1
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Gagnemo Persson R, Drevenhorn E, Rosén H. Experience and the nutritional relevance of protein-enriched ice cream in patients with heart failure - A pilot study. Heliyon 2024; 10:e33661. [PMID: 39040298 PMCID: PMC11261034 DOI: 10.1016/j.heliyon.2024.e33661] [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: 03/22/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
Background Patients with heart failure have a greater risk of malnutrition and need an enhanced intake of nutrients. Purpose The purpose of the study was to describe how patients admitted to a cardiac intensive care unit with heart failure, experience the intake of a protein-enriched ice cream, served as an in-between meal, and to explore this diet supplement's nutritional relevance in these patients. Method In the pilot study, interviews, and collection of diaries with both a qualitative and quantitative approach were used. Inductive, qualitative content analysis was performed of the interviews while data from the diaries were analysed with descriptive analysis. Results The enriched ice cream supplement was perceived as appealing and tasty despite the patients illness and malaise. Different opinions about consistency were experienced according to the patients' individual condition and they made further flavour suggestions. The patients ingested between 500 and 2550 ml each of the ice cream during the study period. Conclusion The patients' experiences can be valuable in order to improve the in-between meal/food snack thus improving the nutritional status of weak patients lacking appetite. The method used requires to be further developed to assess nutritional relevance for patients when consuming a protein-enriched ice cream.
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Affiliation(s)
| | - Eva Drevenhorn
- Dept of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Helena Rosén
- Dept of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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2
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König S, Pellissier V, Hohenstein S, Leiner J, Schanner C, Kwast S, Müller M, Kuhlen R, Bollmann A. Characteristics and outcome of hospitalized patients with heart failure stratified for chronic kidney disease. ESC Heart Fail 2024. [PMID: 38965818 DOI: 10.1002/ehf2.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/10/2024] [Indexed: 07/06/2024] Open
Abstract
AIMS Heart failure (HF) and chronic kidney disease (CKD) place significant challenges on the healthcare system, and their co-existence is associated with shared adverse outcomes. The multinational CaReMe project was initiated to provide contemporary, real-world epidemiological data on cardiovascular and reno-metabolic diseases. Utilizing data from the German CaReMe cohort, we characterize a multicentric HF population and describe in-hospital outcomes stratified for co-morbid CKD. METHODS AND RESULTS This retrospective, observational study analysed administrative data from inpatient cases hospitalized in 87 German Helios hospitals between 1 January 2016 and 31 August 2022. The first hospitalization of patients aged ≥18 years with a primary discharge diagnosis of HF, based on ICD-10 codes, were considered the index cases, and subsequent hospitalizations were considered as readmissions. Baseline characteristics and outcomes were stratified for co-morbid CKD using ICD-10-encoding from the index cases. Cox regression was utilized for readmission endpoints and in-hospital mortality. In total, 174 829 index cases (mean age 79 ± 15 years, 49.9% female) were included; of these, 55.0% had coexisting CKD. Patients with CKD were older, suffered from worse HF-related symptoms, had a higher co-morbidity burden, and in-hospital mortality was increased at index and during follow-up. Prevalent CKD was associated with higher rehospitalization rates and was an independent predictor for in-hospital death. CONCLUSIONS Within this HF inpatient cohort from a multicentric German database, CKD was diagnosed in more than half of the patients and was associated with increased in-hospital mortality at baseline and during follow-up. Rehospitalizations were observed earlier and more frequently in patients with HF and co-morbid CKD.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Vincent Pellissier
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Sven Hohenstein
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Johannes Leiner
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Carolin Schanner
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Stefan Kwast
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | | | | | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
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3
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Elsner C, Bettin S, Tilz R, Häckl D. Economic Considerations of Cardiovascular Implantable Electronic Devices for The Treatment of Heart Failure. Curr Heart Fail Rep 2024; 21:186-193. [PMID: 38662154 DOI: 10.1007/s11897-024-00664-y] [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] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is a major public health problem worldwide, affecting more than 64 million people [1]. The complex and severe nature of HF presents challenges in providing cost-effective care as patients often require multiple hospitalizations and treatments. This review of relevant studies with focus on the last 10 years summarizes the health and economic implications of various HF treatment options in Europe and beyond. Although the main cost drivers in HF treatment are clinical (re)admission and decompensation of HF, an assessment of the economic impacts of various other device therapy options for HF care are included in this review. This includes: cardiovascular implantable electronic devices (CIEDs) such as cardiac-resynchronisation-therapy devices that include pacemaking (CRT-P), cardiac-resynchronisation-therapy devices that include defibrillation (CRT-D), implantable cardioverter/defibrillators (ICDs) and various types of pacemakers. The impact of (semi)automated (tele)monitoring as a relevant factor for increasing both the quality and economic impact of care is also taken into consideration. Quality of life adjusted life years (QALYs) are used in the overall context as a composite metric reflecting quantity and quality of life as a standardized measurement of incremental cost-effectiveness ratios (ICER) of different device-based HF interventions. RECENT FINDINGS In terms of the total cost of different devices, CRT-Ds were found in several studies to be more expensive than all other devices in regards to runtime and maintenance costs including (re)implantation. In the case of CRT combined with an implantable cardioverter-defibrillator (CRT-D) versus ICD alone, CRT-D was found to be the most cost-effective treatment in research work over the past 10 years. Further comparison between CRT-D vs. CRT-P does not show an economic advantage of CRT-D as a minority of patients require shock therapy. Furthermore, a positive health economic effect and higher survival rate is seen in CRT-P full ventricular stimulation vs. right heart only stimulation. Telemedical care has been found to provide a positive health economic impact for selected patient groups-even reducing patient mortality. For heart failure both in ICD and CRT-D subgroups the given telemonitoring benefit seems to be greater in higher-risk populations with a worse HF prognosis. In patients with HF, all CIED therapies are in the range of commonly accepted cost-effectiveness. QALY and ICER calculations provide a more nuanced understanding of the economic impact these therapies create in the healthcare landscape. For severe cases of HF, CRT-D with telemedical care seems to be the better option from a health economic standpoint, as therapy is more expensive, but costs per QALY range below the commonly accepted threshold.
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Affiliation(s)
- Christian Elsner
- Center for Artificial Intelligence, University Hospital Schleswig-Holstein, Lübeck, Germany.
| | - Simon Bettin
- Department for ENT, University of Lübeck, Lübeck, Germany
| | - Roland Tilz
- German Center for Cardiovascular Research (DZHK), Partner Site, Lübeck, Germany
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4
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Bergh N, Lindmark K, Lissdaniels J, Lanne G, Käck O, Cowie MR. Estimating the clinical and budgetary impact of using angiotensin receptor neprilysin inhibitor as first line therapy in patients with HFrEF. ESC Heart Fail 2024; 11:1153-1162. [PMID: 38279516 DOI: 10.1002/ehf2.14551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 01/28/2024] Open
Abstract
AIMS Recent updates of international treatment guidelines for heart failure with reduced ejection fraction (HFrEF) differ regarding the use of angiotensin receptor neprilysin inhibitor (ARNI) as first-line treatment. The American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) 2022 guidelines gives ARNI a Class IA recommendation for HFrEF patients while the European Society of Cardiology's guidelines are less clear when ARNI could be considered as first line treatment option in de novo patients. This study aimed to model the clinical and budgetary outcomes of implementing these guidelines, comparing conservative ARNI prescription patterns with less conservative in Sweden and in the United Kingdom. METHODS AND RESULTS A health economic model was developed to compare different treatment patterns for HFrEF. Incident cohorts were included on an annual basis and followed over 10 years. The model included treatment specific all-cause mortality and hospitalization rates, as well as drug acquisition, monitoring, and hospitalization costs. Increasing the use of ARNI could lead to about 7000-12 300 life years gained and 2600-4600 hospitalizations prevented in Sweden. These health benefits come with an additional cost of 112-195 million euros. Similar results were estimated for the United Kingdom, albeit on a larger population. CONCLUSIONS Increasing the proportion of patients receiving ARNI instead of angiotensin converting enzyme inhibitors as first-line treatment of HFrEF will lead to a considerable number of additional life years gained and prevented hospitalizations but with additional cost in terms of health care expenditure in Sweden and in the United Kingdom.
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Affiliation(s)
- Nicklas Bergh
- Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Krister Lindmark
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | | | | | - Oskar Käck
- Novartis Innovative Medicines, Kista, Sweden
| | - Martin R Cowie
- School of Cardiovascular Medicine, Faculty of Lifesciences & Medicine, King's College London (Royal Brompton Hospital, Guy's & St Thomas' NHS Foundation Trust), London, UK
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5
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Ibsen DB, Chiu YH, Gémes K, Wolk A. Hypothetical 22-Year Intervention With the Dietary Approaches to Stop Hypertension and Risk of Heart Failure in a General Population. Am J Epidemiol 2024; 193:96-106. [PMID: 37656615 PMCID: PMC10773477 DOI: 10.1093/aje/kwad181] [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: 09/10/2022] [Revised: 05/18/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023] Open
Abstract
We used design principles of target trial methodology to emulate the effect of sustained adherence to the Dietary Approaches to Stop Hypertension (DASH) diet on the 22-year risk of heart failure. Women and men aged 45-83 years without previous heart failure, who answered questionnaires in 1997 from the Swedish Mammography Cohort and the Cohort of Swedish Men, were eligible. Follow-up questionnaires were sent in 2008-2009. Incidence of heart failure was ascertained using the Swedish Patient Register, updated until December 31, 2019. The parametric g-formula was used to estimate the 22-year risk of heart failure under sustained adherence to a population-adapted DASH diet compared with no intervention. Intakes before 1997 for before-baseline adjustment was available only for women. In total, 31,238 women and 34,939 men were eligible. The 22-year risk of heart failure was 14.5% with long-term adherence to the DASH diet compared with 15.2% with no intervention (risk difference = -0.7%, 95% confidence interval: 1.6, 0.0%) in women and correspondingly in men 15.3% vs. 16.2% (risk difference = -0.9%, 95% confidence interval: -1.6, -0.2%). Our hypothetical intervention suggests that sustained adherence to the population-adapted DASH diet may reduce risk of heart failure in middle-aged and elderly Swedish women and men.
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Affiliation(s)
- Daniel B Ibsen
- Correspondence to Dr. Daniel B. Ibsen, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 17177 Stockholm, Sweden (e-mail: )
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6
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Allam S, Sartaj S, Moquim H, Husnain MA, Bustos D, Lakkimsetti M, Randhawa AK, Gupta I. Role of Liraglutide Use in Patients With Heart Failure. Cureus 2023; 15:e50065. [PMID: 38186489 PMCID: PMC10769535 DOI: 10.7759/cureus.50065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Heart failure is a clinical condition in which the heart is unable to maintain adequate cardiac output. Liraglutide is a glucagon-like peptide 1 (GLP-1) analogue that is used for the treatment of type 2 diabetes mellitus, but recent evidence suggests that it might have a beneficial role in treating heart failure. We conducted a review of existing literature and found five relevant studies. Data from these studies were extracted and then extrapolated into results following analysis. Four of the five studies found an increase in heart rate in heart failure patients. All five studies reported an increased rate of hospitalization. The five studies also showed an increased risk of adverse effects such as arrhythmia, ventricular tachycardia, atrial fibrillation, and worsening of heart failure. Given the scarcity of evidence in the available literature on liraglutide in heart failure, more research on this population is required.
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Affiliation(s)
- Sanjana Allam
- Internal Medicine, Gandhi Medical College, Secunderabad, IND
| | - Sahil Sartaj
- Internal Medicine, Melmaruvathur Adiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, IND
| | - Hiba Moquim
- Internal Medicine, Shadan Institute of Medical Sciences, Hyderabad, IND
| | - Muhammad Ammar Husnain
- Internal Medicine, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Daniel Bustos
- Internal Medicine, Pontifical Catholic University of Ecuador, Quito, ECU
| | | | - Avneet K Randhawa
- Internal Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, IND
| | - Ishita Gupta
- Internal Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, IND
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7
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Kapelios CJ, Shahim B, Lund LH, Savarese G. Epidemiology, Clinical Characteristics and Cause-specific Outcomes in Heart Failure with Preserved Ejection Fraction. Card Fail Rev 2023; 9:e14. [PMID: 38020671 PMCID: PMC10680134 DOI: 10.15420/cfr.2023.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/15/2023] [Indexed: 12/01/2023] Open
Abstract
Heart failure (HF) is a global pandemic affecting 64 million people worldwide. HF with preserved ejection fraction (HFpEF) has traditionally received less attention than its main counterpart, HF with reduced ejection fraction (HFrEF). The incidence and prevalence of HFpEF show geographic variation and are increasing over time, soon expected to surpass those of HFrEF. Morbidity and mortality rates of HFpEF are considerable, albeit lower than those of HFrEF. This review focuses on the burden of HFpEF, providing contemporary data on epidemiology, clinical characteristics and comorbidities, cause-specific outcomes, costs and pharmacotherapy.
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Affiliation(s)
- Chris J Kapelios
- Department of Cardiovascular Medicine, University of Utah Health Sciences CenterSalt Lake City, UT, US
| | - Bahira Shahim
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
| | - Gianluigi Savarese
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
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8
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Kontogeorgos S, Sandström TZ, Rosengren A, Fu M. A nationwide study of temporal trends of cause-specific hospital readmissions in patients with heart failure. ESC Heart Fail 2023; 10:2973-2981. [PMID: 37519022 PMCID: PMC10567653 DOI: 10.1002/ehf2.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/05/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
AIMS The impact of hospital readmissions on the outcomes of heart failure (HF) patients is well known. However, data on temporal trends of cause-specific hospital readmissions in these patients are limited. METHODS AND RESULTS From 1987 to 2014, we identified and followed up for 1 year 608 135 patients ≥18 years hospitalized with HF according to the International Classification of Diseases (ICD) 9 and 10 from the National Inpatient Register. Readmissions for cardiovascular (CVD) and non-CVD causes and co-morbidities were defined according to ICD-9 and ICD-10 codes. We analysed trends in the incidence rate of readmissions, the median time to the first rehospitalization, and the time to readmission, stratified by sex, age groups and cause of rehospitalization using linear regression. During our study, 1 year all-cause mortality decreased (β = -4.93, P < 0.0001), but the incidence rate of readmissions per 1000 person-years remained unchanged. The readmission rate for CVD causes decreased; in contrast, the readmission rate increased across all age and sex groups for non-CVD causes. Analysing the patients by study periods (1987-1997, 1998-2007 and 2008-2014), CVD and non-CVD co-morbidities had a statistically significant increasing trend (P < 0.001). The median time in hospital decreased and the median time to the first readmission were almost unchanged. CONCLUSIONS Contrary to a declining mortality rate, the incidence rate of readmissions saw no change, possibly because of divergent trends in cause-specific readmissions. An increasing rate of readmissions for non-CVD causes underscores the importance of optimising multimorbidity management to reduce the risk of readmissions in patients with HF.
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Affiliation(s)
- Silvana Kontogeorgos
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska AcademyUniversity of Gothenburg, Sahlgrenska University Hospital/Östra HospitalGothenburgSweden
- Department of Clinical Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Tatiana Zverkova Sandström
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska AcademyUniversity of Gothenburg, Sahlgrenska University Hospital/Östra HospitalGothenburgSweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska AcademyUniversity of Gothenburg, Sahlgrenska University Hospital/Östra HospitalGothenburgSweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska AcademyUniversity of Gothenburg, Sahlgrenska University Hospital/Östra HospitalGothenburgSweden
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9
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Norhammar A, Bodegard J, Vanderheyden M, Tangri N, Karasik A, Maggioni AP, Sveen KA, Taveira-Gomes T, Botana M, Hunziker L, Thuresson M, Banerjee A, Sundström J, Bollmann A. Prevalence, outcomes and costs of a contemporary, multinational population with heart failure. Heart 2023; 109:548-556. [PMID: 36781285 PMCID: PMC10086499 DOI: 10.1136/heartjnl-2022-321702] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/20/2022] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE Digital healthcare systems could provide insights into the global prevalence of heart failure (HF). We designed the CardioRenal and Metabolic disease (CaReMe) HF study to estimate the prevalence, key clinical adverse outcomes and costs of HF across 11 countries. METHODS Individual level data from a contemporary cohort of 6 29 624 patients with diagnosed HF was obtained from digital healthcare systems in participating countries using a prespecified, common study plan, and summarised using a random effects meta-analysis. A broad definition of HF (any registered HF diagnosis) and a strict definition (history of hospitalisation for HF) were used. Event rates were reported per 100 patient years. Cumulative hospital care costs per patient were calculated for a period of up to 5 years. RESULTS The prevalence of HF was 2.01% (95% CI 1.65 to 2.36) and 1.05% (0.85 to 1.25) according to the broad and strict definitions, respectively. In patients with HF (broad definition), mean age was 75.2 years (95% CI 74.0 to 76.4), 48.8% (40.9-56.8%) had ischaemic heart disease and 34.5% (29.4-39.6%) had diabetes. In 51 442 patients with a recorded ejection fraction (EF), 39.1% (30.3-47.8%) had a reduced, 18.8% (13.5-24.0%) had a mildly reduced and 42.1% (31.5-52.8%) had a preserved left ventricular EF. In 1 69 518 patients with recorded estimated glomerular filtration rate, 49% had chronic kidney disease (CKD) stages III-V. Event rates were highest for cardiorenal disease (HF or CKD) and all cause mortality (19.3 (95% CI 11.3 to 27.1) and 13.1 (11.1 to 15.1), respectively), and lower for myocardial infarction, stroke and peripheral artery disease. Hospital care costs were highest for cardiorenal diseases. CONCLUSIONS We estimate that 1-2% of the contemporary adult population has HF. These individuals are at significant risk of adverse outcomes and associated costs, predominantly driven by hospitalisations for HF or CKD. There is considerable public health potential in understanding the contemporary burden of HF and the importance of optimising its management.
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Affiliation(s)
- Anna Norhammar
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Bodegard
- CVRM Evidence, BioPharmaceuticals Medical, AstraZeneca, Oslo, Norway
| | | | - Navdeep Tangri
- Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Avraham Karasik
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Aldo Pietro Maggioni
- Fondazione ReS Ricerca e Salute, Bologna, Italy.,ANMCO Research Center, Florence, Italy
| | - Kari Anne Sveen
- Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Tiago Taveira-Gomes
- Department of Community Medicine, Information and Decision in Health, University of Porto, Porto, Portugal
| | | | - Lukas Hunziker
- Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland
| | | | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK.,Department of Cardiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,The George Institute for Global Health, Newtown, New South Wales, Australia
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10
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Davidge J, Halling A, Ashfaq A, Etminani K, Agvall B. Clinical characteristics at hospital discharge that predict cardiovascular readmission within 100 days in heart failure patients - An observational study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 16:200176. [PMID: 36865412 PMCID: PMC9971266 DOI: 10.1016/j.ijcrp.2023.200176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/18/2023] [Accepted: 02/09/2023] [Indexed: 02/11/2023]
Abstract
Background After a heart failure (HF) hospital discharge, the risk of a cardiovascular (CV) related event is highest in the following 100 days. It is important to identify factors associated with increased risk of readmission. Method This retrospective, population-based study examined HF patients in Region Halland (RH), Sweden, hospitalized with a HF diagnosis between 2017 and 2019. Data regarding patient clinical characteristics were retrieved from the Regional healthcare Information Platform from admission until 100 days post-discharge. Primary outcome was readmission due to a CV related event within 100 days. Results There were 5029 included patients being admitted for HF and discharged and 1966 (39%) were newly diagnosed. Echocardiography was available for 3034 (60%) patients and 1644 (33%) had their first echocardiography while admitted. The distribution of HF-phenotypes was 33% HF with reduced ejection fraction (EF), 29% HF with mildly reduced EF and 38% HF with preserved EF. Within 100 days, 1586 (33%) patients were readmitted, and 614 (12%) died. A Cox regression model showed that advanced age, longer hospital length of stay, renal impairment, high heart rate and elevated NT-proBNP were associated with an increased risk of readmission regardless of HF-phenotype. Women and increased blood pressure are associated with a reduced risk of readmission. Conclusions One third had a CV-readmission within 100 days. This study found clinical factors already present at discharge that are associated with increased risk of readmission which should be considered at discharge.
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Affiliation(s)
- Jason Davidge
- Capio Vårdcentral Halmstad, Halmstad, Sweden,Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden,Corresponding author. Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Box 50332, 20213, Malmö, Sweden.
| | - Anders Halling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Awais Ashfaq
- Center for Applied Intelligent Systems Research, Halmstad University, Halmstad, Sweden
| | - Kobra Etminani
- Center for Applied Intelligent Systems Research, Halmstad University, Halmstad, Sweden
| | - Björn Agvall
- Halland Regional Hospital, Region Halland, Halmstad, Sweden
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11
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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: 653] [Impact Index Per Article: 653.0] [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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12
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Davidge J, Ashfaq A, Ødegaard KM, Olsson M, Costa-Scharplatz M, Agvall B. Clinical characteristics and mortality of patients with heart failure in Southern Sweden from 2013 to 2019: a population-based cohort study. BMJ Open 2022; 12:e064997. [PMID: 36526318 PMCID: PMC9764664 DOI: 10.1136/bmjopen-2022-064997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To describe clinical characteristics and prognosis related to heart failure (HF) phenotypes in a community-based population by applying a novel algorithm to obtain ejection fractions (EF) from electronic medical records. DESIGN Retrospective population-based cohort study. SETTING Data were collected for all patients with HF in Southwest Sweden. The region consists of three acute care hospitals, 40 inpatient wards, 2 emergency departments, 30 outpatient specialty clinics and 48 primary healthcare. PARTICIPANTS 8902 patients had an HF diagnosis based on the International Classification of Diseases, Tenth Revision during the study period. Patients <18 years as well as patients declining to participate were excluded resulting in a study population of 8775 patients. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was distribution of HF phenotypes by echocardiography. The secondary outcome measures were 1 year all-cause mortality and HR for all-cause mortality using Cox regression models. RESULTS Out of 8775 patients with HF, 5023 (57%) had a conclusive echocardiography distributed into HF with reduced EF (35%), HF with mildly reduced EF (27%) and HF with preserved EF (38%). A total of 43% of the cohort did not have a conclusive echocardiography, and therefore no defined phenotype (HF-NDP). One-year all-cause mortality was 42% within the HF-NDP group and 30% among those with a conclusive EF. The HR of all-cause mortality in the HF-NDP group was 1.27 (95% CI 1.17 to 1.37) when compared with the confirmed EF group. There was no significant difference in survival within the HF phenotypes. CONCLUSIONS This population-based study showed a distribution of HF phenotypes that varies from those in selected HF registries, with fewer patients with HF with reduced EF and more patients with HF with preserved EF. Furthermore, 1-year all-cause mortality was significantly higher among patients with HF who had not undergone a conclusive echocardiography at diagnosis, highlighting the importance of correct diagnostic procedure to improve treatment strategies and outcomes.
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Affiliation(s)
- Jason Davidge
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Capio Vårdcentral Halmstad, Capio AB, Halmstad, Sweden
| | - Awais Ashfaq
- Center for Applied Intelligent Systems Research (CAISR), Halmstad University, Halmstad, Sweden
| | | | - Mattias Olsson
- Center for Applied Intelligent Systems Research (CAISR), Halmstad University, Halmstad, Sweden
| | | | - Björn Agvall
- Department of Research and Development, Region Halland, Halmstad, Sweden
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Stolfo D, Lund LH, Benson L, Hage C, Sinagra G, Dahlström U, Savarese G. Persistent High Burden of Heart Failure Across the Ejection Fraction Spectrum in a Nationwide Setting. J Am Heart Assoc 2022; 11:e026708. [DOI: 10.1161/jaha.122.026708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background
Heart failure (HF) has a dramatic impact on worldwide health care systems that is determined by the growing prevalence of and the high exposure to cardiovascular and noncardiovascular events. Prognosis remains poor. We sought to compare a large population with HF across the ejection fraction (EF) spectrum with a population without HF for patient characteristics, and HF, cardiovascular, and noncardiovascular outcomes.
Methods and Results
Patients with HF registered in the Swedish HF registry in 2005 to 2018 were compared 1:3 with a sex‐, age‐, and county‐matched population without HF. Outcomes were cardiovascular and noncardiovascular mortality and hospitalizations. Of 76 453 patients with HF, 53% had reduced EF, 23% mildly reduced EF, and 24% preserved EF. Compared with those without HF, patients with HF had more cardiovascular and noncardiovascular comorbidities and worse socioeconomic status. Incidence of cardiovascular and noncardiovascular events was higher in people with HF versus non‐HF, with increased risk of all‐cause (hazard ratio [HR], 2.53 [95% CI, 2.50–2.56]), cardiovascular (HR, 4.67 [95% CI, 4.59–4.76]), and noncardiovascular (HR, 1.49 [95% CI, 1.46–1.52]) mortality, 2‐ to 5‐fold higher risk of first/repeated cardiovascular and noncardiovascular hospitalizations, and ~4 times longer in‐hospital length of stay for any cause. Patients with HF with reduced EF had higher risk of HF hospitalizations, whereas those with HF with preserved EF had higher risk of all‐cause and noncardiovascular hospitalization and mortality.
Conclusions
Patients with HF exert a high health care burden, with a much higher risk of cardiovascular, all‐cause, and noncardiovascular events, and nearly 4 times as many days spent in hospital compared with those without HF. These epidemiological data may enable strategies for optimal resource allocation and HF trial design.
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Affiliation(s)
- Davide Stolfo
- Division of Cardiology, Department of Medicine Karolinska Institutet Stockholm Sweden
- Cardiothoracovascular Department Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Univeristy Hospital of Trieste Trieste Italy
| | - Lars H. Lund
- Division of Cardiology, Department of Medicine Karolinska Institutet Stockholm Sweden
- Heart and Vascular and Neuro Theme Karolinska University Hospital Stockholm Sweden
| | - Lina Benson
- Division of Cardiology, Department of Medicine Karolinska Institutet Stockholm Sweden
| | - Camilla Hage
- Division of Cardiology, Department of Medicine Karolinska Institutet Stockholm Sweden
- Heart and Vascular and Neuro Theme Karolinska University Hospital Stockholm Sweden
| | - Gianfranco Sinagra
- Cardiothoracovascular Department Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Univeristy Hospital of Trieste Trieste Italy
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences Linkoping University Linkoping Sweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine Karolinska Institutet Stockholm Sweden
- Heart and Vascular and Neuro Theme Karolinska University Hospital Stockholm Sweden
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Olofsson M, Lindmark K, Stålhammar J, Törnblom M, Lundberg A, Wikström G, Boman K. Characteristics and management of very elderly patients with heart failure: a retrospective, population cohort study. ESC Heart Fail 2022; 10:295-302. [PMID: 36208123 PMCID: PMC9871701 DOI: 10.1002/ehf2.14191] [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: 07/26/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 01/29/2023] Open
Abstract
AIMS Unmet needs exist in the diagnosis and treatment of heart failure (HF) in the elderly population. Our aim was to analyse and compare data of diagnostics and management of very elderly patients (aged ≥85 years) compared with younger patients (aged 18-84 years) with HF in Sweden. METHODS Incidence of ≥2 HF diagnosis (ICD-10) was identified from primary/secondary care in Uppsala and Västerbotten during 2010-2015 via electronic medical records linked to data from national health registers. Analyses investigated the diagnosis, treatment patterns, hospitalizations and outpatient visits, and mortality. RESULTS Of 8702 patients, 27.7% were ≥85 years old, women (60.2%); most patients (80.7%) had unknown left ventricular ejection fraction; key co-morbidities comprised anaemia, dementia, and cerebrovascular disease. More very elderly patients received cardiovascular disease (CVD)-related management after diagnosis in primary care (13.6% vs. 6.5%; P < 0.0001), but fewer patients underwent echocardiography (19.3% vs. 42.9%; P < 0.0001). Within 1 year of diagnosis, very elderly patients were less likely to be hospitalized (all-cause admissions per patient: 1.9 vs. 2.3; P < 0.0001; CVD-related admissions per patient: 1.8 vs. 2.1; P = 0.0004) or prescribed an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) plus a β-blocker (45.2% vs. 56.9%; P < 0.0001) or an ACEI/ARB plus a β-blocker plus a mineralocorticoid receptor antagonist (15.4% vs. 31.7%; P < 0.0001). One-year mortality was high in patients ≥85 years old, 30.5% (CI: 28.3-32.7%) out of 1797 patients. CONCLUSIONS Despite the large number of very elderly patients with newly diagnosed HF in Sweden, poor diagnostic work-up and subsequent treatment highlight the inequality of care in this vulnerable population.
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Affiliation(s)
- Mona Olofsson
- Research Unit, Medicine‐GeriatricSkellefteå County HospitalSkellefteåSweden,Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Krister Lindmark
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive MedicineUppsala UniversityUppsalaSweden
| | | | | | | | - Kurt Boman
- Research Unit, Medicine‐GeriatricSkellefteå County HospitalSkellefteåSweden,Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
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Jonsson Holmdahl A, Wessberg G, Norberg H, Söderström A, Valham F, Bergdahl E, Lindmark K. Motives, frequency, predictors and outcomes of MRA discontinuation in a real-world heart failure population. Open Heart 2022; 9:openhrt-2022-002022. [PMID: 36919930 PMCID: PMC9438023 DOI: 10.1136/openhrt-2022-002022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Mineralocorticoid receptor antagonists (MRAs) reduce mortality and morbidity in patients with heart failure and reduced ejection fraction (HFrEF), but are largely underused. We evaluated the frequency, motives, predictors and outcomes of MRA discontinuation in a real-world heart failure population. METHODS AND RESULTS This was a single-centre, retrospective cohort study where medical record-based data were collected on patients with HFrEF between 2010 and 2018. In the final analysis, 572 patients were included that comprised the continued MRA group (n=275) and the discontinued MRA group (n=297). Patients that discontinued MRA were older, had a higher comorbidity index and a lower index estimated glomerular filtration rate (eGFR). Predictors of MRA discontinuations were increased S-potassium, lower eGFR, lower systolic blood pressure, higher frequency of comorbidities and a higher left ventricular ejection fraction. The most common reason for MRA discontinuation was renal dysfunction (n=97, 33%) with 59% of these having an eGFR <30 mL/min/1.73m2, and elevated S-potassium (n=71, 24%) with 32% of these having an S-potassium >5.5 mmol/L. Discontinuation of MRA increased the adjusted risk of all-cause mortality (HR 1.48; 95% CI 1.07 to 2.05; p=0.019). CONCLUSIONS Half of all patients with HFrEF initiated on MRA discontinued the treatment. A substantial number of patients discontinued MRA without meeting the guideline-recommended levels of eGFR and S-potassium where mild to moderate hyperkalaemia seems to be the most decisive predictor. Further, MRA discontinuation was associated with increased adjusted risk of all-cause mortality.
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Affiliation(s)
- Anna Jonsson Holmdahl
- Department of Public Health and Clinical Medicine, Umeå universitet Medicinska fakulteten, Umea, Sweden
| | - Gustav Wessberg
- Department of Public Health and Clinical Medicine, Umeå universitet Medicinska fakulteten, Umea, Sweden
| | - Helena Norberg
- Department of Integrative Medical Biology, Umeå universitet Medicinska fakulteten, Umea, Sweden
| | - Adrian Söderström
- Department of Public Health and Clinical Medicine, Umeå universitet Medicinska fakulteten, Umea, Sweden
| | - Fredrik Valham
- Department of Public Health and Clinical Medicine, Umeå universitet Medicinska fakulteten, Umea, Sweden
| | - Ellinor Bergdahl
- Department of Public Health and Clinical Medicine, Umeå universitet Medicinska fakulteten, Umea, Sweden
| | - Krister Lindmark
- Department of Public Health and Clinical Medicine, Umeå universitet Medicinska fakulteten, Umea, Sweden
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16
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Eligibility of Dapagliflozin and Empagliflozin in a Real-World Heart Failure Population. Cardiovasc Ther 2022; 2021:1894155. [PMID: 35024052 PMCID: PMC8720587 DOI: 10.1155/2021/1894155] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/25/2021] [Accepted: 11/26/2021] [Indexed: 01/10/2023] Open
Abstract
Aims This study is aimed at investigating the eligibility in a real-world heart failure population for the DAPA-HF (testing dapagliflozin) and EMPEROR-reduced (testing empagliflozin) trials, comparing the eligible real-world patients to trial participants and to characterize the noneligible patients. Methods Medical records of all heart failure patients who had a diagnosis of heart failure from the Heart Centre or Department of Internal Medicine at Umeå University Hospital were reviewed. Results 2433 of the hospital's uptake population of 150 000 had a diagnosis of heart failure. 681 patients had left ventricle ejection fraction ≤ 40%, and of these 352 (52%) and 268 (39%) patients met eligibility criteria for DAPA-HF and EMPEROR-reduced, respectively. Comparing eligible patients in our population with the DAPA-HF- and EMPEROR-reduced trial populations, we found that eligible real-world patients were older (79.0 vs. 66.2 years and 80.3 vs. 67.2 years, respectively), had worse renal function (eGFR 54.4 vs. 66.0 ml/min/1.73m2 and 49.5 vs. 61.8 ml/min/1.73m2, respectively), higher prevalence of atrial fibrillation (56.0% vs. 36.1% and 53.0% vs. 35.6%, respectively), and lower prevalence of diabetes mellitus (21.0% vs. 41.8% and 26.1% vs. 49.8%, respectively). The main reasons for ineligibility were low NT-proBNP or low eGFR. Noneligible patients differed according to reason for ineligibility, where patients with low NT-proBNP were generally younger and healthier, and patients with low eGFR were older and had more comorbidities. Conclusions 39-52% of patients with heart failure and reduced ejection fraction in this real-world heart failure population were eligible for SGLT2-inhibitor treatment, corresponding to 11-14% of all heart failure patients. Compared to trial participants, eligible real-world patients were significantly older with worse renal function, more atrial fibrillation, and less diabetes mellitus. Trial entry criteria exclude comparatively young and healthy patients, as well as comparatively old patients with more comorbid conditions.
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17
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Januzzi JL, Tan X, Yang L, Brady JE, Yang M, Banka P, Lautsch D. N-terminal pro-B-type natriuretic peptide testing patterns in patients with heart failure with reduced ejection fraction. ESC Heart Fail 2021; 9:87-99. [PMID: 34918487 PMCID: PMC8787988 DOI: 10.1002/ehf2.13749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is a commonly used biomarker in heart failure for diagnosis and prognostication. We aimed to determine the prevalence of NT‐proBNP testing, distribution of NT‐proBNP concentrations, and factors associated with receiving an NT‐proBNP test in patients with heart failure with reduced ejection fraction (HFrEF), including the subset with a worsening heart failure event (WHFE). Methods and results This was a retrospective cohort study using two US databases: (i) the de‐identified Humana Research Database between January 2015 and December 2018 and (ii) the Veradigm PINNACLE Registry® between July 2013 and September 2017. We included adult patients with a confirmed diagnosis of HFrEF. In each data source, a subgroup of patients with a WHFE was identified, where a WHFE was defined as a heart failure‐related hospitalization or receipt of intravenous diuretics. Bivariate and multivariate analyses were conducted to assess factors associated with receiving NT‐proBNP testing. In Cohort 1 (n = 249 238), 9.2% of patients with HFrEF and 10.8% of patients with a WHFE received NT‐proBNP testing. When restricted to patients with at least one laboratory claim, 11.3% of patients with HFrEF and 13.2% of those with a WHFE received NT‐proBNP testing. In Cohort 2 (n = 91 444), 2.3% of patients with HFrEF were tested. Median (inter‐quartile range) NT‐proBNP concentrations among patients with HFrEF were 1399 (423–4087) pg/mL in Cohort 1 and 394 (142–688) pg/mL in Cohort 2. Median (inter‐quartile range) NT‐proBNP concentrations in the subset of patients with a WHFE in each cohort were 2209 (740–5894) and 464 (174–783) pg/mL, respectively. In Cohort 1, 13.4% of all HFrEF patients receiving NT‐proBNP testing and 18.9% of patients with a WHFE had NT‐proBNP values >8000 pg/mL; in Cohort 2, these percentages were 1.0% and 2.5%, respectively. Conclusions In US clinical practice, NT‐proBNP testing was not frequently performed in patients with HFrEF. NT‐proBNP concentrations varied across data sources and subpopulations within HFrEF.
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Affiliation(s)
- James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Baim Institute for Clinical Research, Boston, MA, USA
| | - Xi Tan
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | - Mei Yang
- Merck & Co., Inc., Kenilworth, NJ, USA
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18
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Yang R, Lv J, Yu C, Guo Y, Pei P, Huang N, Yang L, Millwood IY, Walters RG, Chen Y, Du H, Tao R, Chen J, Chen Z, Clarke R, Huang T, Li L. Modification effect of ideal cardiovascular health metrics on genetic association with incident heart failure in the China Kadoorie Biobank and the UK Biobank. BMC Med 2021; 19:259. [PMID: 34674714 PMCID: PMC8532287 DOI: 10.1186/s12916-021-02122-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both genetic and cardiovascular factors contribute to the risk of developing heart failure (HF), but whether idea cardiovascular health metrics (ICVHMs) offset the genetic association with incident HF remains unclear. OBJECTIVES To investigate the genetic association with incident HF as well as the modification effect of ICVHMs on such genetic association in Chinese and British populations. METHODS An ICVHMs based on smoking, drinking, physical activity, diets, body mass index, waist circumference, blood pressure, blood glucose, and blood lipids, and a polygenic risk score (PRS) for HF were constructed in the China Kadoorie Biobank (CKB) of 96,014 participants and UK Biobank (UKB) of 335,782 participants which were free from HF and severe chronic diseases at baseline. RESULTS During the median follow-up of 11.38 and 8.73 years, 1451 and 3169 incident HF events were documented in CKB and UKB, respectively. HF risk increased monotonically with the increase of PRS per standard deviation (CKB: hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.07, 1.32; UKB: 1.07; 1.03, 1.11; P for trend < 0.001). Each point increase in ICVHMs was associated with 15% and 20% lower risk of incident HF in CKB (0.85; 0.81, 0.90) and UKB (0.80; 0.77, 0.82), respectively. Compared with unfavorable ICVHMs, favorable ICVHMs was associated with a lower HF risk, with 0.71 (0.44, 1.15), 0.41 (0.22, 0.77), and 0.48 (0.30, 0.77) in the low, intermediate, and high genetic risk in CKB and 0.34 (0.26, 0.44), 0.32 (0.25, 0.41), and 0.37 (0.28, 0.47) in UKB (P for multiplicative interaction > 0.05). Participants with low genetic risk and favorable ICVHMs, as compared with high genetic risk and unfavorable ICVHMs, had 56~72% lower risk of HF (CKB 0.44; 0.28, 0.70; UKB 0.28; 0.22, 0.37). No additive interaction between PRS and ICVHMs was observed (relative excess risk due to interaction was 0.05 [-0.22, 0.33] in CKB and 0.04 [-0.14, 0.22] in UKB). CONCLUSIONS In CKB and UKB, genetic risk and ICVHMs were independently associated with the risk of incident HF, which suggested that adherence to favorable cardiovascular health status was associated with a lower HF risk among participants with all gradients of genetic risk.
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Affiliation(s)
- Ruotong Yang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Peking University, 38 Xueyuan Road, Beijing, 100191, China
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Peking University, 38 Xueyuan Road, Beijing, 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Canqing Yu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Peking University, 38 Xueyuan Road, Beijing, 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ninghao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Peking University, 38 Xueyuan Road, Beijing, 100191, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Iona Y Millwood
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Robin G Walters
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Huaidong Du
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ran Tao
- Institute of Chronic Disease, Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Tao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Peking University, 38 Xueyuan Road, Beijing, 100191, China.
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China.
- Center for Intelligent Public Health, Academy for Artificial Intelligence, Peking University, Beijing, 100191, China.
| | - Liming Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Peking University, 38 Xueyuan Road, Beijing, 100191, China.
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China.
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Boman K, Lindmark K, Stålhammar J, Olofsson M, Costa-Scharplatz M, Fonseca AF, Johansson S, Heller V, Törnblom M, Wikström G. Healthcare resource utilisation and costs associated with a heart failure diagnosis: a retrospective, population-based cohort study in Sweden. BMJ Open 2021; 11:e053806. [PMID: 34667015 PMCID: PMC8527145 DOI: 10.1136/bmjopen-2021-053806] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine healthcare resource use (HRU) and costs among heart failure (HF) patients using population data from Sweden. DESIGN Retrospective, non-interventional cohort study. SETTING Two cohorts were identified from linked national health registers (cohort 1, 2005-2014) and electronic medical records (cohort 2, 2010-2012; primary/secondary care patients from Uppsala and Västerbotten). PARTICIPANTS Patients (aged ≥18 years) with primary or secondary diagnoses of HF (≥2 International Classification of Diseases and Related Health Problems, 10th revision classification) during the identification period of January 2005 to March 2015 were included. OUTCOME MEASURES HRU across the HF phenotypes was assessed with logistic regression. Costs were estimated based on diagnosis-related group codes and general price lists. RESULTS Total annual costs of secondary care of prevalent HF increased from SEK 6.23 (€0.60) to 8.86 (€0.85) billion between 2005 and 2014. Of 4648 incident patients, HF phenotype was known for 1715: reduced ejection fraction (HFrEF): 64.5%, preserved ejection fraction (HFpEF): 35.5%. Within 1 year of HF diagnosis, the proportion of patients hospitalised was only marginally higher for HFrEF versus HFpEF (all-cause (95% CI): 64.7% (60.8 to 68.4) vs 63.7% (60.8 to 66.5), HR 0.91, p=0.14; cardiovascular disease related (95% CI): 61.1% (57.1 to 64.8) vs 60.9% (58.0 to 63.7), HR 0.93, p=0.28). Frequency of hospitalisations and outpatient visits per patient declined after the first year. All-cause secondary care costs in the first year were SEK 122 758 (€12 890)/patient/year, with HF-specific care accounting for 69% of the costs. Overall, 10% of the most expensive population (younger; predominantly male; more likely to have comorbidities) incurred ~40% of total secondary care costs. CONCLUSIONS HF-associated costs and HRU are high, especially during the first year of diagnosis. This is driven by high hospitalisations rates. Understanding the profile of resource-intensive patients being at younger age, male sex and high Charlson comorbidity index scores at the time of the HF diagnosis is most likely a sign of more severe disease.
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Affiliation(s)
- Kurt Boman
- Research Unit, Medicine, Department of Public Health and Clinical Medicine, Umea University, Skellefteå, Sweden
| | - Krister Lindmark
- Department of Public Health and Clinical Medicine and Heart Centre, Umea University, Umea, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mona Olofsson
- Research Unit, Medicine, Department of Public Health and Clinical Medicine, Umea University, Skellefteå, Sweden
| | | | | | | | | | - Michael Törnblom
- Real-World & Analytics Solutions, IQVIA Solutions Sweden AB, Solna, Sweden
| | - Gerhard Wikström
- Institute of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
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20
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Abstract
BACKGROUND Lay caregivers are important in contributing to self-care of patients with heart failure (HF). The Caregiver Contributions to Self-Care of Heart Failure Index (CC-SCHFI) measures these contributions, but after developing the Situation-Specific Theory of Caregiver Contributions to Heart Failure Self-Care, the CC-SCHFI needed updating to reflect the theory. OBJECTIVE The aim of this study was to test the psychometric characteristics of the CC-SCHFI 2 that measures caregiver contributions (CC) to HF self-care with 3 scales: CC to self-care maintenance, CC to symptom perception, and CC to self-care management. METHODS This is a cross-sectional study. We tested the CC-SCHFI 2 with confirmatory factor analysis, internal consistency, item-total correlations, and test-retest reliability. With the CC-SCHFI 2, we also administered the Self-Care of Heart Failure Index v.7.2 to patients and the Caregiver Contribution to Heart Failure Self-Care Scale to caregivers to assess concurrent validity. RESULTS A sample of 277 caregivers was enrolled (mean [SD] age, 52.7 [14.9] years; 70.4% female). In confirmatory factor analysis, each CC-SCHFI 2 scale had supportive fit indices: comparative fit index ranged between 0.94 and 0.95, and root mean square error of approximation ranged between 0.05 and 0.07. Internal consistency of the 3 scales was evident with a Cronbach α between .81 and .83 and a global reliability index between 0.79 and 0.86. Item-total correlations were all greater than 0.30. In concurrent validity testing, there were significant correlations between the CC-SCHFI 2 and the Self-Care of Heart Failure Index v.7.2 and the Caregiver Contribution to Heart Failure Self-Care Scale. Test-retest reliability showed intraclass correlation coefficients between 0.72 and 0.91. CONCLUSIONS Testing of the CC-SCHFI 2 supported validity and reliability, indicating that the instrument can be used in clinical practice and research to evaluate CC to the self-care of patients with HF.
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21
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Li M, Gao X, Wang H, Zhang M, Li X, Wang S, Wang S, Cao C, Li Y, Su G. Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient's prognosis. Open Med (Wars) 2021; 16:1134-1142. [PMID: 34435138 PMCID: PMC8359905 DOI: 10.1515/med-2021-0324] [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: 02/20/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 11/15/2022] Open
Abstract
Background Heart failure (HF) is a serious and advanced stage of various cardiac diseases with high mortality and rehospitalization rates. Phosphoglycerate mutase 2 (PGAM2) overexpression was identified in the serum of patients with HF. Material/methods One hundred and fifty-three cases of HF were included in the present work. According to New York Heart Association (NYHA) classification, 22 were grade II, 84 were grade III, and 47 were grade IV. Serum PGAM2, NT-proBNP, B-type natriuretic peptide (BNP), troponin T (TNT), and Cys-C of HF patients were detected using ELISA assay. Left ventricular ejection fraction, left ventricular end-diastolic inner diameter, and left atrium (LA) inner diameter of the included cases were also detected by the cardiac color Doppler. Results The number of patients with atrial fibrillation was significantly higher in NYHA IV group than in groups II and III with statistical difference (p < 0.05). The serum PGAM2, NT-proBNP, and Cys-C were significantly higher in NYHA IV group than in NYHA II and NYHA III groups (p all < 0.05). NT-proBNP had the highest prediction efficacy of HF severity and PGAM2 was also a potential biomarker for HF severity evaluation with relatively high sensitivity, specificity, and area under the ROC. The overall survival among NYHA II, III, and IV groups were statistically different (p = 0.04) with the median survival time of 25 months for NYHA III and IV groups. Conclusion PGAM2 is a new promising biomarker for evaluation of the severity of HF. Combination detection using multiple serum factors such as PGAM2, NT-proBNP, BNP, TNT, and Cys-C can improve the HF severity differential diagnosis performance.
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Affiliation(s)
- Min Li
- Department of Emergency, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250100, China
| | - Xiaoyuan Gao
- Department of Cardiovascular Medicine, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250100, China
| | - Huiyun Wang
- Research Center of Translational Medicine, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250100, China
| | - Mingli Zhang
- Department of Emergency, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250100, China
| | - Xiaoying Li
- Department of Emergency, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250100, China
| | - Shuya Wang
- Department of Cardiovascular Medicine, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250100, China
| | - Shaoqin Wang
- Department of Emergency, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250100, China
| | - Chongfeng Cao
- Department of Intensive Care Unit, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250100, China
| | - Ying Li
- Research Center of Translational Medicine, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, No. 105 Jiefang Road, Lixia District, Shandong Province, Jinan 250100, China
| | - Guohai Su
- Department of Cardiovascular Medicine, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, No. 105 Jiefang Road, Lixia District, Shandong Province, Jinan 250100, China
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22
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Rossides M, Kullberg S, Grunewald J, Eklund A, Di Giuseppe D, Askling J, Arkema EV. Risk and predictors of heart failure in sarcoidosis in a population-based cohort study from Sweden. Heart 2021; 108:467-473. [PMID: 34021039 PMCID: PMC8899480 DOI: 10.1136/heartjnl-2021-319129] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/07/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Previous studies showed a strong association between sarcoidosis and heart failure (HF) but did not consider risk stratification or risk factors to identify useful aetiological insights. We estimated overall and stratified HRs and identified risk factors for HF in sarcoidosis. METHODS Sarcoidosis cases were identified from the Swedish National Patient Register (NPR; ≥2 International Classification of Diseases-coded visits, 2003-2013) and matched to general population comparators. They were followed for HF in the NPR. Treated were cases who were dispensed ≥1 immunosuppressant ±3 months from the first sarcoidosis visit (2006-2013). Using Cox models, we estimated HRs adjusted for demographics and comorbidity and identified independent risk factors of HF together with their attributable fractions (AFs). RESULTS During follow-up, 204 of 8574 sarcoidosis cases and 721 of 84 192 comparators were diagnosed with HF (rate 2.2 vs 0.7/1000 person-years, respectively). The HR associated with sarcoidosis was 2.43 (95% CI 2.06 to 2.86) and did not vary by age, sex or treatment status. It was higher during the first 2 years after diagnosis (HR 3.7 vs 1.9) and in individuals without a history of ischaemic heart disease (IHD; HR 2.7 vs 1.7). Diabetes, atrial fibrillation and other arrhythmias were the strongest independent clinical predictors of HF (HR 2.5 each, 2-year AF 20%, 16% and 12%, respectively). CONCLUSIONS Although low, the HF rate was more than twofold increased in sarcoidosis compared with the general population, particularly right after diagnosis. IHD history cannot solely explain these risks, whereas ventricular arrhythmias indicating cardiac sarcoidosis appear to be a strong predictor of HF in sarcoidosis.
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Affiliation(s)
- Marios Rossides
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Kullberg
- Department of Medicine Solna, Respiratory Medicine Division, Karolinska Institutet, Stockholm, Sweden.,Respiratory Medicine, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Grunewald
- Department of Medicine Solna, Respiratory Medicine Division, Karolinska Institutet, Stockholm, Sweden.,Respiratory Medicine, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Eklund
- Department of Medicine Solna, Respiratory Medicine Division, Karolinska Institutet, Stockholm, Sweden.,Respiratory Medicine, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Daniela Di Giuseppe
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Rheumatology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Elizabeth V Arkema
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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23
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Yasin ZM, Anderson PD, Lingman M, Kwatra J, Ashfaq A, Slutzman JE, Agvall B. Receiving care according to national heart failure guidelines is associated with lower total costs: an observational study in Region Halland, Sweden. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:280-286. [PMID: 32170930 DOI: 10.1093/ehjqcco/qcaa020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/03/2020] [Accepted: 03/12/2020] [Indexed: 12/28/2022]
Abstract
AIMS Patients with heart failure (HF) have high costs, morbidity, and mortality, but it is not known if appropriate pharmacotherapy (AP), defined as compliance with international evidence-based guidelines, is associated with improved costs and outcomes. The purpose of this study was to evaluate HF patients' health care utilization, cost and outcomes in Region Halland (RH), Sweden, and if AP was associated with lower costs. METHODS AND RESULTS A total of 5987 residents of RH in 2016 carried HF diagnoses. Costs were assigned to all health care utilization (inpatient, outpatient, emergency department, primary health care, and medications) using a Patient Encounter Costing methodology. Care of HF patients cost €58.6 M, (€9790/patient) representing 8.7% of RH's total visit expenses and 14.9% of inpatient care (IPC) expenses. Inpatient care represented 57.2% of this expenditure, totalling €33.5 M (€5601/patient). Receiving AP was associated with significantly lower costs, by €1130 per patient (P < 0.001, 95% confidence interval 574-1687). Comorbidities such as renal failure, diabetes, chronic obstructive pulmonary disease, and cancer were significantly associated with higher costs. CONCLUSION Heart failure patients are heavy users of health care, particularly IPC. Receiving AP is associated with lower costs even adjusting for comorbidities, although causality cannot be proven from an observational study. There may be an opportunity to decrease overall costs and improve outcomes by improving prescribing patterns and associated high-quality care.
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Affiliation(s)
- Zayed M Yasin
- Department of Emergency Medicine, Medtigo Medical Group, North Adams, MA, USA
| | - Philip D Anderson
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Markus Lingman
- Halland Regional Hospital, Region Halland, Halmstad, Sweden
| | - Japneet Kwatra
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Awais Ashfaq
- Halland Regional Hospital, Region Halland, Halmstad, Sweden.,Center for Applied Intelligent Systems Research, Halmstad University, Halmstad, Sweden
| | - Jonathan E Slutzman
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Björn Agvall
- Halland Regional Hospital, Region Halland, Halmstad, Sweden
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24
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Ping Y, Wang X, Dai Y, Wang D, Liu W, Yu P, Tao Z. A quantitative detection of Cardiotrophin-1 in chronic heart failure by chemiluminescence immunoassay. J Clin Lab Anal 2021; 35:e23570. [PMID: 33713510 PMCID: PMC8059751 DOI: 10.1002/jcla.23570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/28/2019] [Accepted: 12/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background Cardiotrophin‐1 (CT‐1) is a cytokine that could induce cardiomyocytes hypertrophy and dysfunction. Plasma CT‐1 might serve as a cardiac biomarker both in diagnosis, staging, and prognostic assessment of heart failure. Methods In this study, a one‐step paramagnetic particles‐based chemiluminescence immunoassay (MPs‐CILA) for rapid and sensitive detection of plasma CT‐1 was established. Plasma samples were directly incubated with biotin‐labeled anti‐CT‐1 antibody (bio‐Ab) and acridine ester labeled anti‐CT‐1 antibody (AE‐Ab) to form sandwiched complex. The sandwiched CT‐1 was then captured by streptavidin modified paramagnetic particles (MPs‐SA) for rapid separation and signal generation. Results The proposed MPs‐CLIA presents a laudable linear relationship ranging from 7.8 pg/mL to 200 ng/mL with a detection limit of 1.0 pg/mL. The recoveries of spiked human plasma samples at low (10pg/mL), medium (100 pg/mL), and high (800 pg/mL) levels of CT‐1 were 96%, 104%, and 110% respectively. The intra‐analysis coefficient variation (CVs) of the 3 samples was 8.92%, 6.69%, and 3.54%, respectively. And the inter‐analysis coefficient variation (CVs) was 9.25%, 10.9%, and 4.3%, respectively. These results strongly indicate high sensitivity, wide linear range, acceptable precision, and applicable reproducibility of the proposed method to detect plasma level of CT‐1. Finally, Plasma CT‐1 from 140 subjects with or without chronic heart failure was analyzed to assess the clinical application of MPs‐CILA. Conclusions Noteworthily, the MPs‐CLIA method is highly automated such that it is suitable for high‐throughput detection of CT‐1 in clinical inspection.
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Affiliation(s)
- Ying Ping
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xuchu Wang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yibei Dai
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Danhua Wang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Weiwei Liu
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Pan Yu
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhihua Tao
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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25
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Lindmark K, Boman K, Stålhammar J, Olofsson M, Lahoz R, Studer R, Proudfoot C, Corda S, Fonseca AF, Costa-Scharplatz M, Levine A, Törnblom M, Castelo-Branco A, Kopsida E, Wikström G. Recurrent heart failure hospitalizations increase the risk of cardiovascular and all-cause mortality in patients with heart failure in Sweden: a real-world study. ESC Heart Fail 2021; 8:2144-2153. [PMID: 33751806 PMCID: PMC8120394 DOI: 10.1002/ehf2.13296] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality. We examined the impact of recurrent HF hospitalizations (HFHs) on cardiovascular (CV) mortality among patients with HF in Sweden. Methods and results Adults with incident HF were identified from linked national health registers and electronic medical records from 01 January 2005 to 31 December 2013 for Uppsala and until 31 December 2014 for Västerbotten. CV mortality and all‐cause mortality were evaluated. A time‐dependent Cox regression model was used to estimate relative CV mortality rates for recurrent HFHs. Assessment was also done for ejection fraction‐based HF phenotypes and for comorbid atrial fibrillation, diabetes, or chronic renal impairment. Overall, 3878 patients with HF having an index hospitalization were included, providing 9691.9 patient‐years of follow‐up. Patients were relatively old (median age: 80 years) and were more frequently male (55.5%). Compared with patients without recurrent HFHs, the adjusted hazard ratio (HR [95% confidence interval; CI]) for CV mortality and all‐cause mortality were statistically significant for patients with one, two, three, and four or more recurrent HFHs. The risk of CV mortality and all‐cause mortality increased approximately six‐fold in patients with four or more recurrent HFHs vs. those without any HFHs (HR [95% CI]: 6.26 [5.24–7.48] and 5.59 [4.70–6.64], respectively). Similar patterns were observed across the HF phenotypes and patients with comorbidities. Conclusions There is a strong association between recurrent HFHs and CV and all‐cause mortality, with the risk increasing progressively with each recurrent HFH.
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Affiliation(s)
- Krister Lindmark
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University Hospital, Umeå, Sweden
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, S-901 87, Sweden
| | - Mona Olofsson
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | | | | | | | | | | | | | | | | | - Gerhard Wikström
- Institute of Medical Sciences, Uppsala University, Uppsala, Sweden
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26
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Lee S, Doktorchik C, Martin EA, D'Souza AG, Eastwood C, Shaheen AA, Naugler C, Lee J, Quan H. Electronic Medical Record-Based Case Phenotyping for the Charlson Conditions: Scoping Review. JMIR Med Inform 2021; 9:e23934. [PMID: 33522976 PMCID: PMC7884219 DOI: 10.2196/23934] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/20/2020] [Accepted: 12/05/2020] [Indexed: 12/16/2022] Open
Abstract
Background Electronic medical records (EMRs) contain large amounts of rich clinical information. Developing EMR-based case definitions, also known as EMR phenotyping, is an active area of research that has implications for epidemiology, clinical care, and health services research. Objective This review aims to describe and assess the present landscape of EMR-based case phenotyping for the Charlson conditions. Methods A scoping review of EMR-based algorithms for defining the Charlson comorbidity index conditions was completed. This study covered articles published between January 2000 and April 2020, both inclusive. Embase (Excerpta Medica database) and MEDLINE (Medical Literature Analysis and Retrieval System Online) were searched using keywords developed in the following 3 domains: terms related to EMR, terms related to case finding, and disease-specific terms. The manuscript follows the Preferred Reporting Items for Systematic reviews and Meta-analyses extension for Scoping Reviews (PRISMA) guidelines. Results A total of 274 articles representing 299 algorithms were assessed and summarized. Most studies were undertaken in the United States (181/299, 60.5%), followed by the United Kingdom (42/299, 14.0%) and Canada (15/299, 5.0%). These algorithms were mostly developed either in primary care (103/299, 34.4%) or inpatient (168/299, 56.2%) settings. Diabetes, congestive heart failure, myocardial infarction, and rheumatology had the highest number of developed algorithms. Data-driven and clinical rule–based approaches have been identified. EMR-based phenotype and algorithm development reflect the data access allowed by respective health systems, and algorithms vary in their performance. Conclusions Recognizing similarities and differences in health systems, data collection strategies, extraction, data release protocols, and existing clinical pathways is critical to algorithm development strategies. Several strategies to assist with phenotype-based case definitions have been proposed.
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Affiliation(s)
- Seungwon Lee
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada.,Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chelsea Doktorchik
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Elliot Asher Martin
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Adam Giles D'Souza
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Cathy Eastwood
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Abdel Aziz Shaheen
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joon Lee
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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27
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Melbye H, Stylidis M, Solis JCA, Averina M, Schirmer H. Prediction of chronic heart failure and chronic obstructive pulmonary disease in a general population: the Tromsø study. ESC Heart Fail 2020; 7:4139-4150. [PMID: 33025768 PMCID: PMC7754893 DOI: 10.1002/ehf2.13035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/29/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022] Open
Abstract
Aims Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are main causes of dyspnoea, and echocardiography and spirometry are essential investigations for these diagnoses. Our aim was to determine the prevalence of HF and COPD in a general population, also how the diseases may be identified, and to what extent their clinical characteristics differ. Methods and results In the seventh survey of Tromsø study (2015–16), subjects aged 40 years or more were examined with echocardiography, spirometry, lung sound recordings, questionnaires, including the modified Medical Research Council (mMRC) questionnaire on dyspnoea, and N‐terminal pro‐brain natriuretic peptide analysis. A diagnosis of HF (HF with reduced ejection fraction, HF with mid‐range ejection fraction, or HF with preserved ejection fraction) or COPD was established according to current guidelines. Predictors of HF and COPD were evaluated by logistic regression and receiver operating characteristic curve analysis. A total of 7110 participants could be evaluated for COPD, 1624 for HF, and 1538 for both diseases. Age‐standardized prevalence of HF was 6.8% for women and 6.1% for men; the respective figures for COPD were 5.2% and 5.1%. Among the 1538 evaluated for both diseases, 139 subjects fulfilled the HF criteria, but only 17.1% reported to have the disease. Of those fulfilling the COPD criteria, 31.6% reported to have the disease. Shortness of breath at exertion was a frequent finding in HF; 59% of those with mMRC ≥2 had HF, while such shortness of breath was found in 24% among those with COPD. Reporting mMRC ≥2 had an odds ratio for HF of 19.5 (95% confidence interval 11.3–33.7), whereas the odds ratio for COPD was 6.3 (95% confidence interval 3.5–11.6). Current smoking was the strongest predictor of COPD but did not predict HF. Basal inspiratory crackles were significant predictors of HF in multivariable analysis. Among the subtypes of HF, an age <70 years was most frequently found in HF with reduced ejection fraction, in 51.7%. Clinical scores based on the predictive value in multivariable analysis of history, symptoms, and signs predicted HF and COPD with areas under the curve of 0.833 and 0.829, respectively. Conclusions Study participants with HF and COPD were in most cases not aware of their condition. In general practice, when an elderly patient present with shortness of breath, both diseases should be considered. Previous cardiovascular disease points at HF, while a history of smoking points at COPD. The threshold should be low for ordering echocardiography or spirometry for verifying the suspected cause of dyspnoea.
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Affiliation(s)
- Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Michael Stylidis
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Juan Carlos Aviles Solis
- General Practice Research Unit, Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Maria Averina
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway.,Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Henrik Schirmer
- Campus Ahus, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Akershus University Hospital, Nordbyhagen, 1478, Norway.,Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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28
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Kim EY, Oh S, Son YJ. Caring experiences of family caregivers of patients with heart failure: A meta-ethnographic review of the past 10 years. Eur J Cardiovasc Nurs 2020; 19:473-485. [DOI: 10.1177/1474515120915040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Living with heart failure, a debilitating disease with an unpredictable course, requires ongoing adaptation and management not only from patients but also from their families. Family caregivers have been known to be key facilitators of self-management of heart failure. An integrative understanding of the experiences of family caregivers will provide essential information for improving the quality of life of persons with heart failure and their families. Aims: This study aimed to integrate and synthesize the findings of qualitative studies on family members’ experiences of caring for patients with heart failure. Methods: We employed the meta-ethnography methodology. Five electronic bibliographic databases were used to retrieve studies published from April 2009–March 2019 that explored family caregivers’ experiences of caring for patients with heart failure. Twelve qualitative studies were finally included for the synthesis, based on the eligibility criteria. Results: Three themes were identified: “shouldering the entire burden,” “starting a new life,” and “balancing caregiving and everyday life.” These three themes illustrate how family caregivers fulfilled caregiving roles, what helped them juggle their multiple responsibilities, and how they struck a balance between life as caregivers and individuals in their own right. Conclusion: This review provides a deeper understanding of family caregivers’ experiences of caring for patients with heart failure. The findings can help healthcare providers in the development and implementation of tailored interventions for both patients and family caregivers.
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Affiliation(s)
- Eun Young Kim
- Red Cross College of Nursing, Chung-Ang University, Republic of Korea
| | - Seieun Oh
- College of Nursing, Dankook University, Republic of Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Republic of Korea
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29
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Matboli M, Habib EK, Hussein Mohamed R, Mahran NA, Seleem HS, Nosseir N, Hasanin AH. Pentoxifylline alleviated cardiac injury via modulating the cardiac expression of lncRNA-00654-miR-133a-SOX5 mRNA in the rat model of ischemia-reperfusion. Biomed Pharmacother 2020; 124:109842. [PMID: 31972363 DOI: 10.1016/j.biopha.2020.109842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/19/2022] Open
Abstract
Pentoxifylline (PTX) protects from many cardiovascular complications. It plays a critical role in stem cell proliferation and differentiation. Here, the effect of PTX administration on cardiac ischemia and dysfunction was explored. PTX in 3 doses (20, 30, and 40 mg/kg), was administered in vivo 5 min before a 45 min occlusion of the left anterior descending artery, followed by a 120 min reperfusion in male Wistar rats. The left ventricular end-diastolic pressure and dP/dtmax were assessed. Blood and cardiac tissue samples were collected for measuring the levels of cardiac enzymes and the expression of lncRNA-00654-miR-133a-SOX5. Samples of left ventricles were collected and processed for light microscopic, immunohistochemical staining for c-kit (a marker for cardiac progenitor cells) and transmission electron microscopic examination. PTX administration showed improvements in cardiac function tests, enzymes, and myocytes. Microscopic features showed minimal cardiac edema, hemorrhage, cellular inflammatory infiltration and fibrosis in addition to increased c-kit + cells in cardiac tissue samples. Notably, this treatment also produced a dose-dependent decrease in lncRNA-00654 with an increase in SOX5 mRNA and miRNA-133a-3p expressions. In conclusion, PTX has the potential to alleviate cardiac injury and increase the number of c-kit + cells following ischemia-reperfusion in the rat model via modulation of lncRNA-00654 and miR-133a-SOX5 mRNA expressions.
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Affiliation(s)
- Marwa Matboli
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Eman K Habib
- Anatomy and Embryology Department, Faculty of Medicine, Ain Shams University Cairo, Egypt
| | - Reham Hussein Mohamed
- Clinical Pharmacology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nievin A Mahran
- Fellowship of Clinical Pathology Department, Al Hussein Hospital, Cairo, Egypt; Biochemistry Department, Faculty of Dentistry, Sainai University-Kantara, Egypt
| | - Hanan S Seleem
- Histology Department, Faculty of Medicine, Menoufia University, Shebin El Koum-Menofia, Egypt; Histology Department, Unaizah College of Medicine, Qassim University, Al Qassim region, Saudi Arabia
| | - Nermine Nosseir
- Anatomy Department, Faculty of Medicine, Suez University, Suez, Egypt
| | - Amany H Hasanin
- Clinical Pharmacology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Formiga F, Ferreira Teles CI, Chivite D. Impact of intestinal microbiota in patients with heart failure: A systematic review. Med Clin (Barc) 2019; 153:402-409. [PMID: 31416611 DOI: 10.1016/j.medcli.2019.06.006] [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: 05/21/2019] [Revised: 06/21/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022]
Abstract
Heart failure (HF) is a chronic disease with significant morbidity and mortality. Substantial haemodynamic changes such as hypoperfusion and intestinal congestion can alter the composition of the intestinal microbiota in patients with HF. The aim of this systematic review is to evaluate the influence of bowel function in patients with HF and the possible role of the intestinal microbiota in the development and evolution of the latter. Eleven studies were included in the review. These studies seem to confirm that HF patients present with substantial abnormalities in the composition of their intestinal microbiota. Trimethylamine N-oxide is identified as a key mediator between the alterations in the intestinal microbiota and HF and correlates with worse prognosis in HF patients. In conclusion, patients with HF present with frequent abnormalities in the characteristics of their intestinal microbiota, which may play a role in the prognosis of the disease.
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Affiliation(s)
- Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España.
| | - Cristiana Isabel Ferreira Teles
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
| | - David Chivite
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
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