals Coventry & Warwickshire, a tertiary cardiac centre, received a mortality alert of excess HF deaths based on a high Dr Foster hospital standardised mortality ratio (HSMR). This conflicted with our local NHFA data which showed lower than national average mortality rates. Objective To review various systemic and individual processes of care in patients admitted with HF and examine the validity of HSMR in HF. Design, setting, patients A retrospective case note analysis was performed on a random sample of 100 HF deaths identified by Dr Foster from 2010 to 2016. Measures Case record reviews were performed on the following aspects of care: admission to appropriate wards, resuscitation status, palliative care input and National Confidential Enquiry into Patient Outcome and Death classification. Primary diagnosis coding, diagnostic accuracy and actual causes of death were examined to assess limitations of HSMR. Results Despite evidence of lower mortality on cardiology wards, only 28% of patients with acute HF were admitted to a cardiology-ward. Sixty four per cent were considered palliative but only 4.6% were referred to palliative care. The Do Not Attempt Resuscitation order was appropriate in 91% patients but only 74% had this in place. The primary diagnosis of HF was incorrectly coded in 34% while three cases were misdiagnosed. Conclusion HF may be coded as a cause of death in some cases where the cause is uncertain and misdiagnosed. Although HSMR has many limitations, it is a smoke alarm that should not be ignored.
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Affiliation(s)
- Patrick Tran
- Department of Cardiology, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom
| | | | | | - Fraz Umar
- Department of Cardiology, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom
| | - Prithwish Banerjee
- Department of Cardiology, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom.,Warwick Medical School, Coventry, United Kingdom.,CIRAL, Coventry University, Coventry, United Kingdom
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22
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Germano JF, Sawaged S, Saadaeijahromi H, Andres AM, Feuer R, Gottlieb RA, Sin J. Coxsackievirus B infection induces the extracellular release of miR-590-5p, a proviral microRNA. Virology 2019; 529:169-176. [PMID: 30711774 DOI: 10.1016/j.virol.2019.01.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/23/2022]
Abstract
Coxsackievirus B is a significant human pathogen and is a leading cause of myocarditis. We and others have observed that certain enteroviruses including coxsackievirus B cause infected cells to shed extracellular vesicles containing infectious virus. Recent reports have shown that vesicle-bound virus can infect more efficiently than free virus. Though microRNAs are differentially regulated in cells following infection, few have been associated with the vesicles shed from infected cells. Here we report exclusive trafficking of specific microRNAs into viral vesicles compared to vesicles from non-infected cells. We found that the most highly-expressed unique microRNA in viral vesicles was miR-590-5p, which facilitates prolonged viral replication by blocking apoptotic factors. Cells over-expressing this miR were significantly more susceptible to infection. This may be a mechanism by which coxsackievirus B boosts subsequent rounds of infection by co-packaging virus and a select set of pro-viral microRNAs in extracellular vesicles.
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Affiliation(s)
- Juliana F Germano
- The Smidt Heart Institute and the Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Savannah Sawaged
- The Smidt Heart Institute and the Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Hannaneh Saadaeijahromi
- The Smidt Heart Institute and the Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Allen M Andres
- The Smidt Heart Institute and the Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Ralph Feuer
- The Integrated Regenerative Research Institute (IRRI) at San Diego State University San Diego State University, San Diego, CA, United States
| | - Roberta A Gottlieb
- The Smidt Heart Institute and the Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jon Sin
- The Smidt Heart Institute and the Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
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23
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El Moheb M, Nicolas J, Khamis AM, Iskandarani G, Akl EA, Refaat M. Implantable cardiac defibrillators for people with non-ischaemic cardiomyopathy. Cochrane Database Syst Rev 2018; 12:CD012738. [PMID: 30537022 PMCID: PMC6517305 DOI: 10.1002/14651858.cd012738.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is evidence that implantable cardioverter-defibrillator (ICD) for primary prevention in people with an ischaemic cardiomyopathy improves survival rate. The evidence supporting this intervention in people with non-ischaemic cardiomyopathy is not as definitive, with the recently published DANISH trial finding no improvement in survival rate. A systematic review of all eligible studies was needed to evaluate the benefits and harms of using ICDs for primary prevention in people with non-ischaemic cardiomyopathy. OBJECTIVES To evaluate the benefits and harms of using compared to not using ICD for primary prevention in people with non-ischaemic cardiomyopathy receiving optimal medical therapy. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and the Web of Science Core Collection on 10 October 2018. For ongoing or unpublished clinical trials, we searched the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and the ISRCTN registry. To identify economic evaluation studies, we conducted a separate search to 31 March 2015 of the NHS Economic Evaluation Database, and from March 2015 to October 2018 on MEDLINE and Embase. SELECTION CRITERIA We included randomised controlled trials involving adults with chronic non-ischaemic cardiomyopathy due to a left ventricular systolic dysfunction with an ejection fraction of 35% or less (New York Heart Association (NYHA) type I-IV). Participants in the intervention arm should have received ICD in addition to optimal medical therapy, while those in the control arm received optimal medical therapy alone. We included studies with cardiac resynchronisation therapy when it was appropriately balanced in the experimental and control groups. DATA COLLECTION AND ANALYSIS The primary outcomes were all-cause mortality, cardiovascular mortality, sudden cardiac death, and adverse events associated with the intervention. The secondary outcomes were non-cardiovascular death, health-related quality of life, hospitalisation for heart failure, first ICD-related hospitalisation, and cost. We abstracted the log (hazard ratio) and its variance from trial reports for time-to-event survival data. We extracted the raw data necessary to calculate the risk ratio. We summarised data on quality of life and cost-effectiveness narratively. We assessed the certainty of evidence for all outcomes using GRADE. MAIN RESULTS We identified six eligible randomised trials with a total of 3128 participants. The use of ICD plus optimal medical therapy versus optimal medical therapy alone decreases the risk of all-cause mortality (hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.66 to 0.92; participants = 3128; studies = 6; high-certainty evidence). An average of 24 patients need to be treated with ICD to prevent one additional death from any cause (number needed to treat for an additional beneficial outcome (NNTB) = 24). Individuals younger than 65 derive more benefit than individuals older than 65 (HR 0.51, 95% CI 0.29 to 0.91; participants = 348; studies = 1) (NNTB = 10). When added to medical therapy, ICDs probably decrease cardiovascular mortality compared to not adding them (risk ratio (RR) 0.75, 95% CI 0.46 to 1.21; participants = 1781; studies = 4; moderate-certainty evidence) (possibility of both plausible benefit and no effect). Implantable cardioverter-defibrillator was also found to decrease sudden cardiac deaths (HR 0.45, 95% CI 0.29 to 0.70; participants = 1677; studies = 3; high-certainty evidence). An average of 25 patients need to be treated with an ICD to prevent one additional sudden cardiac death (NNTB = 25). We found that ICDs probably increase adverse events (possibility of both plausible harm and benefit), but likely have little or no effect on non-cardiovascular mortality (RR 1.17, 95% CI 0.81 to 1.68; participants = 1781; studies = 4; moderate-certainty evidence) (possibility of both plausible benefit and no effect). Finally, using ICD therapy probably has little or no effect on quality of life, however shocks from the device cause a deterioration in quality of life. No study reported the outcome of first ICD-related hospitalisations. AUTHORS' CONCLUSIONS The use of ICD in addition to medical therapy in people with non-ischaemic cardiomyopathy decreases all-cause mortality and sudden cardiac deaths and probably decreases mortality from cardiovascular causes compared to medical therapy alone. Their use probably increases the risk for adverse events. However, these devices come at a high cost, and shocks from ICDs cause a deterioration in quality of life.
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Affiliation(s)
- Mohamad El Moheb
- American University of Beirut Medical CenterFaculty of MedicineBeirutLebanon
| | - Johny Nicolas
- American University of Beirut Medical CenterFaculty of MedicineBeirutLebanon
| | - Assem M Khamis
- American University of Beirut Medical CenterClinical Research InstituteBeirutLebanon
| | - Ghida Iskandarani
- American University of Beirut Medical CenterFaculty of MedicineBeirutLebanon
| | - Elie A Akl
- American University of Beirut Medical CenterDepartment of Internal MedicineRiad El Solh StBeirutLebanon
| | - Marwan Refaat
- American University of Beirut Medical CenterDepartment of Internal MedicineRiad El Solh StBeirutLebanon
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Liu CH, Wang JH, Weng SC, Cheng YH, Yeh MK, Bai MY, Chang JC. Is Heart Failure Associated With Risk of Suicide? J Card Fail 2018; 24:795-800. [PMID: 30053581 DOI: 10.1016/j.cardfail.2018.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/26/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The high prevalence of heart failure (HF) in developed countries imposes a substantial burden on health care resources. Depression is widely recognized as a risk factor associated with HF. This study examined the relationship between suicide and HF after controlling for depression and other comorbidities. METHODS AND RESULTS The population comprised 52,749 adult patients who died from suicide from 2000 to 2012 and 210,996 living control subjects matched by age, sex, and residence area. Data were obtained from the Health and Welfare Data Science Center, Taiwan. Multivariable models were constructed to evaluate the relationship between HF and suicide. In the case and control groups 1624 (3.08%) and 4053 (1.92%) patients had HF, respectively, indicating that HF was associated with an increased risk of suicide (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.59-1.79). The risk of suicide was highest during the initial 6 months after HF (adjusted OR 7.04, 95% CI 5.37-9.22) and subsequently declined gradually. Among psychiatric disorders, mood disorders (adjusted OR 7.42, 95% CI 7.06-7.79) yielded the highest odds of suicide. CONCLUSIONS The risk of suicide is higher for patients with HF than for healthy individuals without HF. This risk is particularly high during the first 6 months after HF diagnosis. This study provides strong evidence that depression is a negative prognostic factor for patients with HF and increases the risk of suicide. The results suggest that early screening and treatment for depression and suicide risk should be conducted for patients with HF.
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Affiliation(s)
- Chao-Han Liu
- Biomedical Engineering Program, Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei, Taiwan; Division of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ji-Hung Wang
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Shu-Chuan Weng
- Bachelor Degree Program of Golden-Age Well-Being Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Yen-Huang Cheng
- Division of Emergency Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ming-Kung Yeh
- School of Pharmacy, National Defense Medical Center, Taiwan
| | - Meng-Yi Bai
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology & Adjunct Appoint to the Department of Biomedical Engineering, National Defense Medical Center, Taipei, Taiwan.
| | - Jung-Chen Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
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O S S, G V, A R M, N R, S H, A N K. Long-term outcomes of patients admitted with heart failure in a tertiary care center in India. Indian Heart J 2018; 70 Suppl 1:S85-S89. [PMID: 30122244 PMCID: PMC6097166 DOI: 10.1016/j.ihj.2018.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 12/26/2017] [Accepted: 01/08/2018] [Indexed: 10/31/2022] Open
Abstract
There are limited studies on heart failure in Indian population OBJECTIVE: Present study aimed to assess the in-hospital 90-day and two year outcomes in patients with ischemic (IHD-HF) and non ischemic heart failure (NIHD-HF). METHODS Patients with NYHA Class III & IV, who were admitted to our intensive care unit with heart failure (HF), were evaluated and followed up for 2years. RESULTS In our cohort of 287 patients, there were 192 (66.9%) males and 95 (33.1%) females. Patients were divided into IHD-HF of 180 (62.7%) patients and NIHD-HF of 107 (37.3%) patients. Mean age of IHD-HF group was 66 (+/-10) and in the NIHD-HF group was 61 (+/-11). Prevalence of HF increased with age in the IHD-HF population and there was no relation with age in the NIHD-HF population .Patients readmitted within 90days in the IHD-HF were 56% (n-101) and in the NIHD-HF were 32.7% (n-35) [p- 0.001]. Two- year recurrent admissions were 69.4% (n-125) in the IHD-HF patients and 52.3% (n-56) in the NIHD-HF patients, respectively (p-0.004). Mortality at 90days in the IHD-HF patients was 26.6% (n-48) and in NIHD-HF patients were 14.9% (n-16) [p- 0.021]. Two-year mortality was 42.3% (n-76) in the IHD-HF patients and 29.9%(n-32) in the NIHD-HF patients, respectively (p-0.037). CONCLUSIONS HF in IHD-HF heralds a bad prognosis with recurrent hospitalizations and high mortality when compared to patients with NIHD-HF.
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Affiliation(s)
- Suman O S
- Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
| | - Vijayaraghavan G
- Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
| | - Muneer A R
- Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
| | - Ramesh N
- Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
| | - Harikrishnan S
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - Kalyagin A N
- Department of Medicine and Rheumatology, Irkutsk State Medical University, Irkutsk, Russia.
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Fung E, Hui E, Yang X, Lui LT, Cheng KF, Li Q, Fan Y, Sahota DS, Ma BHM, Lee JSW, Lee APW, Woo J. Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us. Front Physiol 2018; 9:347. [PMID: 29740330 PMCID: PMC5928128 DOI: 10.3389/fphys.2018.00347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/20/2018] [Indexed: 12/11/2022] Open
Abstract
Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO) study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management.
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Affiliation(s)
- Erik Fung
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- Faculty of Medicine, Gerald Choa Cardiac Research Centre, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Elsie Hui
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine and Geriatrics, Shatin Hospital, Sha Tin, Hong Kong
| | - Xiaobo Yang
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Leong T. Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - King F. Cheng
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Qi Li
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yiting Fan
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daljit S. Sahota
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Bosco H. M. Ma
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine and Geriatrics, Shatin Hospital, Sha Tin, Hong Kong
| | - Jenny S. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital and Tai Po Hospital, Tai Po, Hong Kong
| | - Alex P. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- CUHK Jockey Club Institute of Ageing, Chinese University of Hong Kong, Sha Tin, Hong Kong
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El Moheb M, Nicolas J, Iskandarani G, Akl EA, Refaat M. Implantable cardiac defibrillators for patients with non-ischaemic cardiomyopathy. Hippokratia 2017. [DOI: 10.1002/14651858.cd012738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mohamad El Moheb
- American University of Beirut Medical Center; Faculty of Medicine; Beirut Lebanon
| | - Johny Nicolas
- American University of Beirut Medical Center; Faculty of Medicine; Beirut Lebanon
| | - Ghida Iskandarani
- American University of Beirut Medical Center; Faculty of Medicine; Beirut Lebanon
| | - Elie A Akl
- American University of Beirut Medical Center; Department of Internal Medicine; Riad El Solh St Beirut Lebanon
| | - Marwan Refaat
- American University of Beirut Medical Center; Department of Internal Medicine; Riad El Solh St Beirut Lebanon
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González-Robledo G, León J, Buitrago AF, Carvajalino S, Abril D, González V, Morales D, Parra J, Santacruz JG. Cuidado paliativo en falla cardiaca. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Asistencia ventricular izquierda para terapia de destino: primera experiencia en septuagenarios. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jacob J, Miró Ò, Herrero P, Martín-Sánchez F, Gil V, Tost J, Aguirre A, Escoda R, Alquézar A, Andueza J, Llorens P. Predicción de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada: escala EAHFE-3D. Med Intensiva 2016; 40:348-55. [DOI: 10.1016/j.medin.2015.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 02/01/2023]
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Ertl G, Angermann CE, Bekeredjian R, Beyersdorf F, Güder G, Gummert J, Katus HA, Kindermann I, Pauschinger M, Perings S, Raake PWJ, Störk S, Scheidt WV, Welz S, Böhm M. Aufbau und Organisation von Herzinsuffizienz-Netzwerken (HF‑NETs) und Herzinsuffizienz-Einheiten („Heart Failure Units“, HFUs) zur Optimierung der Behandlung der akuten und chronischen Herzinsuffizienz. KARDIOLOGE 2016. [DOI: 10.1007/s12181-016-0072-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sugiyama K, Sasano T, Kurokawa J, Takahashi K, Okamura T, Kato N, Isobe M, Furukawa T. Oxidative Stress Induced Ventricular Arrhythmia and Impairment of Cardiac Function in Nos1ap Deleted Mice. Int Heart J 2016; 57:341-9. [PMID: 27170476 DOI: 10.1536/ihj.15-471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Genome-wide association study has identified that the genetic variations at NOS1AP (neuronal nitric oxide synthase-1 adaptor protein) were associated with QT interval and sudden cardiac death (SCD). However, the mechanism linking a genetic variant of NOS1AP and SCD is poorly understood. We used Nos1ap knockout mice (Nos1ap(-/-)) to determine the involvement of Nos1ap in SCD, paying special attention to oxidative stress.At baseline, a surface electrocardiogram (ECG) and ultrasound echocardiography (UCG) showed no difference between Nos1ap(-/-) and wild-type (WT) mice. Oxidative stress was induced by a single injection of doxorubicin (Dox, 25 mg/kg). After Dox injection, Nos1ap(-/-) showed significantly higher mortality than WT (93.3 versus 16.0% at day 14, P < 0.01). ECG showed significantly longer QTc in Nos1ap(-/-) than WT, and UCG revealed significant reduction of fractional shortening (%FS) only in Nos1ap(-/-) after Dox injection. Spontaneous ventricular tachyarrhythmias were documented by telemetry recording after Dox injection only in Nos1ap(-/-). Ex vivo optical mapping revealed that the action potential duration (APD)90 was prolonged at baseline in Nos1ap(-/-), and administration of Dox lengthened APD90 more in Nos1ap(-/-) than in WT. The expression of Bnp and the H2O2 level were higher in Nos1ap(-/-) after Dox injection. Nos1ap(-/-) showed a reduced amplitude of calcium transient in isolated cardiomyocytes after Dox injection. Administration of the antioxidant N-acetyl-L-cysteine significantly reduced mortality of Nos1ap(-/-) by Dox injection, accompanied by prevention of QT prolongation and a reduction in %FS.Although Nos1ap(-/-) mice have apparently normal hearts, oxidative stress evokes ventricular tachyarrhythmia and heart failure, which may cause sudden cardiac death.
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Affiliation(s)
- Koji Sugiyama
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
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Abstract
Careful review of the literature of the last 20 years since the appearance of the first positive trials in heart failure indicates an evolution in the mode of death moving from sudden death to a predominance of pump failure death (i.e., death due to progression of heart failure). Pump failure is becoming a leading cause of mortality in a range of patient profiles, including patients with newly diagnosed or severe heart failure, patients with devices, and patients with heart failure associated with Chagas' disease. Indeed, the evidence suggests that modern management strategies, such as beta-blockers and devices, are successful in preventing sudden death. However, this means that optimally treated patients are at greater risk for the consequences of pump failure (death, hospitalization, and reduced quality of life). This highlights a new important unmet need in heart failure, and a priority for current research should be therapies that reduce pump failure death and hospitalization for more cost-effective management of the disease. Insofar as one-third of heart failure patients do not survive more than 3 years after diagnosis, properly addressing pump failure is an essential target in heart failure.
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Rodríguez-Reyes H, Muñoz Gutiérrez M, Márquez MF, Pozas Garza G, Asensio Lafuente E, Ortíz Galván F, Lara Vaca S, Mariona Montero VA. [Sudden cardiac death. Risk stratification, prevention and treatment]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:329-36. [PMID: 26253348 DOI: 10.1016/j.acmx.2015.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/01/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | - Manlio F Márquez
- Servicio de Electrocardiología, Instituto Nacional de Cardiología Ignacio Chávez, México, México
| | - Gerardo Pozas Garza
- Servicio de Cardiología, Hospital San José Tecnológico de Monterrey, Monterrey, México
| | | | - Fernando Ortíz Galván
- Centro Universitario del Sur (CUSUR), Universidad de Guadalajara, Cd. Guzmán, Jalisco, México
| | - Susano Lara Vaca
- Servicio de Arritmias, Centro Médico IMSS, León Guanajuato, México
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Sarría-Santamera A, Prado-Galbarro FJ, Martín-Martínez MA, Carmona R, Gamiño Arroyo AE, Sánchez-Piedra C, Garrido Elustondo S, del Cura González I. [Survival of patients with heart failure in primary care]. Aten Primaria 2014; 47:438-45. [PMID: 25487462 PMCID: PMC6983774 DOI: 10.1016/j.aprim.2014.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 03/11/2014] [Accepted: 03/26/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe survival of patients with chronic heart failure (HF) followed up in primary care (PC) and analyse the effect of sex, age, clinical and health services factors, and income levels on survival. DESIGN Longitudinal observational study of a retrospective cohort of patients with information extracted from electronic medical records. SETTING PC Area 7 of the Community of Madrid. PARTICIPANTS Patients 24 year and older with at least one visit to PC in 2006. PRINCIPAL MEASUREMENT Incident cases of HF followed up from 2006 to 2010 or until death. Survival analysis with Kaplan-Meier and Cox proportional hazard multivariate regression. RESULTS A total of 3,061 cases were identified in a cohort of 227,984 patients. The survival rate was 65% at 5 years, with 519 patients dying with a median survival of 49 months. Factors associated with increased risk of mortality were, age (HR=1.04, 1.03-1.05), and having a diagnosis of ischemic heart disease (HR=1.45, 1.15- 1.78), or diabetes (HR=1.52, 1.17-1.95). Factors with a significant protective effect were: female sex (HR=0.72, 0.59-0.86), non-pensioner (HR=0.43, 0.23-0.84), having received the influenza vaccine annually (HR=0.01, 0.00-0.06), prescribed lipid-lowering drugs (HR=0.78, 0.61-0.99) or ACE inhibitors (HR=0.73, 0.60-0.88), and blood tests having been requested (HR=0.97, 0.95-1.00), X-rays (HR=0.81, 0.74-0.88), or electrocardiograms (HR=0.90, 0.81-0.99) in PC. CONCLUSIONS Data from patients with HF followed up in PC indicate that their survival is better than that obtained in other countries, supporting the argument of a better evolution of HF in Mediterranean countries.
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Affiliation(s)
- Antonio Sarría-Santamera
- Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, España; Unidad Docente de Ciencias Sanitarias y Médico Sociales, Universidad de Alcalá, Alcalá de Henares, Madrid, España; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), España.
| | | | | | - Rocío Carmona
- Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, España
| | | | | | - Sofía Garrido Elustondo
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), España; Unidad de Investigación de Atención Primaria de Madrid, Madrid, España
| | - Isabel del Cura González
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), España; Unidad de Investigación de Atención Primaria de Madrid, Madrid, España; Departamento de Medicina Preventiva, Universidad Rey Juan Carlos, Madrid, España
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Wu-Wong JR, Nakane M, Chen YW, Mizobuchi M. Mechanistic analysis for time-dependent effects of cinacalcet on serum calcium, phosphorus, and parathyroid hormone levels in 5/6 nephrectomized rats. Physiol Rep 2013; 1:e00046. [PMID: 24303131 PMCID: PMC3835002 DOI: 10.1002/phy2.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 07/05/2013] [Accepted: 07/08/2013] [Indexed: 12/21/2022] Open
Abstract
This study investigates the time-dependent effects of cinacalcet on serum calcium, phosphorus, and parathyroid hormone (PTH) levels in 5/6 nephrectomized (NX) rats with experimental chronic renal insufficiency. In this study, 5/6 NX male, Sprague-Dawley rats were treated with vehicle or cinacalcet (10 mg/kg, oral, 1× daily). On Day 0 (before treatment), Day 12 and 13 after treatment (to approximate the clinical practice), and also at 0, 1, 4, 8, 16, and 24 hours after the last dosing, blood was collected for analysis. After 12 or 13 days of cinacalcet treatment, modest changes were observed in serum Ca and phosphorus (Pi), while PTH decreased by >45% to Sham levels (152 ± 15 pg/mL). Detailed mapping found that cinacalcet caused a significant time-dependent decrease in serum Ca following dosing, reaching a lowest point at 8 hours (decrease by 20% to 8.43 ± 0.37 mg/dL), and then returning to normal at 24 hours. Cinacalcet also caused a significant increase in serum Pi levels (by 18%). To investigate the potential mechanism of action, a broad approach was taken by testing cinacalcet in a panel of 77 protein-binding assays. Cinacalcet interacted with several channels, transporters, and neurotransmitter receptors, some of which are involved in brain and heart, and may impact Ca homeostasis. Cinacalcet dose-dependently increased brain natriuretic peptide (BNP) mRNA expression by 48% in cardiomyocytes, but had no significant effects on left ventricular hypertrophy and cardiac function. The results suggest that cinacalcet's hypocalcemic effect may be due to its nonspecific interaction with other receptors in brain and heart.
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Affiliation(s)
- J Ruth Wu-Wong
- Department of Pharmacy Practice, University of Illinois at Chicago Chicago, Illinois
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Diez-Quevedo C, Lupón J, González B, Urrutia A, Cano L, Cabanes R, Altimir S, Coll R, Pascual T, de Antonio M, Bayes-Genis A. Depression, antidepressants, and long-term mortality in heart failure. Int J Cardiol 2013; 167:1217-25. [DOI: 10.1016/j.ijcard.2012.03.143] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 02/08/2012] [Accepted: 03/15/2012] [Indexed: 01/06/2023]
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Epidemiology of heart failure in Spain over the last 20 years. ACTA ACUST UNITED AC 2013; 66:649-56. [PMID: 24776334 DOI: 10.1016/j.rec.2013.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 03/26/2013] [Indexed: 11/22/2022]
Abstract
Heart failure is a major health care problem in Spain, although its precise impact is unknown due to the lack of data from appropriately designed studies. In contrast with the 2% prevalence of heart failure elsewhere in Europe and in the United States, studies in Spain report figures of 5%, probably because of methodological limitations. Heart failure consumes enormous quantities of health care resources; it is the first cause of hospitalization in persons aged 65 years or older and represents 3% of all hospital admissions and 2.5% of health care costs. There are two patterns of heart failure: one with preserved systolic function, more often associated with high blood pressure, and another with depressed systolic function, more often associated with ischemic heart disease. In 2010, heart failure accounted for 3% of all deaths in men and for 10% of all deaths in women. In recent years, the mortality rate from heart failure has gradually fallen. The rise in hospital admissions for heart failure and the decrease in mortality from this cause could partly be explained by temporary changes in diagnostic coding, but there is evidence that the reduced mortality could also be due to adherence to clinical practice guidelines.
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Frigola-Capell E, Comin-Colet J, Davins-Miralles J, Gich-Saladich IJ, Wensing M, Verdú-Rotellar JM. Supervivencia de pacientes ambulatorios con insuficiencia cardiaca crónica del área mediterránea. Un estudio de base poblacional. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Survival in Mediterranean ambulatory patients with chronic heart failure. A population-based study. ACTA ACUST UNITED AC 2013; 66:539-44. [PMID: 24776202 DOI: 10.1016/j.rec.2013.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 03/13/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Scarce research has been performed in ambulatory patients with chronic heart failure in the Mediterranean area. Our aim was to describe survival trends in our target population and the impact of prognostic factors. METHODS We carried out a population-based retrospective cohort study in Catalonia (north-east Spain) of 5659 ambulatory patients (60% women; mean age 77 [10] years) with incident chronic heart failure. Eligible patients were selected from the electronic patient records of primary care practices from 2005 and were followed-up until 2007. RESULTS During the follow-up period deaths occurred in 950 patients (16.8%). Survival after the onset of chronic heart failure at 1, 2, and 3 years was 90%, 80%, 69%, respectively. No significant differences in survival were found between men and women (P=.13). Cox proportional hazard modelling confirmed an increased risk of death with older age (hazard ratio=1.06; 95% confidence interval, 1.06-1.07), diabetes mellitus (hazard ratio=1.53; 95% confidence interval, 1.33-1.76), chronic kidney disease (hazard ratio=1.73; 95% confidence interval, 1.45-2.05), and ischemic heart disease (hazard ratio=1.18; 95% confidence interval, 1.02-1.36). Hypertension (hazard ratio=0.73; 95% confidence interval, 0.64-0.84) had a protective effect. CONCLUSIONS Service planning and prevention programs should take into consideration the relatively high survival rates found in our area and the effect of prognostic factors that can help to identify high risk patients.
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Wu-Wong JR, Kawai M, Chen YW, Wessale JL, Huang CJ, Wu MT, Nakane M. Two novel vitamin D receptor modulators with similar structures exhibit different hypercalcemic effects in 5/6 nephrectomized uremic rats. Am J Nephrol 2013; 37:310-9. [PMID: 23548814 DOI: 10.1159/000348755] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/07/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Vitamin D receptor modulators (VDRMs) are indicated for secondary hyperparathyroidism in chronic kidney disease (CKD). Clinical observations demonstrate that VDRM therapy provides cardiovascular (CV) benefit in CKD. Current on-market VDRMs have a narrow therapeutic index at 1- to 4-fold [hypercalcemic toxicity vs. parathyroid hormone (PTH)-suppressing efficacy]. Hypercalcemia leads to the need for frequent drug dose titration and serum calcium (Ca) monitoring. A VDRM with a wider therapeutic index and beneficial CV effects will be clinically useful. METHODS Two structurally similar VDRMs were tested in the 5/6 nephrectomized (NX) rats with elevated PTH, endothelial dysfunction and left ventricular hypertrophy. RESULTS VS-110 and VS-411 at 0.01-1 μg/kg (i.p. 3 times/week for 2 weeks) suppressed serum PTH effectively. VS-411 raised serum Ca with an 11% increase at 0.01 μg/kg (therapeutic index = ~1-fold), while VS-110 did not raise serum Ca even at 1 μg/kg (therapeutic index >50-fold). VS-110 improved endothelium-dependent aortic relaxation in a dose-dependent manner and significantly reduced left ventricular fibrosis without affecting serum Ca. VS-411 also exhibited effects on the CV parameters, but was less potent at the high doses with severe hypercalcemia. VS-110 and VS-411 specifically activated the reporter gene via a chimeric receptor containing the VDR ligand binding domain with EC(50) <0.1 nM. CONCLUSIONS Structurally similar VDRMs can exhibit distinctly different hypercalcemic effects in 5/6 NX uremic rats. While differences exist for the Ca and CV effects of VS-110 and VS-411, the clinical implications are unclear. VS-110's results are promising but clinical outcome studies need to be performed.
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Sakamoto A, Fujishiro M, Koike K, Nagai R, Ishizaka N. The prevalence of malignant neoplastic and non-malignant gastrointestinal lesions in cardiology inpatients. J Cardiol 2013. [DOI: 10.1016/j.jjcc.2012.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Egstrup M, Schou M, Tuxen CD, Kistorp CN, Hildebrandt PR, Gustafsson F, Faber J, Goetze JP, Gustafsson I. Prediction of outcome by highly sensitive troponin T in outpatients with chronic systolic left ventricular heart failure. Am J Cardiol 2012; 110:552-7. [PMID: 22579083 DOI: 10.1016/j.amjcard.2012.04.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/17/2012] [Accepted: 04/17/2012] [Indexed: 11/29/2022]
Abstract
Our aim was to assess the prognostic impact of a high-sensitivity cardiac troponin T (hs-cTnT) assay in an outpatient population with chronic systolic left ventricular heart failure (HF). Four hundred sixteen patients with chronic HF and left ventricular ejection fraction ≤ 45% were enrolled in a prospective cohort study. In addition to hs-cTnT, plasma amino-terminal pro-B-type natriuretic peptide was measured at baseline. Mean age was 71 years, 29% were women, 62% had coronary artery disease (CAD), mean left ventricular ejection fraction was 31%, and 57% had abnormal level of hs-cTnT. During 4.4 years of follow-up, 211 (51%) patients died. In multivariate Cox regression models, hs-cTnT was categorized as quartiles or dichotomized by the 99th percentile of a healthy population. Adjusted hazard ratios for all-cause mortality for quartiles 2 to 4, with quartile 1 as reference, were 1.4 (95% confidence interval 0.9 to 2.4, p = 0.16) for quartile 2, 1.7 (0.9 to 2.5, p = 0.12) for quartile 3, and 2.6 (1.6 to 4.4, p <0.001) for quartile 4 and 1.7 (1.2 to 2.5, p = 0.003) for abnormal versus normal level of hs-cTnT. In patients without CAD, quartile 4 of hs-cTnT was associated with an adjusted hazard ratio of 6.8. In conclusion, hs-cTnT is increased in most outpatients with chronic systolic HF and carries prognostic information beyond clinical parameters and amino-terminal pro-B-type natriuretic peptide. Increased hs-cTnT indicated a particularly deleterious prognosis in patients without CAD.
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Affiliation(s)
- Michael Egstrup
- Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Frederiksberg, Denmark.
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Wu-Wong JR, Kawai M, Chen YW, Nakane M. VS-105: a novel vitamin D receptor modulator with cardiovascular protective effects. Br J Pharmacol 2012; 164:551-60. [PMID: 21557735 DOI: 10.1111/j.1476-5381.2011.01473.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Vitamin D receptor (VDR) modulators (VDRMs) such as calcitriol, paricalcitol and doxercalciferol are commonly used to manage hyperparathyroidism secondary to chronic kidney disease (CKD). CKD patients experience extremely high risks of cardiovascular morbidity and mortality. Clinical observations show that VDRM therapy may be associated with cardio-renal protective and survival benefits for CKD patients. However, hypercalcaemia remains a serious side effect for current VDRMs, which leads to the need for frequent dose titration and serum Ca (calcium) monitoring. Significant clinical benefits can be derived from a VDRM with cardiovascular protective effects without the hypercalcaemic liability. EXPERIMENTAL APPROACH Male Sprague-Dawley rats were 5/6 nephrectomized and 6 weeks later, after they had established uraemia, elevated parathyroid hormone levels, endothelial dysfunction and left ventricular hypertrophy, the rats were treated with VS-105, a novel VDRM. The effects of VS-105 were also tested in cultured HL-60 cells. KEY RESULTS VS-105 induced HL-60 cell differentiation with an EC₅₀ value at 11.8 nM. Treatment (i.p., 3× a week over a period of 2 weeks) of the 5/6 nephrectomized rats by VS-105 (0.004-0.64 µg·kg⁻¹) effectively suppressed serum parathyroid hormone without raising serum Ca or phosphate levels. Furthermore, 2 weeks of treatment with VS-105 improved endothelium-dependent aortic relaxation and attenuated left ventricular abnormalities in a dose range that did not affect serum Ca levels. Similar results were obtained when VS-105 was administered i.p. or by oral gavage. CONCLUSIONS AND IMPLICATIONS VS-105 exhibits an overall therapeutic product profile that supports expanded use in CKD to realize the cardiovascular protective effects of VDR activation.
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Gastrointestinal malignancies and cardiovascular diseases—Non-negligible comorbidity in an era of multi-antithrombotic drug use. J Cardiol 2011; 58:199-207. [DOI: 10.1016/j.jjcc.2011.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 07/19/2011] [Accepted: 08/18/2011] [Indexed: 12/23/2022]
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Kuzmicic J, Del Campo A, López-Crisosto C, Morales PE, Pennanen C, Bravo-Sagua R, Hechenleitner J, Zepeda R, Castro PF, Verdejo HE, Parra V, Chiong M, Lavandero S. [Mitochondrial dynamics: a potential new therapeutic target for heart failure]. Rev Esp Cardiol 2011; 64:916-23. [PMID: 21820793 DOI: 10.1016/j.recesp.2011.05.018] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/31/2011] [Indexed: 12/19/2022]
Abstract
Mitochondria are dynamic organelles able to vary their morphology between elongated interconnected mitochondrial networks and fragmented disconnected arrays, through events of mitochondrial fusion and fission, respectively. These events allow the transmission of signaling messengers and exchange of metabolites within the cell. They have also been implicated in a variety of biological processes including embryonic development, metabolism, apoptosis, and autophagy. Although the majority of these studies have been confined to noncardiac cells, emerging evidence suggests that changes in mitochondrial morphology could participate in cardiac development, the response to ischemia-reperfusion injury, heart failure, and diabetes mellitus. In this article, we review how the mitochondrial dynamics are altered in different cardiac pathologies, with special emphasis on heart failure, and how this knowledge may provide new therapeutic targets for treating cardiovascular diseases.
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Affiliation(s)
- Jovan Kuzmicic
- Centro Estudios Moleculares de la Célula, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago, Chile
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Aguilar JC. La insuficiencia cardíaca en el siglo XXI. Epidemiología y consecuencias económicas. CIRUGIA CARDIOVASCULAR 2011. [DOI: 10.1016/s1134-0096(11)70062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Frankenstein L, Clark AL, Ribeiro JP. Influence of sex on treatment and outcome in chronic heart failure. Cardiovasc Ther 2011; 30:182-92. [PMID: 21599874 DOI: 10.1111/j.1755-5922.2010.00253.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The population is aging, the prevalence of heart failure increases with age, and on average women live longer than men. There is evidence for sex-specific effects of individual, guideline-recommended drugs used for treatment of chronic heart failure. Women are underrepresented in most clinical trials and only a minority of drug applications to regulatory authorities have included sex analyses. The present review focuses on the potential female survival benefit in heart failure, the influence of sex on medical treatment in a broader sense, and the potential benefit to be derived from guideline recommended treatment and common adjunctive heart failure medication.
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Affiliation(s)
- Lutz Frankenstein
- Department of Cardiology, Angiology, Pulmonology, University of Heidelberg, Germany.
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