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Schjødt I, Mols RE, Bakos I, Horváth‐Puhó E, Gustafsson F, Kristensen SL, Larsson JE, Christensen B, Eiskjær H, Løgstrup BB. Socio-economic position, multimorbidity, and health care utilization among Danish left ventricular assist device patients. ESC Heart Fail 2024; 11:1919-1931. [PMID: 38488159 PMCID: PMC11287312 DOI: 10.1002/ehf2.14750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/19/2024] [Indexed: 07/31/2024] Open
Abstract
AIMS Increasing numbers of patients with advanced heart failure and significant comorbidity and social barriers are considered for left ventricular assist devices (LVADs). We sought to examine health care utilization post-LVAD implantation, including the influence of individual-level socio-economic position and multimorbidity. METHODS AND RESULTS We conducted a Danish nationwide cohort study linking individual-level data from clinical LVAD databases, the Scandiatransplant Database, and Danish national medical and administrative registries. Socio-economic position included cohabitation status, educational level, and employment status. Multimorbidity was defined as two or more chronic conditions from at least two chronic disease groups. Health care utilization (hospital activity, general practice activity, and redeemed medical prescriptions) within 2 years post-discharge after LVAD implantation was evaluated using descriptive statistics at 0.5 year intervals. We identified 119 patients discharged alive with first-time LVAD implanted between 2006 and 2018. The median age of the patients was 56.1 years, and 88.2% were male. Patients were followed until heart transplantation, LVAD explantation, death, 31 December 2018, or for 2 years. The median follow-up was 0.8 years. The highest median use of health care services was observed 0-0.5 years post-LVAD discharge compared with the subsequent follow-up intervals: 0.5-1, 1-1.5, and 1.5-2 years, respectively. The median (interquartile range) number of hospitalizations was 10 (7-14), bed days 14 (9-28), outpatient visits 8 (5-12), telephone contacts with a general practitioner 4 (2-8), and total redeemed medical prescriptions 26 (19-37) within 0-0.5 years post-LVAD discharge compared with the median utilization within the consecutive follow-up periods [e.g. within 0.5-1 year: hospitalizations 5 (3-8), bed days 8 (4-14), outpatient visits 5 (3-8), telephone contacts 2 (0-5), and redeemed medical prescriptions 24 (18-30)]. The median use of health care services was stable from 0.5 years onwards. The median number of hospitalizations and bed days was slightly higher in patients living alone with a low educational level or low employment status within 0-0.5 years post-LVAD implantation. Finally, the median number of in-hospital days and redeemed prescriptions was higher among patients with pre-existing multimorbidity. CONCLUSIONS Among patients who underwent LVAD implantation, health care utilization was high in the early post-LVAD discharge phase and was influenced by socio-economic position. Multimorbidity influenced the number of in-hospital days and redeemed prescriptions during the 2 year follow-up.
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Affiliation(s)
- Inge Schjødt
- Department of CardiologyAarhus University HospitalPalle Juul‐Jensens Boulevard 99AarhusDenmark
| | - Rikke E. Mols
- Department of CardiologyAarhus University HospitalPalle Juul‐Jensens Boulevard 99AarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - István Bakos
- Department of Clinical EpidemiologyAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Erzsébet Horváth‐Puhó
- Department of Clinical EpidemiologyAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Finn Gustafsson
- Department of CardiologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Søren L. Kristensen
- Department of CardiologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Johan E. Larsson
- Department of CardiologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Bo Christensen
- Department of Public Health, Research Unit for General PracticeAarhus UniversityAarhusDenmark
- Research Unit for General PracticeAarhus UniversityAarhusDenmark
| | - Hans Eiskjær
- Department of CardiologyAarhus University HospitalPalle Juul‐Jensens Boulevard 99AarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Brian B. Løgstrup
- Department of CardiologyAarhus University HospitalPalle Juul‐Jensens Boulevard 99AarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
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2
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Larsson JE, Kristensen SL, Deis T, Warming PE, Graversen PL, Schou M, Køber L, Rossing K, Gustafsson F. Influence of socioeconomic status on rates of advanced heart failure therapies. J Heart Lung Transplant 2024; 43:920-930. [PMID: 38408549 DOI: 10.1016/j.healun.2024.02.1452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/15/2024] [Accepted: 02/18/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Socioeconomic deprivation is associated with a lower likelihood of referral for advanced heart failure (HF) evaluation, but it is not known whether it influences rates of advanced HF therapies independently of key hemodynamic measures and comorbidity following advanced HF evaluation in a universal healthcare system. METHODS We linked data from a single-center Danish clinical registry of consecutive patients evaluated for advanced HF with patient-level information on socioeconomic status. Patients were divided into groups based on the level of education (low, medium, and high), combined degree of socioeconomic deprivation (low, medium, and high), and household income quartiles. Rates of the combined outcome of left ventricular assist device implantation or heart transplantation (advanced HF therapy) with death as a competing risk were estimated with cumulative incidence functions, and Cox proportional hazards models adjusted for age, sex, central venous pressure, cardiac index, and comorbidities. RESULTS We included 629 patients, median age 53 years, of whom 77% were men. During a median follow-up of 5 years, 179 (28%) underwent advanced HF therapy. The highest level of education was associated with higher rates (high vs low, adjusted HR 1.81 95% CI 1.14-2.89, p = 0.01), whereas household income quartile groups (Q4 vs Q1, adjusted HR 1.37 95% CI 0.76-2.47, p = 0.30) or groups of combined socioeconomic deprivation (high vs low degree of deprivation, adjusted HR 0.86 95% CI 0.50-1.46, p = 0.56) were not significantly associated with rates of advanced HF therapy. CONCLUSIONS Patients with a lower level of education might be disfavored for advanced HF therapies and could require specific attention in the advanced HF care center.
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Affiliation(s)
- Johan E Larsson
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Søren Lund Kristensen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tania Deis
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peder E Warming
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter L Graversen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Schou
- Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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3
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Shakoor A, Abou Kamar S, Malgie J, Kardys I, Schaap J, de Boer RA, van Mieghem NM, van der Boon RMA, Brugts JJ. The different risk of new-onset, chronic, worsening, and advanced heart failure: A systematic review and meta-regression analysis. Eur J Heart Fail 2024; 26:216-229. [PMID: 37823229 DOI: 10.1002/ejhf.3048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
AIMS Heart failure (HF) is a chronic and progressive syndrome associated with a poor prognosis. While it may seem intuitive that the risk of adverse outcomes varies across the different stages of HF, an overview of these risks is lacking. This study aims to determine the risk of all-cause mortality and HF hospitalizations associated with new-onset HF, chronic HF (CHF), worsening HF (WHF), and advanced HF. METHODS AND RESULTS We performed a systematic review of observational studies from 2012 to 2022 using five different databases. The primary outcomes were 30-day and 1-year all-cause mortality, as well as 1-year HF hospitalization. Studies were pooled using random effects meta-analysis, and mixed-effects meta-regression was used to compare the different HF groups. Among the 15 759 studies screened, 66 were included representing 862 046 HF patients. Pooled 30-day mortality rates did not reveal a significant distinction between hospital-admitted patients, with rates of 10.13% for new-onset HF and 8.11% for WHF (p = 0.10). However, the 1-year mortality risk differed and increased stepwise from CHF to advanced HF, with a rate of 8.47% (95% confidence interval [CI] 7.24-9.89) for CHF, 21.15% (95% CI 17.78-24.95) for new-onset HF, 26.84% (95% CI 23.74-30.19) for WHF, and 29.74% (95% CI 24.15-36.10) for advanced HF. Readmission rates for HF at 1 year followed a similar trend. CONCLUSIONS Our meta-analysis of observational studies confirms the different risk for adverse outcomes across the distinct HF stages. Moreover, it emphasizes the negative prognostic value of WHF as the first progressive stage from CHF towards advanced HF.
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Affiliation(s)
- Abdul Shakoor
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Sabrina Abou Kamar
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jishnu Malgie
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jeroen Schaap
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Robert M A van der Boon
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
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Dicks AB, Lakhter V, Elgendy IY, Schainfeld RM, Mohapatra A, Giri J, Weinberg MD, Weinberg I, Parmar G. Mortality differences by race over 20 years in individuals with peripheral artery disease. Vasc Med 2023; 28:214-221. [PMID: 37010137 DOI: 10.1177/1358863x231159947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Racial disparities exist in patients with peripheral artery disease (PAD), with Black individuals having worse PAD-specific outcomes. However, mortality risk in this population has been mixed. As such, we sought to evaluate all-cause mortality by race among individuals with PAD. METHODS We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Baseline data were obtained from 1999 to 2004. Patients with PAD were grouped according to self-reported race. Multivariable Cox proportional hazards regression was performed to calculate adjusted hazard ratios (HR) by race. A separate analysis was performed to study the effect of burden of social determinants of health (SDoH) on all-cause mortality. RESULTS Of 647 individuals identified, 130 were Black and 323 were White. Black individuals had more premature PAD (30% vs 20%, p < 0.001) and a higher burden of SDoH compared to White individuals. Crude mortality rates were higher in Black individuals in the 40-49-year and 50-69-year age groups compared to White individuals (6.7% vs 6.1% and 8.8% vs 7.8%, respectively). Multivariable analysis demonstrated that Black individuals with both PAD and coronary artery disease (CAD) had a 30% higher hazard of death over 20 years compared to White individuals (HR = 1.3, 95% CI: 1.0-2.1). The cumulative burden of SDoH marginally (10-20%) increased the risk of all-cause mortality. CONCLUSIONS In a nationally representative sample, Black individuals with PAD and CAD had higher rates of mortality compared to their White counterparts. These findings add further proof to the ongoing racial disparities among Black individuals with PAD and highlight the necessity to identify ways to mitigate these differences.
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Affiliation(s)
- Andrew B Dicks
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine - Greenville, Greenville, SC, USA
| | - Vladimir Lakhter
- Division of Cardiovascular Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Robert M Schainfeld
- Section of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School Teaching Hospital, Boston, MA, USA
| | - Abhisekh Mohapatra
- Division of Vascular Surgery, Massachusetts General Hospital, Harvard Medical School Teaching Hospital, Boston, MA, USA
| | - Jay Giri
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mitchell D Weinberg
- Department of Cardiology, Northwell Health, Zucker School of Medicine at Hosftra/Northwell, Staten Island University Hospital, Staten Island, NY, USA
| | - Ido Weinberg
- Section of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School Teaching Hospital, Boston, MA, USA
| | - Gaurav Parmar
- Section of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School Teaching Hospital, Boston, MA, USA
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5
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Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 2023; 118:3272-3287. [PMID: 35150240 DOI: 10.1093/cvr/cvac013] [Citation(s) in RCA: 619] [Impact Index Per Article: 619.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/08/2022] [Indexed: 01/25/2023] Open
Abstract
Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the ageing of the population, improved treatment of and survival with ischaemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Moritz Becher
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Giuseppe M C Rosano
- St George's Hospital Medical School, London, UK.,IRCCS San Raffaele Roma, Rome, Italy
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Parati G, Halasz G, Piepoli MF. Editorial comments: Focus on pharmacological management. Eur J Prev Cardiol 2022; 29:1813-1816. [DOI: 10.1093/eurjpc/zwac222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Gianfranco Parati
- Council on Hypertension, European Society of Cardiology, University of Milano-Bicocca and IRCCS, Istituto Auxologico Italiano, Milan 20122 , Italy
| | - Geza Halasz
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza , Piacenza 29121 , Italy
| | - Massimo F Piepoli
- Clinical Cardiology, Policlinico San Donato, University of Milan , S. Donato Milanes 20097 , Italy
- Department of Preventive Cardiology, Wroclaw Medical University , 50-367 Wrocław , Poland
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7
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García R, Muñoz MA, Navas E, Vinyoles E, Verdú-Rotellar JM, Del Val JL. Variability in Cardiovascular Risk Factor Control in Patients with Heart Failure According to Gender and Socioeconomic Status. J Womens Health (Larchmt) 2022; 31:690-697. [PMID: 35041531 DOI: 10.1089/jwh.2021.0404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Despite considerable evidence concerning heart failure (HF) risk factors, there is scarce information about the effect and degree of control regarding socioeconomic and gender inequalities. Methods: Cohort study including HF patients >40 years of age attended in 53 primary health care centers in Barcelona (Spain). Socioeconomic status (SES) was determined by an aggregated deprivation index (MEDEA) according to the neighborhood of residence. Logistic multivariable regression was performed to analyze differences in cardiovascular risk factor control, stratifying by SES and sex. Results: A total of 8235 HF patients were included. Mean age was 78.1 (standard deviation 10.2) years, and 56.0% were women. The most prevalent cardiovascular risk factors were hypertension, diabetes, and dyslipidemia. Blood pressure was the worst controlled factor in both genders with the lowest SES (odds ratio [OR] 0.56 95% confidence interval [CI] 0.56-0.71) and (OR 0.52, 0.46-0.71), respectively. In women, a social gradient was observed for glycemic and body mass index control, which were worse in the most unfavorable socioeconomic position (OR 0.54, 95% CI 0.38-0.77), and (OR 0.45, 95% CI 0.32-0.64), respectively. Men presented worse control of blood pressure (OR 0.55, 95% CI 0.42-0.71) and smoking habit (OR 0.67, 95% CI 0.47-0.90) in the most deprived socioeconomic bracket. Conclusions: Patients with HF in the most disadvantaged socioeconomic levels presented the worst degree of control for cardiovascular risk factors, and this negative effect was stronger in women.
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Affiliation(s)
- Raquel García
- Institut Català de la Salut, Barcelona, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Department of Pediatrics, Obstetrics and Ginecology and Preventive Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Miguel-Angel Muñoz
- Institut Català de la Salut, Barcelona, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Department of Pediatrics, Obstetrics and Ginecology and Preventive Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Elena Navas
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Ernest Vinyoles
- Institut Català de la Salut, Barcelona, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Jose-Maria Verdú-Rotellar
- Institut Català de la Salut, Barcelona, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - José-Luis Del Val
- Institut Català de la Salut, Barcelona, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
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Ge Y, Zhang L, Gao Y, Wang B, Zheng X. Socio-economic status and 1 year mortality among patients hospitalized for heart failure in China. ESC Heart Fail 2022; 9:1027-1037. [PMID: 34994074 PMCID: PMC8934978 DOI: 10.1002/ehf2.13762] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/19/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS This study explored the association between socio-economic status (SES) and mortality among patients hospitalized for heart failure (HF) in China. METHODS AND RESULTS We used data from the China Patient-centred Evaluative Assessment of Cardiac Events-Prospective Heart Failure Study (China PEACE 5p-HF Study), which enrolled patients hospitalized primarily for HF from 52 hospitals between 2016 and 2018. SES was measured using the income, employment status, educational attainment, and partner status. Individual socio-economic risk factor (SERF) scores were assigned based on the number of coexisting SERFs, including low income, unemployed status, low education, and unpartnered status. We assessed the effects of SES on 1 year all-cause mortality using Cox models. We used the Harrell c statistic to investigate whether SES added incremental prognostic information for mortality prediction. A total of 4725 patients were included in the analysis. The median (interquartile range) age was 67 (57-76) years; 37.6% were women. In risk-adjusted analyses, patients with low/middle income [low income: hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.21-2.14; middle income: HR 1.32, 95% CI 1.00-1.74], unemployment status (HR 1.43, 95% CI 1.10-1.86), low education (HR 1.25, 95% CI 1.03-1.53), and unpartnered status (HR 1.22, 95% CI 1.03-1.46) had a higher risk of death than patients with high income, who were employed, who had a high education level, and who had a partner, respectively. Compared with the patients without SERFs, those with 1, 2, 3, and 4 SERFs had 1.52-, 2.01-, 2.45-, and 3.20-fold increased risk of death, respectively. The addition of SES to fully adjusted model improved the mortality prediction, with increments in c statistic of 0.01 (P < 0.01). CONCLUSIONS In a national Chinese cohort of patients hospitalized for HF, low income, unemployment status, low education, and unpartnered status were all associated with a higher risk of death 1 year following discharge. In addition, incorporating SES into a clinical-based model could better identify patients at risk for death. Tailored clinical interventions are needed to mitigate the excess risk experienced by those socio-economic deprived HF patients.
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Affiliation(s)
- Yilan Ge
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
| | - Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
| | - Yan Gao
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
| | - Bin Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
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- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
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9
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Gomes HJDA, Montenegro CEL. Socioeconomic Indicators and Mortality from Heart Failure: Inseparable Parameters? Arq Bras Cardiol 2021; 117:952-953. [PMID: 34817004 PMCID: PMC8682106 DOI: 10.36660/abc.20210826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Helder Jorge de Andrade Gomes
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA) - Faculdade de Medicina de Jundiaí, Jundiaí, SP - Brasil.,Hospital Samaritano de São Paulo, São Paulo, SP - Brasil
| | - Carlos Eduardo Lucena Montenegro
- PROCAPE (Pronto Socorro Cardiológico de Pernambuco) - Universidade de Pernambuco, Recife, PE - Brasil.,Centro Cardiológico Ovídio Montenegro, Recife, PE - Brasil
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10
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Comparative Analysis of Stroke Patients with and without Sequelae: A Cross-Sectional Analysis Using the KOREA National Health and Nutrition Examination Survey (2016-2019). J Clin Med 2021; 10:jcm10184122. [PMID: 34575233 PMCID: PMC8466602 DOI: 10.3390/jcm10184122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: We aimed to evaluate the association between sociodemographic factors and mental health problems and the sequelae of stroke in South Korea by analyzing the annual Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2016 to 2019. (2) Methods: Data were obtained from 32,379 participants who participated in the KNHANES (2016-2019). A total of 567 participants diagnosed with stroke were included in this study. Patients were divided into two groups based on the presence of sequelae: (a) stroke patients with sequelae (n = 227, 40.0%) and (b) stroke patients without sequelae (n = 340, 60.0%). (3) Results: Compared to stroke patients without sequelae, those with sequelae were significantly associated with sex (male, 61.2% vs. 47.6%, p = 0.002), household income (lower half, 78.9% vs. 67.4%, p = 0.005), owning a house (60.4% vs. 68.5%, p = 0.048), marital status (unmarried, 7.05% vs. 1.76%, p < 0.001), depression (13.2% vs. 7.35%, p = 0.045), suicidal ideation (6.17% vs. 3.24%, p = 0.010), and suicide attempts (2.64% vs. 0.88%, p = 0.012). (4) Conclusions: Our study showed that poor sociodemographic factors and mental health problems were significantly associated with sequelae from stroke. Clinical physicians should therefore carefully screen for depression and suicidality in stroke patients with sequelae, especially in those with poor sociodemographic factors.
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11
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Halasz G, Piepoli MF. Editors' presentation: focus on pharmacological interventions. Eur J Prev Cardiol 2021; 28:1-4. [PMID: 33755144 DOI: 10.1093/eurjpc/zwaa166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Geza Halasz
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy
| | - Massimo F Piepoli
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
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Sudevan R. Socioeconomic determinants of heart failure mortality: lessons from Denmark. Eur J Prev Cardiol 2020; 28:76-77. [PMID: 33755141 DOI: 10.1093/eurjpc/zwaa042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Remya Sudevan
- Departments of Health Sciences Research & Cardiology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Amrita lane, Kochi, Ernakulam, Kerala 682041, India
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Andersen J, Gerds TA, Hlatky MA, Gislason G, Schou M, Torp-Pedersen C, Møller S, Madelaire C, Strandberg-Larsen K. The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure: a sex- and cohabitation-stratified study. Eur J Prev Cardiol 2020; 28:78-86. [PMID: 33623976 DOI: 10.1093/eurjpc/zwaa005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022]
Abstract
AIMS Patients with heart failure and low income have a high mortality risk. We examined whether lower survival among low-income patients with heart failure could be explained by different use of β -blockers, renin-angiotensin system inhibitors (RASi), and implanted devices compared with high-income patients. METHODS AND RESULTS We linked Danish national registries to identify patients with new-onset heart failure between 2005 and 2016. A total of 18 308 patients was included in the main analysis. We collected information on medical treatment and device therapy after discharge. We investigated the remaining income disparity if everybody had the same probability of treatment as the high-income patients. We used causal mediation analysis to examine to what extent treatment differences mediate the association between income and 1-year mortality in strata defined by sex and cohabitation status. If low-income patients had the same probability of initiating β-blockers and RASi treatment as high-income patients, low-income men who lived alone would increase initiation of treatment by 12.4% (CI: 10.0% to 14.9%) and as a result reduce their absolute 1-year mortality by 1.0% (CI: -1.4% to -0.5%). If low-income patients had the same probability of not having breaks in medical treatment and getting device therapy, as high-income patients, low-income patients would increase the probability of not having breaks in treatment between 1.8% and 5.8% and increase the probability of getting device therapy between 1.0% and 3.8%, across strata of sex and cohabitation status. CONCLUSION Lower rates of treatment initiation appear to mediate the poorer survival seen among patients with heart failure and low income, but only in males living alone.
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Affiliation(s)
- Julie Andersen
- Department of Research, The Danish Heart Foundation, Vognmagergade 7, 3.sal, 1120 Copenhagen, Denmark
| | - Thomas A Gerds
- Department of Research, The Danish Heart Foundation, Vognmagergade 7, 3.sal, 1120 Copenhagen, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
| | - Mark A Hlatky
- Department of Health Research and Policy, Campus Drive, Stanford University School of Medicine, Stanford, CA, USA
| | - Gunnar Gislason
- Department of Research, The Danish Heart Foundation, Vognmagergade 7, 3.sal, 1120 Copenhagen, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, 2900 Hellerup, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, 2900 Hellerup, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark.,Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Sidsel Møller
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, 2900 Hellerup, Copenhagen, Denmark
| | - Christian Madelaire
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, 2900 Hellerup, Copenhagen, Denmark
| | - Katrine Strandberg-Larsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
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Schjødt I, Johnsen SP, Strömberg A, Valentin JB, Løgstrup BB. Inequalities in heart failure care in a tax-financed universal healthcare system: a nationwide population-based cohort study. ESC Heart Fail 2020; 7:3095-3108. [PMID: 32767628 PMCID: PMC7524228 DOI: 10.1002/ehf2.12938] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/30/2020] [Accepted: 07/16/2020] [Indexed: 12/21/2022] Open
Abstract
Aims Data on socioeconomic‐related differences in heart failure (HF) care are sparse. Inequality in care may potentially contribute to a poor clinical outcome. We examined socioeconomic‐related differences in quality of HF care among patients with incident HF with reduced ejection fraction (EF) (HFrEF). Methods and results We conducted a nationwide population‐based cohort study among patients with HFrEF (EF ≤40%) registered from January 2008 to October 2015 in the Danish Heart Failure Registry, a nationwide registry of patients with a first‐time primary HF diagnosis. Associations between individual‐level socioeconomic factors (cohabitation status, education, and family income) and the quality of HF care defined by six guideline‐recommended process performance measures [New York Heart Association (NYHA) classification, treatment with angiotensin‐converting‐enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), beta‐blockers and mineralocorticoid receptor antagonists, exercise training, and patient education] were assessed using multiple imputation and multivariable logistic regression controlling for potential confounders. Among 17 122 HFrEF patients included, 15 290 patients had data on all six process performance measures. Living alone was associated with lower odds of NYHA classification [adjusted OR (aOR) 0.81; 95% confidence interval (CI): 0.72–0.90], prescription of ACEI/ARB (aOR 0.76; 95% CI: 0.68–0.88) and beta‐blockers (aOR 0.84; 95% CI: 0.76–0.93), referral to exercise training (aOR 0.75; 95% CI: 0.69–0.81), and patient education (aOR 0.73; 95% CI: 0.67–0.80). Compared with high‐level education, low‐level education was associated with lower odds of NYHA classification (aOR 0.93; 95% CI: 0.79–1.11), treatment with ACEI/ARB (aOR 0.99; 95% CI: 0.81–1.20) and beta‐blockers (aOR 0.93; 95% CI: 0.79–1.09), referral to exercise training (aOR 0.73; 95% CI: 0.65–0.82), and patient education (aOR 0.86, 95% CI: 0.75–0.98). An income in the lowest tertile was associated with lower odds of NYHA classification (aOR 0.67; 95% CI: 0.58–0.79), prescription of ACEI/ARB (aOR 0.80, 95% CI: 0.67–0.95) and beta‐blockers (aOR 0.88, 95% CI: 0.86–1.01), referral to exercise training (aOR 0.59, 95% CI: 0.53–0.64), and patient education (aOR 0.66; 95% CI: 0.59–0.74) compared with an income in the highest tertile. Overall, no systematic differences were seen when the analyses were stratified by sex and age groups. Conclusions Living alone, low‐level education, and income in the lowest tertile were associated with reduced use of recommended processes of HF care among Danish HFrEF patients with a first‐time primary HF diagnosis. Efforts are warranted to ensure guideline‐recommended HF care to all HFrEF patients, irrespective of socioeconomic background.
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Affiliation(s)
- Inge Schjødt
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, 8200, Denmark
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Aalborg, Denmark
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden
| | - Jan B Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Aalborg, Denmark
| | - Brian B Løgstrup
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, 8200, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Göbel S, Prochaska JH, Tröbs SO, Panova-Noeva M, Espinola–Klein C, Michal M, Lackner KJ, Gori T, Münzel T, Wild PS. Rationale, design and baseline characteristics of the MyoVasc study: A prospective cohort study investigating development and progression of heart failure. Eur J Prev Cardiol 2020; 28:1009-1018. [DOI: 10.1177/2047487320926438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 01/07/2020] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Heart failure (HF) is a poly-aetiological syndrome with large heterogeneity regarding clinical presentation, pathophysiology, clinical outcome and response to therapy. The MyoVasc study (NCT04064450) is an epidemiological cohort study investigating the development and progression of HF.
Methods
The primary objective of the study is (a) to improve the understanding of the pathomechanisms of HF across the full spectrum of clinical presentation, (b) to investigate the current clinical classifications of HF, and (c) to identify and characterize homogeneous subgroups regarding disease development using a systems-oriented approach. Worsening of HF, that is, the composite of transition from asymptomatic to symptomatic HF, hospitalization due to HF, or cardiac death, was defined as the primary endpoint of the study. During a six-year follow-up period, all study participants receive a highly standardized, biannual five-hour examination in a dedicated study centre, including detailed cardiovascular phenotyping and biobanking of various biomaterials. Annual follow-up examinations are conducted by computer-assisted telephone interviews recording comprehensively the participants´ health status, including subsequent validation and adjudication of adverse events.
Results
In total, 3289 study participants (age range: 35 to 84 years; female sex: 36.8%) including the full range of HF stages were enrolled from 2013 to 2018. Approximately half of the subjects (n=1741) presented at baseline with symptomatic HF (i.e. HF stage C/D). Among these, HF with preserved ejection fraction was the most frequent phenotype.
Conclusions
By providing a large-scale, multi-dimensional biodatabase with sequential, comprehensive medical-technical (sub)clinical phenotyping and multi-omics characterization (i.e. genome, transcriptome, proteome, lipidome, metabolome and exposome), the MyoVasc study will help to advance our knowledge about the heterogeneous HF syndrome by a systems-oriented biomedicine approach.
Trial registration
ClinicalTrials.gov; NCT04064450.
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Affiliation(s)
- Sebastian Göbel
- Centre for Cardiology – Cardiology I, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
| | - Jürgen H Prochaska
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Preventive Cardiology and Preventive Medicine, Centre for Cardiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
- Centre for Thrombosis and Haemostasis, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Sven-Oliver Tröbs
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Preventive Cardiology and Preventive Medicine, Centre for Cardiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Marina Panova-Noeva
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Centre for Thrombosis and Haemostasis, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Christine Espinola–Klein
- Centre for Cardiology – Cardiology I, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Karl J Lackner
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Tommaso Gori
- Centre for Cardiology – Cardiology I, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
| | - Thomas Münzel
- Centre for Cardiology – Cardiology I, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Preventive Cardiology and Preventive Medicine, Centre for Cardiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Philipp S Wild
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Preventive Cardiology and Preventive Medicine, Centre for Cardiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
- Centre for Thrombosis and Haemostasis, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
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