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Salah K, Stienen S, Pinto YM, Eurlings LW, Metra M, Bayes-Genis A, Verdiani V, Tijssen JGP, Kok WE. Prognosis and NT-proBNP in heart failure patients with preserved versus reduced ejection fraction. Heart 2019; 105:1182-1189. [PMID: 30962192 PMCID: PMC6662953 DOI: 10.1136/heartjnl-2018-314173] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We assessed the prognostic significance of absolute and percentage change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients hospitalised for acute decompensated heart failure with preservedejection fraction (HFpEF) versus heart failure with reduced ejection fraction (HFrEF). METHODS Patients with left ventricular ejection fraction ≥50% were categorised as HFpEF (n=283), while those with <40% as were categorised as HFrEF (n=776). Prognostic values of absolute and percentage change in NT-proBNP levels for 6 months all-cause mortality after discharge were assessed separately in patients with HFpEF and HFrEF by multivariable adjusted Cox regression analysis. Comorbidities were compared between heart failure groups. RESULTS Discharge NT-proBNP levels predicted outcome similarly in HFpEF and HFrEF: for any 2.7-factor increase in NT-proBNP levels, the HR for mortality was 2.14 for HFpEF (95% CI 1.48 to 3.09) and 1.96 for HFrEF (95% CI 1.60 to 2.40). Mortality prediction was equally possible for NT-proBNP reduction of ≤30% (HR 4.60, 95% CI 1.47 to 14.40 and HR 3.36, 95% CI 1.93 to 5.85 for HFpEF and HFrEF, respectively) and for >30%-60% (HR 3.28, 95% CI 1.07 to 10.12 and HR 1.79, 95% CI 0.99 to 3.26, respectively), compared with mortality in the reference groups of >60% reductions in NT-proBNP levels. Prognostically relevant comorbidities were more often present in patients with HFpEF than patients with HFrEF in low (≤3000 pg/mL) but not in high (>3000 pg/mL) NT-proBNP discharge categories. CONCLUSIONS Our study highlights-after demonstrating that NT-proBNP levels confer the same relative risk information in HFpEF as in HFrEF-the possibility that comorbidities contribute relatively more to prognosis in patients with HFpEF with lower NT-proBNP levels than in patients with HFrEF.
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Affiliation(s)
- Khibar Salah
- Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amasterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Susan Stienen
- Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amasterdam, The Netherlands.,INSERM, Centre d'Investigation Cliniques Plurithématique, Université de Lorraine, CHRU de Nancy, Nancy, France
| | - Yigal M Pinto
- Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amasterdam, The Netherlands
| | - Luc W Eurlings
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Cardiology, University of Brescia, Brescia, Italy
| | - Antoni Bayes-Genis
- Department of Cardiology, CIBERCV, Hospital Universitari Germans Trias i Pujol, Barcalona, Spain
| | - Valerio Verdiani
- Department of Internal Medicine and Emergency, Careggi University Hospital, Florence, Italy
| | - Jan G P Tijssen
- Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amasterdam, The Netherlands
| | - Wouter E Kok
- Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amasterdam, The Netherlands
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Stienen S, Salah K, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Tijssen JP, Pinto YM, Kok WE. Targeting N-Terminal Pro-Brain Natriuretic Peptide in Older Versus Younger Acute Decompensated Heart Failure Patients. JACC Heart Fail 2016; 4:736-45. [PMID: 27395353 DOI: 10.1016/j.jchf.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the prognostic value and attainability of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in young and elderly acute decompensated heart failure (ADHF) patients. BACKGROUND Less-effective NT-proBNP-guided therapy in chronic heart failure (HF) has been reported in elderly patients. Whether this can be attributed to differences in prognostic value of NT-proBNP or to differences in attaining a prognostic value is unclear. The authors studied this question in ADHF patients. METHODS Our study population comprised 7 ADHF cohorts. We defined absolute (<1,500 ng/l, <3,000 ng/l, <5,000 ng/l, and <15,000 ng/l) and relative NT-proBNP discharge cut-off levels (>30%, >50%, and >70%). Six-month all-cause mortality after discharge was studied for each level in Cox regression analyses, and compared between elderly (age >75 years) and young patients (age ≤75 years). Thereafter, we compared percentages of elderly and young patients attaining NT-proBNP levels (= attainability). RESULTS A total of 1,235 patients (59% male, 45% >75 years of age) was studied. Admission levels of NT-proBNP were significantly higher in elderly versus younger patients. The prognostic value of absolute and relative NT-proBNP levels was similar in elderly and young patients. Attainability was significantly lower in elderly patients for all absolute levels and a >50% relative reduction, but not for >30% and >70%. For absolute levels, attainability differences between age groups were decreased to a large extent after correction for admission NT-proBNP and anemia at discharge. For relative levels, attainability differences disappeared after correction for HF etiology and anemia at discharge. CONCLUSIONS In young and elderly ADHF patients, it is not the prognostic value of absolute and relative NT-proBNP levels that is different, but the attainability of these levels that is lower in the elderly. This can largely be attributed to factors other than age.
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Affiliation(s)
- Susan Stienen
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Khibar Salah
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Luc W Eurlings
- Department of Cardiology, VieCuri Medical Center, Venlo, the Netherlands
| | - Paulo Bettencourt
- Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
| | - Joana M Pimenta
- Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Valerio Verdiani
- Department of Internal Medicine and Emergency, Careggi University Hospital, Florence, Italy
| | - Luca Bettari
- Department of Cardiology, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Valentina Lazzarini
- Department of Cardiology, Ospedale San Pellegrino, Castiglione delle Stiviere, MN, Italy
| | - Jan P Tijssen
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Yigal M Pinto
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Wouter E Kok
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
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Salah K, Kok WE, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Verdiani V, Tijssen JG, Pinto YM. Competing Risk of Cardiac Status and Renal Function During Hospitalization for Acute Decompensated Heart Failure. JACC: Heart Failure 2015; 3:751-61. [DOI: 10.1016/j.jchf.2015.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/29/2015] [Accepted: 05/31/2015] [Indexed: 10/23/2022]
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Salah K, Pinto YM, Eurlings LW, Metra M, Stienen S, Lombardi C, Tijssen JG, Kok WE. Serum potassium decline during hospitalization for acute decompensated heart failure is a predictor of 6-month mortality, independent of N-terminal pro-B-type natriuretic peptide levels: An individual patient data analysis. Am Heart J 2015; 170:531-42.e1. [PMID: 26385037 DOI: 10.1016/j.ahj.2015.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited data exist for the role of serum potassium changes during hospitalization for acute decompensated heart failure (ADHF). The present study investigated the long-term prognostic value of potassium changes during hospitalization in patients admitted for ADHF. METHODS Our study is a pooled individual patient data analysis assembled from 3 prospective cohorts comprising 754 patients hospitalized for ADHF. The endpoint was all-cause mortality within 180 days after discharge. Serum potassium levels and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured at admission and at discharge. RESULTS A percentage decrease >15% in serum potassium levels occurred in 96 (13%) patients, and an absolute decrease of >0.7 mmol/L in serum potassium levels occurred in 85 (12%) patients; and both were predictors of poor outcome independent of admission or discharge serum potassium. After the addition of other strong predictors of mortality-a 30% change in NT-proBNP during hospitalization, discharge levels of NT-proBNP, renal markers, and other relevant clinical variables-the multivariate hazard ratio of serum potassium percentage reduction of >15% remained an independent predictor of 180-day mortality (hazard ratio 2.06, 95% CI 1.14-3.73). CONCLUSIONS A percentage serum potassium decline of >15% is an independent predictor of 180-day all-cause mortality on top of baseline potassium levels, NT-proBNP levels, renal variables, and other relevant clinical variables. This suggest that patients hospitalized for ADHF with a decline of >15% in serum potassium levels are at risk and thus monitoring and regulating of serum potassium level during hospitalization are needed in these patients.
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Affiliation(s)
- Khibar Salah
- Academic Medical Center, University of Amsterdam, Heart failure Research Center & Department of Cardiology, Amsterdam, the Netherlands.
| | - Yigal M Pinto
- Academic Medical Center, University of Amsterdam, Heart failure Research Center & Department of Cardiology, Amsterdam, the Netherlands
| | - Luc W Eurlings
- University Hospital Maastricht, Department of Cardiology, Maastricht, the Netherlands
| | - Marco Metra
- University of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Cardiology, Brescia, Italy
| | - Susan Stienen
- Academic Medical Center, University of Amsterdam, Heart failure Research Center & Department of Cardiology, Amsterdam, the Netherlands
| | - Carlo Lombardi
- University of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Cardiology, Brescia, Italy
| | - Jan G Tijssen
- Academic Medical Center, University of Amsterdam, Heart failure Research Center & Department of Cardiology, Amsterdam, the Netherlands
| | - Wouter E Kok
- Academic Medical Center, University of Amsterdam, Heart failure Research Center & Department of Cardiology, Amsterdam, the Netherlands
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Eurlings LW, Sanders-van Wijk S, van Kraaij DJ, van Kimmenade R, Meeder JG, Kamp O, van Dieijen-Visser MP, Tijssen JG, Brunner-La Rocca HP, Pinto YM. Risk Stratification With the Use of Serial N-Terminal Pro–B-Type Natriuretic Peptide Measurements During Admission and Early After Discharge in Heart Failure Patients: Post Hoc Analysis of the PRIMA Study. J Card Fail 2014; 20:881-90. [DOI: 10.1016/j.cardfail.2014.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 08/10/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
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Salah K, Kok WE, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Damman P, Tijssen JG, Pinto YM. A novel discharge risk model for patients hospitalised for acute decompensated heart failure incorporating N-terminal pro-B-type natriuretic peptide levels: a European coLlaboration on Acute decompeNsated Heart Failure: ELAN-HF Score. Heart 2013; 100:115-25. [PMID: 24179162 DOI: 10.1136/heartjnl-2013-303632] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Models to stratify risk for patients hospitalised for acute decompensated heart failure (ADHF) do not include the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels during hospitalisation. OBJECTIVE The aim of our study was to develop a simple yet robust discharge prognostication score including NT-proBNP for this notorious high-risk population. DESIGN Individual patient data meta-analyses of prospective cohort studies. SETTING Seven prospective cohorts with in total 1301 patients. PATIENTS Our study population was assembled from the seven studies by selecting those patients admitted because of clinically validated ADHF, discharged alive, and NT-proBNP measurements available at admission and at discharge. MAIN OUTCOME MEASURES The endpoints studied were all-cause mortality and a composite of all-cause mortality and/or first readmission for cardiovascular reason within 180 days after discharge. RESULTS The model that incorporated NT-proBNP levels at discharge as well as the changes in NT-proBNP during hospitalisation in addition to age ≥75 years, peripheral oedema, systolic blood pressure ≤115 mm Hg, hyponatremia at admission, serum urea of ≥15 mmol/L and New York Heart Association (NYHA) class at discharge, yielded the best C-statistic (area under the curve, 0.78, 95% CI 0.74 to 0.82). The addition of NT-proBNP to a reference model significantly improved prediction of mortality as shown by the net reclassification improvement (62%, p<0.001). A simplified model was obtained from the final Cox regression model by assigning weights to individual risk markers proportional to their relative risks. The risk score we designed identified four clinically significant subgroups. The pattern of increasing event rates with increasing score was confirmed in the validation group (BOT-AcuteHF, n=325, p<0.001). CONCLUSIONS In patients hospitalised for ADHF, the addition of the discharge NT-proBNP values as well as the change in NT-proBNP to known risk markers, generates a relatively simple yet robust discharge risk score that importantly improves the prediction of adverse events.
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Affiliation(s)
- Khibar Salah
- Heart failure Research Center & Department of Cardiology, Academic Medical Center, University of Amsterdam, , Amsterdam, The Netherlands
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Eurlings LW, Sanders-van Wijk S, van Kimmenade R, Osinski A, van Helmond L, Vallinga M, Crijns HJ, van Dieijen-Visser MP, Brunner-La Rocca HP, Pinto YM. Multimarker strategy for short-term risk assessment in patients with dyspnea in the emergency department: the MARKED (Multi mARKer Emergency Dyspnea)-risk score. J Am Coll Cardiol 2012; 60:1668-77. [PMID: 23021334 DOI: 10.1016/j.jacc.2012.06.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [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] [Received: 04/02/2012] [Revised: 05/28/2012] [Accepted: 06/26/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study aim was to determine the prognostic value of a multimarker strategy for risk-assessment in patients presenting to the emergency department (ED) with dyspnea. BACKGROUND Combining biomarkers with different pathophysiological backgrounds may improve risk stratification in dyspneic patients in the ED. METHODS The study prospectively investigated the prognostic value of the biomarkers N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), Cystatin-C (Cys-C), high-sensitivity C-reactive protein (hs-CRP), and Galectin-3 (Gal-3) for 90-day mortality in 603 patients presenting to the ED with dyspnea as primary complaint. RESULTS hs-CRP, hs-cTnT, Cyst-C, and NT-proBNP were independent predictors of 90-day mortality. The number of elevated biomarkers was highly associated with outcome (odds ratio: 2.94 per biomarker, 95% confidence interval [CI]: 2.29 to 3.78, p < 0.001). A multimarker approach had incremental value beyond a single-marker approach. Our multimarker emergency dyspnea-risk score (MARKED-risk score) incorporating age ≥75 years, systolic blood pressure <110 mm Hg, history of heart failure, dyspnea New York Heart Association functional class IV, hs-cTnT ≥0.04 μg/l, hs-CRP ≥25 mg/l, and Cys-C ≥1.125 mg/l had excellent prognostic performance (area under the curve: 0.85, 95% CI: 0.81 to 0.89), was robust in internal validation analyses and could identify patients with very low (<3 points), intermediate (≥3, <5 points), and high risk (≥5 points) of 90-day mortality (2%, 14%, and 44% respectively; p < 0.001). CONCLUSIONS A multimarker strategy provided superior risk stratification beyond any single-marker approach. The MARKED-risk score that incorporates hs-cTnT, hs-CRP, and Cys-C along with clinical risk factors accurately identifies patients with very low, intermediate, and high risk.
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Affiliation(s)
- Luc W Eurlings
- Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, the Netherlands.
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van Wijk S, Jacobs L, Eurlings LW, van Kimmenade R, Lemmers R, Broos P, Bekers O, Prins MH, Crijns HJ, Pinto YM, van Dieijen-Visser MP, Brunner-La Rocca HP. Troponin T Measurements by High-Sensitivity vs Conventional Assays for Risk Stratification in Acute Dyspnea. Clin Chem 2012; 58:284-92. [DOI: 10.1373/clinchem.2011.175976] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Cardiac troponin T measured by a high-sensitivity assay (hs-cTnT) recently proved to be of prognostic value in several populations. The hs-cTnT assay may also improve risk stratification in acute dyspnea.
METHODS
We prospectively studied the prognostic value of hs-cTnT in 678 consecutive patients presenting to the emergency department with acute dyspnea. On the basis of conventional cardiac troponin T assay (cTnT) and hs-cTnT assay measurements, patients were divided into 3 categories: (1) neither assay increased (cTnT <0.03 μg/L, hs-cTnT <0.016 μg/L), (2) only hs-cTnT increased ≥0.016 μg/L (cTnT <0.03 μg/L), and (3) both assays increased (cTnT ≥0.03 μg/L, hs-cTnT ≥0.016 μg/L). Moreover, the prognostic value of hs-cTnT was investigated if cTnT was not detectable (<0.01).
RESULTS
One hundred seventy-two patients were in the lowest, 282 patients in the middle, and 223 patients in the highest troponin category. Patients in the second and third categories had significantly higher mortality compared to those in the first category (90-day mortality rate 2%, 10%, and 26% in groups 1, 2, and 3, respectively, P < 0.001; 1-year mortality rate 9%, 21%, and 39%, P < 0.001). Importantly, in patients with undetectable cTnT (n = 347, 51%), increased hs-cTnT indicated worse outcome [90-day mortality, odds ratio 4.26 (95% CI 1.19–15.21); 1-year mortality, hazard ratio 2.27 (1.19–4.36), P = 0.013], whereas N-terminal pro–brain-type natriuretic peptide (NT-proBNP) was not predictive of short-term outcome.
CONCLUSIONS
hs-cTnT is associated with mortality in patients presenting with acute dyspnea. hs-cTnT concentrations provide additional prognostic information to cTnT and NT-proBNP testing in patients with cTnT concentrations below the detection limit. In particular, the hs-cTnT cutoff of 0.016 μg/L enables identification of low-risk patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Martin H Prins
- Department of Epidemiology, Maastricht University Medical Center, CARIM, Maastricht, the Netherlands
| | | | - Yigal M Pinto
- Heart Failure Research Center, Academic Medical Center, Amsterdam, the Netherlands
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Salah K, Kok WE, Eurlings LW, Bettencourt P, Pimenta JM, Bettari L, Bayes-Genis A, Verdiani V, Tijssen JG. Prognostic Value of Discharge Levels of N-Terminal Pro-Brain Natriuretic Peptide in 1301 Patients: A European Collaborative Study. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.227] [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: 11/26/2022]
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Nieuwlaat R, Eurlings LW, Cleland JG, Cobbe SM, Vardas PE, Capucci A, López-Sendòn JL, Meeder JG, Pinto YM, Crijns HJGM. Atrial fibrillation and heart failure in cardiology practice: reciprocal impact and combined management from the perspective of atrial fibrillation: results of the Euro Heart Survey on atrial fibrillation. J Am Coll Cardiol 2009; 53:1690-8. [PMID: 19406345 DOI: 10.1016/j.jacc.2009.01.055] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [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] [Received: 03/31/2008] [Revised: 01/08/2009] [Accepted: 01/12/2009] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Our aim was to identify shortcomings in the management of patients with both atrial fibrillation (AF) and heart failure (HF). BACKGROUND AF and HF often coincide in cardiology practice, and they are known to worsen each other's prognosis, but little is known about the quality of care of this combination. METHODS In the observational Euro Heart Survey on AF, 5,333 AF patients were enrolled in 182 centers across 35 European Society of Cardiology member countries in 2003 and 2004. A follow-up survey was performed after 1 year. RESULTS At baseline, 1,816 patients (34%) had HF. Recommended therapy for HF with left ventricular systolic dysfunction (LVSD) with a beta-blocker and either an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker was prescribed in 40% of HF patients, while 29% received the recommended drug therapy for both LVSD-HF and AF, consisting of the combination of a beta-blocker, either ACEI or angiotensin II receptor blocker, and oral anticoagulation. Rate control was insufficient with 40% of all HF patients with permanent AF having a heart rate < or =80 beats/min. In the total cohort, HF patients had a higher risk for mortality (9.5% vs. 3.3%; p < 0.001), (progression of) HF (24.8% vs. 5.0%; p < 0.001), and AF progression (35% vs. 19%; p < 0.001) during 1-year follow-up. Of all recommended drugs for AF and LVSD-HF, only ACEI prescription was associated with improved survival during 1-year follow-up (odds ratio: 0.51 [95% confidence interval: 0.31 to 0.85]; p = 0.011). CONCLUSIONS The prescription rate of guideline-recommended drug therapy for AF and LVSD-HF is low. Randomized controlled trials targeting this highly prevalent subgroup with AF and HF are warranted.
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Affiliation(s)
- Robby Nieuwlaat
- Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands.
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Eurlings LW, Januzzi JL, Pinto YM. Is acute heart failure a highly prevalent orphan disease? Eur Heart J 2006; 27:2619-20. [PMID: 17060342 DOI: 10.1093/eurheartj/ehl332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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