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Sepehrvand N, Sanjebad MN, Youngson E, McAlister F, Ezekowitz J. TIME TO GUIDELINE-DETERMINED MEDICAL THERAPY IN PATIENTS WITH DE NOVO HEART FAILURE: A RETROSPECTIVE POPULATION-BASED STUDY FROM ALBERTA, CANADA. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Wang K, Youngson E, Nikhanj A, Nguyen Q, Qi A, Thomas J, McAlister F, Oudit G. Differential trajectories in LVEF predicts divergent clinical outcomes in HFrEF patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recovery or improvement in LVEF is observed in many HFrEF patients following optimal medical management and device therapies, but whether this reflects true myocardial recovery remains controversial and the significance of LVEF decompensation in relation to clinical outcomes is unclear.
Purpose
To elucidate clinical characteristics and assess prognosis of HFrEF patients with differential trajectories in LVEF.
Methods
Heart failure (HF) patients were enrolled in a prospective Heart Function registry from outpatient cardiology clinics at an academic institution between Feb 2018 and Nov 2019. Retrospective analysis was conducted on 2D-echocardiography (echo) performed between Jan 2009 and Nov 2019. In total, 590 patients met the inclusion criteria with ≥2 repeated echo evaluations separated by ≥1 year. Patient demographics and clinical characteristics at enrollment were collected through review of medical records. Cardiovascular and HF specific admissions were captured using the corresponding ICD-10-CA codes. During a median follow-up of 5.9 years (IQR: 3.1 to 8.5 years) from the first echo date, clinical outcomes were assessed through composite mortality and hospitalizations endpoints.
Results
We identified 3 independent cohorts with 279 patients having permanently reduced LVEF (<40%, HFrEF), 236 patients with recovered LVEF (>40% on serial evaluations, HFrecEF) and 75 patients with subsequent decompensation in LVEF (>40%, then <40%, HFdecEF) following initial recovery. Use of ACE inhibitors or ARBs (94% vs. 99% vs. 91%) and beta blockers (88% vs. 87% vs. 87%) at baseline echo was similar amongst HFrEF, HFrecEF and HFdecEF cohorts respectively. HFrecEF cohort had higher usage of MRA (55% vs. 65% vs. 44%, p=0.002) and diuretics (74% vs. 80% vs. 65%, p=0.026). HFdecEF cohort was characterized by a predominance of males (80% vs. 69% vs. 80%, p=0.01), and more patients with ischemic etiology (41% vs. 28% vs. 60%, p<0.001) compared with the HFrecEF cohort and resembled more closely to demographics of the HFrEF cohort. Median LVEF at baseline echo was similar across the cohorts. However, HFdecEF cohort had lower LV end-diastolic diameter (p<0.001), LV end-systolic diameter (p<0.001) and LV mass (p=0.01) compared with the HFrEF cohort sharing similarities with the HFrecEF cohort on baseline echo, suggesting lesser extent of adverse cardiac remodeling in both HFrecEF and HFdecEF cohorts initially. Over a median 5.9 years follow-up, HFdecEF and HFrEF patients had a significantly higher risk (compared to those with HFrecEF) of composite all-cause mortality with all-cause (80% vs. 75% vs. 57%, p=0.004), cardiovascular (48% vs. 50% vs. 29%, p=0.001) and HF hospitalizations (31% vs. 32% vs. 16%, p=0.004).
Conclusion
HFrEF patients who never recover their LVEF and patients with decompensation in LVEF following initial recovery represent a clinically higher risk group than patients who remained recovered during follow-up.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): University of Alberta Hospital Foundation, Canadian Institutes of Health Research
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Affiliation(s)
- K Wang
- Mazankowski Alberta Heart Institute, Edmonton, Canada
| | | | - A Nikhanj
- Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - Q Nguyen
- Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - A Qi
- Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - J Thomas
- Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - F McAlister
- Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - G.Y Oudit
- Mazankowski Alberta Heart Institute, Edmonton, Canada
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Turgeon R, Youngson E, Graham M. ASSOCIATION OF TICAGRELOR WITH RISK OF PNEUMONIA: A POPULATION-BASED COHORT STUDY. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Mathew A, Youngson E, Wirzba B, Graham M. THE TRAJECTORY OF FRAILTY SCORES OVER THE COURSE OF CARDIAC REHABILITATION. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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McAlister FA, Youngson E, Jacka M, Graham M, Conen D, Chan M, Szczeklik W, Alonso-Coello P, Devereaux PJ. A comparison of four risk models for the prediction of cardiovascular complications in patients with a history of atrial fibrillation undergoing non-cardiac surgery. Anaesthesia 2019; 75:27-36. [PMID: 31282570 DOI: 10.1111/anae.14777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 02/06/2023]
Abstract
It is unclear how best to predict peri-operative cardiovascular risk in patients with atrial fibrillation undergoing non-cardiac surgery. This study examined the accuracy of the revised cardiac risk index and three atrial fibrillation thrombo-embolic risk models for predicting 30-day cardiovascular events after non-cardiac surgery in patients with a pre-operative history of atrial fibrillation. We conducted a prospective cohort study in 28 centres from 2007 to 2013 of 40,004 patients ≥ 45 years of age undergoing inpatient non-cardiac surgery who were followed until 30 days after surgery for cardiovascular events (defined as myocardial injury, heart failure, stroke, resuscitated cardiac arrest or cardiovascular death). The 2088 patients with a pre-operative history of atrial fibrillation were at higher risk of peri-operative cardiovascular events compared with the 34,830 patients without a history of atrial fibrillation (29% vs. 13%, respectively, adjusted odds ratio 1.30 (95%CI 1.17-1.45). Compared with the revised cardiac risk index (c-index 0.60), all atrial fibrillation thrombo-embolic risk scores were significantly better at predicting peri-operative cardiovascular events: CHADS2 (c-index 0.62); CHA2 DS2 -VASc (c-index 0.63); and R2 CHADS2 (c-index 0.65), respectively. Although the three thrombo-embolic risk prediction models were significantly better than the revised cardiac risk index for prediction of peri-operative cardiovascular events, none of the four models exhibited strong discrimination metrics. There remains a need to develop a better peri-operative risk prediction model.
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Affiliation(s)
- F A McAlister
- Alberta SPOR Support Unit, University of Alberta, Edmonton, AB, Canada.,General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - E Youngson
- Alberta SPOR Support Unit, University of Alberta, Edmonton, AB, Canada
| | - M Jacka
- Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Graham
- Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - D Conen
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - M Chan
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong
| | - W Szczeklik
- Jagiellonian University Medical College, Department of Intensive Care and Peri-operative Medicine, Kraków, Poland
| | - P Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB-Sant Pau), CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - P J Devereaux
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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Turgeon R, Koshman S, Youngson E, Har B, Graham M. REAL-WORLD USE OF TICAGRELOR DOES NOT REDUCE MAJOR ADVERSE CARDIOVASCULAR EVENTS, BUT INCREASES MAJOR BLEEDING AND HEALTHCARE VISITS FOR DYSPNEA COMPARED TO CLOPIDOGREL: A CANADIAN REGISTRY STUDY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sepehrvand N, Youngson E, Bakal J, McAlister F, Rowe B, Ezekowitz J. P5132External validation and improvement of EHMRG risk model using a population-based cohort of patients with heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shavadia J, Youngson E, Bainey K, Bakal J, Welsh R. PROPHYLACTIC WARFARIN FOLLOWING EXTENSIVE ANTERIOR ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: INSIGHTS FROM THE VITAL HEART RESPONSE REGISTRY. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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McAlister FA, Jacka M, Graham M, Youngson E, Cembrowski G, Bagshaw SM, Pannu N, Townsend DR, Srinathan S, Alonso-Coello P, Devereaux PJ. The prediction of postoperative stroke or death in patients with preoperative atrial fibrillation undergoing non-cardiac surgery: a VISION sub-study. J Thromb Haemost 2015; 13:1768-75. [PMID: 26270168 DOI: 10.1111/jth.13110] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/07/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal means of pre-operative risk stratification in patients with atrial fibrillation (AF) is uncertain. OBJECTIVE To examine the accuracy of AF thromboembolic risk models (the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores) for predicting 30-day stroke and/or all-cause mortality after non-cardiac surgery in patients with preoperative AF, and to compare these risk scores with the Revised Cardiac Risk Index (RCRI). PATIENTS/METHODS A multicentre (8 countries, 2007-2011) prospective cohort study of patients ≥ 45 years of age undergoing inpatient non-cardiac surgery, who were followed until 30 days after surgery. We calculated c-statistics for each risk prediction model and net reclassification improvements (NRIs) compared with the RCRI. RESULTS The 961 patients with preoperative AF were at higher risk of any cardiovascular event in the 30 days postoperatively compared with the 13 001 patients without AF: 26.6% vs. 9.0%; adjusted odds ratio, 1.58; 95% confidence interval [CI], 1.33-1.88. All thromboembolic risk scores predicted postoperative death just as well as the RCRI (with c-indices between 0.67 and 0.72). Compared with the RCRI (which had a c-index of 0.64 for 30-day stroke/death), the CHADS2 (c-index, 0.67; NRI, 0.31; 95% CI, 0.02-0.61) significantly improved postoperative stroke/mortality risk prediction, largely due to improved discrimination of patients who did not subsequently have an event. CONCLUSIONS In AF patients, the three thromboembolic risk scores performed similarly to the RCRI in predicting death within 30 days and the CHADS2 score was the best predictor of postoperative stroke/death regardless of type of surgery.
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Affiliation(s)
- F A McAlister
- Patient Health Outcomes Research and Clinical Effectiveness Unit, Edmonton, AB, Canada
- Division of General Internal Medicine, Department of Medicine, Edmonton, AB, Canada
| | - M Jacka
- Division of Critical Care Medicine, Department of Medicine, Edmonton, AB, Canada
| | - M Graham
- Division of Cardiology, Department of Medicine, Edmonton, AB, Canada
| | - E Youngson
- Patient Health Outcomes Research and Clinical Effectiveness Unit, Edmonton, AB, Canada
| | - G Cembrowski
- Division of Medical Biochemistry, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - S M Bagshaw
- Division of Critical Care Medicine, Department of Medicine, Edmonton, AB, Canada
| | - N Pannu
- Division of Critical Care Medicine, Department of Medicine, Edmonton, AB, Canada
| | - D R Townsend
- Division of Critical Care Medicine, Department of Medicine, Edmonton, AB, Canada
| | - S Srinathan
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - P Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB-Sant Pau), CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - P J Devereaux
- Departments of Clinical Epidemiology and Biostatistics and Medicine, The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
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Youngson E, Welsh R, McAlister F, Kaul P, Bakal J. EVALUATING THE USE OF ADMINISTRATIVE COMORBIDITY DEFINITIONS IN A REGISTRY OF STEMI PATIENTS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Youngson E, Bakal J, McAlister F, Brass N, MS McMurtry, Tymchak W, Welsh R. VALIDATION OF ADMINISTRATIVE DIAGNOSIS AND PROCEDURE CODES IN A REGISTRY OF STEMI PATIENTS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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