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Chang TW, Hung CL, Ko SL, Liao CT, Hsu CY, Huang N, Mebazaa A, Chang HY. Bridging the STRONG Gap: Call to Optimize Heart Failure Treatment after Hospitalization in Women and Men in Taiwan. Am J Cardiol 2024:S0002-9149(24)00369-2. [PMID: 38763384 DOI: 10.1016/j.amjcard.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 02/13/2024] [Revised: 04/30/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024]
Abstract
The benefits of rapidly up-titrating evidence-based treatments following heart failure (HF) hospitalizations were demonstrated in the STRONG-HF trial and emphasized in contemporary HF guideline. We aimed to assess up-titration patterns of guideline-directed medical treatments in Taiwanese HF population. Combining data from the TSOC-HFrEF registry and the TAROT-AHF study cohort, we formed the "Taiwan real-world cohort". We compared these data with subgroups of patients with left ventricular ejection fraction ≤ 40% in the STRONG-HF trial. Patients in the Taiwan exhibited similar blood pressure, heart rate and N-terminal pro B-type natriuretic peptide levels at discharge compared to those in the STRONG-HF trial. A higher proportion of patients in the STRONG-HF high-intensity care group received up-titrations compared to those in the usual care group and the Taiwan cohort. Composite all-cause mortality or HF hospitalization at 180 days for patients in the high-intensity care group, usual care group, and Taiwan cohort were 17.4%, 23.7%, and 31.9%, respectively, with differences largely contributed by HF hospitalization (10.1%, 17.9%, and 27.6%, respectively), while all-cause mortality rates were similar (11.0%, 9.6%, and 9.3%, respectively). Gender did not affect this trend. In conclusion, our data highlights a treatment gap between the STRONG-HF trial and real-world practices in Taiwan, urging prompt optimization of HF therapy.
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Affiliation(s)
- Tao-Wei Chang
- School of Medicine, College of Medicine, Taipei Medical University
| | - Chung-Lieh Hung
- Institute of Biomedical Sciences, MacKay Medical College; Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital
| | - Shao-Lun Ko
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University
| | | | - Chien-Yi Hsu
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine; Department of Medicine Research, Taipei Medical University Hospital; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine; Taipei Heart Institute, Taipei Medical University
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Alexandre Mebazaa
- Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France;; Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP Nord, Paris, France
| | - Hung-Yu Chang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University; Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
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Ko SL, Hung CL, Chen CN, Tsao TP, Fong MC, Yin WH, Chang HY. Effects of Mask Wearing on Treadmill Exercise Test. Am J Cardiol 2024; 213:161-163. [PMID: 38160925 DOI: 10.1016/j.amjcard.2023.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/19/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Shao-Lun Ko
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, Taiwan and Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
| | - Chiao-Nan Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tien-Ping Tsao
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Man-Cai Fong
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Wei-Hsian Yin
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hung-Yu Chang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, and School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Huang HT, Ko SL, Wang CY, Lo HC, Fong MC, Lin WY, Liao CT, Huang JL, Chang HY. Risk stratification for worsening renal function and renal decline in heart failure patients with reduced ejection fraction after sacubitril/valsartan treatment. J Cardiol 2023; 82:490-496. [PMID: 37295497 DOI: 10.1016/j.jjcc.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND In the real-world setting, data regarding renal decline following sacubitril/valsartan treatment are lacking. This study aimed to develop a scoring system to predict renal outcome in sacubitril/valsartan-treated patients. METHODS Between 2017 and 2018, a total of 1505 heart failure patients with reduced ejection fraction (HFrEF) undergoing sacubitril/valsartan treatment were consecutively enrolled from 10 hospitals to serve as the derivation cohort. Another 1620 HFrEF patients receiving sacubitril/valsartan were included as the validation cohort. Worsening renal function (WRF) was defined as a serum creatinine increase of >0.3 mg/dL and/or >25 % at 8 months of sacubitril/valsartan treatment. The derivation cohort was used to identify independent predictive factors for WRF through multivariate analysis, which were then used to develop the risk score system. RESULTS Among the 3125 HFrEF patients, 689 (22.0 %) patients had WRF at 8 months following sacubitril/valsartan treatment. In the derivation cohort, six prognostic factors (age, functional class, history of peripheral arterial disease, diabetes mellitus, gout or hyperuricemia, and serum albumin level) were independently associated with WRF, and were combined into a risk predicting score. This score showed accurate discrimination in the derivation and validation cohorts (Harrell's concordance indexes 0.74 and 0.71, 95 % confidence intervals 0.71-0.78 and 0.69-0.74, respectively). Patients with a higher risk score experienced a more rapid decline in renal function, poorer clinical outcomes, and a higher rate of discontinuation of sacubitril/valsartan treatment. CONCLUSIONS This study developed a score for WRF after sacubitril/valsartan treatment, which may assist clinicians with risk stratification and therapeutic decision-making.
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Affiliation(s)
- Hsin-Ti Huang
- Division of Nephrology, Department of Internal Medicine and Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shao-Lun Ko
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Yen Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsu-Chung Lo
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Man-Cai Fong
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Wen-Yu Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Te Liao
- Division of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jin-Long Huang
- Cardiovascular Research Center, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Hung-Yu Chang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
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Sung HP, Hsu CY, Lee YH, Lin PL, Liao CT, Chung FP, Ko SL, Huang CY, Lin KC, Chang HY. Iron deficiency in Taiwanese patients with heart failure and reduced ejection fraction. J Chin Med Assoc 2023; 86:725-731. [PMID: 37314316 DOI: 10.1097/jcma.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Iron deficiency (ID) is a common comorbidity among patients with heart failure and reduced ejection fraction (HFrEF), and is associated with poorer outcomes independent of anemia. This study aimed to evaluate the prevalence and prognostic significance of ID in Taiwanese patients with HFrEF. METHODS We included HFrEF patients from two multicenter cohorts at different periods. The multivariate Cox regression analysis was applied to assess the risk of outcomes associated with ID, accounting for the varying risk of death. RESULTS Of the 3612 patients with HFrEF registered from 2013 to 2018, 665 patients (18.4%) had available baseline iron profile measurements. Of these, 290 patients (43.6%) were iron deficient; 20.2% had ID+/anemia+, 23.4% ID+/anemia-, 21.5% ID-/anemia+, and 34.9% ID-/anemia-. Regardless of anemia status, patients with coexisting ID had a higher risk than those without ID (all-cause mortality: 14.3 vs 9.5 per 100 patient-years, adjusted hazard ratio [HR] 1.33; 95% confidence interval [CI], 0.96-1.85; p = 0.091; cardiovascular mortality: 10.5 per 100 patient-years vs 6.1, adjusted HR 1.54 [95% CI, 1.03-2.30; p = 0.037]; cardiovascular mortality or first unplanned hospitalization for HF: 36.7 vs 19.7 per 100 patient-years, adjusted HR 1.57 [95% CI, 1.22-2.01; p < 0.001]). Among patients eligible for treatment in the IRONMAN trial design (43.9%), parenteral iron therapy was estimated to reduce heart failure hospitalizations and cardiovascular deaths by 13.7 per 100 patient-years. CONCLUSION Iron profiles were tested in less than one-fifth of the Taiwanese HFrEF cohort. ID was present in 43.6% of tested patients and was independently associated with poor prognosis in these patients.
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Affiliation(s)
- Hsiao-Ping Sung
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Institute of Hospital and Health Care Administration, Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chien-Yi Hsu
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Ying-Hsiang Lee
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan, ROC
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan, ROC
| | - Po-Lin Lin
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan, ROC
| | - Chia-Te Liao
- Division of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan, ROC
| | - Fa-Po Chung
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Lun Ko
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chun-Yao Huang
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hung-Yu Chang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Ko SL, Tsao TP, Fong MC, Yin WH, Chang HY. Effects of mask-wearing on treadmill exercise test. Eur Heart J 2022. [PMCID: PMC9619489 DOI: 10.1093/eurheartj/ehac544.1189] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Concerning about the spread of COVID-19, World Health Organization recommends wearing facemasks to minimize viral transmission. Patients are required to wear facemasks while conducting treadmill exercise tests in hospitals. The effects of mask-wearing on the results of stress exercise testing remain uncertain. Purpose This study aims to assess the impact of mask-wearing on the physiological parameters during treadmill exercise testing. Methods Patients who underwent treadmill exercise test using the Bruce protocol for the diagnosis of ischemic heart disease were retrospectively examined between 2020 and 2021. A propensity score matching was performed to adjust the baseline characteristics of patients with and without mask. Blood pressure, heart rate, exercise duration, and the interpretation of stress test were compared. The ischemic ST-segment response was defined as flat or downsloping depression of the ST seg-ment >0.1 mV below baseline and lasting longer than 0.08 second. Nondiagnostic result of treadmill exercise test was defined as absence of ischemic ST-segment response in which the 90% of maximal predicted heart rate for age and sex was not achieved. Results Following 1:1 propensity score matching, a total of 3,996 patients were enrolled for analysis, including 1,998 patients who performed treadmill exercise testing with masks, and 1,998 without masks. Baseline characteristics were similar between the two groups (mean age, 56.1±12.1 years; 38.7% female; mean body mass index, 25.5±3.9 kg/m2). At baseline, patients with masks had significantly higher heart rate (84.8±14.7 bpm vs. 82.5±14.0 bpm; p<0.001) and lower systolic blood pressure (130.4±19.0 mmHg vs. 132.4±18.7 mmHg; p=0.001) than those without masks. Patients with masks conducted significantly shorter duration of exercise (435±128 seconds vs. 481±133 seconds; p<0.001), achieved significantly lower measurement of peak heart rate (149.5±17.1 bpm vs. 152.7±17.0 bpm; p<0.001), and had significantly lower rate-pressure products (26,366±5,207 mmHg·bpm vs. 27,629±5,242 mmHg*bpm; p<0.001) than those without masks. The proportion of patients who were unable to complete stage II of the Bruce protocol was significantly higher among patients with masks (15.1% vs. 9.0%; p<0.001). The proportion of nondiagnostic result was significantly higher among patients with mask (12.2% vs. 8.8%; p<0.001), whereas the proportion of positive ischemic ST-segment response rate was significantly higher among patients without mask (28.1% vs. 23.3%; p=0.001). Conclusions Our study demonstrated that performing treadmill exercise test with mask could significantly decrease the duration of exercise, reduce the maximal achieved heart rate, decease the rate-pressure product, and thus reduce the diagnostic power of treadmill exercise testing. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- S L Ko
- National Yang Ming University , Taipei , Taiwan
| | - T P Tsao
- Cheng-Hsin General Hospital , Taipei , Taiwan
| | - M C Fong
- Cheng-Hsin General Hospital , Taipei , Taiwan
| | - W H Yin
- Cheng-Hsin General Hospital , Taipei , Taiwan
| | - H Y Chang
- Cheng-Hsin General Hospital , Taipei , Taiwan
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