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Ma C. The mediating effect of uncertainty in illness between heart failure symptoms and health-related quality of life among rural patients with heart failure: A multi-center cross-sectional study. Heart Lung 2024; 66:71-77. [PMID: 38593676 DOI: 10.1016/j.hrtlng.2024.04.011] [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: 01/03/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The health-related quality of life (HRQoL) of patients with heart failure (HF) in rural settings in China remains unclear. Limited studies explored the mediating effect of uncertainty in illness between heart failure symptoms and HRQoL in this population. OBJECTIVES To explore the status of HRQoL in rural patients with HF; assess the impact of HF symptoms and uncertainty in illness on HRQoL; and examine the mediating effect of uncertainty in illness on the relationship between symptoms and HRQoL in rural patients with HF. METHODS Overall, 298 rural patients with HF were recruited from five township hospitals of Taishan and Jinzhong City in China between November 2021 and August 2022. Three variables, namely HF symptoms, uncertainty in illness, and HRQoL were measured using three validated scales. RESULTS The average score of HRQoL in rural patients with HF was 43.19. Of the participants, 60.4 %, 35.23 %, and 4.37 % exhibited poor, moderate, and good HRQoL, respectively. The HF symptoms (β = -0.47) and uncertainty in illness (β = -0.34) directly influenced HRQoL. Moreover, the HF symptoms also indirectly affected HRQoL through uncertainty in illness (β = -0.07). The indirect effect accounted for 12.96 % of the total effect of HF symptoms on HRQoL. CONCLUSION Rural patients with HF exhibited poor HRQoL. In this population, HF symptoms and uncertainty in illness were negatively associated with HRQoL. Uncertainty in illness mediated the relationship between HF symptoms and HRQoL. Tailored healthcare services should be developed for the rural population to alleviate HF symptoms, reduce uncertainty in illness, and enhance their HRQoL.
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Affiliation(s)
- Chunhua Ma
- School of Nursing, Guangzhou Medical University, 195 Dongfengxi Rd., Guangzhou, Guangdong 510180, China.
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2
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Mulugeta H, Sinclair PM, Wilson A. Health-related quality of life of people with heart failure in low- and middle-income countries: a systematic review and meta-analysis. Qual Life Res 2024; 33:1175-1189. [PMID: 38070032 DOI: 10.1007/s11136-023-03563-2] [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] [Accepted: 11/10/2023] [Indexed: 04/26/2024]
Abstract
PURPOSE Heart failure is a global health concern and associated with poor health-related quality of life and increased mortality. There is a disproportionate burden on patients and health systems in low- and middle-income countries. This systematic review and meta-analysis estimates the health-related quality of life of people with heart failure in low- and middle-income countries. METHODS A systematic literature search was conducted to identify relevant studies from January 2012 to November 2022 using the following databases: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, Scopus and JBI EBP database. Study screening, quality appraisal and data extraction were conducted using JBI methodology. A random-effects model was used to perform the meta-analysis. Heterogeneity was assessed using the I2 statistic. All statistical analyses were done in STATA version 17. RESULTS A total of 33 studies with 5612 participants were included in this review. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Short-Form-36 questionnaire (SF-36) were the most used instruments across 19 and 8 studies, respectively. The pooled mean MLHFQ and SF-36 scores using the random-effects model were 46.08 (95% CI 35.06, 57.10) and 41.23 (95% CI 36.63, 45.83), respectively. In a subgroup analysis using both instruments, the highest health-related quality-of-life scores occurred in studies with inpatient participants. CONCLUSION The overall health-related quality of life of people with heart failure in low- and middle-income countries is poor. Strategies should be strategically developed to improve the health-related quality of life of people with heart failure in these countries. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022377781.
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Affiliation(s)
- Henok Mulugeta
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Amhara Region, Ethiopia.
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.
| | - Peter M Sinclair
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
| | - Amanda Wilson
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
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3
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Chung YW, Cheng JF, Lin YL, Chuang HJ, Chuang CC, Chen CW, Huang WM, Wu CK, Lin LY. A non-invasive nomogram for predicting heart failure with preserved ejection fraction in taiwanese outpatients with unexplained dyspnea and fatigue. J Formos Med Assoc 2024:S0929-6646(24)00108-6. [PMID: 38503670 DOI: 10.1016/j.jfma.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/27/2023] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND While Reddy proposed the H2FPEF diagnostic algorithm to aid in diagnosing heart failure with preserved ejection fraction (HFpEF), certain parameters like age and obesity are not suitable for Asian population, especially given the increasing incidence of HFpEF in younger individuals. Therefore, this study aimed to develop an easy-to-use nomogram with non-invasive indices that can be used in outpatient clinics in Taiwan to quickly estimate the probability of HFpEF and help decide whether further invasive cardiopulmonary exercise test (CPET) is needed. METHODS Outpatients with unexplained dyspnea and fatigue were recruited divided into HFpEF (n = 64) and non-HFpEF (n = 34) groups based on invasive CPET and echocardiography. Multivariate logistic regression analyses identified independent noninvasive variables for developing an HFpEF nomogram. The nomogram's performance was assessed and validated using the concordance index (C-index), area under the curve (AUC), calibration curves, and decision curve analysis. RESULTS Multivariate logistic regression analyses identified five independent noninvasive variables for developing an HFpEF nomogram, including dyslipidemia (OR = 5.264, p = 0.010), diabetes (OR = 3.929, p = 0.050), left atrial area (OR = 1.130, p = 0.046), hemoglobin <13 g/dL (OR = 5.372, p = 0.010), and NT-proBNP ≥245 pg/mL (OR = 5.108, p = 0.027). The nomogram showed good discriminatory ability (C-index = 0.842) and calibration performance (p = 0.873) and high net benefit (0.1-0.95). Notably, the HFpEF nomogram showed better diagnostic accuracy than the H2FPEF score model in predicting Taiwanese HFpEF patients (AUC: 0.873 vs. 0.608, p = 0.0006). CONCLUSION The noninvasive HFpEF nomogram provides a preliminary estimation of the probability of HFpEF in Taiwanese outpatients with unexplained dyspnea and fatigue, which may help the decision-making on further invasive CPET.
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Affiliation(s)
- Yi-Wei Chung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsinchu, Taiwan; Graduate institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Fang Cheng
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Division of Hospitalist, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yen-Liang Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsinchu, Taiwan
| | - Hung-Jui Chuang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Chuan Chuang
- Division of Cardiology, Department of internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Wei Chen
- Division of Cardiology, Department of internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ming Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan.
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4
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Smereka Y, Ezekowitz JA. HFpEF and sex: understanding the role of sex differences. Can J Physiol Pharmacol 2024. [PMID: 38447124 DOI: 10.1139/cjpp-2023-0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Heart failure is a complex clinical syndrome with many etiological factors and complex pathophysiology affecting millions worldwide. Males and females can have distinct clinical presentation and prognosis, and there is an emerging understanding of the factors that highlight the similarities and differences to synthesize and present available data for sex-specific differences in heart failure with preserved ejection fraction (HFpEF). While the majority of data demonstrate more similarities than differences between females and males in terms of heart failure, there are key differences. Data showed that females have a higher risk of developing HFpEF, but a lower risk of mortality and hospitalization. This can be conditioned by different profiles of comorbidities, postmenopausal changes in sex hormone levels, higher levels of inflammation and chronic microvascular dysfunction in females. These factors, combined with different left ventricular dimensions and function, which are more pronounced with age, lead to a higher prevalence of LV diastolic dysfunction at rest and exercise. As a result, females have lower exercise capacity and quality of life when compared to males. Females also have different activities of systems responsible for drug transformation, leading to different efficacy of drugs as well as higher risk of adverse drug reactions. These data prove the necessity for creating sex-specific risk stratification scales and treatment plans.
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Affiliation(s)
- Yuliia Smereka
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Justin A Ezekowitz
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Canadian VIGOUR Centre, Edmonton, AB, Canada
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5
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Zong Y, Wang Y, Hu Y, Wang Z. Clinical Significance of Apela in Acute Cardiorenal Insuffiency of Chronic Heart Failure. Kidney Blood Press Res 2024; 49:100-113. [PMID: 38237563 DOI: 10.1159/000536316] [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: 05/09/2023] [Accepted: 01/13/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Apela has a wide range of biological effects on the cardiovascular system, but the changes and significance of endogenous Apela in patients with chronic heart failure (CHF) and acute deterioration of cardiac and renal function are unclear. METHODS A total of 69 patients with stable CHF combined with well-preserved renal function were enrolled and followed for 12 months. The effects of Apela on human renal glomerular endothelial cells (hRGEC), human glomerular mesangial cells (hMC), and human renal tubular epithelial cells (HK-2) were observed. RESULTS Serum Apela concentration was positively correlated with NYHA class (r = 0.711) and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration (r = 0.303) but negatively correlated with left ventricular ejection fraction (LVEF) (r = -0.374) and 6-min walk distance (r = -0.860) in patients with stable CHF. Twenty-one patients experiencing deterioration of renal and cardiac function were diagnosed with cardiorenal syndrome (CRS) during the follow-up period. In addition, the serum Apela, as well as the difference in Apela between stable and worsening phases (ΔApela), was correlated with the estimated glomerular filtration rate (eGFR) and ΔeGFR in patients with CRS. Apela significantly inhibited the upregulated expression of MCP-1 and TNF-α induced by angiotensin II (AngII) in hRGEC, hMC, and HK-2 cells. Apela inhibited the adhesion of THP-1 cells to hRGEC and promoted the tubular formation of hRGEC. Moreover, Apela enhanced the expression of MMP-9 in hMC but inhibited the upregulated expression of α-SMA and vimentin in HK-2 cells by AngII. CONCLUSION This study suggests that the level of Apela can be used to diagnose heart failure and assess the severity of cardiac dysfunction in patients with stable CHF, and its dynamic changes can be used to evaluate the damage to renal function in patients with CRS. Apela plays multiple protective effects on renal cells, highlighting its clinical application prospect in the prevention and treatment of CRS.
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Affiliation(s)
- Yani Zong
- Department of Cardiovascular Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yajie Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yuexin Hu
- Department of Cardiovascular Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Zhi Wang
- Department of Cardiovascular Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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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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Guan B, Yang M, Shen X, Wang Y, Liu Y, Liu R, Li S, Cao J. Genetically determined serum bilirubin level and the risk of heart failure: A mendelian randomization study. Front Genet 2023; 14:1067146. [PMID: 36713081 PMCID: PMC9881886 DOI: 10.3389/fgene.2023.1067146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023] Open
Abstract
Background: The association between serum bilirubin level and heart failure (HF) was controversial in previous observational studies and the causal effects of bilirubin on HF have not been investigated. Here, we conducted a Mendelian randomization (MR) study to investigate the associations between genetically determined bilirubin level and HF. Methods: Summary data on the association of single nucleotide polymorphisms (SNPs) with serum bilirubin levels were obtained from genome-wide association study (GWAS) for individuals of European descent and East Asian descent separately. Statistical data for gene-HF associations were extracted from three databases: the HERMES Consortium (47,309 cases and 930,014 controls), FinnGen study (30,098 cases and 229,612 controls) for European population and Biobank Japan (2,820 HF cases and 192,383 controls) for East Asian population. We applied a two-sample Mendelian randomization framework to investigate the causal association between serum bilirubin and HF. Results: Findings from our MR analyses showed that genetically determined serum bilirubin levels were not causally associated with HF risk in either European or East Asian population (odds ratio [OR] = 1.01 and 95% confidence interval [CI] = .97-1.05 for HERMES Consortium; OR = 1.01 and 95% CI = .98-1.04 for FinnGen Study; OR = .82, 95% CI: .61-1.10 for Biobank Japan). These results remained unchanged using different Mendelian randomization methods and in sensitivity analyses. Conclusion: Our study did not find any evidence to support a causal association between serum bilirubin and HF.
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Affiliation(s)
- Bo Guan
- Medical School of Chinese PLA General Hospital, Beijing, China
| | - Mingyan Yang
- Medical School of Chinese PLA General Hospital, Beijing, China
| | - Xing Shen
- Department of Experimental Hematology and Biochemistry, Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Yemei Wang
- Jinzhou Medical University, Jinzhou, China
| | - Yutong Liu
- Medical School of Chinese PLA General Hospital, Beijing, China
| | - Ruihan Liu
- Medical School of Chinese PLA General Hospital, Beijing, China
| | - Shijun Li
- Geriatric Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China,*Correspondence: Jian Cao, ; Shijun Li,
| | - Jian Cao
- Geriatric Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China,*Correspondence: Jian Cao, ; Shijun Li,
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8
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Du K, Liu J, Tan N, Huang X, Wang J, Zhao H, Wang W. The effects of qishen granules for patients with chronic heart failure: A multicenter randomized double-blind placebo-controlled trial. Front Pharmacol 2022; 13:1017734. [PMID: 36618925 PMCID: PMC9822771 DOI: 10.3389/fphar.2022.1017734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Despite advancements in chronic heart failure (CHF) treatment, the effect often remains unsatisfactory and unstable. More effective therapies are needed. Qishen granules (QSG) are a novel Chinese botanical drug effective in treating CHF in animal models, but clinical evidence remains inadequate. Objective: This study aims to evaluate the effects of QSG on patients with CHF. Methods: We enrolled CHF patients in this 12-week, randomized, double-blind, placebo-controlled trial and randomly assigned them to the QSG (twice a day, 6.8 g granules at once) or placebo group. The primary endpoint was a change in the plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level after treatment. The secondary outcome consists of the New York Heart Association (NYHA) functional classification, 6-min walking distance (6MWD), TCM syndrome integral scale, quality of life, and echocardiographic index. Results: A total of 191 patients completed the 12-week follow-up period, with 94 in the QSG group and 97 in the placebo group. The Qishen granules group demonstrated a considerably greater reduction in NT-proBNP than the placebo group (50% vs 32% for QSG vs placebo, respectively; p = 0.011). Patients who received QSG performed better in the NYHA functional rank, 6MWD, TCM syndrome integral scale, and quality of life (p < 0.05). The QSG group performed better in HFrEF patients regarding the efficiency of NT-proBNP. There was no statistical significance in the change in evaluated safety parameters, such as blood routine and biochemistry. Conclusion: Based on standard treatment, Qishen granules further reduced the levels of NT-proBNP when compared with placebo. Together with other outcomes, our findings suggest that QSG could be used in combination therapy for CHF. Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT03027375. Registered 9 October 2017.
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Affiliation(s)
- Kangjia Du
- Department of Chinese medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Junjie Liu
- Department of Cardiology, Nanjing Pukou Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Nannan Tan
- Department of Chinese medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xinyi Huang
- Department of Chinese medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Juan Wang
- Department of Chinese medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Huihui Zhao
- Department of Chinese medicine, Beijing University of Chinese Medicine, Beijing, China,*Correspondence: Huihui Zhao, ; Wei Wang,
| | - Wei Wang
- Department of Chinese medicine, Beijing University of Chinese Medicine, Beijing, China,*Correspondence: Huihui Zhao, ; Wei Wang,
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Cai A, Qiu W, Zhou Y, Feng Y, Chen J, Xia S, Li W, Liao Y, Li X, Zhou J, Wang H, Jin W, Zhang Q, Sun Z, Chen M, Wang J, Kong H, Zhang Y, Dong W, Bai L, Xu D, Yuan J, Liu C, Jiang M, Xu Y, Li L, Dong Y, Yang J. Clinical characteristics and 1-year outcomes in hospitalized patients with heart failure with preserved ejection fraction: results from the China Cardiovascular Association Database-Heart Failure Center Registry. Eur J Heart Fail 2022; 24:2048-2062. [PMID: 36054149 DOI: 10.1002/ejhf.2654] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/03/2022] [Accepted: 08/20/2022] [Indexed: 01/18/2023] Open
Abstract
AIM We aimed to evaluate clinical characteristics and 1-year outcomes in hospitalized patients with heart failure with preserved ejection fraction (HFpEF) from China. Factors associated with outcomes (hospitalization for HF [HHF] and cardiovascular [CV] death) were assessed. METHOD AND RESULTS Data were from the China Cardiovascular Association (CCA) Database-HF Center Registry. Between January 2017 and June 2021, 41 708 hospitalized HFpEF patients with 1-year follow-up from 481 CCA Database-HF Center certified secondary and tertiary hospitals across overall 31 provinces of mainland China were included in this study. Of study participants (mean age 72.2 years, 49.3% female), 18.2% had HHF in prior 1 year and 55.8% had New York Heart Association class III/IV. Median left ventricular ejection fraction was 59%. Ischaemia (26.6%), infection (14.4%) and arrhythmia (10.5%) were the three most common precipitating factors for index HHF. Nearly 67.4% had ≥3 comorbidities. Hypertension (65.2%), coronary heart disease (60.3%) and atrial fibrillation (41.2%) were the three most common comorbidities. Device and medication therapy non-compliance with current HF guideline recommendation was observed. The 1-year rate of clinical outcomes was 16.4%, the 1-year rate of HHF was 13.6% and CV death was 3.1%. Factors associated with clinical outcomes included HHF in prior 1 year, serum level of sodium <135 mmol/L and N-terminal pro-B-type natriuretic peptide >1800 pg/ml. CONCLUSION Patients with HFpEF from China were characterized by high comorbid burden and high 1-year risk of HHF and CV death. Immediate efforts are needed to improve HFpEF management in China.
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Affiliation(s)
- Anping Cai
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weida Qiu
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingling Zhou
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingqing Feng
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuang Xia
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weimin Li
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yuhua Liao
- Department of Cardiology, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Hubei, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital to Nanjing Medical University, Jiangsu, China
| | - Jingmin Zhou
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Jin
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Liaoning, China
| | - Mulei Chen
- Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiang Wang
- Department of Cardiology, Xinqiao Hospital, PLA Army Medical University, Chongqing, China
| | - Hong Kong
- Department of Cardiology, Sichuan Provincial People's Hospital, Sichuan, China
| | - Yao Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Wei Dong
- Department of Cardiology, PLA General Hospital, Beijing, China
| | - Ling Bai
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Shanxi, China
| | - Dongjie Xu
- Department of Cardiology, The First Affiliated Hospital to Nanjing Medical University, Jiangsu, China
| | - Jing Yuan
- Department of Cardiology, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Hubei, China
| | - Chen Liu
- Department of Cardiology, Center for Translational Medicine, Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China
| | - Meng Jiang
- Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yamei Xu
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Liwen Li
- Hypertension Research Laboratory, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yugang Dong
- Department of Cardiology, Center for Translational Medicine, Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China
| | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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10
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Escobar C, Palacios B, Varela L, Gutiérrez M, Duong M, Chen H, Justo N, Cid-Ruzafa J, Hernández I, Hunt PR, Delgado JF. Prevalence, Characteristics, Management and Outcomes of Patients with Heart Failure with Preserved, Mildly Reduced, and Reduced Ejection Fraction in Spain. J Clin Med 2022; 11:jcm11175199. [PMID: 36079133 PMCID: PMC9456780 DOI: 10.3390/jcm11175199] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To estimate the prevalence, incidence, and describe the characteristics and management of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Methods: Adults with ≥1 inpatient or outpatient HF diagnosis between 1 January 2013 and 30 September 2019 were identified through the BIG-PAC database. Annual incidence and prevalence by EF phenotype were estimated. Characteristics by EF phenotype were described in the 2016 and 2019 HF prevalent cohorts and outcomes in the 2016 HF prevalent cohort. Results: Overall, HF incidence and prevalence were 0.32/100 person-years and 2.34%, respectively, but increased every year. In 2019, 49.3% had HFrEF, 38.1% had HFpEF, and 4.3% had HFmrEF (in 8.3%, EF was not available). Compared with HFrEF, patients with HFpEF were largely female, older, and had more atrial fibrillation but less atherosclerotic cardiovascular disease. Among patients with HFrEF, 76.3% were taking renin-angiotensin system inhibitors, 69.5% beta-blockers, 36.8% aldosterone antagonists, 12.5% sacubitril/valsartan and 6.7% SGLT2 inhibitors. Patients with HFpEF and HFmrEF took fewer HF drugs compared to HFrEF. Overall, the event rates of HF hospitalization were 231.6/1000 person-years, which is more common in HFrEF patients. No clinically relevant differences were found in patients with HFpEF, regardless EF (50- < 60% vs. ≥60%). Conclusions: >2% of patients have HF, of which around 50% have HFrEF and 40% have HFpEF. The prevalence of HF is increasing over time. Clinical characteristics by EF phenotype are consistent with previous studies. The risk of outcomes, particularly HF hospitalization, remains high, likely related to insufficient HF treatment.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, 28046 Madrid, Spain
| | | | - Luis Varela
- AstraZeneca Farmaceutica, 28033 Madrid, Spain
| | | | | | | | - Nahila Justo
- Evidera, 113 21 Stockholm, Sweden
- Karolinska Institute, Department of Neurobiology, Care Sciences, and Society, 171 77 Stockholm, Sweden
| | | | | | | | - Juan F. Delgado
- Cardiology Department, University Hospital 12 de Octubre, CIBERCV, 28041 Madrid, Spain
- Correspondence:
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11
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Feng Y, Chen X, Schaufelberger M, Zhang Q, Fu M. Patient-level comparison of heart failure patients in clinical phenotype and prognosis from China and Sweden. BMC Cardiovasc Disord 2022; 22:91. [PMID: 35260089 PMCID: PMC8903728 DOI: 10.1186/s12872-022-02540-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/01/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Clinical phenotype and prognosis of heart failure (HF) may be variable among different racial populations. Therefore, a patient-level comparison of hospitalized HF patients in two university hospitals from China and Sweden was performed. METHODS AND RESULTS This study was a pooled data analysis of the patients prospectively enrolled in two single-center studies in China (n = 949) and Sweden (n = 1639) from 2011 to 2015. Clinical characteristics and 6-month all-cause mortality were collected. Higher systolic blood pressure (126.1 ± 20.3 vs. 114.2 ± 15.4 mmHg, p < 0.001) and NT-proBNP level (4540 vs. 3251 pg/mL, p = 0.013) were found in the Swedish cohort, also more patients with ischemic heart disease (32.0% vs. 19.2%), hypertension (64.2% vs. 36.8%), valvular heart disease (40.9% vs.31.6%) and atrial fibrillation (55.3% vs. 39.6%) (all p < 0.001). The use of ACEIs/ARBs (48.8% vs. 80.8%) or beta-blockers (58.8% vs. 86.5%) (both p < 0.001) was lower in Chinese cohort. Given younger age in Chinese cohort (61.6 vs. 76.4 years, p < 0.001), age-stratified analyses were conducted, as there were similar patient numbers in 50-74 years in Chinese (n = 550) and Swedish (n = 554) cohorts, therefore baseline characteristics and prognosis were further compared. The age- and sex-adjusted outcome (HR 0.80 [95% CI 0.55-1.19], p = 0.273) was comparable between the two populations. The NT-proBNP and eGFR independently predicted 6-month mortality in both Chinese (HR [95% CI] 1.006 [1.003-1.008], 0.986 [0.976-0.999]) and Swedish cohort (1.003 [1.000-1.007], 0.988 [0.976-0.999]). CONCLUSIONS Patient-level comparison of real-world HF populations from China and Sweden demonstrated different clinical phenotypes and therapy but similar prognosis and their predictors.
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Affiliation(s)
- Yizhou Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiaojing Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Kong X, Hu X, Hua B, Fedele F, Farmakis D, Pollesello P. Levosimendan in Europe and China: An Appraisal of Evidence and Context. Eur Cardiol 2021; 16:e42. [PMID: 34815750 PMCID: PMC8591618 DOI: 10.15420/ecr.2021.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022] Open
Abstract
The calcium sensitiser levosimendan (SIMDAX; Orion Pharma) has been in clinical use for the management of acute heart failure and a range of related syndromes in many countries around the world for two decades. More recently, levosimendan has become available in China. The authors have examined the profile of levosimendan in clinical trials conducted inside and outside China and grouped the findings under six headings: effects on haemodynamics, effects on natriuretic peptides, effect on symptoms of heart failure, renal effects, effect on survival, and safety profile. Their conclusions are that under each of these headings there are reasonable grounds to expect that the effects and clinical benefits established in trials and with wider clinical use in Europe and elsewhere will accrue also to Chinese patients. Therefore, the authors are confident that global experience with levosimendan provides a reliable guide to its optimal use and likely therapeutic effects in patients in China.
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Affiliation(s)
- Xiangqing Kong
- First Affiliated Hospital, Nanjing Medical University Nanjing, China
| | - Xinqun Hu
- Second Xiangya Hospital, Zhongnan University Changsha, China
| | - Baotong Hua
- First Affiliated Hospital, Kunming Medical University Kunming, China
| | - Francesco Fedele
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, University 'La Sapienza' Rome, Italy
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13
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Booth DE, Gopalakrishna-Remani V, Cooper ML, Green FR, Rayman MP. Boosting and lassoing new prostate cancer SNP risk factors and their connection to selenium. Sci Rep 2021; 11:17877. [PMID: 34504230 PMCID: PMC8429712 DOI: 10.1038/s41598-021-97412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/05/2021] [Indexed: 11/15/2022] Open
Abstract
We begin by arguing that the often used algorithm for the discovery and use of disease risk factors, stepwise logistic regression, is unstable. We then argue that there are other algorithms available that are much more stable and reliable (e.g. the lasso and gradient boosting). We then propose a protocol for the discovery and use of risk factors using lasso or boosting variable selection. We then illustrate the use of the protocol with a set of prostate cancer data and show that it recovers known risk factors. Finally, we use the protocol to identify new and important SNP based risk factors for prostate cancer and further seek evidence for or against the hypothesis of an anticancer function for Selenium in prostate cancer. We find that the anticancer effect may depend on the SNP-SNP interaction and, in particular, which alleles are present.
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Affiliation(s)
- David E Booth
- M&IS Department, Kent State University, 595 Martinique Circle, Kent, OH, 44242, USA.
| | | | - Matthew L Cooper
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Fiona R Green
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Margaret P Rayman
- Department of Nutritional Sciences, University of Surrey, Guildford, GU27XH, UK
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14
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Shah AS, Isom S, Dabelea D, D'Agostino R, Dolan LM, Wagenknecht L, Imperatore G, Saydah S, Liese AD, Lawrence JM, Pihoker C, Urbina EM. A cross sectional study to compare cardiac structure and diastolic function in adolescents and young adults with youth-onset type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth Study. Cardiovasc Diabetol 2021; 20:136. [PMID: 34233679 PMCID: PMC8265135 DOI: 10.1186/s12933-021-01328-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/29/2021] [Indexed: 01/19/2023] Open
Abstract
AIMS To compare left ventricular structure (LV) and diastolic function in young adults with youth- onset diabetes by type, determine the prevalence of abnormal diastolic function by diabetes type using published values from age similar healthy controls, and examine the risk factors associated with diastolic function. METHODS In a cross sectional analysis we compared LV structure and diastolic function from two dimensional echocardiogram in participants with type 1 (T1D) and type 2 diabetes (T2D) who participated in the SEARCH for Diabetes in Youth Study. Linear models were used to examine the risk factors associated with worse diastolic function. RESULTS Of 479 participants studied, 258 had T1D (mean age 21.2 ± 5.2 years, 60.5% non-Hispanic white, 53.9% female) and 221 had T2D (mean age 24.8 ± 4.3 years, 24.4% non-Hispanic white, 73.8% female). Median diabetes duration was 11.6 years. Participants with T2D had greater LV mass index and worse diastolic function that persisted after adjustment for differences in risk factors compared with participants with T1D (all p < 0.05). Abnormal diastolic function, quantified using healthy controls, was pronounced in both groups but greater in those with T2D than T1D (T2D: 57.7% vs T1D: 47.2%, respectively), p < 0.05. Risk factors associated with worse diastolic function included older age at diabetes diagnosis, female sex, higher BP, heart rate and HbA1c and longer diabetes duration. CONCLUSIONS LV structure and diastolic function is worse in individuals with T2D compared to T1D. However, abnormal diastolic function in seen in both groups compared to published values from age similar healthy controls.
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MESH Headings
- Adolescent
- Adult
- Age of Onset
- Case-Control Studies
- Cross-Sectional Studies
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diastole
- Echocardiography
- Female
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/epidemiology
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Predictive Value of Tests
- Prevalence
- Risk Assessment
- Risk Factors
- United States/epidemiology
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
- Ventricular Remodeling
- Young Adult
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Affiliation(s)
- Amy S Shah
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children's Hospital Medical Center and The University of Cincinnati, 3333 Burnet Ave ML 7012, Cincinnati, OH, 45229, USA.
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus (CU-Anschutz), Aurora, USA
| | - Ralph D'Agostino
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, USA
| | - Lawrence M Dolan
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children's Hospital Medical Center and The University of Cincinnati, 3333 Burnet Ave ML 7012, Cincinnati, OH, 45229, USA
| | - Lynne Wagenknecht
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, USA
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Los Angeles, USA
| | - Cate Pihoker
- Department of Pediatrics, The University of Washington, Washington, USA
| | - Elaine M Urbina
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children's Hospital Medical Center and The University of Cincinnati, 3333 Burnet Ave ML 7012, Cincinnati, OH, 45229, USA
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15
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Abstract
The current trends of prevalence, incidence, and mortality in heart failure with preserved ejection fraction are summarized. We describe the differences in the definitions of heart failure with preserved ejection fraction used in community-based studies, heart failure registries, and clinical trials. The worldwide prevalence of heart failure with preserved ejection fraction is approximately 2%; it is becoming the dominant form of heart failure owing to the aging population. The longitudinal trend of mortality in this disease is decreasing, and the risk of mortality is similar between heart failure with preserved ejection fraction and heart failure with reduced ejection fraction.
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16
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Wang H, Jia Q, Shi J, Hu Y. Prognostic value of serum bilirubin in patients with heart failure: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26180. [PMID: 34087882 PMCID: PMC8183714 DOI: 10.1097/md.0000000000026180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Heart failure (HF) is one of the common and critical disease, and often accompanied by increased level of serum bilirubin, but the role of an indicator of bilirubin to monitor the prognosis of patients with heart failure is still unclear, so we implemented the study to systematically evaluate the predictive value of bilirubin in HF. METHODS A comprehensive search and systematic review will be conducted on electronic databases such as Medline, Cochrane Library, Embase, Web of Science, Cochrane Clinical Trials Database of study on the relationship between bilirubin and prognosis of HF patients. Review Manager software (version 5.3.5) and STATA 14 software (version 14.0) will be used for data analysis and synthesis. RESULTS The results will systematically and comprehensively reveal the evidence on the predictive value of bilirubin in HF. CONCLUSION The study will display the effect of bilirubin level on the prognosis of patients with heart failure, and help clinicians to pay more attention to the level of bilirubin in patients with HF, and can take certain treatment measures as earlier as possible. INPLASY REGISTRATION NUMBER INPLASY202140116.
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Affiliation(s)
- Huan Wang
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Qiulei Jia
- Graduate School, Beijing University of Chinese Medicine
| | - Jingjing Shi
- Graduate School, Beijing University of Chinese Medicine
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanhui Hu
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
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17
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Hao G, Wang X, Chen Z, Zhang L, Zhang Y, Wei B, Zheng C, Kang Y, Jiang L, Zhu Z, Zhang J, Wang Z, Gao R. Prevalence of heart failure and left ventricular dysfunction in China: the China Hypertension Survey, 2012-2015. Eur J Heart Fail 2020; 21:1329-1337. [PMID: 31746111 DOI: 10.1002/ejhf.1629] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/02/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a major health burden worldwide. However, there is no nationwide epidemiological data on HF in China after 2000. The aims of this study are (i) to determine the prevalence of left ventricular (LV) dysfunction and HF (with reduced, mid-range, and preserved ejection fraction) in a nationally representative Chinese population, and (ii) to investigate the treatment and control of hypertension in HF patients. METHODS AND RESULTS Data from the China Hypertension Survey (CHS) and 22 158 participants were eligible for analysis in this study. For each participant, a self-reported history of HF and any other cardiovascular diseases was acquired. Two-dimensional and Doppler echocardiography was used to assess LV dysfunction. Overall, 1.3% (estimated 13.7 million) of the Chinese adult population aged ≥35 years had HF, 1.4% of participants had LV systolic dysfunction (ejection fraction <50%), and 2.7% were graded as having 'moderate' or 'severe' LV diastolic dysfunction. The weighted prevalence of HF was similar between urban and rural residents (1.6% vs. 1.1%, P = 0.266), and between men and women (1.4% vs. 1.2%, P = 0.632). In addition, among HF patients with hypertension, 57.7% received antihypertensive medication, and 14.5% had their blood pressure controlled <140/90 mmHg. CONCLUSIONS In summary, there was an increase in the prevalence of HF, and LV dysfunction was very common in China. However, treatment and control of hypertension in participants with HF were low. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR-ECS-14004641.
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Affiliation(s)
- Guang Hao
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Xin Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Zuo Chen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Linfeng Zhang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Yuhui Zhang
- Heart Failure Center, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Bingqi Wei
- Heart Failure Center, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Congyi Zheng
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Yuting Kang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Linlin Jiang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenhui Zhu
- Department of Echocardiography, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Jian Zhang
- Heart Failure Center, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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18
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Wan J, Liu S, Yang Y, Wang D, Ran F, Xia S, Ma S, Hou J, Zhou P, Sun Y, Wang P. Roles of arterial pressure volume index and arterial velocity pulse index trajectories in risk prediction in hypertensive patients with heart failure with preserved ejection fraction. Clin Exp Hypertens 2020; 42:469-478. [PMID: 31851528 DOI: 10.1080/10641963.2019.1705319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Arterial pressure volume index (API) and arterial velocity pulse index (AVI) contribute to the development of vascular damage and cardiovascular disease. However, the relationship between common API/AVI trajectories and cardiovascular outcomes in hypertensive patients with heart failure with preserved ejection fraction (HFpEF) is unknown.Methods: A total of 488 consecutive hypertensive patients with HFpEF who repeatedly underwent API/AVI measurements were prospectively examined. We then applied API/AVI measurements into actual clinical practice. Latent mixture modeling was performed to identify API/AVI trajectories. Hazards ratios (HRs) were measured using Cox proportional hazard models.Results: We identified four distinct API/AVI trajectory patterns: low (7.6%), moderate (43.8%), high (28.9%), and very high (19.7%). Compared with the low group, higher API trajectories were associated with increased risk of total cardiovascular events (high group, adjusted HR: 2.91, 95% confidence interval [CI]: 1.97-4.26; very high group, adjusted HR: 2.46, 95%CI: 1.18-3.79). Consistently, higher AVI trajectories were also associated with a higher risk of total cardiovascular events (high group, adjusted HR: 2.58, 95%CI: 1.23-5.47; very high group, adjusted HR: 3.12, 95%CI: 1.83-6.08), compared with the low trajectory group.Conclusion: High API/AVI trajectories are strong predictors of cardiovascular risk in hypertensive patients with HFpEF. Among these patients, measuring API/AVI may improve risk stratification and provide additional information to tailor treatment strategies.
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Affiliation(s)
- Jindong Wan
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, PR China.,Department of Cardiology, Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Sen Liu
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, PR China.,Department of Cardiology, Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Yi Yang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, PR China.,Department of Cardiology, Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Dan Wang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, PR China.,Department of Cardiology, Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Fei Ran
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, PR China.,Department of Cardiology, Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Siwei Xia
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, PR China.,Department of Cardiology, Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Shuangtao Ma
- Division of Nanomedicine and Molecular Intervention, Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Jixin Hou
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, PR China.,Department of Cardiology, Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Peng Zhou
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, PR China.,Department of Cardiology, Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Yun Sun
- Department of Party Secretary, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, PR China
| | - Peijian Wang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, PR China.,Department of Cardiology, Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
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19
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Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail 2020; 22:1342-1356. [PMID: 32483830 PMCID: PMC7540043 DOI: 10.1002/ejhf.1858] [Citation(s) in RCA: 875] [Impact Index Per Article: 218.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022] Open
Abstract
The heart failure syndrome has first been described as an emerging epidemic about 25 years ago. Today, because of a growing and ageing population, the total number of heart failure patients still continues to rise. However, the case mix of heart failure seems to be evolving. Incidence has stabilized and may even be decreasing in some populations, but alarming opposite trends have been observed in the relatively young, possibly related to an increase in obesity. In addition, a clear transition towards heart failure with a preserved ejection fraction has occurred. Although this transition is partially artificial, due to improved recognition of heart failure as a disorder affecting the entire left ventricular ejection fraction spectrum, links can be made with the growing burden of obesity‐related diseases and with the ageing of the population. Similarly, evidence suggests that the number of patients with heart failure may be on the rise in low‐income countries struggling under the double burden of communicable diseases and conditions associated with a Western‐type lifestyle. These findings, together with the observation that the mortality rate of heart failure is declining less rapidly than previously, indicate we have not reached the end of the epidemic yet. In this review, the evolving epidemiology of heart failure is put into perspective, to discern major trends and project future directions.
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Affiliation(s)
- Amy Groenewegen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arend Mosterd
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Arno W Hoes
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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20
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Xin YG, Chen X, Zhao YN, Hu J, Sun Y, Hu WY. Outcomes of spironolactone treatment in patients in Northeast China suffering from heart failure with mid-range ejection fraction. Curr Med Res Opin 2019; 35:561-568. [PMID: 30183419 DOI: 10.1080/03007995.2018.1520695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM The treatment effects of spironolactone on heart failure with reduced (HFrEF LVEF <40%) and preserved (HFpEF LVEF ≥50%) ejection fraction are well characterized. It is not clear whether heart failure patients with mid-range ejection fraction (HFmrEF, LVEF 40-49%) benefit from spironolactone. The present study aims to evaluate the efficacy of spironolactone in HFmrEF patients. METHOD This study compared a high dosage of spironolactone (50 mg daily), a low dosage of spironolactone (25 mg daily), and an untreated group for the prevention of major adverse cardiovascular events (MACE) in 279 patients admitted to hospital diagnosed with HFmrEF. RESULTS With a mean follow-up duration of 1 year, the death and HF-rehospitalization rate demonstrated significantly lower incidence in those taking spironolactone, compared with the untreated group (21.3% vs 34.5%, p = .014, respectively). Further analysis showed no difference between two spironolactone groups (21.8% vs 20.7%, p = .861). Kaplan-Meier analysis of outcome-free survival illustrated a significant difference in survival rate among three groups (log-rank testing, p = .045). Compared with the baseline level, patients receiving 25 mg spironolactone had a lower physical score (p < .05) at 1-year follow-up. MLHFQ total scores in the two spironolactone groups markedly improved compared with the untreated group (p < .001); similar results were observed in the MLHFQ physical scores (p = .025, .001, respectively) and emotional sub-scale (p = .023, .011, respectively); however, paired comparison between the two spironolactone groups showed no difference. CONCLUSIONS In patients with HFmrEF, treatment with spironolactone significantly reduced the incidence of the primary composite outcomes of all-cause death, and rehospitalization for the management of heart failure compared with placebo, and a high dosage of spironolactone did not show trends of reduction in MACE.
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Affiliation(s)
- Yan-Guo Xin
- a Department of Cardiology , The First Affiliated Hospital, China Medical University , Shenyang , PR China
- b Department of Cardiology , West China Hospital, Sichuan University , Chengdu , PR China
| | - Xin Chen
- a Department of Cardiology , The First Affiliated Hospital, China Medical University , Shenyang , PR China
- c Department of Cardiology , Fuling Central Hospital , Chongqing , PR China
| | - Yi-Nan Zhao
- d Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, PR China
| | - Jian Hu
- a Department of Cardiology , The First Affiliated Hospital, China Medical University , Shenyang , PR China
| | - Yingxian Sun
- a Department of Cardiology , The First Affiliated Hospital, China Medical University , Shenyang , PR China
| | - Wen-Yu Hu
- a Department of Cardiology , The First Affiliated Hospital, China Medical University , Shenyang , PR China
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21
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Tromp J, Teng TH, Tay WT, Hung CL, Narasimhan C, Shimizu W, Park SW, Liew HB, Ngarmukos T, Reyes EB, Siswanto BB, Yu CM, Zhang S, Yap J, MacDonald M, Ling LH, Leineweber K, Richards AM, Zile MR, Anand IS, Lam CSP. Heart failure with preserved ejection fraction in Asia. Eur J Heart Fail 2018; 21:23-36. [PMID: 30113120 DOI: 10.1002/ejhf.1227] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a global public health problem. Unfortunately, little is known about HFpEF across Asia. METHODS AND RESULTS We prospectively studied clinical characteristics, echocardiographic parameters and outcomes in 1204 patients with HFpEF (left ventricular ejection fraction ≥50%) from 11 Asian regions, grouped as Northeast Asia (Hong Kong, Taiwan, China, Japan, Korea, n = 543), South Asia (India, n = 252), and Southeast Asia (Malaysia, Thailand, Singapore, Indonesia, Philippines, n = 409). Mean age was 68 ±12 years (37% were < 65 years) and 50% were women. Seventy per cent of patients had ≥2 co-morbidities, most commonly hypertension (71%), followed by anaemia (57%), chronic kidney disease (50%), diabetes (45%), coronary artery disease (29%), atrial fibrillation (29%) and obesity (26%). Southeast Asian patients had the highest prevalence of all co-morbidities except atrial fibrillation, South Asians had the lowest prevalence of all co-morbidities except anaemia and obesity, and Northeast Asians had more atrial fibrillation. Left ventricular hypertrophy and concentric remodelling were most prominent among Southeast and South Asians, respectively (P < 0.001). Overall, 12.1% of patients died or were hospitalized for heart failure within 1 year. Southeast Asians were at higher risk for adverse outcomes, independent of co-morbidity burden and cardiac geometry. CONCLUSION These first prospective multinational data from Asia show that HFpEF affects relatively young patients with a high burden of co-morbidities. Regional differences in types of co-morbidities, cardiac remodelling and outcomes of HFpEF across Asia have important implications for public health measures and global HFpEF trial design.
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Affiliation(s)
- Jasper Tromp
- National Heart Centre Singapore, Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.,Duke-NUS Medical School, Singapore, Singapore
| | - Tiew-Hwa Teng
- National Heart Centre Singapore, Singapore, Singapore
| | - Wan Ting Tay
- National Heart Centre Singapore, Singapore, Singapore
| | | | | | - Wataru Shimizu
- Nippon Medical School's Department of Cardiovascular Medicine, Tokyo, Japan
| | | | - Houng Bang Liew
- Jeffrey Cheah School Of Medicine And Health Sciences, Monash University Malaysia & Department of Cardiology, Queen Elizabeth Hospital 2, Malaysia
| | | | | | - Bambang B Siswanto
- National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia
| | - Cheuk-Man Yu
- Heart Centre, Hong Kong Baptist Hospital, Hong Kong, SAR, The People's Republic of China
| | - Shu Zhang
- Fuwai Hospital, Beijing, The People's Republic of China
| | - Jonathan Yap
- National Heart Centre Singapore, Singapore, Singapore
| | | | - Lieng Hsi Ling
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road Singapore, Singapore 119228.,Cardiac Department, National University Health System, Singapore
| | | | - A Mark Richards
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road Singapore, Singapore 119228.,National University Heart Centre, Singapore, Singapore.,Christchurch Heart Institute, University of Otago, 2 Riccarton Avenue, Christchurch 8011, New Zealand
| | - Michael R Zile
- Medical University of South Carolina, and the Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Inder S Anand
- Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,National University Heart Centre, Singapore, Singapore
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22
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Li Y, Pastori D, Guo Y, Wang Y, Lip GYH. Risk factors for new-onset atrial fibrillation: A focus on Asian populations. Int J Cardiol 2018; 261:92-98. [PMID: 29657061 DOI: 10.1016/j.ijcard.2018.02.051] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/23/2018] [Accepted: 02/13/2018] [Indexed: 12/21/2022]
Abstract
The incidence of new-onset atrial fibrillation (NOAF) is increasing both in the Asian populations and Western countries. Several demographic and clinical risk factors were independently associated with NOAF, including ageing, male sex, obesity, obstructive sleep apnea syndrome, hypertension, coronary artery disease, renal dysfunction and heart failure. However, some differences in the incidence of NOAF, the prevalence of some risk factors and lifestyle or environmental conditions may exist between Asian and Western countries. Early recognition and holistic management of risk factors in an integrated manner may help reduce the burden of NOAF and its complications. While some risk scores have been developed to predict the risk of NOAF, thus far none are currently recommended or adequately validated to be used as a screening tool especially in the Asian population. The present semi-systematic review article aims to provide a comprehensive overview on the risk factors associated to NOAF, focusing on those explored in the Asian populations.
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Affiliation(s)
- Yanguang Li
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Chinese PLA General Hospital, Chinese PLA Medical School, Department of Cardiology, Beijing, China
| | - Daniele Pastori
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Yutao Guo
- Chinese PLA General Hospital, Chinese PLA Medical School, Department of Cardiology, Beijing, China
| | - Yutang Wang
- Chinese PLA General Hospital, Chinese PLA Medical, Department of Geriatric Cardiology, Beijing, China
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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23
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Rajadurai J, Tse HF, Wang CH, Yang NI, Zhou J, Sim D. Understanding the Epidemiology of Heart Failure to Improve Management Practices: An Asia-Pacific Perspective. J Card Fail 2017; 23:327-339. [PMID: 28111226 DOI: 10.1016/j.cardfail.2017.01.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/13/2016] [Accepted: 01/18/2017] [Indexed: 01/08/2023]
Abstract
Heart failure (HF) is a major global healthcare problem with an estimated prevalence of approximately 26 million. In Asia-Pacific regions, HF is associated with a significant socioeconomic burden and high rates of hospital admission. Epidemiological data that could help to improve management approaches to address this burden in Asia-Pacific regions are limited, but suggest patients with HF in the Asia-Pacific are younger and have more severe signs and symptoms of HF than those of Western countries. However, local guidelines are based largely on the European Society of Cardiology and American College of Cardiology Foundation/American Heart Association guidelines, which draw their evidence from studies where Western patients form the major demographic and patients from the Asia-Pacific region are underrepresented. Furthermore, regional differences in treatment practices likely affect patient outcomes. In the following review, we examine epidemiological data from existing regional registries, which indicate that these patients represent a distinct subpopulation of patients with HF. In addition, we highlight that patients with HF are under-treated in the region despite the existence of local guidelines. Finally, we provide suggestions on how data can be enriched throughout the region, which may positively affect local guidelines and improve management practices.
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Affiliation(s)
- Jeyamalar Rajadurai
- Department of Cardiology, Subang Jaya Medical Centre, Subang Jaya, Malaysia.
| | - Hung-Fat Tse
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chao-Hung Wang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ning-I Yang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jingmin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - David Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore
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